Dr.T.V.

Rao MD

Dr.T.V.Rao MD

A Tribute to
Ignaz Semmelweiss (1818-1865)

Ignaz Semmelweiss (1818-1865)

 Obstetrician, practised in
Vienna
 Studied puerperal (childbed)
fever
 Established that high maternal
mortality was due to failure of
doctors to wash hands after
post-mortems
 Reduced maternal mortality by
90%
 Ignored and ridiculed by
colleagues

Dr.T.V.Rao MD

What is Hospital Acquired

Infections

Any infection
that is not
present or
incubating at the
time the patient
is admitted to
the hospital

Dr.T.V.Rao MD

Consequences of Hospital Acquired

Infections


Additional morbidity
Prolonged
hospitalization
Long-term physical,
developmental and
neurological sequelae
 Increased cost of
hospitalization
 Death
Dr.T.V.Rao MD

Why Everyone Concerned with

Hospital Infections

 The Centers for Disease

Control (CDC) estimates
that 2 million U.S. patients a
year acquire hospital-related
infections. These infections
cost an average of $47,000
per patient to treat and
cause 90,000 deaths each
year. The added cost to
hospitals is $4.8 billion
annually in extended care
and treatment.

Dr.T.V.Rao MD

What is Infection Control

 Infection control is the discipline concerned with
preventing nosocomial or healthcare-associated infection.
As such, it is a practical (rather than an academic) subdiscipline of epidemiology. It is an essential (though often
under-recognized and under-supported) part of the
infrastructure of health care. Infection control and
hospital epidemiology are akin to public health practice,
practiced within the confines of a particular health-care
delivery system rather than directed at society as a whole.
Dr.T.V.Rao MD

Infection Control is Complex

programme

 Infection control addresses factors related to the spread of

infections within the health-care setting (whether patientto-patient, from patients to staff and from staff to
patients, or among-staff), including prevention (via hand
hygiene/hand washing,
cleaning/disinfection/sterilization, vaccination,
surveillance), monitoring/investigation of demonstrated
or suspected spread of infection within a particular
health-care setting (surveillance and outbreak
investigation), and management (interruption of
outbreaks).
Dr.T.V.Rao MD

Beginning of Hospital Infection

Programme

 Modern hospital infection

control programs first began in
the 1950s in England, where
the primary focus of these
programs was to prevent and
control hospital-acquired
staphylococcal outbreaks. In
1968, the American Hospital
Association published

"Infection Control in the

Hospital," the first and only
standards available for many
years.
Dr.T.V.Rao MD

Centre For Disease Control and

Prevention

The Communicable

Disease Center, later to

be renamed the Centers
for Disease Control and
Prevention (CDC),
began the first training
courses specifically
about infection control
and surveillance.
Dr.T.V.Rao MD

CDC Initiates Hospital

Infection Branch

 In 1972, the Hospital

Infections Branch at the
CDC was formed and the
Association for Practitioners
in Infection Control was
organized. By the close of
the decade, the first CDC
guidelines were written to
answer frequently asked
questions and establish
consistent practice.

Dr.T.V.Rao MD

10

First Data on Infection Control

Efficacy

 In 1985, the Study of the

Efficacy of Nosocomial
Infection Control (SENIC)
project was published,
validating the cost-benefit of
infection control programs.
Data collected in 1970 and
1976-1977 suggested that
one-third of all nosocomial
infections could be
prevented

Dr.T.V.Rao MD

11

Joint Commission on Accreditation of

Healthcare Organizations (JCAHO)

 In 1969, the Joint

Commission for
Accreditation of Hospitals-later to become the Joint
Commission on
Accreditation of Healthcare
Organizations (JCAHO)-first required hospitals to
have organized infection
control committees and
isolation facilities

Dr.T.V.Rao MD

12

CDC formulates Guidelines on

Infection Control

 In 1972, the Hospital

Infections Branch at the

CDC was formed and the
Association for
Practitioners in Infection
Control was organized.
By the close of the decade,
the first CDC guidelines
were written to answer
frequently asked
questions and establish
consistent practice.

Dr.T.V.Rao MD

13

Break the Chain of Infections

 1. Organisms that can
cause infection are
subject to risk
assessment under the
COSHH regulations
and Management of
Health and Safety at
Work Regulation
1992.
Dr.T.V.Rao MD

14

Risk assessment of Substances

in use for ICP

 Various substances such as disinfectants used to prevent cross

infection are subject to risk assessment prior to use. Health and
Safety guidance highlights the importance of the risk
assessment process i.e. Identify the risk
 Assess the risk
 Note current measures which are being used to control or
mitigate the risk
 Inform/train staff
 Monitor outcomes
 Implement policies and procedures
Dr.T.V.Rao MD

15

Beginning of AIDS Pandemic Necceciates

Stronger Infection Control Protocols

 The second and certainly most

significant factor influencing
infection control at the time was
the advent of acquired
immunodeficiency syndrome
(AIDS). The human
immunodeficiency virus (HIV)
has taken an enormous toll in
terms of loss of life and
productivity. For infection
control professionals (ICPs),
HIV has been a challenge for
education, risk reduction and
resource utilization.

Dr.T.V.Rao MD

16

Study of the Efficacy of Nosocomial

Infection Control (SENIC) project

 Study of the Efficacy of Nosocomial Infection Control (SENIC)

project was published, validating the cost-benefit of infection
control programs. Data collected in 1970 and 1976-1977
suggested that one-third of all nosocomial infections could be
prevented if all the following were present:
 One infection control professional (ICP) for every 250 beds.
 An effective infection control physician.
 A program reporting infection rates back to the surgeon and
those clinically involved with the infection.
 An organized hospital-wide surveillance system.

Dr.T.V.Rao MD

17

Infection Control Challenges of

Healthcare in 2000










Decreasing reimbursement
Increasing emerging infections
Increasing resistant organisms
Increasing drug costs
Institute of Medicine Report--healthcare-associated infections
Nursing shortage
OSHA safety legislation
Multiple benchmark systems
FDA legislation on reuse of single-use devices

Dr.T.V.Rao MD

18

Infection control was influenced by the

reform of the Healthcare System

 Infection control programs had to encompass not only

hospitals but also the long-term care facility, home
health/hospice, rehabilitation facilities, free-standing surgical
centers, and physician office practices. A dramatic shift in
patient care practices occurred as greater than 65% of surgery
cases were operated on in an outpatient setting. Issues that will
continue to impact infection control programs into the new
millennium are a challenging combination of cost and clinical
factors and increasing cost to treat infections, and financial
impact of implementing new government regulations .
Dr.T.V.Rao MD

19

Changing Demands on Infection

Control programme

 Today's ICP needs

knowledge of
epidemiology statistics,
patient care practices,
occupational health,
sterilization, disinfection,
and sanitation, infectious
diseases, microbiology,
education and
management

Dr.T.V.Rao MD

20

Infection Control Committee and Antibiotic Policies are

Back bone for reduction of Infections

Dr.T.V.Rao MD

21

Major Responsibilities of I C P

 The major responsibilities for ICPs to oversee include
surveillance, specific environmental monitoring,
continuous quality improvement, consultation,
committee involvement, outbreak and isolation
management, regulatory compliance and education. To
plan, coordinate, and succeed in fulfilling these
responsibilities, many ICPs have to redefine their roles.
More ICPs are becoming managers by creating
multidisciplinary support teams to carry out many of the
functions.
Dr.T.V.Rao MD

22

GUIDELINES AND
RECOMMENDATIONS

 Hand washing and

Hospital Environmental
Control
* Immunization
* Infectious Diseases
Control
* Intravascular DeviceRelated Infections and its
control
* Isolation Precautions

Dr.T.V.Rao MD

23

Good House Keeping a Boon to

Infection Control

Dr.T.V.Rao MD

24

Scientific Disinfection Practices

Saves Several Lives

Long-Term Care Facilities

*Guidelines for Infection
Control in Health Care
Personnel
* Surgical Site Infections
Control
* Urinary Tract and Respiratory
Tract Infections Control
* Ordering and Preparing
Guidelines appropriately
 * Home care
 * Hospital Construction
 * Sterilization / Disinfection


Dr.T.V.Rao MD

25

Surveillance
 The key to ongoing
monitoring is surveillance
for nosocomial infections.
Various techniques for
surveillance have been
described and evaluated
including total house
surveillance, targeted
surveillance, Kardex, or
laboratory-base

Dr.T.V.Rao MD

26

Computerized Surveillance

Dr.T.V.Rao MD

 Surveillance traditionally
involved significant manual data
assessment Increasingly,
integrated computerized
software solutions are becoming
available that assess incoming
risk messages from microbiology
and other online sources. By
reducing the need for data entry,
this software significantly
reduces the data workload of
ICPs, freeing them to concentrate
on clinical surveillance.
27

Infection Control programme is

Hospital Oriented

 ICPs should evaluate their

institutional needs and develop
a surveillance plan to present
to the infection control
committee on a yearly basis.
Choosing one or two specific
surveillance problems and
setting a goal for reduction will
focus the efforts of the ICP.
JCAHO requires documenting
the rationale for selecting a
specific surveillance approach

Dr.T.V.Rao MD

28

Outbreak Investigations

 Unlike scheduled activities,
occasional clusters of
patients who are colonized
or infected will trigger
further investigation
including a case-control
study. New laboratory
methods developed and
refined within the last
decade can now determine
how related the strain is at
the molecular level.

Dr.T.V.Rao MD

29

Infection Control Programme

Integrated with Health Authorities

 The institution usually makes the

infection control program
responsible for reporting
communicable diseases required
by state law. ICPs need to plan on
interacting with local and state
health departments regarding
exposure that may need
immediate community follow-up
(e.g., tuberculosis, Cholera).
ICPs should assist the health
department in confirming cases
that may have been seen in the
hospital or clinic.

Dr.T.V.Rao MD

30

Formulating an Infection Control

Plan

 Every infection control program should develop a welldefined written plan outlining the organizational
philosophy regarding infection prevention and control.
The plan should take into account the goals, mission
statement, and an assessment of the infection control
program. It should include a statement of authority, and
should review patient demographics including
geographic locations of patients served by the healthcare
system

Dr.T.V.Rao MD

31

Staff Training in ICP

 Education programs for employees

and volunteers are one method to
ensure competent infection control
practices. It is a unique challenge
since employees represent a wide
range of expertise and educational
background. The ICP must become
knowledgeable in adult education
principles and use educational
tools and techniques that will
motivate and sustain behavioral
change.

Dr.T.V.Rao MD

32

Infection Control Programme and

Documentation

 Goals of the infection

control program need to
be incorporated into the
mission statement of the
facility. A mission
statement should tell who
you are, what you do, and
should communicate a
clear view of purpose and
set a strategy for
accomplishing the goal

Dr.T.V.Rao MD

33

Document Antibiograms with

WHONET

 WHONET is a free
Windows-based database
software developed for
the management and
analysis of microbiology
laboratory data with a
special focus on the
analysis of antimicrobial
susceptibility test results.

Dr.T.V.Rao MD

34

CDC Guides the Medical profession

ICP

 CDC with the Hospital Infection Control Practices Advisory

Committee (HICPAC) has produced or revised several major
guidelines in the past two years including, Guidelines for
Infection Control in Healthcare Personnel, and Guidelines for
Management of Healthcare Worker Exposures to HIV and
Recommendations for Post exposure Prophylaxis, Guidelines
for Prevention of Surgical Site Infections. APIC has developed
several guidelines covering topics including antisepsis and
hand washing, disinfection and sterilization, endoscopy, and
long-term care.
Dr.T.V.Rao MD

35

Health Care Means In patient

care and outpatient care
 Significant trends in
healthcare are occurring
everyday including new
medical procedures (i.e.,
gene therapy), new
technology (multipurpose intravenous
catheters), and a shift
from inpatient to
outpatient care.

Dr.T.V.Rao MD

36

Dr.T.V.Rao MD

37

Light technology to combat

Hospital Infections

 A pioneering lighting system

that can kill hospital superbugs
including MRSA and C.diff
has been developed by
researchers at the University of
Strathclyde in Glasgow,
Scotland. The technology
decontaminates the air and
exposed surfaces by bathing
them in a narrow spectrum of
visible-light wavelengths,
known as HINS-light.

Dr.T.V.Rao MD

38

Light technology to combat hospital

infections

 The technology decontaminates the air and exposed

surfaces by bathing them in a narrow spectrum of visiblelight wavelengths, known as HINS-light.
 Clinical trials at Glasgow Royal Infirmary have shown
that the HINS-light Environmental Decontamination
System provides significantly greater reductions of
bacterial pathogens in the hospital environment than can
be achieved by cleaning and disinfection alone, providing
a huge step forward in hospitals' ability to prevent the
spread of infection.
Dr.T.V.Rao MD

39

Light Technology to Combat Hospital

Infections

 HINS-light is a safe treatment

that can be easily automated to
provide continuous
disinfection of wards and other
areas of the clinical
environment. The pervasive
nature of light permits the
treatment of air and all visible
surfaces, regardless of
accessibility, either through
direct or reflected exposure to
HINS-light within the treated
environment

Dr.T.V.Rao MD

40

Medical Dressing Uses

Nanotechnology to Fight Infection

 Scientists at the University

of Bath and the burns team
at the Southwest UK
Pediatric Burns Centre at
Frenchay Hospital in Bristol
are working together with
teams across Europe and
Australia to create an
advanced wound dressing.

Dr.T.V.Rao MD
41

New Bandages Change Color If

Infections Arise

The dressing will

Dr.T.V.Rao MD

work by releasing
antibiotics from Nano
capsules triggered by
the presence of
disease-causing
pathogenic bacteria,
which will target
treatment before the
infection takes hold.

42

New Nanotechnology for Hospital Infection

Control Receives FDA Approval

 SilvaGard can be used to

treat virtually any medical
device and its use does not
alter the device's original
properties. Due to these and
other unique attributes,
SilvaGard is expected to
have a significant impact on
the battle against hospitalrelated infections.

Dr.T.V.Rao MD

43

Dr.T.V.Rao MD

44

Long Sleeves x Short Sleeves

 Results from a study by Denver

Health and University of Colorado

Health Services Center researchers
showed there were no statistically
significant differences found in
bacterial or MRSA counts between
physicians coats and newly
laundered short-sleeved
uniforms.The researchers findings
sheds new light on British
government agencies policies
banning physicians white coats
based on the belief that long
sleeves carry more bacteria and
pose a greater risk of bacterial
transmission
Dr.T.V.Rao MD

45

. Vision-based hand gesture recognition

Technology

 The technology relies on hand

gestures as commands, which
can control robotic nurses or
tell computers to display
pertinent patient health
information, Juan Pablo
Wachs, assistant professor of
industrial engineering at
Purdue University works and
popularises.The vision-based
hand gesture recognition
technology could also be used
for the coordination of
emergency response activities
during disasters.

Dr.T.V.Rao MD

46

Involvement of Physicians More

Important

Physicians to be more involved

and lead quality improvement
efforts in their respective
healthcare settings. Drs.
Pronovost and Marsteller suggest
that even though quality
improvement efforts exist, there is
not enough data supporting the
notion that quality improvement
efforts are actually enhancing
patient outcomes. One of the
reasons for this lack of progress,
they say, is inadequate physician
engagement and leadership in
quality improvement work.
Peter Pronovost, MD, PhD, and Jill Marsteller,
PhD, MP

Dr.T.V.Rao MD

47

Scientific Documentation Reduces

Hospital Infections

 Researchers evaluated the

effect of an electronic medical
record on the use of
antimicrobial agents and
infection rates of Clostridium
difficile and MRSA. Results
showed that implementation of
an EMR significantly increased
chart reviews and antimicrobial
recommendations, leading to a
decrease in antimicrobial use
and MRSA as well as C.
difficile infection rates.

Dr.T.V.Rao MD

48

Impact of Hand Washing on

Influenza

 Health experts believe a flu

epidemic was averted last year
because of regular hand-washing,
suggesting healthcare facilities
should promote hand-washing
among staff and patients to
prevent the spread of disease. The
American Society for Microbiology
and the American Cleaning
Institute released a study in Sept.
2010 reporting that 85 percent of
people washed their hands in
public restrooms in 2008, the
highest levels observed since the
Dr.T.V.Rao MD research began in 1996.

49

Hand Hygiene Compliance

 Researchers have implemented a hand

hygiene program driven by a
behavioral change approach to increase
hand hygiene compliance. The hand
hygiene program was packaged with
several initiatives. It included access to
alcohol sanitizer, education as well as
ongoing audit and feedback. The
program was also supplemented with
behavior modification practices, such
as immediate positive reinforcement as
well as annually changing incentives.
The researchers report the program has
resulted in significant and sustained
improvements in hand hygiene
compliance.

Dr.T.V.Rao MD

50

Which Skin Preparation Agent is

Superior

 Researchers conducted a review of surgical

skin prep agents to conclude which agent
was most cost-effective and superior in
preventing surgical site infections. Based on
information collected from two databases,
researchers compared povidone-iodine,
Chlorhexidine gluconate, parachoroxylenol
and iodine povacrylex (0.7 percent available
iodine) in 74 percent isopropyl alcohol
(DuraPrep). Researchers concluded that each
prep agent has specific advantages and
disadvantages and no one skin prep agent is
superior in all clinical situations. Factors to
consider when choosing a skin prep agent
include surgeon preference and
environmental risks.

Dr.T.V.Rao MD

51

Health Care Workers are at Risk

Need for Vaccination

 Health care workers may be exposed to certain infections in the

course of their work. Vaccines are available to provide some
protection to workers in a healthcare setting. Depending on
regulation, recommendation, the specific work function, or
personal preference, healthcare workers or first responders
may receive vaccinations for hepatitis B; influenza measles,

mumps and rubella; Tetanus, diphtheria, pertussis; N.

meningitides; and varicella.
 The problem of resources for proving Vaccines in Developing
countries continues to be real problem, need additional
economic resources
Dr.T.V.Rao MD

52

Become a Member of Alliance for the

Prudent Use of Antibiotics (APUA)
www.apua.org

 An international
organization dedicated to
curbing antibiotic
resistance
 Chapters exist currently
in several Asian countries:
Australia, China, India,
Nepal, Pakistan,
Philippines, South Korea,
Taiwan, Vietnam

Dr.T.V.Rao MD

53



Created by Dr.T.V.Rao MD for e learning
resources for Infection Control Personal in
the Developing World
 Email
 doctortvrao@gmail.com

Dr.T.V.Rao MD

54