Nosocomial Infection
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Transcript Nosocomial Infection
“Infections Are Most Often Transmitted From Patient To
Patient On The Hands Of Healthcare Workers…”
- Dr.William Jarvis
Introduction:
"Nosocomial" comes from two Greek words "nosus" meaning "disease" + "komeion" meaning "to
take care of" -disease contracted by a patient
while under medical care.
Infection may manifest during the patient’s stay,
after get discharged, Visitors to the hospital also.
Also called as “Hospital Acquired Infection”
(HAI).
Pasien yang dirawat di Rumah Sakit dan
mendapatkan infeksi di Rumah Sakit yang
sebelumnya pasien tidak dalam fase
prodromal/inkubasi penyakit tersebut
Factors Predispose HAI :
Hospital Pathogen
Poor Condition Of Hospital
Crowding Of Patient’s
Instruments
Extremes Of Age
Immunity
Contaminations
Source Of Nosocomial Infection :
Source
Endogenous
Cause Self Infection
Or Auto Infection
Exogenous
Cause Cross Infection Or
Environmental Infection
Routes of transmission:
Airborne Transmission
Common vehicle Transmission
Contact Transmission
Droplet Transmission
Vector borne Transmission
Air borne transmission :
Tiny droplet nuclei (< 5 microns)
that remain Suspended in the air.
Dusts From Bedding & Floor.
Exudates Dispersed From Wound.
Common vehicle transmission:
Transmitted indirectly by material
contaminated with the infectious
microbes.
Example: contaminated food , blood
products, water or contaminated
instruments & other items.
CONTACT TRANSMISSION:
Most important and frequent mode of
transmission of nosocomial infections. It is
divided into two subgroups :
•Direct-contact transmission
•Indirect-contact transmission
Droplet transmission :
Droplets generated by :
Coughing
Sneezing
Respiratory tract procedures such as
bronchoscopy
Secretions
Vector transmission :
Transmitted through insect & other
invertebrate animals.
Examples : mosquitoes can transmit
“malaria” and “yellow fever”.
Fleas can transmit “plague”.
Nosocomial infection factors :
High prevalence of pathogen .
High prevalence of compromised
hosts .
Efficient mechanisms of
transmission from one to another.
This is also known as chain of
transmission :
o The movement of pathogen
from individual to individual via
various routes.
Pathological agents important
in nosocomial infection:
Staphylococcus aureus
Escherichia coli
Pseudomonas aeuroginosa
Viruses :
There is a possibility of nosocomial
transmission of,
Hepatitis B & C viruses (transfusion ,
dialysis, injection, endoscopy)
Respiratory Synctyial Virus (RSV)
Rotavirus
Cytomegalovirus
Herpes virus
Influenza
Parasites & Fungi:
Many of them are lethal organisms
and cause infection during extended
antibiotics treatment and severe
immunosuppression.
Candida albicans, Aspergillus species
Cryptosporidium, Toxoplasma
pneumoniae.
SITES OF INFECTION :
Distribution according to the French national
prevalence survey(1996),
Following are the most common nosocomial
infections:
Urinary tract
Surgical Site
Respiratory tract
Bacteraemia
Surgical site infection:
They are also frequent : the
incidence varies from 0.5 to15%
depending on the type of operation &
underlying patient status.
The definition is mainly clinical :
discharges around the wound, or
spreading pus from the wound.
By Stitches, Umbilical Cuts,
Surgery spots.
Organisms: S.aureus, P.aeruginosa.
Advanced age
Obesity
Infection at a remote site (spread through
blood stream)
Malnutrition
Diabetes
Extended preoperative hospital stay
Greater than 12 hours between preoperative
shaving of site and surgery
Extended time of surgery
Inappropriate timing of prophylactic
antibiotics
Nosocomial pneumonia :
The most important are patients on
ventilators in intensive care units, where the
rate of pneumonia is 3% per day .
It accounts for 15% and have high mortality
(13-55%).
Mostly caused by respiratory devices,
instruments.
Organisms : S. aureus , Streptococcus
pneumoniae , Influenzae.
Urinary Tract Infections :
It constitutes 40% of Nosocomial
infections.
Typically by catheterization,
Instruments.
Manifests as Cystisis, Urethritis.
Organisms : E.coli, Proteus, Klebsilla
Advanced age
Female gender
Severe underlying diasese
Placement of indwelling urine catheter
Nosocomial Bacteraemia:
These infection represent a small proportion of
nosocomial infection (approximately 5-6%).
The incidence is increasing , particularly for
certain organisms such as Staphylococcus &
Candida Species
Infection may occur at the skin entry site of the
intravascular device , or in the subcutaneous path
of the catheter ,organisms colonizing the catheter
within the vessel may produce bacteraemia without
visible external infection.
Age 1 year of age or younger or 60 years of
age and older
Malnutrition
Immunosuppressive chemotherapy
Loss of skin integrity (burns, decubitus)
Severe underlying illness
Indwelling device (catheter)
Intensive care unit stay
Prolonged hospital stay
Problems of nosocomial infection :
Nosocomial infection will become more
important as public health problem, as it
causes:
Additional suffering
Prolong hospital stay
Increase the cost of care significantly
Nosocomial infection are important
contributors to morbidity & mortality
Results :
May cause death
Increase emotional stress of the
patient
Morbidity ,mortality ratio
Excess costs on stay
Can be transmitted to discharged
patients or visitors
High antibiotic resistance
Diagnosis : phenotypic
Biotyping
Phage typing
Serotyping
Plasmid profile
Antibiogram
Plasmid analysis
Restriction endonuclease analysis of
chromosomal DNA
Control
Mask, Eye Protection:
To prevent splashes, sprays of
secretions & excretion transmitting
infection.
Sterilization :
Sterilization of all reusable equipment
such as ventilators , humidifiers & any
devices that come in contact with the
respiratory tract.
Linen :
Solid, reusable items are placed in
biohazard bags to prevent leakage.
Gloves:
On contact with blood, body fluids, wounds.
Change of gloves after using it for 1 patient
Removal always in reversal manner so as not to
touch surface.
Hand washing:
Is the single most important measure to reduce
the risk of transmitting microorganisms from one
person to another or from one site to another on
the same patient.
Segregation
of infected patients in private
rooms or chorting of patients if private
rooms is not available
Cleaning of all isolation rooms alter the
patients after is discharged
Placement of cards on the patien’s door
specifiying the type of isolation and
instruction for visitor and nursing staff
Strict isolation (chicken pox, pneumoniae
plaque, lassa fever)
Respiration isolation (measle, haemophilus
influenza, Neisseria meningitidis)
Enteric precaution (amoebic dysentri,
Salmonella, Shigella)
Contact isolation for patient infected MDRO
AFB isolation for patient with M.tuberculosis
Drainage and secretion precaution for person
with conjunctivitis and burn
Blood and body fluid precaution for individual
with AIDS
Tell your doctor everything:
All symptoms.
Other prescription medications.
Previous diseases.
Don’t assume it’s not important just because your
doctor did not ask.
Aprons :
Wearing an aprons during patient care
reduces the risk of infection . The apron should be
disposable.
Conclusion :
There is no official, national approach and no real
managerial support from health authorities for
control of nosocomial infections
All diposable items should be properly diposed in
puncture proof bags without touching.
Miss use of antibiotics has produced antibiotic
resistant organisms and these increase clinical
complications of patients, lengthening their hospital
stay and adding to treatment costs.
Only thing is proper asepsis ,sterilization ,proper
washing of hand.
REFERENCES
Gerard J. Tortora, Berdell R. Funke, Christine L. case,
“Microbiology – An introduction”, 9th edition, pearson and
Benjamin Cummings Inc., 2006.
BS Nagoba, Asha Pichare , “Medical Microbiology” , 1st
edition, Reed Elsevier private Limited, New Delhi,2007.
Eugene W Nester, Denise G. Anderson, C. Evans Roberts Jr,
Nancy N Pearsall, Martha T. Nester, “Microbiology- A Human
Perspective”, 3rd Edition, Mc Graw Hill, North America.
http://en.wikipedia.org/wiki/hospital_acquired_infection