Nosocomial Infection“Infections Are Most Often Transmitted From Patient To Patient On The Hands Of Healthcare Workers…”

- Dr.William Jarvis

S.P Siva Shankari @ RekhaM.Sc NanoscienceLady Doak CollegeIva Puspitasari,MD

"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).

Introduction:

ARTI INFEKSI NOSOKOMIAL 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

Tiny droplet nuclei (< 5 microns) that remain Suspended in the air.

Dusts From Bedding & Floor.

Exudates Dispersed From Wound.

Air borne transmission :

Transmitted indirectly by material contaminated with the infectious microbes.

Example: contaminated food , blood products, water or contaminated instruments & other items.

Common vehicle transmission:

Most important and frequent mode of transmission of nosocomial infections. It is divided into two subgroups :

• Direct-contact transmission • Indirect-contact transmission

CONTACT TRANSMISSION:

Droplet transmission :

Droplets generated by :

Coughing

Sneezing

Respiratory tract procedures such as

bronchoscopy

Secretions  

Transmitted through insect & other invertebrate animals.

Examples : mosquitoes can transmit “malaria” and “yellow fever”.

Fleas can transmit “plague”.

Vector transmission :

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.

Nosocomial infection factors :

Pathological agents important in nosocomial infection:

Staphylococcus aureus

Pseudomonas aeuroginosa

Escherichia coli

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

 

Many of them are lethal organisms and cause infection during extended antibiotics treatment and severe immunosuppression.

Candida albicans, Aspergillus species

Cryptosporidium, Toxoplasma pneumoniae.

Parasites & Fungi:

SITES OF INFECTION :

Distribution according to the French national prevalence survey(1996),

Following are the most common nosocomial infections:

Urinary tractSurgical SiteRespiratory tract Bacteraemia

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.

Surgical site infection:

RISK FACTOR SSI:

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

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.

Nosocomial pneumonia :

Urinary Tract Infections :

It constitutes 40% of Nosocomial infections.

Typically by catheterization, Instruments.

Manifests as Cystisis, Urethritis.

Organisms : E.coli, Proteus, Klebsilla

RISK FACTOR UTI:

Advanced age Female gender Severe underlying diasese Placement of indwelling urine catheter

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.

Nosocomial Bacteraemia:

RISK FACTOR BSI:

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

 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

Problems of nosocomial infection :

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

Results :

Biotyping

Phage typing

Serotyping

Plasmid profile

Antibiogram

Diagnosis : phenotypic

DIAGNOSIS: GENOTYPIC Plasmid analysis Restriction endonuclease analysis of

chromosomal DNA

ControlMask, 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. 

CONTROL

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

CATEGORY OF ISOLATION

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. 

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.

Conclusion :

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

Thank You !!!