Microbiology
Healthcare-Associated Infections
Definition: HAI is an infection acquired in a hospital (or healthcare facility) 48 hours or
more after admission.
« HAIs were previously referred to as “nosocomial” or “hospital” infections.
« HAIs may occur in patients, visitors, or healthcare members (staff & workers) of a
hospital.
« HAIs can be caused by any microbial agent: bacteria, virus, fungus, or parasite.
Types of HAIs:
1. Central line-associated bloodstream infections
2. Catheter-associated urinary tract infections
3. Ventilator-associated pneumonia
4. Surgical site infections
5. Others e.g. C. difficile infections.
Source of HAI:
I. Endogenous source:
From patient’s own flora of the skin, gastrointestinal, respiratory, or genitourinary tract.
II. Exogenous source
1. Animate source:
a) Medical personnel (staff & healthcare workers).
b) Patients.
2. Inanimate source:
a) Hospital environment: air dust, water
b) Patient care equipment & medical devices: such as catheters & intravenous
(IV) fluids, ventilators & respiratory equipment, endoscopes, disinfectants
and bedpans.
Mode of Transmission:
1. Contact transmission: e.g. MRSA & Clostridium difficile.
a. Direct contact with an infected person.
b. Indirect contact with contaminated surfaces (touched by the infected person, or
where droplets or body fluid settled).
Hands are the most important vehicle of transmission of HAI
2. Respiratory (Airborne) transmission:
Aerosols (i.e. particles < 5µm in size) remain suspended in air for long time & widely
spread organisms by air currents, e.g. T.B., Measles & Varicella.
3. Droplet transmission:
Droplets (i.e. particles > 5µm in size) travel for short distance through air, & organisms are
deposited on mucosa of mouth, conjunctiva or nose, e.g. Influenza & Mumps.
4. Common vehicle transmission:
Contaminated items such as food, water, devices & medication transmit organisms to host.
5. Vector borne transmission:
Vectors such as mosquitoes, flies, rats, and other pests transmit organisms to host
Factors affecting HAI:
Microbial factors:
1. Microbial virulence.
2. Microbial dose.
3. Resistant strains.
Higher microbial virulence, dose & resistance increase the risk of HAI.
Patient susceptibility:
1. Age: infants & old age patients are more susceptible to infection.
2. Immune status: immunocompromised patients are more susceptible to infection.
3. Prolonged hospital stays.
Environmental factors:
• Hospitals house large number of sick & immunocompromised people.
• Medical procedures bypass body’s natural protective barriers.
• Empirical use of antibiotics in hospitals leads to emergence of resistant strains.
• Medical staff move from patient to patient, so may help spread of pathogens.
“The Chain of Infection”
« The infectious disease process results from “the interaction between the
pathogenic organism, the environment, and the host”. This is known as “The
chain of infection”.
« It can be represented as a chain of six (6) links: microbial agent, reservoir, portal
of exit, mode of transmission, portal of entry, and a susceptible host. Each link
has a unique role in the chain, and each link can be interrupted/broken by various
methods.
HAI Prevention & Control Precautions
These are measures practiced by healthcare workers (HCWs) to prevent transmission of
infection from patients to HCWs, or from HCW to patients. They include:
I. Standard precautions
II. Transmission-based precautions
III. HCWs vaccination
I. Standard Precautions
Definition: Set of practices designed to prevent the transmission of pathogens (bacteria &
viruses).
Formerly known as “universal precautions”.
These practices should be done for care of all patients all the time.
Transmission-Based Precautions
Transmission-based precautions are used (in addition to Standard Precautions) for
patients with known or suspected infections (airborne, droplet & contact) or patients
at risk of acquiring infection from others (protective).
1. Airborne Precautions
2. Droplet Precautions
3. Contact Precautions
4. Protective (Environment) precautions
Ø For patients at risk of acquiring infection from others e.g. stem cell transplants patients.
Ø Patient in private room (positive pressure & HEPA filter).
Health care workers vaccination
Post HBV vaccination serological testing:
To test the HCW's response to vaccine,
perform anti-HBs testing
1–2 months after the last vaccine dose
If anti-HBs <10 mIU/mL
If anti-HBs ≥10 mIU/mL (responder)
HCW should be revaccinated ➔
HCW is immune, have long-term
anti-HBs testing 1–2 months after
protection ➔ no further testing
the third dose
If anti-HBs remains <10 mIU/mL (vaccine non-responder)
Test HCW for HBsAg and anti-HBc to determine infection status ➔
those not HBV infected should be considered susceptible to HBV
infection.
Management of Exposure to Blood-borne pathogens(BBPs)
Types of exposure:
1. sharps injury.
2. Splash or blood or body fluids
Risk of exposure:
• HBV: risk is up to 30%
• HCV: risk is up to 3 %
• HIV: risk is up to 0.3%
Management of exposure:
[Link] aid measures:
1. Encourage gentle bleeding, do not suck.
2. Wash the skin thoroughly with soap and water, do not squeeze.
3. Irrigate contaminated mucous membranes e.g. mouth and eyes with large
quantities of tap water.
4. Cover the injury with waterproof dressing and seek medical advice without
delay.
5. Report to the supervisor and the infection control team.
B. Post-exposure Prophylaxis (PEP) of health-care personnel (HCP):
• Against HBV infection:
• If HCW is immune…. only first aid measures are required
• If HCW is not immune …. Immediate supply with anti HBV
immunoglobulins and start vaccination course
• Against HCV infection:
Baseline HCV testing of the source and exposed HCP.
• If the source is negative for HCV antibody….
only first aid measures are required
• If the source is positive for HCV antibody ….
Source anti HIV testing
If negative ➔ No PEP and If positive ➔ start PEP of HCW immediately
no follow up testing of HCW and follow up anti HIV testing at 6 weeks,
12 weeks, & 6 months after exposure; ➔
if seroconversion occurs ➔ link the HCW to
anti HIV treatment.
- PEP by 2-3 antiretroviral drugs for 28 days
(4 weeks).
Testing for infection is required for HCW;
If HCW is negative…. just follow up
is required
If HCW is positive……He should
start treatment
• Against HCV infection:
