HYGIENEAND
HEALTHCAREASSOCIATED
INFECTIONS
I
INTRODUCTION
MUDr. Bohdana Rezková, Ph.D.
HAI
Definition
 Healthcare associated infection means diseases or pathologies
related to the presence of infectious agents or its products in
association with exposure to healthcare facilities or healthcare
procedures or treatments.
(definition for the purpose of Recommendations of the Council of
the European Union, 2009)
in hospital
in outpatient medical facilities
in long-term care facilities
in day- care centres
in assisted living facilities etc.
Healthcare
associated
infections
HAI
WHAT
EXACTLY
are they?
• Occur in a patient during the process of care in a hospital or other
health care facility.
• Are not present and incubating at the time of admission.
• Can also appear after discharge.
• Represent the most frequent adverse event during care delivery.
HAI definition
from:
1) EU law
http://eur-
lex.europa.eu
2) National
Healthcare
Safety Network
(NHSN)
A nosocomial infection associated to the current hospital stay is
defined as infection that matches one of the case definitions
AND
 the onset of symptoms was on Day 3 or later (day of admission =
Day 1) of the current hospital admission
OR
 the patient underwent surgery on day 1 or day 2 and develops
symptoms of a Surgical Site Infection before day 3
OR
 an invasive device was placed on day 1 or day 2 resulting in an HAI
before day 3.
HAI
Frequency
 Frequency of HAIs from WHO data:
- In developed countries in average at least 7% of hospitalized
patients.
- In developing countries in average 15.5% of hospitalized patients.
• ECDC - Point prevalence survey of healthcare associated
infections and antimicrobial use in European acute care hospitals
2016–2017:
- Prevalence of HAI in acute care hospitals in the PPS sample was
5.9% (country range: 2.9–10.0%).
- HAI prevalence was highest in patients admitted to ICU, where
19.2% patients had at least one HAI.
HAI
Consequences
 Prolonged hospital stay
 Long-term disability
 Unnecessary death
 Increased additional cost for care
 High cost for patient and his family
 Increased antibiotic resistance of germ
 Occupational hazards for healthcare workers
Prevention of HAIs is worth of a great attention across
the world!
HAI
Epidemiological
distribution
NON- SPECIFIC
 Common communityacquired
infections brought
by patient or other person.
 Primary pathogens
 e.g. respiratory or
gastrointestinal infection
SPECIFIC
 Infection associated with
specific procedures in health
care facilities.
 Often caused by resistant
microorganisms (superbugs)
or opportunistic pathogens.
 e.g. urinary tract infection,
blood-stream infection,
ventilator-associated
pneumonia,…
CHAINOF
INFECTION
SOURCE TRANSMISSION
SUSCEPTIBLE
PERSON
HAI
Source
in healthcare
Enviroment
Other person
Health-care professional
Patient!
PATIENT
as
a source
 WHEN:
- misdiagnosed
- in incubation period
- abortive or latent form of infection
- carrier of resistant agent (MRSA),
TBC,VHB,VHC,…
EACH PATIENT CAN BE INFECTIOUS!!!
You are certainly not healthy,
because medicine is so advanced
today that a healthy person
basically does not exist!
TRANSMISSION
in
healthcare
facilities
 The most frequent route is a contact, mostly indirect
way of transmission.
 Most transmissions of pathogens
happen via healthcare workers hands!
(WHO Guidelines on Hand Hygiene in Health Care)
PATIENT
as a
susceptible
person
IMMUNOCOMPROMISED INDIVIDUAL:
• HIV patients,
 oncology patients,
 smokers,
 diabetics,
 alcoholics,
 patients that have autoimmune or other chronic disorders.
INFECTION
PREVENTION
PRECAUTIONS
Safer care for patients.
Protection for healthcare professionels.
CDC
(Centre of
disease control
and
prevention)
„Summary of Infection Prevention Practices in Dental Settings“
2016
www.cdc.gov/oralhealth/infectioncontrol/guidelines/index.htm
Possibilities of
prevention
Standard
precautions
the basic level of
infection control
precautions
to be used, as a
minimum, in the care
of all
patients.
prevent transmision
from both recognized
and unrecognized
sources
Isolation
precautions
In specific situation
mostly aimed on
recognized pathogen
differ from the way of
transmission