Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Preventing Healthcare-Associated Infection; a Worldwide Strategy Professor Didier Pittet, MD, MS, Infection Control Program University of Geneva Hospitals, Switzerland and Division of Investigative Science Imperial College of Science, Technology, and Medicine, London, UK Hosted by Paul Webber Sponsored by [email protected] Maunco Medical www.webbertraining.com www.mauncomedical.com 1 2 3 4 Nosocomial infections Nosocomial infections Every year in the US, Every year in the US, preventable hospital-acquired diseases, preventable hospital-acquired diseases, including nosocomial infections, including nosocomial infections,/ year 9 billion are responsible for 44’000-98’000 deaths are responsible7 to US$ for2 44’000-98’000 deaths Kohn Institute of Medicine 1999 US$1 Kohn Institute of Medicine 1999 at least £ 1 b In UK, nosocomial infections may be In UK, nosocomial infectionsillio mayn / y beear responsible for > 5’000 deaths/year responsible for > 5’000 deaths/year BMJ 2.12.2000 BMJ 2.12.2000 5 6 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 1 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Maternal mortality rates, First and Second Obstetric Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1846 Ignaz Philipp Semmelweis Maternal First Mortality Second (%) 0 2 4 6 8 1012141618 1 2 45 84 1 184 1843 1844 18 1846 7 Semmelweis IP, 1861 8 Intervention May 1847 Students and doctors were required to: clean their hands with a chlorinated lime solution when entering the labor room in particular when moving from the autopsy to the labor room 9 10 Maternal mortality rates, First and Second Obstetrics Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1850 Intervention May 15, 1847 First Second Maternal Mortality Maternal 0 2 4 6 8 1012141618 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 Semmelweis IP, 1861 11 Florence Nightingale, 1820 - 1907 12 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 2 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com from Notes on Hospitals published in 1863 13 14 Early days of infection control Infection Control and Quality Healthcare in the New Millenium What did we learn from the early days ? 1847 1863 15 16 Infection Control and Quality Healthcare in the New Millenium Does infection control What did we learn from the early days ? Recognize Explain Act control infections ? 17 18 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 3 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com SENIC study SENIC study Haley RW et al. Am J Epidemiol 1985;121(2):182-205 Haley RW et al. Am J Epidemiol 1985;121(2):182-205 Study on the Efficacy of Nosocomial Infection Study on the Efficacy of Nosocomial Infection Control Control Relative change in NI in a 5 year period (1970-1975) Relative change in NI in a 5 year period (1970-1975) 30% Without infection control 26% 30% Without infection control 26% 19% 18% 19% 18% 20% 14% 20% 14% 9% 9% 10% 10% LRTI SSI UTI BSI Total LRTI SSI UTI BSI Total 0% 0% -10% -20% -30% -27% -31% -32% -40% -35% -35% 19 With infection control 20 SENIC SENIC Study on the Efficacy of Nosocomial Infection Control Study on the Efficacy of Nosocomial Infection Control per 110 beds 1 infection control nurse per 200 to 250 beds 1 infection control nurse per 200 to 250 beds 1 hospital epidemiologist per hospital (1000 beds) 1 hospital epidemiologist per hospital (1000 beds) Organized surveillance for nosocomial Organized surveillance for nosocomial infections infections Feedback of nosocomial infection rates Feedback of nosocomial infection rates Haley RW et al. Am J Epidemiol 1985;121(2):182-205 Haley RW et al. Am J Epidemiol 1985;121(2):182-205 21 22 Approach to infection control 1st principle of infection prevention 35-50% of all nosocomial infections are associated 1847 with only 5 patient care practices: 1863 1958 Use and care of urinary catheters 1970 Use and care of vascular access lines 1980 Therapy and support of pulmonary functions Experience with surgical procedures Hand hygiene and standard precautions 23 24 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 4 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Relation between opportunities for hand hygiene Relation between opportunities1. Recognize for hand hygiene for nurses and compliance across hospital wards for nurses and compliance2. across Explain hospital wards 65 65 pediatrics pediatrics On average, On average, 55 medicine 22 opp / hour 55 medicine 22 opp / hour for an ICU nurse for an ICU nurse surgery surgery 45 ob / gyn 45 ob / gyn ICU ICU 35 35 Compliance withCompliance hand hygiene ( , %) withCompliance hand hygiene ( , %) 8 12 16 20 8 12 16 20 Opportunities for hand hygiene per patient-hour of care Opportunities for hand hygiene per patient-hour of care adapted from Pittet D et al. Annals Intern Med 1999; 130:12625 adapted from Pittet D et al. Annals Intern Med 1999; 130:126 26 Observed reasons for not washing hands Time constraint = major obstacle for hand hygiene Time and system constraints • High demand for hand hygiene is associated with low compliance • Full compliance with conventional guidelines is unrealistic handwashing alcohol-based Voss and Widmer - Inf Control Hosp Epidemiol 1997; 18:205 hand antisepsis hand rub Pittet et al, Annals Intern Med 1999; 130:126 27 1 to 1.5 min 15 to 20 sec 28 Handwashing … Handwashing … an action of the past an action of the past (except when hands are visibly soiled) (except when hands are visibly soiled) 1. Recognized 2. Explained Alcohol-based 3. Act Alcohol-based hand rub hand rub is standard of care29 is standard of care30 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 5 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Alcohol-based hand rub at the point of care Hôpitaux Universitaires de Genève Before and after any patient contact 31 Before and after glove use 32 In between different body site care « Talking walls » BEFORE AFTER 33 34 My son, if they don’t get me, you will become multiresistant 35 36 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 6 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Handrub DIRTY STAPH is the natural out of hospital killer of cross transmission 37 38 39 40 Hospital-wide nosocomial infections; trends 1994-1998 12/94 12/95 12/96 12/97 www.hopisafe.ch www.hopisafe.ch 41 Pittet D et al, Lancet 2000; 356: 1307-1312 42 Pittet D et al, Lancet 2000; 356: 1307-1312 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 7 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Key parameters for success System change Administrative support Education of healthcare workers Monitoring and feedback of performance Change in behavior Rub hands … Associated with compliance it saves improvement and reduction in cross- money transmission and infection rates 43 44 Pittet D et al, Inf Control Hosp Epi 2004; 25:264 Infection control in Infection control in developing developing countries countries: main issues Unfavorable social background Facilities badly structured and equipped Technological gap 45 46 Lack of adequate conditions in hospitals Consequences Inadequately/insufficiently equipped Unsafe invasive procedures Inadequate hygiene conditions •Simonsenet al. Bull WHO 1999;77:789-800. ¾ 50% injections = unsafe in 14 out of 19 countries Lack of microbiological data ¾Ïsepsis, hepatitis B and C, HIV, Ebola, Lassa and malaria Understaffing Nosocomial outbreaks of introduced community • Pessoa-Silva et al J Pediatrics 2002;141:381-7. pathogens Overcrowding • Paton et al. Infect Control Hosp Epidemiol 1991;12:710-7 •Merchant et alJ Hosp Infect 1999;38:143-148. ¾ Shigella spp. / Salmonella spp. – Bed occupancy exceeding capacity: 140%! Spread of multiresistant microorganisms Low staff preparedness •Hart & KariukiBMJ 1998;317:647-50. •IssackMI J Hosp Infect 1999;42:339-344. – Unecessary measures / lack of adequate measures Higher healthcare-associated infection rates 47 48 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 8 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Consequences Consequences Higher device-associated nosocomial rates Inadequate use of technology Author, year, country Setting CR-BSI* VAP* CR-UTI*