Nosocomial Infections
Dr Samaha
objectives
• Definition of hospital acquired infection.
• Importance of hospital acquired infection.
• Factors influencing the development of Nosocomial Infections
• Magnitude of the problem
• Sources of infection and mode of transmission
• causative agents and Commonest sites for hospital acquired
infection
• Infection control precautions in patient care.
• Requirements for establishment of an effective infection control
(IC) program
A "Hospital-Acquired Infection" or "Healthcare-
Associated Infection" (HAI) or “Nosocomial Infection”
Is an infection occurring in a patient in a hospital or other health
care facility in whom the infection was not present or incubating at
the time of admission.
This includes infections acquired in the hospital but appearing after
discharge, and also occupational infections among staff of the
facility.
Infections occurring more than 48 hours after admission are
usually considered nosocomial, also within 30 days after discharge
following in patient care.
Importance of hospital acquired infection:
1. It causes significant morbidity among patients who already suffer
from their original illnesses.
2. It is the leading cause of death among hospitalized patients.
3. It leads to prolonged hospital stay and increased costs.
4. It impairs the patient's quality of life.
5. With the increase of elderly population in our community, they are
vulnerable to develop hospital acquired infections.
Factors influencing the development of Nosocomial
Infections:
1. Patient susceptibility: Patient factors including extreme age, immune
status, malnutrition, chronic diseases and diagnostic and therapeutic
interventions.
2. Environmental factors: Crowded conditions within the hospital,
frequent transfers of patients from one unit to another, and
concentration of patients highly susceptible to infection in one area (e.g.
newborn infants, burn patients, intensive care)
3. Bacterial resistance: Many strains of Pneumococci, Staphylococci
mainly methicillin resistance Staph Aureus MRSA, Enterococci, and
tuberculosis are currently resistant to most or all antimicrobials which
were effective. Multiresistant Klebsiella and Pseudomonas aeruginosa
are prevalent in many hospitals. This problem is particularly critical in
developing countries.
Magnitude of the problem
- The overall rate ranges from 5%-10% of hospitalized patients.
- In intensive care, healthcare-associated infection affects about
30% of patients and the attributable mortality may reach 44%.
- In some developing countries, the proportion of patients affected
by a HAI can exceed 25%.
Sources of infection
1. Endogenous from the patient himself.
2. Exogenous from hospital environment e.g. hospital personnel
and environment like equipment, beds, surfaces and dressings.
Mode of transmission:
1. Contact is the main mode of transmission either direct from
hospital personnel or indirect through contact with contaminated
instruments.
2. Airborne infection.
3. Feco-oral route
Causative agents:
A. Bacteria:
- Anaerobic Gram-positive rods (e.g. Clostridium), cause gangrene.
- Gram-positive bacteria: Staphylococcus aureus (cutaneous bacteria that
colonize the skin and nose of both hospital staff and patients) cause lung,
bone, heart and bloodstream infections and are frequently resistant to
antibiotics (methicillin resistant staph. aureus MRSA);
- Gram-negative bacteria: Enterobacteriacae (e.g. Escherichia coli,
Proteus, Klebsiella, Enterobacter,), may colonize sites when the host
defenses are compromised (catheter insertion, bladder catheter, cannula
insertion)
B. Viruses:
- Hepatitis B and C viruses through transfusions, dialysis,
injections, endoscopy, and respiratory syncytial virus (RSV),
rotavirus, enteroviruses (transmitted by hand-to mouth contact
and via the fecal-oral route).
C. Fungi:
- Many fungi and other parasites are opportunistic organisms and
cause infections during extended antibiotic treatment and severe
immunosuppression (Candida albicans, Aspergillus spp.,
Cryptosporidium). These are a major cause of systemic
infections among immuno-compromised patients.
Commonest sites for hospital acquired
infection
Prevention of HAI:
The three basic principles are:
1. To identify and separate known infected patients, patients with
high potential for contamination of the environment, from other
patients.
2. To eliminate or minimize potential routes of transmission from
sources of microorganisms (e.g. use aseptic technique when
inserting IV catheters)
3. Use basic barrier techniques to eliminate or to minimize the risk of
transmitting infectious agents from patient to patient, from patient
to caregiver, and from caregiver to patient.
Infection control precautions in patient care:
Isolation and other barrier precautions must be a clearly written
policy that are standardized, and adaptable to the infectious agent and
the patients.
These include:
A. Standard or routine precautions to be followed for all patients.
B. Additional precautions for selected patients.
Infection control program “is a group of activities directed to
minimize the magnitude of hospital acquired infections
(nosocomial infection)”.
Requirements for establishment of an effective infection control
(IC) program:
1. Proper hospital design.
2. Setting rules for different activities in the hospital related to
infection control measures.
3. Developing a program for supervising the proper use of
antimicrobial drugs.
4. Protective measures for health care workers (HCW).
5. Environmental cleaning and safe hospital waste management.
6. Conducting an IC surveillance system in the hospital.
7. Establishment of an Infection Control Committee in the hospital for
planning and implementation of effective infection control program in
the hospital.