dr. Angela N.

Abidin, MARS, SpMK

RS St. Carolus
JAKARTA
"nosus" = disease
"komeion" = to take care of

Infections that occur during hospitalization but are

not present nor incubating upon hospital admission
 Ignaz Semmelweis, (1840s)
demonstrated importance of hand
hygiene
No progress for next century
1976, the Joint Commission on
Accreditation of Healthcare
Organizations - standards for infection
control
Nosocomial infection still on the
increase - emerging infection
 5-10% of patients admitted to acute care hospitals
acquire infections
2 million patients/year
of nosocomial infections occur in ICUs
90,000 deaths/year
Attributable annual cost: $4.5 $5.7 billion
Cost is largely borne by the healthcare facility not 3rd party
payors

Weinstein RA. Emerg Infect Dis 1998;4:416-420.

Weinstein
Jarvis RA.
WR.Emerg
EmergInfect
InfectDis
Dis1998;4:416-420.
2001;7:170-173.
Jarvis WR. Emerg Infect Dis 2001;7:170-173.
70% are due to antibiotic-resistant
organisms
Invasive devices are more important
than underlying diseases in
determining susceptibility to
nosocomial infection

Burke JP. New Engl J Med 2003;348:651-656.

Safdar N et al. Current Infect Dis Reports 2001;3:487-495.
 Urinary tract infection
Bloodstream infection
Pneumonia (ventilator-associated)
Surgical site infection
Definition :
a localized or systemic condition resulting from
an adverse reaction to the presence of an
infectious agent(s) or its toxin(s). There must be
no evidence that the infection was present or
incubating at the time of admission to the acute
care setting.
Virtually all microorganisms can
cause nosocomial infections
Viruses
Bacteria
Fungi
Parasites
Bacteria
Gram +
Staphylococcus aureus
Staphylococcus epidermidis
Gram -
Enterobacteriaceae
Pseudomonas aeruginosa
Acinetobacter baumanni
Mycobacterium tuberculosis
 Viruses
Blood borne infections : HBV, HCV, HIV
Others: CMV, rubella,
varicella, SARS
Fungi
Candida
Aspergillus
1.Endogenous:
Caused by the organisms that are present as
part of normal flora of the patient
2. Exogenous:
Caused by organisms acquiring by exposure to
hospital personnel, medical devices or
hospital environment
Air-borne
Skin scales, droplet nuclei
Contact
Direct
Hands & clothing
Droplet contact followed by autoinoculation
Clinical equipment
Indirect
Bedpans, bowls, jugs, etc
The hands are the most important
vehicle of transmission of
HCAI
 "Universal precautions" refers to a set of
protocols for handling body fluids properly (i.e.,
blood, saliva, urine, vomit).
Body Substance Isolation (BSI) is an acceptable
and alternative set of procedures to universal
precautions and differs primarily in that this
includes handling of all body fluids and
substances.
Universal precautions include:
hand washing,
avoiding punctures,
utilizing gloves when handling body fluids,
using containers with plastic liners to dispose of
contaminated tissues,
having special containers for disposing of
contaminated sharp objects,
promptly washing blood and other human fluids
from skin, and
cleaning hard surfaces with a disinfectant (e.g.,
diluted household bleach).
 Standard Precautions are the minimum infection
prevention practices that apply to all patient
care, regardless of suspected or confirmed
infection status of the patient, in any setting
where healthcare is delivered.
These practices are designed to both protect HCP
and prevent HCP from spreading infections among
patients.
Standard Precautions include:
1. Hand hygiene,
2. Use of personal protective equipment (e.g.,
gloves, gowns, masks),
3. Safe injection practices,
4. Safe handling of potentially contaminated
equipment or surfaces in the patient
environment, and
5. Respiratory hygiene/cough etiquette
 PATIENTSCLOTHES
BED SHEET
PILLOW-CASE
BLANKETS
TOWELS
ETC

A.SUGIHARTO 17 MARET 2009 23

 LINEN BERSIH

<6 X 10 SPORA BACILLUS / INCH

A.SUGIHARTO 17 MARET 2009 24

Treat all linens as potentially
infectious Standard
precautions

A.SUGIHARTO 17 MARET 2009 25

 Onemust ensure that Laundry workers
personal protective garments are not
contaminated with blood
Laundry facilities
Receiving area of contaminated textiles must have
negative pressure compared to clean area.
Ensure Hand washing after handling contaminated
clothes & before handling clean clothes
Do not leave damp textiles or fabrics in machines
overnight.
Disinfection of washing and drying machines not
needed, if properly maintained
Contaminated laundry (OSHA) : laundry
which has been soiled with blood or other
potentially infectious material or may
contain sharps

No sorting in patient care areas

Use leak resistant containers
Use Identity Labels for the contaminated
bags

OSHA : Occupational Safety and Health Administration

 Soiled linen can be transported in the hospital by
cart or chute. Bagging linen is indicated if chutes
are used, since improperly designed chutes can be
a means of spreading microorganisms throughout
the hospital
Soiled linen may or may not be sorted in the
laundry before being loaded into
washer/extractor units
 Sorting before washing protects both machinery
and linen from the effects of objects in the linen
and reduces the potential for recontamination of
clean linen that sorting after washing requires.
Sorting after washing minimizes the direct
exposure of laundry personnel to infective
material in the soiled linen and reduces airborne
microbial contamination in the laundry.
Protective apparel and appropriate ventilation
can minimize these exposures.
 Dry cleaning not required for routine
laundering
No recommendations regarding disposable
v/s durable goods unresolved issue
Hygienically clean textiles laundered not
sterilized
Mattresses & Pillows keep them dry
Maintain integrity of mattress discard
when torn
 Can be done by several physical and chemical
factors
Although dilution is not a microbicidal
mechanism, it is responsible for the removal of
significant quantities of microorganisms
 Soaps or detergents loosen soil and also have
some microbicidal properties.
Hot water provides an effective means of
destroying microorganisms, and a temperature of
at least 71 degrees C (160 F) for a minimum of 25
minutes is commonly recommended for hot-water
washing.
Chlorine bleach provides an extra margin of
safety. A total available chlorine residual of 50-
150ppm is usually achieved during the bleach
cycle.
 Thelast action performed during the washing
process is the addition of a mild acid to neutralize
any alkalinity in the water supply, soap, or
detergent. The rapid shift in pH from
approximately 12 to 5 also may tend to inactivate
some microorganisms.
 Handle contaminated laundry as little as possible
with minimal agitation.
Bag contaminated laundry at the location of use.
Do not sort or rinse laundry at the location where
it was used.
Place wet contaminated laundry in leak-proof, and
color-coded or labeled containers, at the location
where it was used.
 Whenever contaminated laundry is wet and
presents a reasonable likelihood of soak-through or
of leakage from the bag or container, the laundry
shall be placed and transported in bags or
containers which prevent soak-through and/or
leakage of fluids to the exterior.
Contaminated laundry must be placed and
transported in bags or containers labeled with the
biohazard symbol or put in red bags.
 Contaminated laundry bags should not be held
close to the body or squeezed when transporting
to avoid punctures from improperly discarded
syringes.
Normal laundry cycles should be used according to
the washer and detergent manufacturer's
recommendations.
 Most of the occupational transmission can be
prevented

standard precaution has been shown to reduce

exposures and hence the transmission of infection

Healthcare workers have to be educated about

pre and post-exposure prophylaxis

Healthcare institution needs to develop a clear

protocol

Postgrad Med J 2003;79:324328

A.SUGIHARTO 17 MARET 2009 37
 Administrators Role in infection Control in the Hospital by dr. Bharat
Gadhavi, Chief Medical Administrator Sterling
Lessons in Linen, Following Aseptic Technique in the Laundry Department,
by Kelly M. Pyrek, 2003
Guidelines for Environmental Infection Control in Health-Care Facilities,
Recommendations of CDC and the Healthcare Infection Control, Practices
Advisory Committee (HICPAC), U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention (CDC), Atlanta, GA
30333, 2003
Pengendalian Infeksi Nosokomial di bidang linen dan laundry, Aus
Sugiharto, Lab Mikrobiologi Klinik FK Unika Atma Jaya, 2009