MEDICAL

MICROBIOLOGY
IN CLINICAL PRACTICE
what infection means
Dr.T.V.Rao MD

My Friends we are moving from Microbiology

to Infectious diseases

INFECTION IS
GREAT THREAT TO

LIFE
Life is Infection in spite of

The great threat to

many Medical advances

The Morbidity and Mortality in

Developing countries is much higher
many patients are illiterate and
poor, so really we do not work on
this area as there is no

Life is a experience start

learning
The TIME IS TICKING

Vision:
Vision: to provide the safest healthcare
system in the world through creating a
zero tolerance approach to avoidable
infections, and delivering safe,
effective and person centred care
through continued improvement in
the prevention and control of Healthcare
Associated Infections.

Learning Objectives
1. Recognize patient safety as an important nursing
responsibility in global health care systems.
2. Apply required knowledge in preventing and/or
minimizing infection.
3. Perform appropriate behaviors required to
prevent health care associated infections.
4. Demonstrate required competence to provide
patients with safe care.

Cannot autoclave patients

Introduction to Patient Safety:

Background
Adverse medical events are widespread and
preventable (Emanuel et al., 2008) .
Much unnecessary harm is caused by health-care
errors and system failures.
Ex. 1: Hospital acquired infections from poor handwashing.
Ex. 2: Complications from administering the wrong

medication.

Global Infection Problems

According to WHO (2005),
On average, 8.7% of hospital patients suffer health
care-associated infections (HAI).
In developed countries:

5-10%

In developing countries:
Risk of HAI: 2-20 times higher
HAI may affect more than 25% of patients
At any one time, over 1.4 million people worldwide
suffer from infections acquired while in hospital.

Health Care-Associated Infections (HAI)

According to WHO:
HAI is also called nosocomial.
HAI is defined as:
an infection acquired in hospital by a patient who
was admitted for a reason other than that
infection.
an infection occurring in a patient in a hospital or
other health-care facility in whom the infection was
not present or incubating at the time of admission.

What is Hospital Acquired

Infections
Any infection
that is not
present or
incubating at
the time the
patient is
admitted to
Dr.T.V.Rao MD' TMC Kollam Kerala

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Do we Spread Infections?
Despite our best intentions,
health professionals sometimes
act as vectors of disease,
disseminating new infections
among their unsuspecting
clients. Attention to simple

What is Infection
Control?
Identifying and reducing the risk of
infections developing or spreading

7/30/15

Dr.T.V.Rao MD @Health Care

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Impression of my Hand Showing

the Growth of Bacteria

WHO IS INCHARGE OF INFECTION

Infection control programmes are
cost-effective, but their
implementation is often hindered by
a lack of support from
administrators and poor

compliance by doctors, nurses,

and other health workers. Some
health professionals suffer from the

Why Everyone Concerned with

Hospital Infections
The Centers for
Disease Control
(CDC) estimates
that 2 million U.S.
patients a year
acquire hospitalrelated infections.
Dr.T.V.Rao MD' TMC Kollam Kerala

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Impacts of Health Care-Associated

Infections (HAI)
HAI can:
Increase patients suffering.
Lead to permanent disability.
Lead to death.
Prolong hospital stay.
Increase need for a higher level of care.
Increase the costs to patients and hospitals.

Impact of Nosocomial
Infections
They lead to functional disability and emotional
stress to the patient.
They lead to disabling conditions that reduce
the quality of life.
They are one of the leading causes of death.
The increased economic costs are high:
Increased length of hospital stay (SSI - 8.2 days),
extra investigations, extra use of drugs and extra
health care by doctors and nurses.
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Dr.T.V.Rao MD @Health Care

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Frequency of Nosocomial
Infection
Nosocomial

infections occur worldwide.

The incidence is about 5-8% of hospitalized
patients, 1/3 of which is preventable.
The highest frequencies are in East Mediterranean
and South-East Asia.
A

high frequency of N.I. is evidence

of poor quality health service
delivered.

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Dr.T.V.Rao MD @Health Care

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Nosocomial infections can spread

to Community
Organisms causing N.I.
can be transmitted to the
community through
discharged patients, staff
and visitors. If organisms
are multi-resistant they
may cause significant
disease in the community.
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Dr.T.V.Rao MD @Health Care

21

HAI - common bacteria

Staphylococci - wound, respiratory and
gastro-intestinal infections
Escherichia coli - wound and urinary tract
infections
Salmonella - food poisoning
Streptococci - wound, throat and urinary
tract infections
Proteus - wound and urinary tract
infections (Peto, 1998)
C.difficle an emerging pathogen

Dr.T.V.Rao MD' TMC Kollam Kerala

22

HAI - common viruses

Hepatitis A - infectious
hepatitis
Hepatitis B - serum hepatitis
Human immunodeficiency virus
[HIV] - acquired
immunodeficiency syndrome
[AIDS] (Peto, 1998)
Dr.T.V.Rao MD' TMC Kollam Kerala

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Required Skills
Apply universal precautions*
Use personal protection methods
Know what to do if exposed
Encourage others to use universal precautions
Report breaks in technique that increase patient
risks
Observe patients for signs and symptoms of infection

Main Sources of Infection

Person to person via hands of health-care providers, patients,
and visitors
Personal clothing and equipment (e.g. Stethoscopes,
flashlights etc.)
Environmental contamination
Airborne transmission
Hospital staff who are carriers
Rare common-source outbreaks

Campaigns to Decrease Infection Rates

WHO Clean hands are safer hands campaign
Centres for Disease Control and Prevention
(CDC) prevent antimicrobial resistance
campaign in health-care settings
Institute for Healthcare Improvement (IHI)
5 million lives campaign
Developing country focus

Antibiotic Resistant Microorganisms

normal flora too can cause Infections

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Problem exists because of overuse

and inappropriate use
Resistant to multiple antibiotics
Reduced options for treatment
Require isolation precautions
Examples: MRSA, VRE, MDR TB
Solutions: more appropriate
antibiotic use, better infection
Dr.T.V.Rao MD @Health Care

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Leading causes of death

53.9 million from all causes, worldwide

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Incidence of Healthcare associated

infections
Lack of reliable data affects estimates on the burdenmillions worldwide every year
No health-care facility, no country, no health-care
system in the world is free of this problem
Developed world: 510% patients
Developing countries: risk is at least 2 times higher
and can exceed 25%
ICU - 30% patients; attributable mortality as high
as 44%
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Main Routes for infections

Urinary tract infections (UTI)
Catheter-associated UTIs are the most frequent,
accounting for about 35% of all HAI.

Surgical infections: about 20% of all HAI

Bloodstream infections associated with the use of
an intravascular device: about 15% of all HAI
Pneumonia associated with ventilators: about15%
of HAI

DROPLET INFECTION IS A
THREAT TO HEALTH CARE
WORKERS
1

Influenza

2
Tuberculosis

Types of Infections

Burke J Infection control-a problem for patient safety New Eng Journal
of Medicine (February 13, 2003)

Infection control in developing

countries
None/inadequate Infection Control infrastructure
Lack of strategic direction at national/local level
Lack of resources/financial governance
Well-organized, effective infection control programmes are confined
to academic institutions, well-funded government and private hospitals
Smaller hospitals in urban areas and hospitals in rural centres have
less resources
None or inadequate infection control programme
Lack of Microbiology Laboratory supports
Availability of antimicrobial agents, hand hygiene products and hand washing
facilities, Personal Protective Equipment and sterile goods

33

NO COST MEASURES
Good infection control
practices

Aseptic technique for all sterile procedures

Remove indwelling devices when no longer needed

Isolation of patient with communicable
diseases/multi-resistant organism
Avoid unnecessary Per Vaginal (PV) examination in
women in labour
Placing mechanically ventilated patients in a semirecumbent position
Minimize number of people
inJournal
operating
theatre
Damani NN.
of Hospital infection
2007; 65(S1): 151-154.
34

Standard precautions
Treating all patients in the
health care facility with the
same basic level of standard
precautions involves work
practices that are essential to
providea high level of protection
to patients, health care workers

Nosocomial Infections
Cost
The cost varies according to the type and

severity of these infections.

An estimated 1 to 4 extra days for a urinary
tract infection, 7 8 days for a surgical site
infection, 7 21 days for a blood stream
infection, and 7 30 days for pneumonia.
The CDC has recently reported that US$5
billion are added to US health costs every
year as a result of NI.
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Dr.T.V.Rao MD @Health Care

36

Include the following:

Hand washing and antisepsis (hand
hygiene); use of personal protective
equipment when handling blood, body
substances, excretions and secretions;
appropriate handling of patient care
equipment and soiled linen;
prevention of needle stick/sharp
injuries; environmental cleaning and
spills-management; and appropriate

. METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

refers to S. aureus organisms

that are resistant to
methicillin
1940- PENICILLIN was
discovered
Soon after penicillin was
introduced, S. aureus became
all but universally penicillin
resistant

Neonatal sepsis among NICU

(University Hospital in Egypt)

Increase rates of early

onset neonatal sepsis
among infants in ICU
Mortality rates : 55%
All infants placed on IV
fluids and antibiotics
Yassin S. et al 5th IFIC Congress Malta, 2003

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Effect of hand washing on child health

Randomised controlled trial in Karachi, Pakistan.

Hand washing with soap and water

Children under age of 5 years

50% lower incidence of pneumonia

Children under age of 15 years

53% lower incidence of diarrhoea

34% lower incidence of impetigo
Luby SP et al. Lancet 2005; 366: 225-33.
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Health Education need of the Hour

Educate patients and families/visitors
about clean hands and infection
transmission.
Ensure patients on precautions have same
standard of care as others:
frequency of entering the room
monitoring vital signs

Breaking the Chain

How to prevent the spread of
Infection

CONTROL
Control is best
achieved by
1.intensifying cleaning,
2.using Contact
Precautions for
infected patients
3.stressing glove use
4.hand hygiene for all
care workers.

CDC RECOMMENDATION
1. Intensified
environmental cleaning
using 1:10 bleach :
water solution
2. Equipment cleaned
whenever visibly soiled
3. Items close to the
patient should be
cleaned daily
4. IV poles should be

Five moments for hand hygiene

Before patient contact
Before an aseptic task
After body fluid exposure even if wearing
gloves!
After patient contact
After contact with patient surroundings

How should you wash your hands?

4 Rinse your
hands well
under clean,
running water.
5Dry your
hands using a
clean towel or

Hand washing reduces spread of

Microbes
We can take to reduce
the spread of diarrheal
and respiratory illness
so you can stay
healthy. Regular
Handwashing,
particularly before and
after certain activities,
is one of the best ways
to remove germs, avoid
getting sick, and
prevent the spread of

What to Use for Hand Washing

Alcoholic hand
disinfection is
generally used in
Europe, while hand
washing with
medicated soap is
more commonly

USED SYRINGE AND NEEDLE

A threat to Life
The important pathogens to be considered in this
situation are hepatitis B virus , hepatitis C
virus (HCV) and HIV . It is essential that the
health care provider be knowledgeable about the
risks of acquisition of these viruses following
needle stick injuries, and the recommendations
for management and follow-up. it is prudent to
assume that the needle may have been
contaminated with one or more of these viruses.

DO NOT PLAY WITH NEEDLES

WHO reports in the World
Health Report 2002, that of
the 35 million health-care
workers, 2 million
experience percutaneous
exposure to infectious
diseases each year. It
further notes that 37.6% of
Hepatitis B, 39% of
Hepatitis C and 4.4% of
HIV/AIDS in Health-Care

DO NOT RECAP NEEDLES

Needle stick injuries
are a common event in
the healthcare
environment. These
injuries also commonly
occur during needle
recapping and as a
result of failure to

Dealing with Needle Stick Injuries

Encourage bleeding at the site of
puncture
Wash the wound
Do not scrub the wound while you're
washing it. This can make the injury
worse.
Never try to suck the wound
Dry and cover the wound. Use a sterile
material to dry the wound and
immediately cover the wound with a
waterproof plaster or dressing.

Elements of Standard Precautions

1. hand hygiene
2. use of gloves and other barriers
(eg, mask, eye protection, face
shield, gown),
3. handling of patient care
equipment and linen
4. environmental control
5. prevention of injury from
sharps devices
6. patient placement.

1.

Hand Hygiene

Hands should be
washed with soap
and water
Antimicrobial
agents (eg,
chlorhexidine
gluconate,
iodophors,

Hand Hygiene
Effective hand
washing requires at
least 20 seconds of
vigorous scrubbing
with special
attention to the
area around nail
beds and between
fingers, where there

Universal Precautions
CDC (Centers for Disease Control) in
1987:
All patients be regarded as
potentially infective (HIV &
Hepatitis)

that all patients are

colonized or infected
with microorganisms,
whether or not there
are signs or symptoms

WE ARE ALL RESPONSIBLE

Important Conclusions
Nosocomial transmission of pathogenic
bacteria creates a major health burden
Multifaceted interventions are needed for
high level control: proper hand hygiene is
the cornerstone of prevention efforts
Isolation of patients may place them at
risk for errors of omission
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Dr.T.V.Rao MD @Health Care

58

WHO IS MORE INTELLIGENT

SUPERBUGS OR ANTIBIOTICS

Conclusions

Identify unsafe, unnecessary and

ineffective infection control practices
Divert resources to apply basic
evidence based practice in Infection
control
Implement simple & effective
solutions according to local need
and resources which are achievable
and affordable
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BEST PRAYER IN THE HOSPITAL

ADVICE FROM MY TEACHERS

TO CORRECT WITH KNOWLEDGE

WE ARE ALL RESPONSIBLE

INFECTION CONTROL

 The Program Created by Dr.T.V.Rao MD

for the Resident doctors what Infection
means when they start working in the
Hospitals.
Email
doctortvrao@gmail.com