Download 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