nosocomial infection

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this is a series of lectures on microbiology, useful for undergraduate and post graduate medical and paramedical students.. this lecture is on hospital acquired infection

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nosocomial infection

  1. 1. NOSOCOMIAL INFECTION Presented by, Dr. Ashish Jawarkar MD Page 1
  2. 2. History • Semmelweis could control infection during hospital deliveries (peurperal sepsis) by hand washing • Lister could control surgical site infections by phenol sprays Page 2
  3. 3. INTRODUCTION • Nosocomial infection comes from Greek words “nosus” meaning disease and “ komeion” meaning to take care of • Also called as HOSPITAL ACQUIRED INFECTION • Infections are considered nosocomial if they first appear 48hrs or more after hospital admission or within 30 days after discharge.
  4. 4. Rise in nosocomial infection as a result of four factor • Crowded hospital conditions • New microorganism • Increasing number of people with compromised immune system • Increasing Bacterial resistance
  5. 5. EPIDEMIOLOGY • Nosocomial infections can be exogenous (external organism) and endogenous (opportunist normal flora) • Host susceptibility Is an important factor in the development of nosocomial infection. • Medical equipments and procedures (surgery) are often responsible for infections
  6. 6. Page 6
  7. 7. COMMON INFECTIONS Following are the most common nosocomial infections: • Urinary tract infection • Pneumonia • Blood stream infections • Surgical site infections
  8. 8. COMMON SITES OF INFECTION
  9. 9. Common agents • Gram positive – Methicillin resistant staph aureus • Gram negative – E coli, proteus, pseudomonas • Virus – HIV, Hepatitis B and C • Fungi like Candida • Protozoa like plasmodium
  10. 10. Page 10
  11. 11. URINARY TRACT INFECTIONS • It is the most common cause of nosocomial infections • 80% of the infections are associated with indwelling catheters. • Main agents – Gram negative bacilli like E coli, proteus, Pseudomonas
  12. 12. NOSOCOMIAL PNEUMONIA • The most important are patients on ventilators/tubes in ICU. Also known as VAP (ventilator associated pneumonia) Most commonly caused by drug resistant Staphylococcus aureus and pseudomonas with acinetonacter baumanii.
  13. 13. NOSOCOMIAL BACTERAEMIA • Infections may occurs at the skin entry site of the IV device or in the sub cutaneous path of catheter. • Gram negative bacilli are most common pathogens
  14. 14. SURGICAL SITE INFECTIONS • The definition is mainly clinical (purulent discharge around wounds or the insertion site of drain, or spreading cellulites from wounds within a week of surgery) Stich abcess – S epidermidis Strepto pyogenes – within a day or two Staphylococci – take 4-5 days Gram negative bacilli – take 6-7 days Burns patients - psuedomonas
  15. 15. Diagnosis • Routine methods – smear, staining, microscopy, culture, antibiotic sensitivity testing • When an outbreak occurs – hospital personell, inanimate objects, water, air or food can be tested • Test sterilization techniques like defective autoclaves, improper chemicals used
  16. 16. PREVENTION AND CONTROL FORMATION OF HOSPITAL INFECTION CONTROL COMMITTEE Consist of Lab head (microbiologist/pathologist) Medical staff Nursing staff Hospital administrator
  17. 17. Functions of HICC • Forming guidelines for admission, handling infectious patients • Surveillance of sterilization techniques • Determining antibiotic policies • Educating patients and hospital staff
  18. 18. Prevention and control of hospital acquired infections • • • • • Hand washing Preventing UTI Preventing surgical site infections Preventing nosocomial pneumonia Preventing bacteremia Page 18
  19. 19. Hand washing • • • • Simple and most effective way Often overlooked Soap and water are enough If not an alcohol based hand steriliser can be used Page 19
  20. 20. Soap and water • Wash for atleast 15-20 seconds • Wash hands before eating, changing diapers, after coughing/sneezing, blowing nose, using bathroom, before and after attending to a patient Page 20
  21. 21. Preventing UTI • Limit duration of catheter • Aseptic technique of insertion • Closed drainage Page 21
  22. 22. Preventing Surgical site infections • Clean technique • Clean OT • Preoperative shower and preparation of patient • Antibiotic prophylaxis • Wound surveillance post operatively Page 22
  23. 23. Preventing pneumonia • • • • Aseptic intubation Limited duration Use sterile water for oxygen therapy Isolation policy Page 23
  24. 24. Preventing Bacteremia • Limit duration of use • Local skin preparation • Removal if infection suspected Page 24
  25. 25. Role of nursing staff Nursing head • Participate in HICC meets • Train staff • Supervise implementation of infection control measures in wards, OT, ICU and maternity , neonatal units Page 25
  26. 26. Ward incharge • Enforce hygiene, hand washing • Report promptly to doctor if any evidence of infection • Limit patient exposure to visitors, staff and other patients • Proper waste disposal • Maintain adequate supply of drugs Page 26
  27. 27. Work restrictions for nurses • Conjuctivitis – No direct patient contact until discharge ceases • Diarrhoea – acute illness – no patient contact till further evaluation; typhoid – no contact till stool culture negative • Sore throat (streptococci) – no contact till after 24 hours of start of antibiotic therapy • Chicken pox – No contact till incubation period ceases Page 27
  28. 28. • Herpes simplex – Genital – no restrictions – Hands – no contact till heals – Orofacial – no contact till heals Page 28
  29. 29. • Respiratory infections (like cold/influenza) – Masks – No contact in initial phase Page 29
  30. 30. Questions that can be asked in exam • Nosocomial infections – define, organisms responsible, prevention • What is the role of nurses in preventing HAI • Hand hygiene • Organisms causing – nosocomial UTI, pneumonia, surgical site infections, bacteremia Page 30
  31. 31. Page 31

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