Healthcare-Associated I - PowerPoint Presentation

Slide1

Healthcare-Associated

Infections Occurring in Hospitals

Darline

Dupree

PhD Student

Walden University

PUBH 8165-2

Instructor: Dr. Robert Marino

Winter 2012Slide2

Hospital Board of Directors

OSHACounty Public Health DepartmentsCenter for Disease Control (CDC)Environmental Health DepartmentHealthcare Practitioners

StakeholdersSlide3

Generate awareness concerning Hospital-Associated Infections (HAIs)

Generate awareness regarding the varying types of HAIsGenerate awareness regarding the financial burden that HAI’s pose on hospitals Promote practitioners adherence to infection prevention guidelines Promote the enhancement of Infection Surveillance SystemsImprove hospital infectious control policies

Promote quality of care practices that minimize HAI risk

ObjectivesSlide4

Define Hospital Associated Infections

Explain HAI impact on public healthIdentify four of the most common infections occurring in hospitals

Name preventative measures used to prevent/control HAIs

Explain the impact of HAI on low-income developing countries

Explain HAI surveillance systems

Identify states with laws requiring HAI reporting

Understand the importance of activating infection control requirements

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Hospital-Associated Infections (HAI) are infections caused by a wide variety of common and unusual bacteria, fungi, and viruses during the course of receiving medical care” (CDC, 2011)

Infections that develop during hospitalization that are not present nor incubating upon the patient’s admission to the hospital (Collins, 2008)

What

are

Hospital-Associated

I

nfections (HAIs)?

Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 19, 2012 from: http://www.cdc.gov/hai/

Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/ Slide6

Traditional hospital

Outpatient surgery centers

Long-term care facilities

Rehabilitation centers

Community clinics

Healthcare Settings Vulnerable to InfectionsSlide7

Health

1 out of every 20 patients contract some form of hospital related infections

HAI is responsible for approximately 90, 000 deaths annually

Financial

Responsible

for

approximately $28.4 billion to $33.8

billion dollars in

direct

healthcare

cost

Responsible for approximately $8.5 billion in overall hospital net cost

Public Health Burden of HAI

Center for Disease Control and Prevention. Healthcare associated infections: Burden. Retrieved on January 19, 2012 from: http://www.cdc.gov/HAI/burden.html

Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf

Slide8

Device related infections

Central Line-Associated Bloodstream Infection (CLABSI)

Catheter-Associated Urinary Tract Infection (CAUTI)

Ventilator-Associated Pneumonia (VAP)

Procedure related infections

Surgical Site Infection (SSI)

Types of HAIs

Center for Disease Control and Prevention. Healthcare associated infections: Infection Types.

Retrieved on January 1, 2012 from http://www.cdc.gov/HAI/infectionTypes.html Slide9

UTI accounts for 36%

SSI accounts for 20%

Bloodstream infection (BSI) accounts for 11%

Pneumonia accounts for 11%

Most common type of infections occurring in hospitals within the US annually

World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide:

Clean Care is Safer Care (ISBN 978 92 4 150150 7)) Slide10

Most common type of hospital-associated infections

Responsible for between approximately 75%-97% of urinary tract infections in the hospitalAccounts for approximately > 30% of HAIs infections Responsible for an Estimated 13,000 HAI deaths annually Occurs when bacteria enters the urinary tract through the urinary catheter

Prolonged use of urinary catheter increase the risk for infections

Catheter

Associated

U

rinary

T

ract

I

nfection (CAUTI)

World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide:

Clean Care is Safer Care (ISBN 978 92 4 150150 7).

Center for Disease Control and Prevention. Healthcare associated infections:

Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdfSlide11

Perform proper hand hygiene practices in accordance to CDC recommended standard precautions

Insert catheters only when needed Remove catheters immediately when the need for it no longer exist Use aseptic techniques for insertionsMaintain a closed drainage system Preventing CAUTIs

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections.

Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html Slide12

Infection occurring after surgery in the part of the body that was operated on

Accounts for approximately 300,000 of all HAI casesResponsible for 75% of SSI associated deathsInfections range from superficial to serious Approximately 12% to 84 % of surgical site infections are discovered after patients are released from the hospitalmost infections discovered within 21 days after surgical operation

Surgical Site Infection

(SSI)

Center for Disease Control and Prevention. Healthcare associated infections: FAQs about SSI. Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/ssi/faq_ssi.html

Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/ Slide13

Administer antimicrobial prophylaxis

Prepare surgical site of skin with an antiseptic agentTreat remote infections prior to performing operations

Use sterilized instruments to perform surgery

Maintain a sterile environment by limiting traffic in the operating room

Use sterile dressings to protect incisions

Preventing SSI

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012

from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.htm

l Slide14

Occurs when bacteria or viruses enters the bloodstream through the catheter

Marked by fever and soreness around the area where the catheter was inserted Responsible for up to 35% of HAI related mortalitiesResponsible for approximately 87% of BSICentral Line-Associated

Bloodstream

Infection

(CLABSI)

World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7).

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012retrieved from

:http://www.cdc.gov/HAI/pdfs/toolkits/CLABSItoolkit_white020910_final.pdfSlide15

Perform proper hand hygiene practices in accordance to CDC recommended standard precautions

Select an insertion site least vulnerable to infectionsWear sterile surgical protective gear

Properly insert central lines

Use appropriate agent for skin antisepsis

Remove central line when no longer needed

Preventing Central Line-Associated Bloodstream

Infection

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare

Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.htmlSlide16

Lung infection that develop in a person who is on a ventilator

Infection occurs when germs enter the tube and accumulate in the patient’s lungs Accounts for 83% of hospital associated pneumoniaVentilator-Associated Pneumonia (VAP)

World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7

) Slide17

Perform proper hand hygiene practices in accordance to CDC recommended standard precautions

Elevate the bed of patients( varies based upon age in pediatrics)Remove the ventilator as soon as the patient is able to breathe without it.Preventing VAP

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012

from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.htmlSlide18

Antibiotic associated

Clostridium

difficile

infection (CDAD)

Antibiotic resistant infections

Methicillin-resistant

Staphylococcus

aureus

(MRSA) Infection

Emerging

Infections

Commonly Associated W

ith

HAI Slide19

Spore-forming, gram-positive anaerobic bacillus bacterium

Accounts for 15%-25% of all episodes of antibiotic-associated diarrhea

R

esponsible for 9,000 deaths annually

Occurs most often in elderly people and people with certain medical problems

Causes diarrhea and other serious intestinal conditions

Transmission

Contaminated bed linens, bed rails, bathroom fixtures and medical equipment

P

erson to person on the hands of hospital personnel and visitors

Clostridium

difficile

Infection

(C.diff)

Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf Slide20

Perform proper hand hygiene practices in accordance to CDC recommended standard precautions

Clean and disinfect equipment and overall environmentUtilize contact precautions during the duration of diarrheaIsolate symptomatic patientsImplement universal glove use

Preventing Clostridium

difficile

Infections (CDI)

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012

from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.htmlSlide21

Staph bacteria resistant to certain antibiotics

Occurs more often among patients who undergo invasive medical procedures or who have weakened immune systemsCauses severe and potentially life-threatening infections25% of MRSA cases occur in the hospital Transmission

Spread from patient to patient on unclean hands of healthcare personnel or through the improper use or reuse of equipment

Hands may become contaminated with MRSA by contact with: colonized or infected patients; devices, surfaces contaminated with body fluids, infected hospital personnel

Methicillin-Resistant

Staphylococcus

A

ureus

(MRSA) Infection

Center for Disease Control and Prevention. Hospital associated infections: Methicillin-resistant Staphylococcus

aureus

(MRSA) Infection. Retrieved on January

14, 2012 from: http://www.cdc.gov/HAI/organisms/mrsa-infection.html

Center for Disease Control and Prevention. Symptoms of MRSA. Retrieved on January 14,2012 from: http://www.cdc.gov/mrsa/symptoms/index.html

Center for Disease Control and Prevention. Protect Yourself from MRSA . Retrieved on January 14, 2012 from: http://www.cdc.gov/Features/MRSAinHealthcare/Slide22

Perform proper hand hygiene practices in accordance to CDC recommended standard precautions

Implement contact precautions for colonized and infected MRSA patientsImmediately report MRSA lab results Preventing MRSA

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012

from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.htmlSlide23

Endogenous

Body sites that house microorganisms as part of the normal microbial floraEx. skin, nose, mouth gastrointestinal tract, vaginaExogenous Sources external to the patientEx. medical devices, health-care workers, healthcare environment, visitors, patient care equipment

Contributing Factors of HAI

WHO (2011) Report on the burden of Endemic Health Care- Associated Infection Worldwide. Retrieved on January, 14, 2012 from

http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf Slide24

Compromised immune systems

Primary immunodeficiency (e.g., anemia or autoimmune disease)Secondary immunodeficiency’s (e.g., chemotherapy, corticosteroids, diabetes, leukemia)Patient Susceptibility

Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved on January 14, 2012 from:

http://www.ncbi.nlm.nih.gov/books/NBK2683/ Slide25

Patients admitted to ICUs

Burn patientsTransplant patientsNeonatesHigh Risk PatientsSlide26

Examining the Global Burden of HAISlide27

HAI is an issue that extends past our US borders

HAIs are more frequent in resource-limited settings than in developed countriesWhat is Known

WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 12, 2012 from

http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdfSlide28

15 out of every 100 patients hospitalized in low-income developing countries acquire HAI

SSI is the leading infection within the general patient population Central vascular lines, ventilators, and urinary catheters are approximately 19 times higher in low- income countries Newborn HAI rates are 3- 20 times higher in low-income developing countries then in high income countries

Responsible for 4% to 56% of all causes of death with the numbers increasing to 75% in countries such as South-East Asia and Sub-Saharan Africa

.

HAI is more frequent in critically-ill patients admitted to ICUs.

Account for 42.7 episodes per 1000 patient-days in developing countries

HAI in Low-income

Developing

C

ountries

WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 14,201 from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdfSlide29

Insufficient environmental sanitary conditions and waste disposal

Meager infrastructureInadequate equipment

Understaffing

Overcrowding

Poor knowledge and application of basic infection control measures

Nonexistent local and national guidelines

Insufficient hospital policies

Unawareness of injection and blood transfusion safety

Determinants of HAI Specific to Low-income Countries Slide30

Pathway to

Addressing the ProblemSlide31

“Primary prevention offers the hopes of eliminating unnecessary illness, injury, and even death” (Cohen et al, 2010)

Improves healthReduces CostRequires concerted efforts by all healthcare practitioners, public health officials, governmental officials and the general public

Primary Prevention is Key

Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA: Josey-Bass Slide32

Implement policies for the development of HAI prevention programs

Action Plan to Prevent Healthcare Associated Infections 29 states and the District of Columbia passed laws related to HAI prevention 3 States developed reporting procedures that don’t require legislations Activate infection control requirements. Appropriate training, accreditation and licensure to encourage adherence to infection control requirements

Encourage continued research to acclimatize surveillance protocols and preventive strategies.

Focus of Prevention at the National and International

Level

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections

.

Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdfSlide33

Establish minimum reporting requirements for all healthcare facilities

Status of current Surveillance System National Healthcare Safety Network (NHSN)

Secure web-based system that facilitates reporting from healthcare facilities

Mandated by 23 states and the District of Columbia

Intended use in approximately 5,000 hospitals within the U.S.

23

developing countries (23/147) reported a functioning national surveillance system

Focus of Prevention at the National and International

Level

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections.

Retrieved from: http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdfSlide34

Alabama

CaliforniaColoradoConnecticutDelawareWashington D.C. District of ColumbiaFloridaHawaiiIllinois

Maine

Maryland

Massachusetts

Minnesota

Missouri

New Hampshire

New Jersey

New Mexico

New York

OhioOklahomaOregon

Pennsylvania

Rhode Island

South Carolina

Tennessee-limited Texas

VirginiaVermontWashingtonWest Virginia U.S. States With

Laws

Requiring

the

Reporting

of

Hospital

A

ssociated

I

nfections

The committee to reduce infectious disease (2011). Retrieved on January 12, 2012 from :

http://www.hospitalinfection.org/legislation.shtml Slide35

Minimize environmental exposure

Implement standard precautions to include best hand hygiene practices

Develop hospital policies and procedures geared toward protecting health and safety

Include appropriate preventive measures for hospital related infection risks

Train staff on the principles of infection control

comply with requirements for staff education and training as established through existing federal, state, and local regulations

Coordinate efforts with the infection control department in monitoring and investigating potentially harmful infectious exposures and outbreaks among personnel

Focus

Prevention

at the Hospital

LevelSlide36

American Recovery and Reinvestment Act

Signed into law on February 17, 2009 Designed to stimulate economic recovery in various ways including strengthening the nation's healthcare infrastructure and reducing healthcare costs Authorize $50 million to support states in the prevention and reduction of Healthcare Associated Infections Positive Strides Toward

HAI Prevention

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/ Slide37

Patient Protection and Affordable Care Act of 2010

Health ReformReimbursement of Medicare/Medicaid funding contingent upon HAI prevention CMS Hospital Inpatient Quality Reporting Program

de facto national mandate

95% of hospitals participates in this program

Requires hospitals to report select infections

CLABSI’s in ICUs

Certain SSI

Positive Strides

Toward

HAI Prevention

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections.

Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdfSlide38

Be proactive

Partner with other agencies to enhance prevention strategies

Familiarize yourself with the statues and regulations surrounding HAI prevention

Foster relationships with and engage stakeholders in HAI programs

Educate the public on HAI

Moving

ForwardSlide39

Hospital Associated Infections poses a serious threat to the health and financial viability of the healthcare system in general.

The elimination of HAI is going to take a concerted effort from all healthcare practitionersIn order to improve infectious control policies and enhance infection surveillance systems, there must be collaboration and involvement from policymakers, and governing/regulatory entities

Focus must be placed on better educating service providers on infection control techniques

ConclusionSlide40

QuestionsSlide41

Center for Disease Control and Prevention. Healthcare associated infections: Burden Retrieved on January 19, 2012 from: http://www.cdc.gov/HAI/burden.html

Center for Disease Control and Prevention. Healthcare associated infections: Infection Types. Retrieved on January 1, 2012 from http://www.cdc.gov/HAI/infectionTypes.html Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated InfectionsWorld Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7).

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

Center for Disease Control and Prevention. Healthcare associated infections: FAQs about SSI. Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/ssi/faq_ssi.html

Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/

References Slide42

Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf WHO(2011)Health care-associated infections :FACT SHEET. Retrieved from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA:

Josey

-Bass

Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

References Slide43

Infection Control Policies and Hospital-Associated Infections Among Surgical Patients: Variability and Associations in a Multicenter Pediatric Setting. (www.pediatrics.org/cgi/doi/10.1542/peds.2004-2014)

Diseases and Organisms in Healthcare Settings. (www.cdc.gov/HAI/organisms/organisms.html)

National healthcare Safety Network (NHSN) Report, data summary for 2010, device associated module (www.cdc.gov/nhsn/PDFs/dataStat/2009NHSNReport.pdf)

Resources for Further Reading