Nosocomial infection

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Nosocomial infection

  1. 1. Dr. Jayesh V Patidar www.drjayeshpatidar.blogspot.com 1
  2. 2. 1. Susceptible patient:Many patients in hospital have impaired defense mechanism due to pre-existing disease, such as diabetes, immunosuppression & patients with prosthetic implants. They are, therefore more susceptible to infection. 12/26/2013 www.drjayeshpatidar.blogspot.com 2
  3. 3. 2. Hospital Environment:Pathogens may be present in air, dust, water, food or antiseptic lotion. Equipment may be contaminated. Bedding, linen & utensils may act as fomites. Patients shed the organisms from their bodies while hospital personnel spread these organisms 12/26/2013 www.drjayeshpatidar.blogspot.com 3
  4. 4. 3. Diagnostic or therapeutic procedures:During diagnostic or therapeutic procedures such as insertion of urethral or intravenous catheters, the slightest lapse in asepsis may lead to infection. 12/26/2013 www.drjayeshpatidar.blogspot.com 4
  5. 5. 4. Drug Resistance:- Hospital infections are generally refractory to treatment as the infecting agents are usually multidrug resistant. 12/26/2013 www.drjayeshpatidar.blogspot.com 5
  6. 6. 5. Transfusion:Blood, blood products & intravenous fluids used for transfusion, if not properly screened, can transmit many infections. Blood, blood products & intravenous fluids used for transfusion, if not properly screened, can 12/26/2013 www.drjayeshpatidar.blogspot.com 6
  7. 7. 6. Advances in medical progress:- Advances in treatment of cancer, organ transplantation, implanted prostheses & other sophisticated technologies enhance the risk of infection. 12/26/2013 www.drjayeshpatidar.blogspot.com 7
  8. 8.  Esch. Coli, Klebsiella, Enterobacter, proteus & Serratia have become the most important hospital pathogens, particularly because of dissemination among them of R factor conferring multiple drug resistance.  Pseudomonas aeruginosa & other pseudomonas species have always been important hospital pathogens because of their intrinsic resistance to most antibiotics & ability to survive & even multiply in disinfectants solutions. 12/26/2013 www.drjayeshpatidar.blogspot.com 8
  9. 9.  Tetanus spores can survive in dust & may sometimes contaminate items used in hospital. Hospital tetanus is usually due to faulty sterilization techniques or other lapses in asepsis.  HIV & hepatitis B & C viruses are transmitted by contaminated blood & blood products.  Virus diarrhea & chickenpox may spread in hospitals. Cytomegalovirus, influenza, herpes virus, enterovirus are some other virus which may cause hospital infection. 12/26/2013 www.drjayeshpatidar.blogspot.com 9
  10. 10. 1. Contact:a) Hands or clothing:Hands or hospital staff are an important vehicle of spread of infection. There is adequate scope of transmission of microorganisms from one person to another by contact of hands and clothing of attendants. Staphylococcus aureus and streptococcus pyogenes are two 12/26/2013 www.drjayeshpatidar.blogspot.com 10
  11. 11. b) Inanimate objects :Certain instruments (endoscope, bronc hoscope, cystoscop e), if not property disinfected, may transmit pathogenic organisms (eg:pseudomonas aeruginosa) 12/26/2013 www.drjayeshpatidar.blogspot.com 11
  12. 12. 2. Airborne:a) Droplets:Droplets of respiratory infection is transmitted by inhalation. b) Dust:Dust from bedding , floors, exudates dispersed from a wound during dressing & from skin by natural shedding of skin scales (measles, staphylococcal sepsis), may contribute in spread in of infection eg:. Pseudomonas aeruginosa, staph. aureus. c) Aerosols:Aerosols produced by nebulizers, humidifiers & air conditioning apparatus transmit certain pathogens to the respiratory tract occurrence of legionellae in hospital water supply has lead to out 12 breaks of infections mainly 12/26/2013 legionella with www.drjayeshpatidar.blogspot.com
  13. 13. 3. Oral Route:Hospital food may contain antibiotic-resistant bacteria (pseudomonas aeruginosa, Esch. Coli, klebsiella spp. & others ), which may colonize the intestine & later cause infection in susceptible patients. 4. Parenteral Route:With the introduction of disposable syringes & needles, transmission of infection by parenteral route has been infrequent. Certain infection may be transmitted by blood transfusion or tissue donation, contaminated blood products (Factor VIII) & contaminated infusion fluid. Hepatitis B & HIV are two viruses which may be transmitted in 12/26/2013 www.drjayeshpatidar.blogspot.com 13 this way.
  14. 14. Toys and Transmission of infection:Playing together & sharing of contribute to the child’s development of social skill. Toys may be considered as a part of the equipment of a pediatrics unit, but sharing of toys poses a potential health risk. Microbial contaminated of toys has been documented in hospital, pediatrician offices & day care centre. Fecal coli forms & rotavirus have been found on toys 12/26/2013 in day care centre & in hospital. www.drjayeshpatidar.blogspot.com 14
  15. 15. 12/26/2013 www.drjayeshpatidar.blogspot.com 15
  16. 16. 1. Urinary Tract Infection:This is usually associated with catheterization or instrumentation of urethra, bladder or kidney. Infection is caused by Esch. Coli, Klebsiella, proteus, serr atia pseudomonas, providencia, c 12/26/2013 www.drjayeshpatidar.blogspot.com 16
  17. 17. 2. Respiratory Infection:Aspiration in unconscious patients & pulmonary ventilation may lead to nosocomial pneumonia. The major pathogens include staph. aureus, klebsiella, enterobactor , serratia, proteus, Esch. Colli, pseudomonas aeruginosa, acinetobacter & respiratory viruses. 12/26/2013 www.drjayeshpatidar.blogspot.com 17
  18. 18. 3. Wound and skin sepsis:- Aspiration in unconscious patients & pulmonary ventilation may lead to nosocomial pneumonia. The major pathogens include staph. aureus, klebsiella, enter obactor , serratia, proteus, Esch . Colli, pseudomonas aeruginosa, acinetobact er & respiratory viruses. 12/26/2013 www.drjayeshpatidar.blogspot.com 18
  19. 19. 5. Gastrointestinal Infections:Food poisoning & neonatal septicemia in hospital have been reported. Salmonella & sligella sonnei are mainly associated with these infections. 6. Burns:Staph. aureus, pseudomonas aeruginosa, acinetobacter & str. Pyogenes are responsible for hospital acquired infections in cases of burns. 12/26/2013 www.drjayeshpatidar.blogspot.com 19
  20. 20. 6. Bacteraemia and septicemia:These may be consequences of infection at any site but are generally caused by infected intravenous canula. Gram negative bacilli are common pathogens. Intravenous rehydration in diarrhea should be replaced by oral fluids as early as possible. Staph. epidermidis bacteraemia is found commonly in patients with artificial heart valve. Bacteraemia in those with valular defects may lead to endocarditis. 12/26/2013 www.drjayeshpatidar.blogspot.com 20
  21. 21. Hospital acquired infection may occur sporadically or as out breaks. Diagnosis is by the routine bacteriological methods such as direct smear examination, from possible sources of infection such as hospital personal, inanimate objects water, air or food. Typing of isolate (phage typing bacteriocin typing, biotyping or autibiogram) may indicate a causal connection. 12/26/2013 www.drjayeshpatidar.blogspot.com 21
  22. 22. control of hospital infection should be a permanent ongoing activity. Examples of sources of hospital out breaks are nasal carriage of staphylococci in hospital staff or pseudomonas growing in lotions. Carriers should be suitably treated. The cause of infection may be a defective autoclave, therefore, sterilization techniques have to be tested. This may lead to selected colonization by multi-resistant pathogens & has a harmful effect. 12/26/2013 www.drjayeshpatidar.blogspot.com 22
  23. 23. Administration of antibiotic therapy to the carrier staff or source patient to destroy the pathogenic agents.  Proper sterilization & disinfection of the inanimate objects should be done . this helps to control the source of infection.  Disinfection of excreta & infection material is necessary to control the exit point of infection.  Transmission of infection can be controlled by regular washing of hand, disinfection of equipments & change of working clothes.  12/26/2013 www.drjayeshpatidar.blogspot.com 23
  24. 24. •The use of sterile dressing, surgical gloves, face-marks & I/V fluids further contribute in control of infection. •Preoperative disinfection of the patient’s skin. •Rational antibiotics prophylaxis. •Cleaning of toys :-Toys used by infants & young children should optimally be cleaned between use by different patient. -Disinfect with 1:1000 bleach solution, wash soap &water & air dry. •Proper investigation of hospital – acquired infection & the treatment of such cases. 12/26/2013 www.drjayeshpatidar.blogspot.com 24
  25. 25. Every hospital must have an effective hospital – acquired infection control committee (HAICC) which should be responsible for the control of hospital –acquired infection (HAI). The committee should be chaired be medical superintendent & should have of all clinical departments, blood bank, microbiologist, medical record officer, chief of nursing services & infection control sister as members. Chief of all the supportive services (O.T, dietetics, laundry, house keeping etc. ) 12/26/2013 www.drjayeshpatidar.blogspot.com 25
  26. 26. HAICC must meet at least once every mouth to formulate & update policy on matters related to hospital infection & to manage outbreaks of hospital acquired infection. The committee will review infection control activities of the hospital, emergency of drug resistance, use of different antimicrobial agent, sterilization& disinfection procedures, hospital environment, incidence & type of infection & antimicrobial sensitivity patterns of the prevent pathogens. 12/26/2013 www.drjayeshpatidar.blogspot.com 26
  27. 27. Nurse caring for young children are frequently in contact with body substances, especially urine, feces, & vomits. Nurse need to exercise judgment for those situation when gloves, gown or masks are necessary.  During feedings, gowns should be worn if the child is likely to vomit or spit up, which often occurs during burping. When gloves are worn, the hands are washed thoroughly after removing the gloves, because both latex & vinyl gloves fail to provide complete protection.  12/26/2013 www.drjayeshpatidar.blogspot.com 27
  28. 28. •All needles (uncapped & unbroken) are disposed of in a rigid, puncture – resistant container located near the site of use. •Nurse should follow standard precaution for the car of children’s. 12/26/2013 www.drjayeshpatidar.blogspot.com 28
  29. 29. Q. Explain the nursing responsibility regarding the prevention of nosocomial infection in pediatric unit. 12/26/2013 www.drjayeshpatidar.blogspot.com 29
  30. 30. 1. 2. 3. 4. David wilson Ms. Etal. Nursing care of infants & children. 7th editions. Mosby publication (2006). P. No. 1334-1336. Parul Datta. . Pediatric nursing. 1st edition(2007) Jaypee brothers publication. New Delhi. P. No. 3-7. O.P. Ghai. Essential pediatrics. 6th edition (2004). Published by Dr. Ghai New Delhi.P. No. 668-670. RL Ichhpujani, Rajesh Bhatia. Microbilogy for Nurses. 2nd edition (2003), Jaypee publication New Delhi. P. No. 198-200. 12/26/2013 www.drjayeshpatidar.blogspot.com 30
  31. 31. 12/26/2013 www.drjayeshpatidar.blogspot.com 31

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