Chapter 12: Healthcare Epidemiology

Healthcare epidemiology can be defined as the study of occurrence, determinants, and

distribution of health and disease within healthcare settings.
Healthcare Associated Infections
Infectious disease can be divided into two categories:
Infections that are acquired within hospitals or other healthcare facilities are called
healthcare-associated infections (HAIs).
Infections that are acquired outside of facilities are called community-acquired infections.
An iatrogenic infection is an infection that results from medical or surgical treatment-an infection
that is caused by a surgeon, another phyician, or some other healthcare worker.
Frequency of HAIs
In the United States approximately 5% of hospitalized patients develop HAIs. The greatest
number of death was caused by pneumonia.
Pathogens Most Often Involved in Healthcare-Associated Infections
Gram-positive cocci (Staphylococcus aureus, Enterococcus)
Gram-negative bacilli (Escherichia coli, Pseudomonas aeruginosa, Enterobacter,
Klebsiella)
Approximately 70% of HAIs involve drug-resistant bacteria.
Mode of Transmission
Contact Transmission: 2 types:
1. Direct- pathogens are transferred from one infected person to another person without
a contaminated intermediate object or person.
2. Indirect- when pathogens are transferred via contaminated intermediate object or
person.
Droplet Transmission- respiratory droplets carrying pathogens transmit infection when
they travel from respiratory tract of an infectious individual to susceptible mucosal
surface of a recipient.
Airborne Transmission- occurs with dissemination of either airborne droplet nuclei or
small particles containing pathogens.
Most Common Types of HAIs
1. UTIs- 32% of all HAIs and 13% cause of death
2. Surgical site infections- 22% of all HAIs and 8% death
3. Lower respiratory tract infections (primarily pneumonia)- 15% HAIs and 36% death
4. Bloodstream infections (septicemia)- 14% HAIs and 31% death
Other Common HAIs are the gastrointestinal disease caused by C. difficile- associated diseases.
The enterotoxin causes a disease known as antibiotic-associated diarrhea. The cytotoxin causes
known as pseudomembranous colitis, in which section of the lining of the colon slough off,
resulting bloody stools.
12 Steps to prevent Antimicrobial Resistance among Hospitalized Adults
1. Vaccinate
2. Get the catheters out
3. Target the pathogens
4. Access the experts
5. Practice Antimicrobial control
6. Use local data
7. Treat infection: not contamination
8. Treat infection: not colonization
9. Know when to say no to vancomycin
10. Stop antimicrobial treatment
11. Isolate the pathogen
12. Break the chain of contagion
Patients most likely to develop HAIs
Immunosuppressed patients are especially likely to develop HAIs.
Major Factors Contributing to Healthcare Associated Infections
The three major causes of HAIs are: drug resistant bacteria, failure of healthcare personnel to
follow infection control guidelines, an increase number of immunocompromised patients.
What Can Be Done to Reduce the Number of HAIs?
The primary way to reduce the number of HAIs is strict compliance with infection control
guidelines.
Hand washing is the single most important measure to reduce risk of transmitting pathogens to
another patient from one anatomic site to another on the same patient.


What can be done To Reduce the number of Nosocomial Infections?
Handwashing is the single most important measure to reduce the risks of transmitting pathogens from one
patient to another of from one anatomic site to another on the same patient.
Other means of reducing the incidence of nosocomial infections include disinfection and sterilization
techniques, air filtration, use of ultraviolet lights, isolating especially infectious patients, and wearing
gloves, masks and gowns whenver appropriate.

Infection Control
Infection Control pertains to the numerous measures that are taken to prevent infections from occuring
in health-care settings. These preventive measures include actions taken to eliminate or contain reservoirs
of infection, interrupt the transmission of pathogens and protect persons from becoming infected.
Ignaz Semmelweis and Joseph Lister Discovered a concept called Asepsis that states that wound
contamination is not inevitable and that pathogens can be prevented from reaching vulnerable areas.
Asepsis literally means without infection. It includes any actions (referred to as aseptic techniques)
taken to prevent infection or break the chain of infection. There are 2 types of asepsis.:
1. Medical Asepsis
2. Surgical Asepsis

Medical Asepsis
Medical Asepsis or clean technique involves procedures and practices that reduce the number
and transmission of pathogens.
Inlcudes all the precautionary measures necessary to prevent direct transfer of pathogens from
person to person and indirect transfer of pathogens through the air or on instruments, bedding,
equipment, and other inanimate object (formites).
Medical Aseptic technique include frequent and thorough handwashing, personal grooming,
proper cleaning of supplies and equipment, disinfection, proper disposal of needles, contaminated
materials and infectious waste, and sterilization.

Surgical Asepsis
Surgical Asepsis or sterile technique includes practices used to render and keep objects and
areas sterile.
Its goal is to exclude all microorganisms.
Practiced in operating rooms, labor and delivery areas.

The Surgical site of the patients skin must be shaved and thoroughly cleansed and scrubbed with soap
and anti-septic. If the surgery is to be extensive, the surrounding are is covered with a sterile plastic film
or sterile cloth drapes so that a sterile surgical field is established.


Standard Precautions
In a healthcare setting, one is not aware of which patients are infected with communicable pathogens.
Thus, to prevent transmission of pathogens, standard precautions are used for the care of all hospitalized
patients, regardless of their diagnosis or presumed infection status.
Standard precautions are designed to reduce the risk of:
Transmission of bloodborne
All body fluid (secretions and excretions except sweat)
Nonintact skin
Mucous membranes
Standard precautions provide guidelines regarding handwashing:
Wearing of gloves, masks, eye protection, and gowns.
Cleaning of patient-care equipment
Environmental Control
Handling of soiled linens
Handling and Disposal of used needles and other sharps
Resuscitation devices
Patient placement

Standard precautions will protect healthcare professionals and their patients from becoming infected with
HIV, HBV and most other pathogens
TRANSMISSION-BASED PRECAUTIONS
(5) Five main transmission of pathogens are:
A. Contact (either direct or indirect contact)
B. Airborne
C. Droplet
D. Vehicular
E. Vectors

Within a hospital, pathogens are transmitted by three major routes: airborne, droplet and
contact.
Designed for patients known or suspected to be infected with highly transmissible or
epidemiologically important pathogens are required to interrupt transmission in the hospital.
Three types of transmission-based precautions are airborne precautions, droplet precautions
and contact precautions.
Note:
These transmission-based precautions are to be used in addition to the standard precautions
already being used.

Airborne Precautions
Airborne transmission involves either airborne droplet nuclei or dust particles containing a
pathogen. Airborne droplet nuclei are small-particles residues of evaporated droplet containing
microorganisms, because of their small size, they remain suspended in air for a long period of time. In
addition to standard precautions, the patient is placed in a private room having negative air pressure and
from rich air is either discharged outdoors or (If recirculated) passed through high efficiency particulate
air (HEPA) filters. If a private room is not available the patient may be placed in a room with a patient
having active infection with the same pathogen but with no other infection.
Droplet Precautions
Droplets precaution must be used for patients known or suspected to be infected with
microorganisms transmitted by droplets that can be generated in the way we previously mention;
Meningococcal meningitis, Streptoccocal Pneumonia and Influenza. If the patient is not in the private
room the patient may be placed in a room with a patient having active infection with the same pathogen
but with no other infection. Special air handling and ventilation are not required to prevent droplet
transmission. Person working within 3ft of the patient must wear a mask.
Contact Precaution
Are used for patient known or suspected to be infected or colonized with epidemiologically
important pathogens that can be transmitted by direct or indirect contact; examples include multidrug-
resistant bacteria, chickenpox or shingles, scabies, impetigo and viral hemorrhagic fevers. In addition to
standard precautions the patient is placed in a private room if a private room is not available the patient
may be placed in a room with the patient having active infection with the same pathogen but with no
other infection. A. Wearing gown B. Wearing gloves are the standard precautions. If the patient is
transported out of the room ensure the precautions are maintained to minimize the risk of transmission
pathogens to other patients contamination of environmental surfaces or equipments.

Medical Waste Disposal
General Regulations
According to OSHA standards, medical wastes must be disposed properly. These standards include the
following:
Any receptacle.
Any receptacle used for decomposable solid or liquid waste or refuse must be constructed so
that it does not leak and must be maintained in a sanitary condition.
All sweepings, solid or liquid wastes, refuse, and garbage shall be removed.
Disposal of Sharps
Sharps should be handled and dispose of in the following manner:
Preferably, needles shall not be resheathed.
Should it be necessary to resheath needles, never do so using both hands.
After use, needles, disposable syringes, scalpel blades, and other sharp items must be placed in
puncture resistant containers for disposal of sharps.
Sharps containers must be easily accessible to all personnel, needles are commonly used, as
where blood is drown, including patients rooms, ER, ICU and surgical suites.
Sharps containers must be constructed in such a manner that the contents will not spill if
knocked over and will not cause injuries.
Infection Control Committees and Infection Control Professionals
3. All healthcare facilities should have some type of formal injection control program in place.
It functions will vary slightly from one type of healthcare facility to another. In a hospital, the
infection control program is usually under the jurisdiction of the hospitals Infection Control.
*The ICC or Infection Control Committee or Epidemiology Service.
- It is composed of
A representative from the hospitals departments includes:
5. Medical and Surgical Services
6. Pathology Nursing
7. Hospital Administration

8. Risk Management
9. Pharmacy
10. Housekeeping
11. Food Services
12. Central Supply
The ICC periodically review the hospitals infection control program and the incidence of
nosocomial infections.

The ICC Responsibilities:
13. Patient surveillance
14. Environmental surveillance
15. Investigation of outbreaks and epidemics
16. Education of the hospital staff regarding infection control
Role of Microbiology Laboratory in Hospital Epidemiology and Infection Control
Clinical Microbiology Laboratory (CML) personnel participate in infection control in three major
ways:
13. By monitoring the types and numbers of pathogens isolated from hospitalized patients.
14. By noticing the appropriate ICP should a usual pathogen or an unusually high number of isolates
of a common pathogen be detected.
15. By processing environmental sample, including samples from hospitals employees, that have
been collected from within affected wards. It is hoped that this will pinpoint the exact source of
the pathogen that is causing the exact source of the pathogen that is causing the outbreaks.

Traditionally, the two most commonly used methods have been biotype and anti-bio gram.
If the two strains produce the same biochemical test results this is called same biotype.
If they produce the exact same susceptibility and resistance pattern when antimicrobial
susceptibility testing performed, they are said to have the same anti-bzz