infec disease lecture 3 - healthcare epidemiology

healthcare epidemiology

study of occurrence, determinates and distribution of health and disease withing healthcare settings

primary focus of healthcare epidemiology

• infection control

• prevention of healthcare associated infections (HAIs)

• includes any activities designed to study and improve patient care outcomes

healthcare associated infections

• infectious disease can be divided into two categories

  • those acquired within health care facilities

    • called health care associated infections HAI’s

  • those acquired outside of healthcare facilities

    • called community acquired infections CAI’s

community acquired infections

• present or incubating at time of admission into healthcare facility

  • acquired outside

healthcare acquired infe4ctions (HAI’s)

• all other infe4ctions = HAI

• acquired within a healthcare facility

  • up to 14 days after discharge

• Does not = iatrogenic infection

iatrogenic infection

• infection from a medical or surgical treatment

• all iatrogenic infections are HAI’s

• but not all HAI’s are iatrogenic infections

  • those infections not from surgical/medical treatment

1 in 31 hospital pt has at least one healthcare associated infection

1 out of 22 Americans pt who acquire a HAI will die

5 most common types of HAI’s

1. clostridium difficile- associated diarrhea (GIT)

2. urinary tract infection (UTI’s)

3. surgical site infections (also referred to as postsurgical wound infections)

4. lower respiratory tract infections (primarily pneumonia)

5. bloodstream infections (septicemia)

VAE- ventilator associated events

CLABSI- central line associated bloodstream infections

CAUTI- catheter associated UTI

living reservoirs

• humans, animals/pets farm animal’s insects and arachnids

• ticks and mites

• person or animal reservoirs may not be experiencing illness caused by pathogens that they harbor (carriers)

3-5% of the population are carriers for c diff

opportunistic pathogens

• do not cause disease under ordinary conditions, but have the potential to cause should the opportunity present itself

animals need water to survive

sporadic disease

• there is a risk of human plague wherever presence of plague natural foci and human population co-exist

• the bacteria, an animal reservoir and a vector

pathogens most often involved in HAI

• the sources of these pathogens are

  • healthcare professionals

  • other healthcare workers

  • visitors

  • and the pt themselves

approx 70% of HAI’s involved drug resistant bacteria

careless use of antibiotics has led to some bacteria developing resistance

• 70% of HAI’s

• overuse of antibiotics can cause bacteria to become resistant

• meaning current treatment will no longer work

common findings of pathogens that cause HAI’s

1. drug resistant pathogens

2. indigenous microbiota or part of normal flora

3. infect immunocompromised patient

pt who are most likely to develop HAI’s

• elderly pt

• women in Land D

• premature infants and newborns

• surgical and burn pts

• diabetic, cancer and transplant pt

• pt receiving treatment with antibiotics, steroids, chemotherapy and radiation

• immunosuppressed pt

• pt with paralysis or are undergoing renal dialysis or catheterization

primary mode of transmission of HAIs

• contact

  • direct contact

    • pathogens transferred from one infected person to another person directly

  • indirect contact transmission

    • pathogens are transferred via a contaminated intermediate object/person

• droplet

  • less than 5 nanometer in diameter

• airborne

  • dissemination of either droplet nuclei or small particles containing pathogens

major contributing factors to HAI’s

1. increase number of drug-resistant pathogens

2. failure of healthcare personnel to follow infection control guidelines

3. an increased number of immunocompromised patients

immunosuppressed are especially likely to develop HAI’s

additional factors contributing to HIA’s

• overcrowding of hospitals and shortages of healthcare staff

• indiscriminate use of antimicrobial agents

• a false sense of security about antimicrobial agents

• length and more complicat3ed types of surgery

• increased use of less highly trained healthcare workers

• increased use of anti-inflammatory and immunosuppressant agents

• overuse and improper use of indwelling devices

what can be done to reduce number of HAi’s

• critical for all healthcare workers to be aware of HAI’s and take steps to minimize infections that occur in healthcare facilities

• the primary way to reduce number of HAI’s is compliance with infection control guidelines

HAI’s can add several weeks to a pt hospital stay and may lead to serious complications and even death

insurance companies rarely reimburse healthcare facilities for cost associated with HAI’s

HAi’s can be avoided through proper education and disciplined compliance with infection control practices

all healthcare workers must

• fully comprehend the problem of Hai’s

• be completely knowledgeable about infection control practices

• personally do everything in their power to prevent HAI’s from occurring