The purpose of this video is to provide general information and education about the care of
a critically ill child.
It is in no way a substitute for the independent decision making and judgment by a qualified
healthcare professional.
The information contained in this video should not be used to make a diagnosis or to overrule
the advice of a qualified healthcare provider.
Nor should it be used to provide advice for emergency medical treatment.
Healthcare-associated infections, by Deb Morrow.
Please note that in this video, we will be following the guidelines used at Boston Children's
Hospital.
Some of this information may need to be modified based on the equipment, guidelines, and practices
in place in your institution.
Hi, my name is Deb Morrow and I am a staff nurse 3 and the infection prevention coordinator
in the Cardiac Intensive Care unit at Children's Hospital, Boston.
Today I'm going to be discussing methods that we use to prevent the development of healthcare-associated
infections in the pediatric intensive care units at our institution.
Introduction.
What is a healthcare-associated infection?
These have been defined by the United States Center for Disease Control and Prevention
as a condition resulting from an adverse reaction to an infectious agent or it's toxin.
There must be no evidence that the infection was present or incubating at the time of admission
to the hospital.
Unless the infection is related to a recent admission or a procedure, such as a surgical
site infection.
Infections are considered healthcare-associated if the infection occurs on or after day 3
of hospitalization.
A device associated infection occurs when an indwelling catheter is in place.
The infection was not present at the time of the catheter placement, and it cannot be
related to an infection at another site.
Examples of indwelling catheters are central venous lines, endotracheal tubes, and urinary
catheters.
The device must be in place for 2 days with day of insertion being day 1 for an infection
to be considered device-associated.
However, if a patient is admitted from another hospital or another unit with an indwelling
catheter in place, there is a 48 hour grace period where an infection would be attributed
to the transferring location.
Healthcare-associated infections are a major cause of death and disability worldwide, and
cost billions of dollars.
For example, in Mexico healthcare-associated infections are the third leading cause of
death for the entire population.
The cost of these infections equals 70% of the entire budget of the Ministry of Health.
In Brazil and Indonesia more than half of neonatal patient admissions get a healthcare-associated
infection, with mortality rates between 12% to 52%.
And in the United States, a study on clinical and economic outcomes of healthcare infections
showed that sepsis and pneumonia added more than $8 billion to the cost of healthcare.
And caused more than 48,000 deaths.
Mortality rates were highest for patients who developed sepsis and pneumonia after surgery.
What is needed for an infection to occur?
There were three basic elements needed for infection.
First, there must be an infectious agent, such as a bacterium, virus, fungus, parasite,
or prion.
Sources of infectious agents include humans, animals, and the environment.
Second, there must be a person who is susceptible to the infectious agent.
And finally, the mode of transmission is the way that an infectious agent gets to a susceptible
host.
The mode of transmission is the element, the key element, in breaking the cycle of infection.
Most infection prevention practices are designed to target this element.
It is important to remember that in pediatrics newborns have immature immune systems.
And cardiac patients may have other conditions, such as asplenia or DiGeorge syndrome which
increase the risk for infection.
The three most common interventions that increase the risk for healthcare-associated infections
in the pediatric intensive care unit are the use of central venous lines, mechanical ventilation,
and total parenteral nutrition.
Modes of Transmission.
Let's talk about the mode of transmission for infectious agents.
There are five major modes of transmission: contact, droplet, airborne, common vehicle,
and vector.
The modes of transmission vary by the type of infectious agent, and some agents may be
transmitted by more than one mode.
Contact is the most common mode of transmission, and it is divided into two categories.
Direct contact involves the transfer of infectious agents from an infected person directly to
another person.
Indirect contact involves the transfer of an infectious agent through a contaminated
intermediate object or a person.
The contaminated hands of health care workers are important contributors to indirect contact
transmission.
And most pathogens can be spread by either direct or indirect contact.
Indirect contact transmission can also occur when patient care equipment or the environment
are not cleaned properly between patients.
Infectious agents can be spread when doctors, nurses, and other health care workers do not
clean their hands when leaving a patient's room.
Droplet transmission occurs when respiratory droplets carrying infectious agents are propelled
short distances by coughing, sneezing, or endotracheal suctioning.
These agents may cause infection when they enter the nose, eyes, or mouth of a susceptible
person.
Close contact with a sick person is needed.
And examples of pathogens that can be spread by droplet transmission are influenza viruses,
adenovirus, pertussis, meningococcemia.
Airborne transmission occurs when tiny particles that contain infectious agents are small enough
to remain suspended in the air for long periods of time.
These particles may travel over long distances on air currents.
Infection occurs when these particles are inhaled by a susceptible person.
Close contact with a sick person is not needed.
Common vehicle transmission occurs when an infectious agent is spread from a contaminated
common source such as food, water, or medications.
For example, salmonella food poisoning or legionella water contamination.
Vector-borne is when a disease is transmitted to humans by an animal or an insect, such
as rabies or malaria.
Colonization.
During hospitalization, patients can become colonized with organisms foreign to their
normal body flora.
Colonization is defined as the persistent presence of an organism in the host, without
alteration in body function.
The organism is present on culture.
Normal flora is usually present, with few polymorphonuclear leukocytes on gram stain.
And the patient, or host, has no signs of illness.
Colonization usually occurs in areas of the body exposed to the outside environment such
as the skin, respiratory tract, gastrointestinal tract, or urinary tract due to repeated urinary
catheterizations.
Patients are never colonized in sterile body areas such as the bloodstream or the cerebrospinal
cavity.
Pathogens here indicate infection.
When a patient becomes infected, the organism disrupts physical function and causes disease.
Colonization almost always precedes infection.
The number one intervention for preventing the spread of infectious agents in health
care settings is careful hand hygiene by doctors, nurses, and other health care workers.
That concludes our video on health care associated infections.
Thank you.
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