• Hospital acquired infection is cross infection of
one patient by another or by doctors, nurses
and other hospital staff while in the hospital.
• A high frequency of HAI is an evidence of a
poor quality health service delivery.
• Nosocomial infections are wide spread.
• They are an important contribution to
morbidity and mortality.
• Nosocomial infections or hospital acquired
infections are infections acquired during
hospital care which are not present at the
time of admission.
• Infections occuring more than 48 hours after
admission are considered nosocomial.
• They have become important as a public
health problem because:
• Increasing number and crowding of people.
• More frequent impaired immunity.
• New micro organisms.
• Increasing bacterial resistance to antibiotics.
• A prevalence survey conducted by WHO in 55
hospitals of 14 countries showed an average
of 8.7% of hospital patients had nosocomial
• Over 1.4 million people worldwide suffer from
• Nosocomial infections are considered either
endemic or epidemic.
• Endemic infections are more common.
• Epidemic infections occur during outbreaks,
defined as an unusual increase above the
baseline of a specific infection or infecting
TYPES OF NOSOCOMIAL INFECTION
• Surgical site infection: Any purulent discharge,
abcess or spreading cellulitis at the surgical
site during the month after the operation.
• Urinary infection: Positive urine culture with
atleast 10 5 bacteria per ml, with or without
• Respiratory infection: Prespiratory symptoms
with atleast two of the following signs
appearing during hospitalisation:
• Purulent sputum
• New infiltrate on chest radiograph consistent
• Vascular catheter infection: Inflamation,
lymphangitis or purulent discharge at
insertion site of catheter.
• Sepicaemia: Fever or rigours and atleast one
positive blood culture.
• HAI is usually due to failure to observe aseptic
precautions while carrying out hospital
procedures such as surgical operations, iv
infusion, dressing of wounds, lumbar
puncture, giving injections etc.
• Development of resistance by the organisms to
commonly used drugs.
• Owercrowding of the hospital.
• Poor environmentg of the hospital both inside
• Decreased resistance and increased susceptibility
of the vulnerable groups of patients such as those
suffering from tb, leprosy, severe PEM, anemia,
cardiac patients, old age.
• 50% of HAI are due to Staphylococci and
about 45% are due to gram negative bacilli like
E.coli, Klebsiella, Proteus, Pseudomonas,
Salmonella, Shigella etc.
• Remaining 5% are caused by viruses, protozoa,
• Among the viruses emergence of HBV and HIV
have worsened the condition.
PROBLEM STATEMENT IN INDIA
• Research on hospital infections in India reveals
several concerning trends.
• In Indian ICUs, the rate of vancomycin-resistant
enterococcus (VRE), a dangerous hospital
infection, is five times the rate in the rest of the
• Rates of methicillin-resistant Staphylococcus
aureus in Indian ICUs are also high, with one
study finding over 80% of S. aureus samples
testing positive for resistance to methicillin and
closely related antibiotics.
• Antibiotic resistant infections are difficult, and
sometimes impossible, to treat.
• They lead to longer hospital stays, increased
treatment costs, and in some cases, death. GARP
research estimates that of the approximately
190,000 neonatal deaths in India each year due
• Over 30% are attributable to antibiotic resistance.
Antibiotic resistant hospital infections can be
especially deadly because antibiotics are used
intensely in hospitals compared with the
community, and frequent use drives the
development of highly resistant bacteria.