Healthcare Epidemiology: Ma. Concepcion A. Maico, RN, Man, Edd

Ma. Concepcion A.
Maico, RN, MAN, EdD

z
HEALTHCARE
EPIDEMIOLOGY
z
 as the study of the occurrence, determinants, and distribution of

health and disease within healthcare settings
 the primary focus of healthcare epidemiology is on infection

control and preventing healthcare-associated infections (HAIs)
 healthcare epidemiology includes any activities designed to

study and improve patient-care outcomes
z
 activities include surveillance measures; risk reduction programs

focused on device and procedure management; policy
development and implementation; education of healthcare
personnel in infection control practices and procedures; cost–
benefit assessment of prevention and control programs; and any
measures designed to eliminate or contain reservoirs of
infection, interrupt the transmission of infection, and protect
patients, healthcare workers, and visitors against infection and
disease.
z
Healthcare-Associated Infections
 Infectious diseases (infections) can be divided into two

categories, depending on where the person became infected:
 (a) infections that are acquired within hospitals or other healthcare
facilities (called healthcare-associated infections or HAIs) and
 (b) infections that are acquired outside of healthcare facilities
(called community-acquired infections)
 All other infections are considered HAIs, including those that

erupt within 14 days of hospital discharge.
z
Iatrogenic Infection
 An iatrogenic infection is an infection that results from medical

or surgical treatment (i.e., an infection that is caused by a
surgeon, another physician, or some other healthcare worker).
 Examples of iatrogenic infections are surgical site infections and

urinary tract infections (UTIs) that result from urinary
catheterization of patients. Iatrogenic infections are a type of
HAI, but not all HAIs are iatrogenic infections.
z
 The hospital environment harbors many pathogens and potential

pathogens. Some live on and in healthcare professionals, other
hospital employees, visitors to the hospital, and patients
themselves.
 Others live in dust or wet or moist areas such as sink drains,

showerheads, whirlpool baths, mop buckets, flower pots, and even
food from the kitchen.
 The bacterial pathogens that are present in hospital settings are

usually drug resistant strains and, quite often, are multidrug-
resistant.
z
 Many come from the patients themselves—their own indigenous

microbiota that enter a surgical incision or otherwise gain
entrance to areas of the body other than those where they
normally reside.
 Urinary catheters, for example, provide a “superhighway” for

indigenous microbiota of the distal urethra to gain access to the
urinary bladder.
z
Modes of Transmission
 Contact Transmission
 In direct contact transmission, pathogens are transferred from one
infected person to another person without a contaminated
intermediate object or person.
 Indirect contact transmission happens when pathogens are
transferred via a contaminated intermediate object or person.
z
Droplet Transmission
 In droplet transmission, respiratory droplets carrying pathogens

transmit infection when they travel from the respiratory tract of
an infectious individual (e.g., by sneezing or coughing) to
susceptible mucosal surfaces of a recipient. Droplets
traditionally have been defined as being larger than 5 μm in
size.
z
Airborne Transmission
 Airborne transmission occurs with dissemination of either

airborne droplet nuclei or small particles containing pathogens.
Traditionally, airborne droplets are defined as being less than or
equal to 5 μm in size.
z
Most Common Types of HAIs
 UTIs
 surgical site infections
 lower respiratory tract infections (primarily pneumonia)
 bloodstream infections (septicemia)

z
 Other common HAIs are the gastrointestinal diseases caused by

Clostridium difficile , which are referred to as C. difficile-
associated diseases . C . difficile (often referred to as “C. diff”)
is an anaerobic, spore-forming, Gram-positive bacillus.
 It is a common member of the indigenous microbiota of the

colon, where it exists in relatively small numbers. C. difficile
produces two types of toxins (an enterotoxin and a cytotoxin),
the concentrations of these toxins are too low to cause disease
when only small numbers of C. difficile are present.
z
 Superinfections of C . difficile can occur when a patient

receives oral antibiotics that kill off susceptible members of the
gastrointestinal microbiota C. difficile, which is resistant to
many orally administered antibiotics, then increases in number,
leading to increased concentrations of the toxins. The
enterotoxin causes a disease known as antibiotic-associated
diarrhea (AAD).
z
 The cytotoxin causes a disease known as pseudomembranous

colitis (PMC), in which sections of the lining of the colon slough
off, resulting in bloody stools. Both AAD and PMC are common
in hospitalized patients.
z
Patients Most Likely to Develop HAIs
 Patients most likely to develop HAIs are immunosuppressed

patients
 Contributing factors include an aging population; increasingly

aggressive medical and therapeutic interventions; and an increase
in the number of implanted prosthetic devices, organ
transplantations, xenotransplantations (the transplantation of
animal organs or tissues into humans), and vascular and urinary
catheterizations.
 The highest infection rates are in intensive care unit (ICU) patients.
z
Infection Control
 pertains to the numerous measures that are taken to prevent

infections from occurring within healthcare settings.
 These preventive measures include actions taken to eliminate or

contain reservoirs of infection, interrupt the transmission of
pathogens, and protect persons (patients, employees, and
visitors) from becoming infected—in short, they are ways to
break various links in the chain of infection.
z
 Asepsis, which literally means without infection , includes any

actions (referred to as aseptic techniques) taken to prevent
infection or break the chain of infection. Such actions include
general cleanliness, frequent and thorough handwashing,
isolation of infected patients, disinfection, and sterilization.
z
Medical Asepsis
 Medical asepsis, or clean technique, involves procedures and

practices that reduce the number and transmission of
pathogens. Medical asepsis includes 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 objects (fomites).
z
 Medical aseptic techniques include frequent and thorough

handwashing; personal grooming; wearing of clean masks,
gloves, and gowns when appropriate; proper cleaning of
supplies and equipment; disinfection; proper disposal of
needles, contaminated materials, and infectious waste; and
sterilization.
z
Disinfection
 High-level disinfectants kill all microbes (including viruses),f

except large numbers of bacterial spores.
 Intermediate-level disinfectants might kill mycobacteria,

vegetative bacteria, most viruses, and most fungi, but do not
necessarily kill bacterial spores.
 Low-level disinfectants kill most vegetative bacteria, some fungi,

and some viruses within 10 minutes of exposure.
z
Surgical Asepsis
 Surgical asepsis, or sterile technique, includes practices used

to render and keep objects and areas sterile (i.e., free of
microbes). Note the differences between medical and surgical
asepsis:
 Medical asepsis is a clean technique, whereas surgical asepsis is a
sterile technique.
 The goal of medical asepsis is to exclude pathogens, whereas the
goal of surgical asepsis is to exclude all microbes.
z
 Surgical aseptic techniques are practiced in operating rooms, in

labor and delivery areas, and during invasive procedures.
 Other surgical aseptic techniques include surgical scrubbing of

hands and fingernails before entering the operating room;
wearing sterile masks, gloves, caps, gowns, and shoe covers;
using sterile solutions and dressings; using sterile drapes and
creating a sterile field; and using heat-sterilized surgical
instruments.
z
Standard Precautions
 To prevent transmission of pathogens within healthcare settings,

two levels of safety precautions have been developed by the CDC:
Standard Precautions and Transmission-Based Precautions.
 Standard Precautions combine the major features of Universal

Precautions and Body Substance Isolation Precautions, and are
intended to be applied to the care of all patients in all healthcare
settings, regardless of the suspected or confirmed presence of an
infectious agent.
 Transmission-Based Precautions on the other hand, are enforced

only for certain specific types of infections.
z
 Vaccination
 Hand hygiene
 Personal protective equipment (PPE): gloves, masks, isolation

gowns, eye protection, respiratory protection
 Patient-care equipment
 Environmental control
 Linens
 Disposal of sharps
z
Transmission-Based Precautions
 Contact precautions - used for patients known or suspected to

be infected or colonized with epidemiologically important
pathogens that can be transmitted by direct or indirect contact
 Droplet precautions - used for patients known or suspected to

be infected with microbes transmitted by droplets
 Airborne precautions - apply to patients known or suspected to

be infected with epidemiologically important pathogens that can
be transmitted by the airborne route.

Healthcare Epidemiology: Ma. Concepcion A. Maico, RN, Man, Edd

Uploaded by

Copyright:

Available Formats

Healthcare Epidemiology: Ma. Concepcion A. Maico, RN, Man, Edd

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Healthcare Epidemiology: Ma. Concepcion A. Maico, RN, Man, Edd

Uploaded by

Copyright:

Available Formats

Ma. Concepcion A.

Maico, RN, MAN, EdD

 as the study of the occurrence, determinants, and distribution of

 the primary focus of healthcare epidemiology is on infection

 healthcare epidemiology includes any activities designed to

 activities include surveillance measures; risk reduction programs

 Infectious diseases (infections) can be divided into two

 All other infections are considered HAIs, including those that

 An iatrogenic infection is an infection that results from medical

 Examples of iatrogenic infections are surgical site infections and

 The hospital environment harbors many pathogens and potential

 Others live in dust or wet or moist areas such as sink drains,

 The bacterial pathogens that are present in hospital settings are

 Many come from the patients themselves—their own indigenous

 Urinary catheters, for example, provide a “superhighway” for

 In droplet transmission, respiratory droplets carrying pathogens

 Airborne transmission occurs with dissemination of either

 surgical site infections

 lower respiratory tract infections (primarily pneumonia)

 bloodstream infections (septicemia)

 Other common HAIs are the gastrointestinal diseases caused by

 It is a common member of the indigenous microbiota of the

 Superinfections of C . difficile can occur when a patient

 The cytotoxin causes a disease known as pseudomembranous

 Patients most likely to develop HAIs are immunosuppressed

 Contributing factors include an aging population; increasingly

 pertains to the numerous measures that are taken to prevent

 These preventive measures include actions taken to eliminate or

 Asepsis, which literally means without infection , includes any

 Medical asepsis, or clean technique, involves procedures and

 Medical aseptic techniques include frequent and thorough

 High-level disinfectants kill all microbes (including viruses),f

 Intermediate-level disinfectants might kill mycobacteria,

 Low-level disinfectants kill most vegetative bacteria, some fungi,

 Surgical asepsis, or sterile technique, includes practices used

 Surgical aseptic techniques are practiced in operating rooms, in

 Other surgical aseptic techniques include surgical scrubbing of

 To prevent transmission of pathogens within healthcare settings,

 Standard Precautions combine the major features of Universal

 Transmission-Based Precautions on the other hand, are enforced

 Personal protective equipment (PPE): gloves, masks, isolation

 Contact precautions - used for patients known or suspected to

 Droplet precautions - used for patients known or suspected to

 Airborne precautions - apply to patients known or suspected to

You might also like