Module on Epidemiology of Infections-Hospital Associated Infections (HAI)Article 1 Edited by Dr.T.V.Rao MD

Module on Epidemiology of Infections-Hospital Associated Infections (HAI)Article 1 Edited by Dr.T.V.Rao MD

An Introduction to Infection control in Hospitals and Health Care Environments – Handout for Learners

Module on Epidemiology of Infections Associated Infections (HAI)

a. Definition of Hospital Associated Infections.

b. Prevalence and Incidence of Hospital Associated Infections.

c. Systematic reviews in Hospital Associated infections.

d. Prevention and Control of Hospital Associated Infections.

LEARNING OBJECTIVE FOR EPIDEMIOLOGY OF INFECTIONS ASSOCIATED INFECTIONS(HAI)

? At the end of the Module, the learners will be able to:

o defines hospital Associated Infections;

o recognizes the common hospital Associated infections;

o identifies the causes of hospital Acquired infections;

o Institute contextually relevant and appropriate prevention and control measures in their own settings.

PREREQUISITES: Since the medium of instruction is English, the registrants will be expected to have reasonable written and spoken English proficiency.

To begin what is an Infection-. The invasion of bodily tissue by pathogenic microorganisms that proliferate, resulting in tissue injury that can progress to disease:

1 What are Healthcare/Hospital Associated Infections (HAI)

According to the World Health Organization (WHO), a Health care/Hospital-Acquired (Associated) Infection is, “an infection acquired in healthcare institutions or hospital by acquired the patient who was admitted for a reason other than the infection he. This includes infections acquired in the institution but appearing after discharge from hospital care. In other words, nosocomial infections are those infections acquired in hospital or healthcare service unit that first appear 48 hours or more after hospital admission while receiving treatment for medical or surgical conditions, however, many HAIs are preventable. Furthermore, they include occupational infections among staff. HCAI represents the most frequent adverse event during care delivery and no institution or country can claim to have solved the problem yet. Based on data from several countries, it can be estimated that each year, hundreds of millions of patients around the world are affected by HCAI. The burden of HCAI is several folds higher in low- and middle-income countries than in high-income ones. Modern healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Infections can be associated with medical and surgical procedures and great threat is associated with the devices used in medical procedures, such as catheters or ventilators. HAIs are important causes of morbidity and mortality, one of the most common wards where HAIs occur is the intensive care unit (ICU), where doctors treat serious diseases. About 1 in 10 of the people admitted to a hospital will contract an HAI. They’re also associated with significant morbidity, mortality, and involves personal and hospital costs.

2 HAI are a worldwide phenomenon. A survey on HAIs reveals that at any time, over 1.4 million people worldwide are suffering from infections acquired in a variety of treatment centers, with an estimated 80,000 deaths annually. The actual rates vary from 5% to 10% of all patients admitted to modern healthcare centers in the industrialized world to up to 25% in developing countries.

3 Developing countries faces much greater challenges -- The risk of health care-associated infection in developing countries is 2 to 20 times higher than in developed countries.

HAI’s occur in all types of care settings, including: A Acute care hospitals

B Ambulatory surgical centers

D Dialysis facilities

E Outpatient care (e.g., physicians' office's surgical dressing rooms and health care clinics)

F Long-term care facilities (e.g., nursing homes and rehabilitation facilities)

4 Hospital-associated infections in India - In India, accurate estimates of the burden of healthcare-associated infections are limited by the absence of reliable and routine standardized surveillance data.

Published reports of healthcare-associated infections are mostly from individual health facilities and include short term prospective studies and point prevalence surveys conducted in selected patient units of large hospitals. These indicate a prevalence of healthcare-associated infections ranging from 7 to 18 per 100 patients, which is like that reported from other low- and middle-income countries.

As in other settings, healthcare-associated infections in India are associated with longer hospital stays, increased mortality, and added costs. The data available indicate that the burden of healthcare-associated infections in low- and middle-income countries like India is high, with an estimated pooled prevalence of 15.5 per 100 patients, more than double the prevalence in Europe and the US.

MAJOR CAUSES OF HOSPITAL ASSOCIATED INFECTIONS –

Catheter-associated urinary tract infections

Surgical site infections

Ventilator-associated events/ventilator-associated pneumonia

Clostridium difficile infections

LOW-QUALITY INFECTION CONTROL KNOWLEDGE MEASURES AND MISUSE OF ANTIBIOTICS In India, overuse of antibiotics, limited clinical diagnostic and laboratory capacity, and poor infection control, hygiene, and sanitation—have contributed to the emergence and spread of HAI mostly.

At present, however, a lack of adequate systems and infrastructure for infection prevention and control in many healthcare facilities contributes to the development of healthcare-associated infections and the spread of resistant pathogens.

The quality and consistency of surveillance data on healthcare-associated infections are limited in India.

Infection prevention and control measures and practices reduce the opportunities for resistant pathogens to spread in healthcare facilities. Although hospital accreditation is not mandatory in India, groups like the autonomous National Accreditation Board of Hospitals and the National Health Mission National Health Systems Resource Centre have incorporated programs on infection prevention and control, including Surveillance of healthcare-associated infections, as a core part of the review and certification process.

At the national level, there has been growing recognition of the need for policy and guidance documents, and in 2016 the Indian Council of Medical Research released guidelines on infection prevention and control. In addition, as part of the national Swacch Bharat Abhiyan (clean India mission), the National Health Mission launched Kayakalp (clean hospital initiative), which aims to promote and reward cleanliness, hygiene, and infection control practices in public healthcare facilities.

Surveillance of healthcare-associated infections should drive the implementation of evidence-based infection prevention and control practices to reduce the incidence of these infections, decrease the transmission of resistant pathogens in healthcare settings, and improve patient safety.

ROLE OF MINISTRY OF HEALTH IN INDIA - Ministry of Health agencies in India, with support from the Centers for Disease Control and Prevention, are implementing healthcare-associated infection surveillance that is tied to strengthening infection prevention and control practices and characterizing antimicrobial resistance patterns

In India, and elsewhere in South East Asia, the government led initiatives can be used to advocate for and prioritize commitment and funding to sustain healthcare-associated infection surveillance and infection prevention and control programs. Systems, policies, and procedures to measure and prevent healthcare-associated infections are essential for a comprehensive response to HAI. As Hospital-acquired infections are serious illnesses that cause death in about 1% of cases. Rapid diagnosis and identification of the responsible microorganism is necessary, so treatment can be started as soon as possible.

WHY THE HOSPITAL ASSOCIATED INFECTIONS ARE IMPORTANT FOR EVERYONE

HAIs are a significant source of complications across the continuum of care and can be transmitted between different health care facilities. However, recent studies suggest that implementing existing prevention practices can lead to up to a 70 percent reduction in certain HAIs.

What as a learner / expected to learn and practice?

Learners are expected to:

Review student handout provided for this module;

Read additional material mentioned;

Consider discussing the topic among other participants;

Actively participate in the discussion forum;

If the participant can have access, then visit to a healthcare facility is advised;

Make personal efforts to implement the learning into practice;

Complete the assessment within the stipulated time.

***A note from Dr.T.VRao MD after reviewing the topic

Please note

It is suggested better to use HOSPITAL ASSOCIATED INFECTIONS RATHER THAN HOSPITAL ACQUIRED INFECTIONS 1 The Topic is reorganized with additions and few deletions to give a better picture of the Hospital-associated infections

A training module on Hospital Associated Infection formulated by

Dr.T.V.Rao MD