Healthcare Associated Infections

• Formerly known as Nosocomial infection or Hospital acquired infections
• Infection acquired by patients, health care workers and patient relations in hospital environment.
• The patient may acquire the infection while seeking health care services and health workers during discharge of their duties while relations can be infected during visit and support care to hospitalized patients
• Prevalence varies from hospital to hospital and units/wards.
• Prevalence range between 3 -18% in Nigeria.
• Infection rate is relatively high in
• Surgical wards
• Emergency wards
• Intensive care unit
• Most frequent HCAIs are surgical wound infections, UTI & lower respiratory tract infections
• Sources of infection are
• Patients: from their own flora
• Other patients
• Health care workers,
• Visitors/patient relations who may be carrier,
• Environment: formites, surfaces, linens, dressing, infusion, anaesthetic equipment.

• Bacteria:
• Gram positive (staph aureus, streptococci spp, M. Tuberculosis, clostrodia spp)
• Gram negative (klebsiella, E.Coli, pseudomonas, H. Influenza) gram negative infection is 4 times common than gram positive
• Viral: HIV virus, hepatitis B, viral hemorrhagic fever - Ebola, Lassa
• Fungal: Candida spp, pneumocystic carinii
• Protozoa: malaria, amoebiasis

• Age: children & elderly are more vulnerable
• Long hospital stay
• Procedure like dialysis, catheterization, intubation, etc.
• Underlying Chronic disease like diabetes, SCD, cancer
• Immunosuppressive conditions like TB and HIV infection
• Drugs: steroids, cancer drugs
• Poor sanitation of patients and hospital: poor water supply and waste management

• Prolonged patient's hospital stay
• May alter prognosis of initial health problem/disease condition
• Increase cost to patient (extra cost for drugs, hospital bed, lab test etc.)
• Man hour loss from prolonged hospital stay or work absenteeism
• Increase chance of drug resistance

• Personal hygiene especially hand hygiene
• Environmental sanitation in hospital
• Maintain sterile procedures at all time
• Apply Universal and/or standard precautions
• Use of personal protective equipment (PPE)/devices
• Health Education & provision of IEC materials
• Staff training and re-training with supervision
• Established functional infection control committee
• Hospital surveillance for HCAIs

Membership: minimum requirement

• Physician (medicine or paediatric)
• Surgeon
• Epidemiologist (community medicine)
• Microbiologist
• Infection control nurse
• Admin officer to serve as secretary and do necessary follow-up
• Representative from works department
• Representative from hospital waste management unit/committee

1. Meet regularly and upon special indication
2. Regular risk assessment to identify hazard/sources and institute appropriate intervention
3. Make provision for adequate isolation policy and procedure
4. Monitor trends of HCAIs in the hospital
5. Monitor antibiotics usage and resistance
6. Review practices and procedures that compromise patient’s resistance to infection like catheterization, intubation & chemo-prophylaxis
7. Monitor compliance to policies on infection prevention & control (IPC) and SOP in the hospital
8. Recommend antibiotics regimen for use in common HCAIs based on surveillance and lab results
9. Conduct periodic training and sensitization for staff on topical issues relating to IPC e.g. Lassa or Ebola, COVID-19 outbreak, approach to management of accidental needle prick etc.
10. Provide regular feedback and annual report