Hospital acquired Infections:

DIAGNOSIS CLINICAL DIAGNOSIS

a . Watch for Symptoms b. Most important clinical indicator is Medical history c. History of travel d. Occupational history e. Exposure to wildlife f. Exposure to infected patients

Practical HCAI Control measures

a. Basic Measures for Infection Control -Standard precautions -Additional precautions (airborne, droplet and contact) b. Education and Training of Health Care Workers c. Protection of Health Care Workers, e.g. Immunization d. Identification of Hazards & Minimizing Risks e. Routine Practices Essential to Infection Control - aseptic techniques - use of single use devices - reprocessing of instruments and equipment - Policy on antibiotic usage - management of blood/body fluid exposure - handling and use of blood and blood products - management of medical waste f. Effective work practices and procedures - Environmental management practices (management of hospital/clinical waste) - support services (e.g., food, linen) - use of therapeutic devices g. Surveillance h. Incidence monitoring i. Outbreak investigation j. Infection control in specific situations k. Research

Early SYMPTOMS

a. Fever of Sudden onset b. Intense weakness c. Muscle pain d. Headache e. Sore throat

Sources of the agents of HCAI

a. Human reservoirs -Patients -Healthcare personnel -Household members -Other visitors b. Clinical Status of Human Reservoirs -Active infection -Asymptomatic -Incubation period -Transiently colonized -Chronically colonized

Agents of HCAI?

a. MRSA, VRSA, VISA b. MDRSP, VRE c. MDR- GNB -ESBL producing gram negative bacteria -Stenotrophomonas maltophilia -Acinetobacter spp d. MDR-TB e. HBV f. HCV g. HIV h. EBOLA VIRUS

Full meanings

a. MRSA: methicillin-resistant staphylococcus aureus b. VISA: Vancomycin-resistant Staphylococcus aureus c. VISA: Vancomycin Intermediate Staphylococcus aureus d. MDRSP: Multi drug resistant streptococcus pneumoniae e. VRE: vancomycin resistant enterococcus f. MDR- GNB: multidrug resistant gram-negative bacilli g. MDR-TB : multidrug-resistant tuberculosis

CASE DEFINITION for clinic use

a. PERSON UNDER INVESTIGATION: -No s/s -Positive history of travel or contact b. SUSPECTED CASE: -s/s plus history of travel or contact c. PROBABLE CASE: -s/s plus history of contact with death of the contact  d. CONFIRMED CASE: -after lab diagnosis

Risk Factors for HCAI

a. Prolonged and inappropriate use of invasive devices and antibiotics; b. High-risk and sophisticated procedures; c. Immuno-suppression and other severe underlying patient conditions; d. Insufficient application of standard and isolation precautions e. Inadequate environmental hygienic conditions and waste disposal; f. Poor infrastructure; g. Insufficient equipment; h. Understaffing; i. Overcrowding; j. Poor knowledge and application of basic infection control measures; k. Lack of procedure; l. Lack of knowledge of injection and blood transfusion safety; m. Absence of local and national guidelines and policies.

The impact of HCAI?

a. Prolonged hospital stay b. Long term disability c. Increased resistance of microorganisms to antimicrobials d. Massive additional financial burden for health system e. High cost for patients & their family f. Unnecessary deaths

Additional precautions

a. Used for patients known or suspected to be infected or colonized with highly transmissible pathogens, including: -Airborne transmission e.g. PTB, measles - Droplet transmission:- rubella, pertussis - Contact transmission:- MRSA, VRE organisms

SYMPTOMS: Later Acute symptoms

a. Vomiting & Diarrhoea b. Abdominal pain c. Bleeding red eyes skin rash Bleeding from skin Mouth bleeding or vomiting blood, Bloody stool Bloody urine Nose & ear bleeding

Five pillars of infection control **AOC

b. Decontamination of items and equipment e. Decontamination of environment d. Handwashing c. Prudent use of antibiotics a. Isolation of patients and barrier precautions

CHAIN OF INFECTION

factors that lead to the transmission or spread of disease a. Causative agent b. Reservoir c. Portal of exit from reservoir d. Mode of transmission e. Portal of entry into host f. Susceptible host g. Causative agent

Risk Groups?

i. Patients ii. Patients Relatives iii. Hospital Staff -Clinical -Administrative iv. Visitors

the Indirect Route of Transmission of agents of HCAI

¡ Hospital Environment, Common Hospital Surfaces ¡ Doctors' white coats, Ties ¡ Nurses' uniforms ¡ Hospital garments ¡ Privacy drapes ¡ Stethoscopes ¡ Thermometer ¡ Bed rails ¡ Patient care devices, Equipment ¡ Trolleys ¡ Tables

Prevention: Containment

TRAINING & RE-TRAINING SAFETY precaution PPE Proper handling & disposal (wastes & corpse) Sterilization & Disinfection Hand hygiene hand washing hand sanitizing ISOLATION precaution (Isolation, Quarantine, Contact tracing)

Approach to HCAI Control

Infection control Unit (HEAD-Chief Executive) Infection Control Committee (HEAD-Infectious Dxs Physician) Infection Control Team (HEAD-Nurse)

PPE

Gloves Gowns Caps Shoe covers Masks Respirators Goggles Face shields

PPE (waterproof)

Gloves Gowns Caps Shoe covers Masks Respirators Goggles Face shields

DIFFERENTIAL DIAGNOSIS

Malaria Typhoid fever Shigellosis Cholera Meningitis Hepatitis Other VHFs... LASSA FEVER, MARBURG, CONGO-CRIMEAN

TREATMENT

NO CURE !!!!!!!!!

Prevention: vaccination

NO VACCINE!!!!!!!!

Institutional consideration

-Ebola Response Committee Strategic framework Surveillance Ebola Rapid Response Team Triaging SOP Checklist Collaborations Containment Health Care Giver's Safety . PPE . Training

How is HCAI Transmitted?

1. Contact 2. Droplet 3. Airborne 4. Common vehicle transmission food, water, devices, equipment

How is HCAI Transmitted?

1. Contact -Direct (hands of health care personnel) -Indirect 2. Droplet -Large particle droplets (> 5 microns) -Generated during coughing, sneezing, talking or tracheal suctioning -Pneumonias, pertussis, diphtheria, influenza type B, mumps, and meningitis 3. Airborne - Evaporated droplet <5 micron -Remain suspended in the air for long periods of time - Pulmonary tuberculosis (TB), measles, chicken pox, pulmonary plague and haemorrhagic fever with pneumonia 4. Common vehicle transmission food, water, devices, equipment

Standard precaution

1. Hand washing and antisepsis (hand hygiene) 2. Use of personal protective equipment (e.g., gloves, gowns, masks) 3. Safe injection practices and sharps management 4. Safe handling of potentially contaminated equipment or surfaces including soiled linen in the patient's environment 5. Environmental cleaning and spills-management 6. Appropriate handling of waste 7. Respiratory hygiene/cough etiquette. 8. Appropriate personal health practices

OTHER NAMES of Hospital acquired Infections:

1. Hospital infections 2. Nosocomial infections 3. Health Care Associated Infections (HCAI)

CLASSIFICATION of Hospital acquired Infections:

2. Procedure or Non-procedure specific 1. Occupational or Non-occupational 3. Localised or Systemic 1. Occupational or Non-occupational 4. Toxigenic or Non-toxigenic

Approach to HCAI Control

A. Policies & Principles -Infection control policy statement (Procedural) -Infection control manual B. Structural Organization (Infection Control Unit) -Chief Executive • Establish an infection control committee • Provide adequate resources -Infection control committee -Infection control Team C. Affiliates ¡ Microbiology (Lab), Nursing Dept, Epidemiologist, Works Dept (Engr), Computer Unit, Infectious Diseases Physicians etc

What is the CONTROL of HCAI

Break the Chain of Infection! All activities within any hospital setting to ensure that: 1. The infected - do not transmit their pathogen - do not acquire new pathogen 2. Carriers of Potential Pathogen - do not transmit their pathogen - do not acquire new pathogen 3. Uninfected/None-carriers - do not acquire any pathogen

TRANSMISSION OF EBOLA VIRUS

CONTACT mainly 1. ANIMALS-HUMAN: Bodily fluids of infected animals: blood, urine, faeces, other secretions Organs and other parts of the Body of infected animals 2. HUMAN-HUMAN: Direct: -(through broken skin or mucous membranes) -Bodily fluids of infected people: blood, urine faeces, saliva, sweat, semen, vaginal secretions, other secretions, organs or other body parts -Semen (Ebola virus present in semen, even 7 weeks after recovery from illness) -Vaginal Secretions???????????? Indirect: -(contaminated environments/ items) -Burial ceremonies & Sites

Definitive LAB. DIAGNOSIS of evd

Categories of tests for definitive diagnosis A. Electron microscopy B. ELISA (1). Antigen capture (2). Antibody capture (IgM, IgG) B. Serum neutralization tests C. Immunohistochemistry testing D. Viral isolation by culture E. PCR (RT-PCR)

The Burden of HCAI?

Developed Countries -National Prevalence: 5.1%-11.6% -12/100 patients -UTI - most frequent Developing countries -Hospitalwide Prevalence: 5%-19% -20 /100 patients -Surgical Site Infection most common (1/3 of operated patients)

the impact of HCAI?

Europe -16 x 10>6 extra days of hospital stay -37 000 deaths -7 billion pounds United State -99 000 deaths -6.5 billion dollars Developing Countries

Hospital acquired Infections:

Hospital acquired Infections are Originating in an hospital/health-care facility i. Consequent upon contact with healthcare ii. Not Usually manifesting until after 48hours of contact iii. Not present or incubating at the time of contact (admission!) iv. May be manifesting after contact (discharge!)

The Burden of HCAI?

More Studied HCAI 1. CLA-BSI 2. VAP 3. CR-UTI 4. Adult & Neonatal ICU Associated Infections

Nosocomial transmission

Nosocomial transmission -Contact - Direct & Indirect -Laboratory Air borne transmission (Aerosol generation) 1. Contact with contaminated Hospital Equipment 2. Contact with Infected tissues, Bodily fluids, hospital wastes 3. CONTACT with Infected Patients

Definitive LABORATORY DIAGNOSIS of evd

TIMELINE OF INFECTION and DIAGNOSTIC TESTS AVAILABLE a. Within a few days after symptoms begin · Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing · IgM ELISA · Polymerase chain reaction (PCR) · Virus isolation/ culture b. Later in disease course or after recovery · IgM and IgG antibodies assay c. Retrospectively in deceased patients · Immunohistochemistry testing · PCR · Virus isolation/ culture