Healthcare Associated infection (HAI) Surveillance in Infection Prevention & Control. Protect your patients. Protect yourself. Protect your family.

Transcription

1 Healthcare Associated infection (HAI) Surveillance in Infection Prevention & Control

2 Definition Systemic collection of data pertaining to the occurrence of specific diseases, analysis and interpretation of these data, Dissemination of consolidated & processed information to contributors to the surveillance and other interested persons

3 Typical Hospital Organisms Organism Usual Location Risk Factors Typical Infections MRSA Enterococci & VRE Nasal or cutaneous Gut & hospital environment Antibiotic use Skin lesions Overcrowding Antibiotics ie Cephalosporins Skin, wound, Orthopedic, IV devices Respiratory tract Low virulence in ICU patients Clostridium Difficile Multi-drug resistant gram negatives Gut & hospital environment Gut & hospital environment Antibiotics, lack of hygiene Antibiotics, lack of hygiene, HDU & ICU Diarrohoea, Pseudomembranous colitis Intra-abdominal respiratory & blood stream infections

4 Predisposing factors in nosocomial infections Patient factors Debility Extremes of age Impaired gag reflex Trauma Immunosuppressive illness (eg HIV) Normal flora potential pathogens Medical & Surgical Interventions Surgical incisions Intravascular devices Urinary catheters Prostheses Antibiotic use Immunosuppression Anaesthesia & ventilation Hospital Environment Other patient organisms Cross-infection transient staff carriage Environmental organisms Lack of hygiene Overcrowding Understaffing Hospital pathogens

5 Why should we care about detecting healthcare-associated infections?

6 Objectives Monitor the incidence of infection Provide early warning and investigation of problems and subsequent planning and intervention to control Monitor trends, including the detection of outbreaks Examine the impact of interventions Gain information on the quality of care Prioritize the allocation of resources

7 Impact Healthcare Associated Infections In US, an estimated 200,000 HAIs occur every year Cause more than 90,000 deaths annually Cost billion $ in additional healthcare spending annually Additional cost per patient $8832 Little data from African countries World Health Organization (WHO) estimates 10-30% of all admissions result in an HAI

8 How does HAI Surveillance Fit in to IPC Activities? Infection Prevention/Control (IPC) Fundamentals Standard Precautions hand hygiene, PPE, disinfection, inj. safety, waste mgmt. Transmission based precautions Contact, Droplet, Airborne Putting IPC fundamentals into practice requires administrative support and HCW motivation HAI surveillance generates concrete data that can motivate behavior change

9 How can Surveillance Data Motivate Action? Raises Awareness Quantifies the burden of HAI Highlights circumstances under which HAIs occur Provides feedback to motivate Healthcare workers Administrators and policy makers Generates data to evaluate interventions Educational campaigns Hand hygiene Respiratory cohorting

10 HAI Surveillance Can Support Ongoing Activities in Kenya Since 2007, Kenya MoH has been supporting the expansion of IPC programs Little data on HAI burden or reduction to support or inform progress

11 Raising Awareness: Making the Invisible Visible Because transmissions are invisible, we dismiss their importance more easily HCW may not recognize that some of their own behaviors may result in HAI HAI surveillance and feedback can help convince administrators to take IPC seriously and to support IPC activity

12 Example of Making the Invisible Visible: Make Microbes Visible A pair of hospital hands A pair of hospital hands after hand hygiene Visibility Awareness

13 Surveillance makes the invisible visible with data Data can be fed back on a regular basis to HCWs and administrators Intervention Data can be used to evaluate the impact of interventions (e.g. hand hygiene) Visibility Awareness

14 Transmission: Via Healthcare Worker Contact Routes Between Patients Nurse-to-Patient Ratio From patient 3 1 CR#6 2 CR#5 3 Assume 1 nurse treats 3 patients in 3 occupied beds in reality nurse: patient ratio is lower Assume each patient is potentially source and recipient of HAI Here, each patient has two potential contact routes TOTAL # Contact Routes = (#beds) x (#beds 1) = (3) x (3-1) = 6

15 Transmission: Via Healthcare Worker Now Consider 1:10 Nurse-to-Patient Ratio Here, each patient has nine potential contact routes TOTAL # Contact Routes = (#beds) x (#beds 1) = (10) x (10-1) =

16 Transmission: Via Healthcare Worker Transmission pathways between patients via healthcare workers can be eliminated by: 1) Hand hygiene between patient care events 2) Cohorting of patients with respiratory illnesses Use heightened infection control precautions when caring for cohorted patients Identification of patients with respiratory illness will raise healthcare worker awareness ( knowledge is power )

17 Motivating Healthcare Workers: Commitment to Patient Safety Patients are why we are in the field of health care Hospitals should be safe places-they are where people come to get well, not sicker. We have committed ourselves to do no harm. Recognizing HAIs and trying to prevent them is part of our commitment to patient safety

18 Having HAI Data can Motivate Administrators: Numbers are Powerful Assume the following, based on literature: HAI rate of 20% Average daily admission of 17 patients (250-bed hospital) 3 additional nights stay resulting from HAIs In one month, expect: 510 admissions 102 HAIs, resulting in 306 additional patient-days of admission and care

19 Numbers are Powerful: HAI Reduction can Reduce Hospital Stays Percentage Reduction in Inpatient HAI Rates Avoided In- Hospital Days per Year* 10% 1,836 20% 3,672 30% 5,508 40% 7,344 *Based on assumptions in previous slide *Reduction in HAIs can increase staff time and conserve resources *Hospital capacity increases; Quality of care improves

20 Reducing HAI can Prevent Overcrowding Hospital-Acquired Infections lead to Increased crowding and congestion Increased staff work load Diminished quality of care

21 HAI Surveillance can help Detect and Limit Outbreaks Many common infectious diseases amplify in healthcare settings If transmission detected early, HCWs can take action to break chain of infection

22 Mobilizing nations Ministerial Pledges I resolve to work to reduce healthcareassociated infection (HAI) through actions such as: Acknowledging the importance of HAI; Hand hygiene campaigns at national or subnational levels; Sharing experiences and available surveillance data, if appropriate; Using WHO strategies and guidelines Ministerial signature

23 Yaoundé, 4/09/08: Ministerial commitment to address HAI

24 Issues and Challenges (1) In the African region, most countries lack national policies on safe health care practices. Inappropriate funding, Unavailability of critical support systems: Strategies, Guidelines, Tools and patient safety standards

25 Issues and Challenges (2) Inadequate human resources for health, Weak health care delivery systems : Sub optimal infrastructure, Under equipped health facilities have brought about a situation where the likelihood of adverse events including HAI is high. Availability of minimum supplies Basic treatment tools, lack of adequate working conditions in hospitals and Overcrowding have direct implication on the provisions of safe patient care.

26 Issues and Challenges (3) Inadequate data is one of the major draw back in the African region Weak health information and surveillance system on HAI and over all patient safety related issues. To collect and organize data for decision-making remain an important challenge in the Region

27 Actions proposed/solutions (1) In order to adress HAI we need major investment in: Policy-making, Capacity building Infrastructure development Develop a comprehensive national policy to address HAI: guidelines, national strategies Formulate a national strategic plan to implement HAI policy Ensure that HAI agenda is a central component of national health systems

28 Actions proposed 2) Improve knowledge and learning in patient safety and HAI: provision of guidance on the concepts and safe practices procedures for patient safety is important areas of interventions. Intensive sensitization campaign of health care workers (HCWs) on the prevention of HAI should be held on a regular basis.

29 HAI solutions Prevention: Patient screening and environmental controls Intervention: Diagnosis of HAI and outbreak management Surveillance: Information management (alert statistics, epidemiology studies and antibiotic monitoring)

30 Review Surveillance is an important component of IPC Raises awareness of HAI burden Provides feedback for motivation Generates data to evaluate interventions Detects outbreaks HAI Reduction Reduces length of hospital stay Reduces the cost of patient care Reduces suffering Saves lives

31 Are there any questions?