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NOSOCOMIAL

INFECTIONS
A hospital-acquired infection, also known as a
HAI or in medical literature as a nosocomial
infection, is an infection that develops in a
patient during hospitalization. It is usually
defined as an infection that is identified at least
forty-eight to seventy-two hours following
admission, so infections incubating, but not
clinically apparent, at admission are excluded.
With recent changes in health care delivery, the
concept of “nosocomial infections” has
sometimes been expanded to include other
“health care–associated infections.”
The most frequent types of infection are urinary-
tract infection, surgical-wound infection,
pneumonia, and bloodstream infection. These
infections follow interventions necessary for
patient care, but which impair normal
defenses. Nosocomial pneumonia occurs most
frequently in intensive-care-unit patients
with endotracheal intubation on mechanical
ventilation—the endotracheal tube bypasses
normal defenses of the upper airway. Finally,
primary nosocomial bloodstream infection
occurs virtually only with the use of
indwelling central vascular catheters, and
correlates directly with
In the United States, the Centers for Disease Control and
Prevention estimated roughly 1.7 million hospital-associated
infections, from all types of microorganisms,
including bacteria, combined, cause or contribute to 99,000
deaths each year. In Europe, where hospital surveys have been
conducted, the category of Gram-negative infections are
estimated to account for two-thirds of the 25,000 deaths each
year. Nosocomial infections can cause severe pneumonia and
infections of the urinary tract, bloodstream and other parts of
the body. Many types are difficult to attack with antibiotics,
and antibiotic resistance is spreading to Gram-
negative bacteria that can infect people outside the hospital.
Known nosocomial infections
 Ventilator-associated pneumonia
 Staphylococcus aureus
 Methicillin resistant Staphylococcus aureus
 Candida albicans
 Pseudomonas aeruginosa
 Acinetobacter baumannii
 Stenotrophomonas maltophilia
 Clostridium difficile
 Tuberculosis
 Urinary tract infection
 Hospital-acquired pneumonia
 Gastroenteritis
 Vancomycin-resistant Enterococcus
 Legionnaires' disease
Spreading of MRSA
Patient with sepsis (bed-sore)
Patient with sepsis (sugulations)
Furuncul
Carbuncul
Mastitis
Control and prevention

Prevention of nosocomial infections requires a


systematic, multidisciplinary approach. This is
usually achieved under the leadership of an
institutional infection-control program. The
principle activities of such a program include
surveillance, outbreak management, policy
development, expert advice, and education. An
optimal program may decrease the incidence
of nosocomial infections by 30 to 50 percent.
 An effective infection-control program requires
dedicated staff with appropriate training and
sufficient resources. The number of personnel is
determined by the size and complexity of the facility.
Infection-control practitioners, usually from a nursing
background, are responsible for program activity. In
larger hospitals, program leadership is provided by a
physician with training in epidemiology and infection
control. Smaller facilities may obtain such expertise
by contractual arrangement with outside experts.
Oversight of the infection-control program is usually
provided by a multidisciplinary infection-control
committee. The program director, however, should
report directly to senior hospital management to
ensure optimal program effectiveness.
Sterilization

Sterilization goes further than just sanitizing.


It kills all microorganisms on equipment
and surfaces through exposure to
chemicals, ionizing radiation, dry heat, or
steam under pressure.
Isolation

Isolation precautions are designed to


prevent transmission of microorganisms
by common routes in hospitals. Because
agent and host factors are more difficult to
control, interruption of transfer of
microorganisms is directed primarily at
transmission.
Handwashing and gloving

 Handwashing frequently is called the single most


important measure to reduce the risks of
transmitting skin microorganisms from one person to
another or from one site to another on the same
patient. Washing hands as promptly and thoroughly
as possible between patient contacts and after contact
with blood, body fluids, secretions, excretions, and
equipment or articles contaminated by them is an
important component of infection control and
isolation precautions.
The microbes comprising the
resident flora
 Staphylococcus epidermidis, S. hominis,
and Microccocus, Propionibacterium,
Corynebacterium, Dermobacterium,
and Pitosporum spp., while in the
transitional could be found S. aureus,
and Klebsiella pneumoniae,
and Acinetobacter,
Enterobacter and Candida spp.
Surface sanitation

 Sanitizing surfaces is an often overlooked, yet


crucial, component of breaking the cycle of
infection in health care environments. Modern
sanitizing methods such as NAV-CO2 have
been effective against gastroenteritis, MRSA,
and influenza agents. Use of hydrogen
peroxidevapor has been clinically proven to
reduce infection rates and risk of acquisition.
Antimicrobial surfaces

 Touch surfaces commonly found in hospital rooms,


such as bed rails, call buttons, touch plates, chairs,
door handles, light switches, grab rails, intravenous
poles, dispensers (alcohol gel, paper towel, soap),
dressing trolleys, and counter and table tops are
known to be contaminated
with Staphylococcus, MRSA (one of the most
virulent strains of antibiotic-resistant bacteria)
and vancomycin-resistant Enterococcus (VRE).