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1. Fever in a hospitalized
patient
Sunil Kumar Daha

2. Nosocomial Infections
• 5–10% of patients
• Nosocomial pathogens have reservoirs, are
transmitted by largely predictable routes, and
require susceptible hosts
• The mode of transmission usually is either
cross-infection or autoinoculation
• Coughing and sneezing
• Contaminated material

3. Risk Factors
• Environmental
• Inadequate cleaning of fomites (furniture,
medical equipment)
• Building work and dust
• Contaminated water supply
• Contact with other patient and infected
HCW

4. Cont’d
• Personal
• Prolonged admission
• Immunocompromised
• Antibiotic use
• Blood product recipient
• Surgical procedures

5. Health Care–Acquired Conditions
• Vascular catheter–associated infections
• Specific surgical-site infections
• Catheter-associated urinary tract infections
• Decubitus ulcers
• Fractures/other injuries from falls or trauma
• Foreign objects retained after surgery
• Air embolism
• Blood incompatibilities

6. Prevention and Control
• Institutional
• Handling, storage and disposal of clinical waste
• Containment and safe removal of spilled blood
and body fluids
• Cleanliness of environment and medical
equipment
• Sterilization and disinfection of instruments
and equipment
• Food hygiene

7. Cont’d
• Health-care staff
• Education
• Hand hygiene, including hand washing
• Sharps management and disposal
• Use of personal protective equipment (masks,
sterile gloves, gowns and aprons)
• Screening health workers for disease (eg. TB,
HBV)

8. Cont’d
• Prevention of Central Venous Catheter Infections
• Educate personnel about catheter insertion and
care.
• Use chlorhexidine to prepare the insertion site.
• Use maximal barrier precautions during catheter
insertion.
• Consolidate insertion supplies (e.g., in an insertion
kit or cart).
• Use a checklist to enhance adherence to the
bundle.
• Empower nurses to halt insertion if asepsis is
breached.
• Cleanse patients daily with chlorhexidine.

9. Cont’d
• Prevention of Ventilator-Associated Pneumonia
and Complications
• Elevate head of bed to 30°- 45° degrees.
• Decontaminate oropharynx regularly with
chlorhexidine
• Use peptic ulcer disease prophylaxis.
• Use deep-vein thrombosis prophylaxis (unless
contraindicated).

10. Cont’d
• Prevention of Urinary Tract Infections
• Place bladder catheters only when absolutely
needed(e.g., to relieve obstruction), not solely
for the provider's convenience.
• Use aseptic technique for catheter insertion
and urinary tract instrumentation.
• Minimize manipulation or opening of drainage
systems.
• Ask daily: Is the bladder catheter needed?
Remove catheter if not needed.

11. Management
• Should be directed at most likely cause of
infection
• Therapy should be chosen on the basis of
culture results
• If caused by any device- should be
removed

12. Con’td
• For Methicillin resistant S-aureus infection
• Vancomycin inj. 500mg (first line)
• Linezolid 600mg IV
• Daptomycin 6mg/kg IV, Ceftaroline
• Vancomycin-Resistant Enterococcus infection
• Linezolid, daptomycin,
Quinupristin/Dalfupristin
• Lower UTI-Nitrofurantoin, Ampicillin,
Ciprofloxacin

13. Cont’d
• Multi-drug resistant G-ve infections
• Choices often limited
• In addition to β-lactum/lactamase
inhibitor Carbapenem, Tigecycline,
colistin may be useful

14. References
• Foster, Corey. The Washington Manual of Medical
Therapeutics. Philadelphia, Pa: Wolters Kluwer/Lippincott
Williams & Wilkins, 2015.
• Colledge, Nicki R, Brian R. Walker, Stuart Ralston, and Stanley
Davidson. Davidson's Principles and Practice of Medicine 22nd
edition. Edinburgh: Churchill Livingstone/Elsevier, 2014.

15. THANK YOU