This document discusses hospital acquired infections (HAIs), also known as nosocomial infections. It defines HAIs as infections acquired during hospital care that were not present or incubating upon admission. It outlines the epidemiology, microorganisms involved, sites of infection, and prevention strategies for HAIs. The most common sites of HAIs are urinary, surgical site, and respiratory infections. Bacteria such as S. aureus, E. coli, and Klebsiella are frequent causes. Prevention involves risk stratification of patients, reducing person-to-person transmission through hand hygiene and barrier measures, and preventing transmission from the hospital environment via cleaning and disinfection.
Microbes and vectors swim in the evolutionary stream, and they swim faster than we do. Bacteria reproduce every 30 minutes. For them, a millennium is compressed into a fortnight. They are fleet afoot, and the pace of our research must keep up with them, or they will overtake us. Microbes were here on earth 2 billion years before humans arrived, learning every trick for survival, and it is likely that they will be here 2 billion years after we depart ......
coronavirus disease (COVID-19),origin,epidemiology,risk factors and causes,mode of transmission,pathophysiology,signs and symptoms,management,comlication,preventive measures
A type of virus that causes herpes infections and has DNA as its genetic material. There are two types of human herpesviruses. Infections with type 1 viruses cause cold sores on the lips or nostrils. Infections with type 2 viruses cause sores on the genitals (external and internal sex organs and glands).
Microbes and vectors swim in the evolutionary stream, and they swim faster than we do. Bacteria reproduce every 30 minutes. For them, a millennium is compressed into a fortnight. They are fleet afoot, and the pace of our research must keep up with them, or they will overtake us. Microbes were here on earth 2 billion years before humans arrived, learning every trick for survival, and it is likely that they will be here 2 billion years after we depart ......
coronavirus disease (COVID-19),origin,epidemiology,risk factors and causes,mode of transmission,pathophysiology,signs and symptoms,management,comlication,preventive measures
A type of virus that causes herpes infections and has DNA as its genetic material. There are two types of human herpesviruses. Infections with type 1 viruses cause cold sores on the lips or nostrils. Infections with type 2 viruses cause sores on the genitals (external and internal sex organs and glands).
a research presentation done by Augustine Mwaawaaru Level 400) and Matthew Frimpong Antwi (Level 300) students of( Presbyterian University College-Ghana on Antimicrobial resistance and the way foeward in Ghana. contact 0261825262
lecture for MBBS students
Rickettsia named after HOWARD
TAYLOR RICKETTS died of Typhus fever contracted during his studies
Discovered spotted fever rickettsia (1906)
Obligate intracellular parasite
Gram negative pleomorphic rods
Parasite of arthropods – fleas, lice, ticks and mites.
No Human to human transmission.
Rickettsia are transmitted to humans by the bite of infected arthropod vector.
Multiply at the site of entry and enter the blood stream.
Localise in the vascular endothelial cells and multiply to cause thrombosis lead to rupture & necrosis
Zoonoses :- derived from the Greek words
Zoon- Animal & Noson – Disease
Zoonoses was coined and first used by Rudolf Virchow who defined it for communicable diseases.
Diseases and infections which are naturally transmitted between vertebrate animals and humans - WHO 1959
Of the 1415 microbial diseases affecting humans, 61% are zoonotic with 13% species regarded as emerging or reemerging
Link b/w human & animals with their surrounding are very close especially in developing countries
My Guest Lecture at Mahamicron 2014 - XX Maharashtra Chapter Conference of the Indian Association of Medical Microbiologists, Nagpur, 19/09/2014 to 21/09/2014.
Dr Rajesh Karyakarte Delivered this Guest Lecture on 21/09/2014 at 9:30 AM.
Module 1.1 An overview of emerging and re emerging infectious diseasesAdaora Anyichie - Odis
This module helps to understand the global trends of emerging & re-emerging infections and chronic diseases, identify the threats of diseases and develop desirable attitude and skill in planning to go for new treatment regimens and public health programs that substantially reduce and even prevent the spread of infections and promotion of public health
a research presentation done by Augustine Mwaawaaru Level 400) and Matthew Frimpong Antwi (Level 300) students of( Presbyterian University College-Ghana on Antimicrobial resistance and the way foeward in Ghana. contact 0261825262
lecture for MBBS students
Rickettsia named after HOWARD
TAYLOR RICKETTS died of Typhus fever contracted during his studies
Discovered spotted fever rickettsia (1906)
Obligate intracellular parasite
Gram negative pleomorphic rods
Parasite of arthropods – fleas, lice, ticks and mites.
No Human to human transmission.
Rickettsia are transmitted to humans by the bite of infected arthropod vector.
Multiply at the site of entry and enter the blood stream.
Localise in the vascular endothelial cells and multiply to cause thrombosis lead to rupture & necrosis
Zoonoses :- derived from the Greek words
Zoon- Animal & Noson – Disease
Zoonoses was coined and first used by Rudolf Virchow who defined it for communicable diseases.
Diseases and infections which are naturally transmitted between vertebrate animals and humans - WHO 1959
Of the 1415 microbial diseases affecting humans, 61% are zoonotic with 13% species regarded as emerging or reemerging
Link b/w human & animals with their surrounding are very close especially in developing countries
My Guest Lecture at Mahamicron 2014 - XX Maharashtra Chapter Conference of the Indian Association of Medical Microbiologists, Nagpur, 19/09/2014 to 21/09/2014.
Dr Rajesh Karyakarte Delivered this Guest Lecture on 21/09/2014 at 9:30 AM.
Module 1.1 An overview of emerging and re emerging infectious diseasesAdaora Anyichie - Odis
This module helps to understand the global trends of emerging & re-emerging infections and chronic diseases, identify the threats of diseases and develop desirable attitude and skill in planning to go for new treatment regimens and public health programs that substantially reduce and even prevent the spread of infections and promotion of public health
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
The Role of Microorganism in Hospital Acquired Infection.pptxManitaPaneri
Hospital Acquired infections, also called nosocomial infections can be defined as the infections acquired by the patients in the hospital by a patient -
1. who was admitted for a reason other than that infection.
2. In whom infection was not present or incubated at the time of admission.
3. Symptoms should appear at least after 48 hours of admission.
In these slides, microbes responsible for hospital acquired infections and preventive strategies are shared.
a study about the infections that are cought in the hospital.
usually they are antibiotic resistant infections. they include
urinary tract infections (UTIs)
surgical site infections
gastroenteritis
meningitis
pneumonia
they are also called HAIs Hospital Acquired Infections.
Hospital-acquired infections are caused by viral, bacterial, and fungal pathogens; the most common types are bloodstream infection (BSI), pneumonia (eg, ventilator-associated pneumonia [VAP]), urinary tract infection (UTI), and surgical site infection (SSI)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
2. • Introduction
• Definition, Criteria for inclusion, Diseases included/ not included
• Epidemiology
• Source
• Site
• Mode of infection
• Microorganisms
• Reservoir & Transmission
• Recipient of infection
• Epidemiological markers
• Prevention
• Antimicrobial Resistance
• Hospital Acquired Infections Control Committee
Nosocomial Infections 2
3. HOSPITAL ACQUIRED/ NOSOCOMIAL INFECTIONS/
CROSS INFECTIONS
• Infections acquired during hospital care which are
not present or incubating at admission.
• Infections occurring more than 48 hours after
admission are usually considered nosocomial.
Nosocomial Infections 3
4. • Should encompass infections occurring in patients
receiving treatment in any health care setting.
• Infections acquired by staff or visitors to the hospital
or other health care setting.
4Nosocomial Infections
5. Criteria to be classified as Nosocomial Infections
– Not present at time of admission
– Not related to primary disease at time of
hospitalization
– New disorder developed in the patient following
hospitalization
Nosocomial Infections 5
6. Special situations
considered as
Nosocomial infections
1.Infection acquired in
hospital becoming
apparent after
discharge
2.Infection of neonate
from passage thru birth
canal
Special situations NOT
considered as
Nosocomial infections
1. Infections associated
with complication
2. Extension of infection
already present
3. Trans-placental
infection of neonate
Nosocomial Infections 6
7. • Important case of Mortality & Morbidity worldwide
• Prevalence survey - 8.7% of hospital patients. Higher
prevalence in EMRO and SEARO
– Study by WHO in 14 countries representing 4 WHO
Regions
• 25-40% in India
• 1.4 million people affected worldwide.
7Nosocomial Infections
8. Impact of Nosocomial infections
• May lead to disabling conditions - reduce QoL
• Leading causes of death.
• Economic costs –
– increased length of stay- overall increase- 8.2 days
(3 days for gynaec, 9.9- gen surg and 19.8- ortho)
– Indirect costs due to lost work.
– Increased use of drugs, need for isolation, and use
of additional diagnostic studies also contribute.
• Divert scarce funds to the management of potentially
preventable conditions.
Nosocomial Infections 8
10. Factors influencing development of HAI
1. Microbial agent
– Characteristics, including resistance to
antimicrobial agents, intrinsic virulence, and
amount (inoculum) of infective material.
2. Patient Susceptibility
– age, immune status, underlying disease, and
diagnostic and therapeutic interventions.
Nosocomial Infections 10
11. 3. Environmental factors
– Patients with infections or carriers – potential
sources of infection.
– Crowding, frequent transfers of patients, and
concentration of highly susceptible patients in
one area
4. Bacterial Resistance
Nosocomial Infections 11
13. Sources of Infection
• Exogenous
– Other patients, hospital staff, inanimate objects
• Endogenous
– Patients own flora which at the time of infection
• May invade patients tissues spontaneously
• May be introduced iatrogenically
–Surgical procedure
–Nursing care
–Instrumental manipulation
Nosocomial Infections 13
15. Type of
nosocomial
Infection
Simplified criteria
Surgical site
infection
Any purulent discharge, abscess, or spreading
cellulitis at the surgical site during the month
after operation
Urinary infection Positive urine culture (1 or 2 species) with at least
105 bacteria/ml, with or without clinical
symptoms
Respiratory
infection
Respiratory symp. with at least two signs:
— cough
— purulent sputum
— new infiltrate on CXR consistent with Infection
Vascular
catheter
Inflammation, lymphangitis or infection purulent
discharge at the insertion site of the catheter
Septicaemia Fever or rigours & at least one +ve blood culture15Nosocomial Infections
16. 1. URINARY INFECTIONS
– Most common nosocomial infection
– 80% associated with indwelling bladder catheter
– Less morbidity than other nosocomial infections,
occasionally lead to bacteraemia and death.
– Bacteria responsible
• Escherichia coli
• Multi-resistant Klebsiella
Nosocomial Infections 16
17. 2. SURGICAL SITE INFECTIONS
• Incidence varies from 0.5 to 15%
• Considerable impact on hospital costs and
postoperative length of stay (3 and 20 addnl days)
• Infection is usually acquired during the operation:
– exogenously – from air, medical equipment,
surgeons and other staff),
– endogenously – from flora on the skin or in the
operative site or,
– rarely, from blood used in surgery.
Nosocomial Infections 17
18. • Infecting microorganisms – variable
• Risk factors
– Extent of contamination during the procedure (clean,
clean-contaminated, contaminated, dirty)
– patient’s general condition .
– quality of surgical technique,
– foreign bodies including drains,
– virulence of the microorganisms,
– concomitant infection at other sites,
– preoperative shaving,
– experience of the surgical team.
Nosocomial Infections 18
19. 3. NOSOCOMIAL PNEUMONIA
• Patients on ventilators in ICUs – rate of pneumonia is
3% per day.
• Microorganisms :
– Often endogenous (digestive system or nose and
throat),
– May be exogenous, often from contaminated
respiratory equipment.
Nosocomial Infections 19
20. • Patients with seizures or decreased level of
consciousness are at risk for nosocomial infection,
even if not intubated.
– Children – Viral bronchiolitis (RSV)
– Elderly – Influenza and secondary bacterial
pneumonia.
– Immuno-compromised – Legionella, Aspergillus
– High prevalence of TB, particularly MDR.
Nosocomial Infections 20
21. 4. NOSOCOMIAL BACTERAEMIA
• Approx. 5% of nosocomial inf.; high CFR (>50%).
• Incidence is increasing- multiresistant coagulase-
negative Staphylococcus and Candida spp.
• Infection may occur at
– skin entry site of the intravascular device, or
– in the sc path of the catheter (tunnel infection).
– Resident/ transient cutaneous flora is the source
• Main risk factors
– length of catheterization,
– level of asepsis at insertion, and
– continuing catheter care.
Nosocomial Infections 21
22. 5. OTHER NOSOCOMIAL INFECTIONS
• Skin and soft tissue infections: open sores (ulcers,
burns and bedsores).
• Gastroenteritis
– most common nosocomial infection in children
– Rotavirus in children, Clostridium difficile in adults
• Sinusitis and other enteric infections, infections of
the eye and conjunctiva.
• Endometritis and other infections of the
reproductive organs following childbirth.
Nosocomial Infections 22
24. MICROORGANISMS
• BACTERIA
– Most common nosocomial pathogens.
– Commensal bacteria
• Cutaneous coagulase negative staphylococci –
IV line infection
• Intestinal E. coli – most common cause of
urinary infection.
– Pathogenic Bacteria
24Nosocomial Infections
25. – Pathogenic bacteria
• Greater virulence; cause infections (sporadic or
epidemic) regardless of host status.
• Anaerobic Gram-positive rods (Clostridium)
cause gangrene.
• Gram-positive cocci:
– Staph aureus – lung, bone, heart and bloodstream
infections; frequently resistant to antibiotics;
– Beta-haemolytic streptococci.
Nosocomial Infections 25
26. • Enterobacteriacae (E. coli, Proteus, Klebsiella,
Enterobacter, Serratia marcescens),
– Colonize sites during catheter insertion, bladder
catheter, cannula insertion
– May be highly resistant.
• Pseudomonas sp. – in water and damp areas. May
colonize digestive tract of hospitalized patients.
• Legionella sp. – pneumonia through inhalation of
aerosols containing contaminated water (AC,
showers, therapeutic aerosols).
Nosocomial Infections 26
27. VIRUS
• Hepatitis B and C viruses
– (transfusions, dialysis, injections, endoscopy),
• RSV, Rotavirus, and Enteroviruses
– (hand-to-mouth contact and via faecal-oral route).
• Other viruses – CMV, HIV, Ebola, Influenza viruses,
HSV, Varicella-zoster virus.
Nosocomial Infections 27
28. PARASITES AND FUNGI
• Giardia lamblia – among adults or children.
• Opportunistic infections during extended antibiotic
treatment and severe immuno-suppression
– Candida albicans, Aspergillus spp., Cryptococcus
neoformans, Cryptosporidium.
• Environmental contamination – Aspergillus spp.
originate in dust and soil.
• Sarcoptes scabies (scabies) – repeated outbreaks in
health care facilities.
Nosocomial Infections 28
29. RESERVOIRS & TRANSMISSION
1. Permanent or transient flora of the patient
(endogenous infection)
– Transmission to sites outside natural habitat (urinary
tract),
– damage to tissue (wound) or
– inappropriate antibiotic therapy that allows overgrowth (C.
difficile, yeast spp.)
• Gm -ve bacteria in GIT cause surgical site
infections after abdominal surgery or UTI in
catheterized patients.
29Nosocomial Infections
30. 2. Flora from another patient or member of
staff (exogenous cross-infection)
• through direct contact between patients (hands,
saliva droplets or other body fluids),
• in the air (droplets or dust contaminated by a
patient’s bacteria),
• via staff contaminated through patient care (hands,
clothes, nose and throat) who become transient or
permanent carriers,
• via objects contaminated by the patient (including
equipment), staff’s hands, visitors or other
environmental sources (e.g. water, other fluids,
food). Nosocomial Infections 30
31. 3. Flora from the health care environment (endemic
or epidemic exogenous environmental infections).
• in water, damp areas, and occasionally in sterile
products or disinfectants (Pseudomonas,
Acinetobacter, Mycobacterium)
• in linen, equipment & supplies used in care
• in food
• in fine dust and droplet nuclei generated by coughing
or speaking
– (bacteria smaller than 10 μm in diameter remain
in the air for several hours and can be inhaled in
the same way as fine dust).
Nosocomial Infections 31
32. RECIPIENT OF INFECTION
• Susceptible Patients
– Extremes of age — infancy and old age
– Chronic disease such as malignancy, DM, renal
failure, or AIDS
– Immunosuppressive drugs or irradiation
– Injuries to skin or mucous membranes bypass
natural defence mechanisms.
– Malnutrition
Nosocomial Infections 32
33. Wards of Hospital with higher prevalence of
Nosocomial infections
– Burns unit
– ICU & CCU
– Neonatology ward and NICU
– PNC ward
– Post Operative Surgical ward
– Oncology ward
– Haematology ward
– Stroke ward and PMR units (esp. UTI)
Nosocomial Infections 33
34. Modes of Infection
– Oral
– Airborne
– Injection
– Contact with equipment
Nosocomial Infections 34
35. Epidemiological markers for Nosocomial
Infections
• Definition :
– a test which establishes similarity or differences of
the organism
• Importance:
– To find source of infection
Nosocomial Infections 35
36. 1. Antibiogram/ Resistogram –
– S aureus, Salmonella, Pseudomonas, Proteus
2. Bio-typing
– H influenza, S aureus, Klebsiella, Proteus, E coli
3. Phage typing
– S aureus, Salmonella, Klebsiella, Pseudomonas
4. Sero-typing
– Campylobacter, Shigella, Ecoli, Pseudomonas
5. Serum Opacity Factor - Streptococci
6. Protein Markers - S aureus, H influenzae
7. RNA Electrophoresis - Rotavirus
8. Cytotoxicity Assay
9. Reverse phage typing - S aureus
10. Plasmid Profile - multiple organisms
Nosocomial Infections 36
37. Prevention of Nosocomial Infections
1. Risk Stratification
2. Reducing Person-to-person transmission
3. Preventing transmission from the environment
37Nosocomial Infections
39. Reducing person-to-person transmission
1. Hand decontamination
– Minimal and Moderate Risk
• Hand-washing with non-antiseptic soap or rubbing with alcoholic
solution
– Surgical scrub (surgical care):
• surgical hand and forearm washing with antiseptic soap and
sufficient time and duration of contact (3–5 min).
2. Personal hygiene
– All staff must maintain good personal hygiene.
• Nails clean and kept short.
• Hair must be worn short or pinned up.
• Beard and moustaches must be kept trimmed short and clean.
Nosocomial Infections 39
40. 3. Clothing
– Working clothes
• Normally, clothes covered by a white coat.
• In special areas (burn or ICUs) : OT gown
– Shoes
• In aseptic units and in operating rooms, dedicated shoes.
– Caps
• In aseptic units, operating rooms, or performing selected invasive
procedures.
– Masks
• Cotton wool, gauze, or paper are ineffective.
• Paper masks with synthetic material for filtration effective barrier
against microorganisms.
– Gloves
• sterile gloves for surgery, care for immuno-compromised patients,
invasive procedures which enter body cavities.
40Nosocomial Infections
41. 4. Safe injection practices
– To prevent transmission of infections between patients
with injections:
• eliminate unnecessary injections
• use sterile needle and syringe
• use disposable needle and syringes, if possible
• prevent contamination of medications
• follow safe sharps disposal practices
41Nosocomial Infections
43. Preventing transmission from the environment
– 90% of microorganisms present within “visible dirt”.
– Neither soap nor detergents have antimicrobial activity;
cleaning process depends essentially on mechanical action.
1. Cleaning of the hospital environment
2. Use of Hot/Superheated water
3. Disinfection of patient equipment
4. Sterilization
5. Structural Measures
43Nosocomial Infections
44. 1. Cleaning of the hospital environment
• Zone A:
– no patient contact.
– Normal domestic cleaning (e.g. administration, library).
• Zone B:
– care of patients who are not infected, and not highly susceptible,
– No Dry sweeping or vacuum cleaners are not recommended. Use
detergent solution.
• Zone C:
– infected patients (isolation wards).
– Clean with detergent/disinfectant solution, separate cleaning equipment.
• Zone D:
– highly-susceptible patients (protective isolation) or protected areas such
as OT, delivery rooms, ICUs, haemodialysis units.
– Clean with detergent/ disinfectant solution, separate cleaning equipment.
44Nosocomial Infections
45. 2. Use of hot/superheated water
45Nosocomial Infections
46. 3. Disinfection of patient equipment
Disinfection removes microorganisms without complete
sterilization to prevent transmission of organisms between
patients.
• Procedures must :
– meet criteria for killing of
organisms
– have a detergent effect
– act independently of
bacterial concentration,
hardness of water, or
presence of soap and
proteins (that inhibit some
disinfectants).
• To be acceptable:
– easy to use
– non-volatile
– not harmful to equipment,
staff or patients
– free from unpleasant
smells
– effective within a relatively
short time.
46Nosocomial Infections
47. Levels of Disinfection
– High-level disinfection (critical)
• destroy all microorganisms, except heavy contamination by
bacterial spores.
– Intermediate disinfection (semi-critical)
• inactivates M. tuberculosis, vegetative bacteria, most viruses and
fungi, but not necessarily kill bacterial spores.
– Low-level disinfection (non-critical)
• kill most bacteria, some viruses and some fungi, but cannot be
relied on for killing more resistant bacteria such as M. tuberculosis
or bacterial spores.
47Nosocomial Infections
48. 4. Sterilization
– Destruction of all microorganisms.
– Operationally defined as a decrease in microbial load by
10-6.
– Thermal sterilization
• Wet sterilization:
– water at 121°C for 30 min, or 134°C for 13 min in autoclave.
• Dry sterilization:
– exposure to 160°C for 120 min, or 170°C for 60 min; less reliable than
the wet process.
– Chemical sterilization
• Ethylene oxide, formaldehyde – (phased out)
• Peracetic acid instead.
48Nosocomial Infections
49. 5. Structural Measures
I. Building
• traffic flow to minimize exposure of high-risk patients and
facilitate patient transport
• adequate spatial separation of patients
• adequate number and type of isolation rooms
• appropriate access to handwashing facilities
• materials (e.g. carpets, floors) that can be adequately cleaned
• appropriate ventilation for isolation rooms and special patient
care areas (operating theatres, transplant units)
• preventing patient exposure to fungal spores with renovations
Nosocomial Infections 49
50. II. Air Flow
– Outdoor air inlets located high above ground level; away from
ventilation discharge outlets, incinerators, or boiler stacks.
– Within rooms, ceiling inlets and low wall outlets allow clean air to
move downward through the area toward the contaminated floor.
– Cooling towers and humidifiers should be regularly inspected and
cleaned – Legionella spp.
– Positive air pressure for areas which must be as clean as possible.
– Zoning of air systems may confine the air of a department to that
department alone.
Nosocomial Infections 50
51. – Microbiology laboratories : use special unidirectional airflow hoods to
handle microbial cultures.
– Pharmacies : Hoods to prevent airborne contamination of sterile fluids
when containers are opened – when adding antibiotic to sterile IVF.
– ICUs : laminar flow units used in the treatment of immunosuppressed
patients.
– Operating theatres : unidirectional clean airflow system with a
minimum an air speed of at least 0.25 m/s, ensures instrument
sterility throughout the procedure.
Nosocomial Infections 51
52. III. Waste
• Includes all waste generated by health care establishments,
research facilities, and laboratories.
• 10–25% hazardous, and may create some health risks
– Guidelines
Segregation at source.
General health care waste in stream of domestic refuse.
Sharps to be collected at source in puncture-proof containers
with fitted covers → chemical treatment / shredding
Microbiological laboratory waste sterilized by autoclaving → red
bags → autoclaving.
Anatomical and contaminated combustible wastes → yellow bag
→ incineration
Liquid wastes to be disinfected and discharged into drains
Nosocomial Infections 52
53. Preventive Measures
1. Hygiene : hand washing, water & food sanitation
2. Disinfection : clothes, bedsheets
3. Disposal of hospital waste
4. Good infrastructure – ventialtion, temperature
5. Judicious use of IV Fluids, antibiotics
6. Intellectual use of instrumentation
7. Chemoprophylaxis in specific situations
8. Isolation of immuno-suppressed/compromised
9. Screening and vaccination of staff
10. Infection control committee
Nosocomial Infections 53
54. Surveillance
• Collection of data
– Date of admission, duration of infection,
length of stay, Culture & sensitivity
• Analysis of data
– Incidence = Prevalence x LA
LN – INTN
LA = Mean length of hospital stay for all patients
LN = Mean length of hospital stay for patients with
nosocomial infections
INTN = Mean interval from admission to first nosocomial
infetion
Nosocomial Infections 54
56. • Standard precautions for all patients
– Wash hands promptly after contact with infective material
– Use no touch technique wherever possible
– Wear gloves when in contact with blood, body fluids, secretions,
excretions, mucous membranes and contaminated items
– Wash hands immediately after removing gloves
– All sharps should be handled with extreme care
– Clean up spills of infective material promptly
– Ensure that patient-care equipment, supplies and linen
contaminated with infective material is either discarded, or
disinfected or sterilized between each patient use
– Ensure appropriate waste handling
– If no washing machine is available for linen soiled with infective
material, the linen can be boiled.
56Nosocomial Infections
57. • Additional precautions for specific modes of transmission
– Airborne precautions (droplet nuclei <5 μm)
(Tb, V-Z, measles)
• individual room with adequate ventilation – negative pressure;
door closed; at least six air exchanges/hour
• staff wearing high-efficiency masks in room
• patient to stay in room.
– Droplet precautions (droplet nuclei >5 μm)
(bacterial meningitis, diphtheria, RSV)
• individual room for the patient, if available
• mask for health care workers
• restricted circulation for the patient; patient wears a surgical mask if
leaving the room.
57Nosocomial Infections
58. – Contact precautions
• individual room for the patient if available;
• staff wear gloves on entering the room; a gown for patient contact
or contact with contaminated surfaces or material
• wash hands before and after contact with the patient, and on
leaving the room
• restrict patient movement outside the room
• appropriate environmental and equipment cleaning, disinfection,
and sterilization.
58Nosocomial Infections
59. Antimicrobial Resistance
• Discovery of sulfonamides and penicillin in the mid-20th
century → 1950 and 1970, “golden age” of antimicrobial
discovery
↓
• overuse and misuse
↓
• many microorganisms have become resistant to different
(sometimes nearly all) antimicrobial agents.
↓
• Resistant bacteria may cause increased morbidity and death,
particularly immunocompromised.
59Nosocomial Infections
60. • Continuous use of antimicrobial agents → selection pressure
→ emergence, multiplication, and spread of resistant strains.
• Inappropriate and uncontrolled use
– overprescribing, administration of suboptimal doses,
insufficient duration of treatment, misdiagnosis,
underdosing due to shortage of antibiotics.
• Nosocomial infections are often caused by antibiotic- resistant
organisms
60Nosocomial Infections
61. Alexander Fleming
“Penicillin” Nobel Lecture, 1945
"The time may come
when penicillin can be
bought by anyone in
the shops. Then there
is the danger that the
ignorant man may
easily underdose
himself and by
exposing his microbes
to non‐lethal
quantities of the drug
make them resistant.”
61Nosocomial Infections
Editor's Notes
Educated pregnant ladies opting for home deliveries
Patients with chronic disease have an increased susceptibility to infections with opportunistic pathogens Immunosuppressive drugs or irradiation, Malnutrition
depending on the type and location of surgery, and antimicrobials received by the patient.
depending on the type and location of surgery, and antimicrobials received by the patient.
depending on the type and location of surgery, and antimicrobials received by the patient.
depending on the type and location of surgery, and antimicrobials received by the patient.
depending on the type and location of surgery, and antimicrobials received by the patient.
Klebsiella SAT; Infected in Kerala hospital, 38 newborns die in 4 months At least 38 new-born babies who died at the Government Sri Avittam Thirunal Hospital in Thiruvananthapuram are now confirmed to have been killed by infections that they picked up in the hospital in just the past four months. Over a hundred more babies have also been infected by drug-resistant bacteria, forcing the state government to start a belated firefighting effort.
burns ward
British doctors will no longer be wearing white coats or ties following rules issued by the U.K. Department of Health. In an effort to reduce hospital-acquired infections, the agency has instituted a “bare below the elbows” dress code—including jewelry, watches, white coats and necks ties—during clinical activity.
BURNS
WHO report released April 30, 2014 states, "this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance–when bacteria change so antibiotics no longer work in people who need them to treat infections–is nows a major threat to public health."[2]