Control of nosocomial Infection in pediatricsControl of Nosocomial Infection in Paediatrics Shahnaz...
Transcript of Control of nosocomial Infection in pediatricsControl of Nosocomial Infection in Paediatrics Shahnaz...
ControlofNosocomialInfectioninPaediatricsShahnazArmin,ShaheedBeheshtee University,Iran
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ControlofnosocomialInfectioninpediatrics
SH.ArminAssociatedprofessorofShaheed
BeheshteeUniversity
www.webbertraining.com July16,2019
Learningobjective
Whatisthenosocomialinfection/Healthcareassociatedinfection(HCAIs)?
WhatistheImpactofHCAIsonHealthsystem?
whataretheriskfactors?
Howtominimizetherisksofcontamination?
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ControlofNosocomialInfectioninPaediatricsShahnazArmin,ShaheedBeheshtee University,Iran
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Definition
Nosocomialinfectiondefinedbyexpertsas:
HCAIsareinfectionsthatarefirstappearin48hoursormoreafterhospitalizationorwithin30daysafterhavingreceivedhealthcareinpatientwhowasadmittedforaproblemlikelynotrelatedtothemicrobialpathogenandnotinincubationperiod.
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HAIs
devicerelatedsurgicalsiteinfections(SSIs)transmissible/infectiousdiseasesorpathogensofconcern(viral,bacterial,fungal,andMDRo)
donotdiscriminatebetweenage,gender,religion,orethnicity
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ControlofNosocomialInfectioninPaediatricsShahnazArmin,ShaheedBeheshtee University,Iran
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RateofNosocomial
inEurope,incidencesvaryfrom1%foralltypesofnosocomialinfectionsandupto23.6%inPICU.InUSAthetotalratearound4%.StudyfromSoutheastAsiancountriesreportedoverallprevalencerateof9.1%.Overally inhigh-incomecountriesHCAIsrateis5%–15%ofthehospitalizedpatients
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ImpactofHCAIs
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morbidity
mortality
cost
Hospitalstay
Abresistance
ControlofNosocomialInfectioninPaediatricsShahnazArmin,ShaheedBeheshtee University,Iran
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ImpactofHCAIs
CDCcalculatedapproximately1.7millionnosocomialinfectionsfromalltypesofmicroorganismsresultingin99,000deathsannuallyinUSA.
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ImpactofHCAIs
StudyshowsthatseverelyimmunocompromisedhospitalizedpatientsareatthehighestriskofHAIs.
AmortalityrateduetoBSIinpediatricpopulationandneonateswere3%and11%,respectivelyespeciallyinverylow-birthweights
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ImpactofHCAIs
specializedprogramsneedtobedevelopedandtailoredtomeettheneedsofthepediatricpopulationbasedon:age-relatedfactorsthatpreventthechildfromadheringtoIP&CstandardsEffectofcaregiversonpreventionandtransmissionimmatureimmunesystemsDevelopmentalstage
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Generalriskfactor
closephysicalcontactwithhealth-careworkersstayinenvironmentswhereantibiotic-resistantorganismsareendemicStayinintensivecarewithindwellingdevicesHyperalimentationmechanicalventilationComorbiditiesneutropenicpatientstransplantation
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ChildrenarenotlittleadultTheyrefusetofollowisolationpercussionsChildlife- makingisolationfeelsolonelyNeedt5oplyroominhospital,whichchildisinfectiousinthereandcleanedisveryimportantChildismoreexposetohandonthanadultHandhygienedifficulttoreinforceforthemPPEmaynotfitoravailableforthem
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RiskfactorsforNI
• Theimmunologicalnaivetyofyoungchildren
• congenital/acquiredID• congenitalsyndromes• Closephysicalcontactbetween
childrenandvisitorsanduncontrolledfluidsandbodilysecretions
• Childrenaresusceptibletoinfectionsthatarepreventedinolderbyvaccinationorpreviousnaturalexposure
• Agemakevarietyincausativeorganisms
• chronicordegenerativeorgansystemdisorder
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HIGHRISKAREA
InfectionratesarethehighestinneonatalandPICU(wherebloodstreaminfectionsarethemostfrequent),andareusuallyassociatedwithintravasculardevices.Prematureinfantsmayhaveimmaturedefensemechanisms(includingskin,gastrointestinalsystems,lungsorbebornwithseveremedicalconditions
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Ongeneralpediatricwards:respiratoryandgastrointestinalinfectionspredominate
reflectingtheoccurrenceinthecommunity.
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pathophysiologyForthedevelopmentofaNI,twopathophysiologicfactorsmustbepresent:1-impairedhostdefenses2- colonizationbypathogenicornon-pathogenicbacteria
Mostnosocomialinfectionsarisefromtheendogenousbacterialfloraalthoughmanycriticallyillpatientseventuallybecomecolonizedwithresistantbacterialstrains.
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Chainofinfection
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Modeoftransmission
agent
source
Susceptiblehost
Portofentry
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Portalofentryintothehost
PortalofentryisthewaytheinfectiousagentcanenteranewhostCommonportalsofentryinclude:•Respiratorytract•Gastrointestinaltract•Mucosa(e.g.,conjunctiva,nose,mouth)•Genitourinarytract•Breachofskinintegrity
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Threetypesofinfectionaccountformorethan60%ofallnosocomialinfections:pneumonia(usuallyventilator-associated)urinarytractinfection(usuallycatheter-associated)primarybloodstreaminfection(usuallyassociatedwiththeuseofanintravasculardevice)
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Germsacquireways
person-personviahandsofhealth-careproviders,patientsandvisitorspersonalequipment(stethoscopes,personaldigitalassistants)andclothingairbornetransmission
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Modeoftransmission
Directtransmission
Indirecttransmission
Dropletinfection
Contactwithsoil
Inoculationintoskinormucosa
Vehicle-borne
Air-borne
Fomite-born
Uncleanhandsandfingers
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Humansourceofmicroorganismsthosewhoalreadyhaveadisease,orthosewhoareconsideredtobechroniccarriersofaninfectiousagent.
Patient
Visitor WorkerInfectioncontrol
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Modesoftransmission
Directcontact:consistofdirectbodysurfacetobodysurfacecontactandphysicaltransferofbacteriabetweenasusceptiblehostandaninfectedorcolonizedindividual.
Indirectcontact:involvescontactofasusceptiblehostwithacontaminatedobjectsuchasmedicalinstruments,dressings,glovesthatarenotchangedbetweenpatients.handhygiene
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Modesoftransmission
Droplet:distancefromthesource>1m,Infectiousdropletsaregeneratedduringcoughing,sneezing,talkingandthroughproceduressuchasbronchoscopyandsuctioning.Transmissionoccurswhenthesedropletsarepropelledashortdistancethroughtheairanddepositedonahost'smouth,nasalmucosaorconjunctivae.Wearasurgicalmaskwhileintheroom
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Dropletcontact
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Airborne:consistofdustparticlescontainingbacteriaorairbornedropletnucleiofevaporateddropletscontainingmicroorganismsthataresuspendedintheairforlongerdurationsoftime.Microorganismstransmittedinthismannercanbeinhaledbyasusceptiblehostventilationofthespace
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Strictpolicies
Educationofallcaregiversincreasetheadherenceandcompliancetopolicy
Monitoringcomplianceofhand,personalandenvironmentalhygiene
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educationandreinforcementrequiredtoensurepediatricsafety
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CentersforDiseaseControlandPrevention.CDCtwentyfourseven.SavingLives,ProtectingPeopleRecommendationsforApplicationofStandardPrecautionsfortheCareofAllPatientsinAllHealthcareSettings
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HANDHYGIENE
Inneonates,ongoingresearchfocuseson:reducingcontaminatingperiods(eg,lesshandlingofneonates)sequencingtypesofinfantcare(eg,movingfromcleantodirtysitesduringinfanthandling,Groupingonetypeofinfantcaretoonehandlingperiod
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Encourageotherstoparticipateininfectioncontrol
studentsmayroutinelyobservestaffwho:
failtowashhandsapplyinadequatetechniqueinhandwashingroutinelyviolatecorrectinfectioncontrolprocedures
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barrierstohandhygienecanbeovercomewhenrolemodelspromotingtheprocedureareclearlyidentifiededucationofthevisitortoensurethatheorshedoesn'ttransmitpathogenstohisorherchildortoother
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SusceptiblehostSeverelyimmunocompromisedchildrenrequireextraprotection:ventilationsystemsthatreducetheriskofexposuretofilamentousfungiTreatmentofunderlayingdiseaseImmunizationProphylacticantibiotictherapy
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Susceptiblehost,healthcareworker
AAP:Ø Healthcareworkersshouldreceivetheinfluenza
vaccineannually
Ø Whentransportingacontagiouspatient,facilitiesshouldcommunicateinformationaboutthepatient'sdiagnosisandisolation
Ø appropriatemanagementofinvasiveproceduresanddevices,sterilizationanddisinfectionofequipment,provisionofacleanenvironmentandadequatestaffing.
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ControlofNosocomialInfectioninPaediatricsShahnazArmin,ShaheedBeheshtee University,Iran
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StandardPersonalProtectiveEquipment(PPE)
IFdirectcontactwithblood&bodyfluids,secretions,excretions,mucousmembranes,non-intactskinGlovesPLUSgown
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Theappropriateuseofprophylacticantimicrobialstherapypreventssomenosocomialinfections,especiallyinhigh-riskpatients.
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Theimpactofinfectioncontrolonantimicrobialresistantinfections
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goals
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EffectiveIP&CProgram
forceful
Coverneedsofallagegroup
Supportedbyhigher
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ContinueandSurveillance
Focuson:staffingnumbersandlevelsofexperienceearlydetectionandinterventioninoutbreaksituationsenvironmentalcontrols,adequatesuppliesprogramsforeducation.
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Noticetohighriskgroup:Immuno-deficientpatientsCancersTransplantscertainlungdiseasesimmaturity/VLBWnewborn
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ThefamilyisacorecomponentinpediatricwarditisimportanttorecognizeKnowledgeandcompliance ofthemasapotentialsourceforinfectionspread.
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goalofinfectioncontrolprograms
decreasetheincidenceofinfectionsinpatientsandstaffConsiderationsrelevanttoantimicrobialresistantorganisms
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