Control of nosocomial Infection in pediatricsControl of Nosocomial Infection in Paediatrics Shahnaz...

ControlofNosocomialInfectioninPaediatricsShahnazArmin,ShaheedBeheshtee University,Iran

AWebberTrainingTeleclass

HostedbyPaulWebberpaul@webbertraining.comwww.webbertraining.com

ControlofnosocomialInfectioninpediatrics

SH.ArminAssociatedprofessorofShaheed

BeheshteeUniversity

HostedbyPaulWebberpaul@webbertraining.com

www.webbertraining.com July16,2019

Learningobjective

Whatisthenosocomialinfection/Healthcareassociatedinfection(HCAIs)?

WhatistheImpactofHCAIsonHealthsystem?

whataretheriskfactors?

Howtominimizetherisksofcontamination?

Definition

Nosocomialinfectiondefinedbyexpertsas:

HCAIsareinfectionsthatarefirstappearin48hoursormoreafterhospitalizationorwithin30daysafterhavingreceivedhealthcareinpatientwhowasadmittedforaproblemlikelynotrelatedtothemicrobialpathogenandnotinincubationperiod.

devicerelatedsurgicalsiteinfections(SSIs)transmissible/infectiousdiseasesorpathogensofconcern(viral,bacterial,fungal,andMDRo)

donotdiscriminatebetweenage,gender,religion,orethnicity

RateofNosocomial

inEurope,incidencesvaryfrom1%foralltypesofnosocomialinfectionsandupto23.6%inPICU.InUSAthetotalratearound4%.StudyfromSoutheastAsiancountriesreportedoverallprevalencerateof9.1%.Overally inhigh-incomecountriesHCAIsrateis5%–15%ofthehospitalizedpatients

ImpactofHCAIs

morbidity

mortality

Hospitalstay

Abresistance

ImpactofHCAIs

CDCcalculatedapproximately1.7millionnosocomialinfectionsfromalltypesofmicroorganismsresultingin99,000deathsannuallyinUSA.

ImpactofHCAIs

StudyshowsthatseverelyimmunocompromisedhospitalizedpatientsareatthehighestriskofHAIs.

AmortalityrateduetoBSIinpediatricpopulationandneonateswere3%and11%,respectivelyespeciallyinverylow-birthweights

ImpactofHCAIs

specializedprogramsneedtobedevelopedandtailoredtomeettheneedsofthepediatricpopulationbasedon:age-relatedfactorsthatpreventthechildfromadheringtoIP&CstandardsEffectofcaregiversonpreventionandtransmissionimmatureimmunesystemsDevelopmentalstage

Generalriskfactor

closephysicalcontactwithhealth-careworkersstayinenvironmentswhereantibiotic-resistantorganismsareendemicStayinintensivecarewithindwellingdevicesHyperalimentationmechanicalventilationComorbiditiesneutropenicpatientstransplantation

ChildrenarenotlittleadultTheyrefusetofollowisolationpercussionsChildlife- makingisolationfeelsolonelyNeedt5oplyroominhospital,whichchildisinfectiousinthereandcleanedisveryimportantChildismoreexposetohandonthanadultHandhygienedifficulttoreinforceforthemPPEmaynotfitoravailableforthem

RiskfactorsforNI

• Theimmunologicalnaivetyofyoungchildren

• congenital/acquiredID• congenitalsyndromes• Closephysicalcontactbetween

childrenandvisitorsanduncontrolledfluidsandbodilysecretions

• Childrenaresusceptibletoinfectionsthatarepreventedinolderbyvaccinationorpreviousnaturalexposure

• Agemakevarietyincausativeorganisms

• chronicordegenerativeorgansystemdisorder

HIGHRISKAREA

InfectionratesarethehighestinneonatalandPICU(wherebloodstreaminfectionsarethemostfrequent),andareusuallyassociatedwithintravasculardevices.Prematureinfantsmayhaveimmaturedefensemechanisms(includingskin,gastrointestinalsystems,lungsorbebornwithseveremedicalconditions

Ongeneralpediatricwards:respiratoryandgastrointestinalinfectionspredominate

reflectingtheoccurrenceinthecommunity.

pathophysiologyForthedevelopmentofaNI,twopathophysiologicfactorsmustbepresent:1-impairedhostdefenses2- colonizationbypathogenicornon-pathogenicbacteria

Mostnosocomialinfectionsarisefromtheendogenousbacterialfloraalthoughmanycriticallyillpatientseventuallybecomecolonizedwithresistantbacterialstrains.

Chainofinfection

Modeoftransmission

source

Susceptiblehost

Portofentry

Portalofentryintothehost

PortalofentryisthewaytheinfectiousagentcanenteranewhostCommonportalsofentryinclude:•Respiratorytract•Gastrointestinaltract•Mucosa(e.g.,conjunctiva,nose,mouth)•Genitourinarytract•Breachofskinintegrity

Threetypesofinfectionaccountformorethan60%ofallnosocomialinfections:pneumonia(usuallyventilator-associated)urinarytractinfection(usuallycatheter-associated)primarybloodstreaminfection(usuallyassociatedwiththeuseofanintravasculardevice)

Germsacquireways

person-personviahandsofhealth-careproviders,patientsandvisitorspersonalequipment(stethoscopes,personaldigitalassistants)andclothingairbornetransmission

Modeoftransmission

Directtransmission

Indirecttransmission

Dropletinfection

Contactwithsoil

Inoculationintoskinormucosa

Vehicle-borne

Air-borne

Fomite-born

Uncleanhandsandfingers

Humansourceofmicroorganismsthosewhoalreadyhaveadisease,orthosewhoareconsideredtobechroniccarriersofaninfectiousagent.

Patient

Visitor WorkerInfectioncontrol

Modesoftransmission

Directcontact:consistofdirectbodysurfacetobodysurfacecontactandphysicaltransferofbacteriabetweenasusceptiblehostandaninfectedorcolonizedindividual.

Indirectcontact:involvescontactofasusceptiblehostwithacontaminatedobjectsuchasmedicalinstruments,dressings,glovesthatarenotchangedbetweenpatients.handhygiene

Modesoftransmission

Droplet:distancefromthesource>1m,Infectiousdropletsaregeneratedduringcoughing,sneezing,talkingandthroughproceduressuchasbronchoscopyandsuctioning.Transmissionoccurswhenthesedropletsarepropelledashortdistancethroughtheairanddepositedonahost'smouth,nasalmucosaorconjunctivae.Wearasurgicalmaskwhileintheroom

Dropletcontact

Airborne:consistofdustparticlescontainingbacteriaorairbornedropletnucleiofevaporateddropletscontainingmicroorganismsthataresuspendedintheairforlongerdurationsoftime.Microorganismstransmittedinthismannercanbeinhaledbyasusceptiblehostventilationofthespace

Strictpolicies

Educationofallcaregiversincreasetheadherenceandcompliancetopolicy

Monitoringcomplianceofhand,personalandenvironmentalhygiene

educationandreinforcementrequiredtoensurepediatricsafety

CentersforDiseaseControlandPrevention.CDCtwentyfourseven.SavingLives,ProtectingPeopleRecommendationsforApplicationofStandardPrecautionsfortheCareofAllPatientsinAllHealthcareSettings

HANDHYGIENE

Inneonates,ongoingresearchfocuseson:reducingcontaminatingperiods(eg,lesshandlingofneonates)sequencingtypesofinfantcare(eg,movingfromcleantodirtysitesduringinfanthandling,Groupingonetypeofinfantcaretoonehandlingperiod

Encourageotherstoparticipateininfectioncontrol

studentsmayroutinelyobservestaffwho:

failtowashhandsapplyinadequatetechniqueinhandwashingroutinelyviolatecorrectinfectioncontrolprocedures

barrierstohandhygienecanbeovercomewhenrolemodelspromotingtheprocedureareclearlyidentifiededucationofthevisitortoensurethatheorshedoesn'ttransmitpathogenstohisorherchildortoother

SusceptiblehostSeverelyimmunocompromisedchildrenrequireextraprotection:ventilationsystemsthatreducetheriskofexposuretofilamentousfungiTreatmentofunderlayingdiseaseImmunizationProphylacticantibiotictherapy

Susceptiblehost,healthcareworker

AAP:Ø Healthcareworkersshouldreceivetheinfluenza

vaccineannually

Ø Whentransportingacontagiouspatient,facilitiesshouldcommunicateinformationaboutthepatient'sdiagnosisandisolation

Ø appropriatemanagementofinvasiveproceduresanddevices,sterilizationanddisinfectionofequipment,provisionofacleanenvironmentandadequatestaffing.

StandardPersonalProtectiveEquipment(PPE)

IFdirectcontactwithblood&bodyfluids,secretions,excretions,mucousmembranes,non-intactskinGlovesPLUSgown

Theappropriateuseofprophylacticantimicrobialstherapypreventssomenosocomialinfections,especiallyinhigh-riskpatients.

Theimpactofinfectioncontrolonantimicrobialresistantinfections

EffectiveIP&CProgram

forceful

Coverneedsofallagegroup

Supportedbyhigher

administration

ContinueandSurveillance

Focuson:staffingnumbersandlevelsofexperienceearlydetectionandinterventioninoutbreaksituationsenvironmentalcontrols,adequatesuppliesprogramsforeducation.

Noticetohighriskgroup:Immuno-deficientpatientsCancersTransplantscertainlungdiseasesimmaturity/VLBWnewborn

ThefamilyisacorecomponentinpediatricwarditisimportanttorecognizeKnowledgeandcompliance ofthemasapotentialsourceforinfectionspread.

goalofinfectioncontrolprograms

decreasetheincidenceofinfectionsinpatientsandstaffConsiderationsrelevanttoantimicrobialresistantorganisms

Control of nosocomial Infection in pediatricsControl of Nosocomial Infection in Paediatrics Shahnaz...

Documents

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