Dr. Jayesh V Patidar
1. Susceptible patient:Many patients in
hospital have impaired
due to pre-existing
disease, such as
diabetes, immunosuppression & patients
with prosthetic implants.
They are, therefore
more susceptible to
Environment:Pathogens may be
air, dust, water, food
or antiseptic lotion.
Equipment may be
Bedding, linen &
utensils may act as
shed the organisms
from their bodies
3. Diagnostic or therapeutic procedures:During diagnostic or
procedures such as
insertion of urethral or
lapse in asepsis may
lead to infection.
4. Drug Resistance:-
treatment as the
are usually multidrug resistant.
5. Transfusion:Blood, blood products
& intravenous fluids
transfusion, if not
transfusion, if not
6. Advances in medical progress:-
enhance the risk
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
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
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.
1. Contact:a) Hands or clothing:Hands or
hospital staff are an
important vehicle of
spread of infection. There
is adequate scope of
microorganisms from one
person to another by
contact of hands and
clothing of attendants.
pyogenes are two
b) Inanimate objects :Certain instruments
e), if not property
2. Airborne:a) Droplets:Droplets of respiratory infection is transmitted
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
breaks of infections mainly 12/26/2013 legionella
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
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
Toys and Transmission of
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
in day care centre & in hospital. www.drjayeshpatidar.blogspot.com
1. Urinary Tract Infection:This is
usually associated with
urethra, bladder or kidney.
Infection is caused by Esch.
Coli, Klebsiella, proteus, serr
pseudomonas, providencia, c
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
Wound and skin sepsis:-
Aspiration in unconscious
patients & pulmonary
ventilation may lead to
The major pathogens
aureus, klebsiella, enter
, serratia, proteus, Esch
. Colli, pseudomonas
er & respiratory viruses.
Gastrointestinal Infections:Food poisoning &
neonatal septicemia in hospital have been
reported. Salmonella & sligella sonnei are
mainly associated with these infections.
Burns:Staph. aureus, pseudomonas
aeruginosa, acinetobacter & str. Pyogenes are
responsible for hospital acquired infections in
cases of burns.
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
Staph. epidermidis bacteraemia is
found commonly in patients with artificial heart
valve. Bacteraemia in those with valular defects
may lead to endocarditis.
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
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.
Administration of antibiotic therapy to the carrier
staff or source patient to destroy the pathogenic
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.
•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.
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
(O.T, dietetics, laundry, house keeping etc. )
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
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.
•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.
Explain the nursing responsibility
regarding the prevention of
nosocomial infection in pediatric
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O.P. Ghai. Essential pediatrics. 6th edition
(2004). Published by Dr. Ghai New Delhi.P.
RL Ichhpujani, Rajesh Bhatia. Microbilogy for
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New Delhi. P. No. 198-200.