Nosocomial infections, also known as hospital-acquired infections, are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare facility. The document discusses the definition, causes, types, modes of transmission, and strategies for controlling nosocomial infections. Key factors that contribute to the spread of these infections include direct contact between patients and healthcare workers, contaminated medical equipment, and inadequate infection control practices like improper hand hygiene. Hospitals can help prevent nosocomial infections through measures such as establishing infection control committees, implementing surveillance programs, providing staff training, and enforcing hygienic practices.

1. NOSOCOMIAL INFECTION

2. Contents
 Nosocomial Infection –Definition
 Nosocomial Infection
 Definition
 Aetiology and Types
 Mode of Spread
 Demonstration of Cases and Environmental Contamination
 Types of Infected Cases

3.  Mode of Spread
 Control of Infection
 Hand Washing
 Use of barrier precaution
 Waste Disposal
 Use of Disposable Items
 Disinfection / Aseptic Practices
 Waste Disposal Practices
 Health Education and training for Health Care Providers
 Hospital Infection Control Committee ( HICC)

4. DEFINITION
“Infection acquired by the person in the hospital,
manifestation of which may occur during
hospitalization (usually after 48 hours)or after
discharge from hospital.” The person may be a
patient, members of the hospital staff and/ or
visitors.

5. Aetiology and Types
 Post Operative Wound – Staphylococcus aureus
 Urinary tract infection – E. coli
 Septicaemia – Pseudomonas
 Respiratory tract infection – K. pneumonae

6. MODE OF SPREAD
DIRECT
 Direct contact
 Droplet infection.
Hospital Staff
Patients Visitors
INDIRECT
 Contaminated inanimate articles such as -
– Food and drink
– Dust
– Bed linen
– Equipment (invasive procedures)

7. Demonstration of Cases
Types of Infected Cases
-Case No 1,2, 3.

8. Demonstration of Environmental
Sources of Contamination
 Spread of Bacteria by droplets, hands, air and
fomites.
 Prevention by simple hygienic practices
 Equipment
 Culture plates – blood agar ( BA)
 Sterile swab sticks
 Antiseptic agent ( 70% alcohol)
 Disinfectant solution glutaraldehyde – 2%
 ( Cidex)
 Gloves ( sterile)
 Incubator adjusted to 370 C.

9.  Checking Air Contamination
Expose sterile BA plates for 1 hr in different parts
of a room , incubate for 24 – 48 hrs at 37 o C, do
colony counts describe the different types of
bacteria grown on the plate.
 Spread by Chough
Chough on a BA plate with lid open kept ar a
distance of 1 feet, incubate and examine as in (i)
iii) Use of Hand Washing
Cul

10. TYPES OF INFECTION
 Pneumonia
 Bacteremia
 Surgical site infection
 Urinary tract infection

11. HOSPITAL PERSONNEL
OTHER PATIENTS
PATIENT
Interrelationship of sources of
infection
Air
Endogenous
Apparatus
Instruments
Fomites
Environment

12. EPIDEMIOLOGY
 The Agent
 The Host
 The Environment

13. THE AGENT
 Mostly gram-ve organisms.
 Staphylococci (coagulase +ve phage
typeable)
 Proteus,
 E. coli
 Salmonella
 Shigella
 Klebsiella
 Ps. Aeruginosa.

14. Organisms responsible for
human infection
Organisms
E. Coli
Staphylococcus aureus
Other staphylococci
Pseudomonas
Klebsiella
Proteus
Others/ Mixed
Percentage
- 20
- 11
- 11
- 9
- 9
- 8
- 32

15. THE HOST
 Immuno compromized state.
 Invasive therapeutic and diagnostic
procedures.
 Endogenous infections.

16. THE ENVIRONMENT
 Self infection
 Cross infection
 Food, water, dust and other contaminated
inanimate articles.
 Drug resistance microorganism in hospital
environment
 Infectious patients, hospital staff, visitors

17. DIRECT ROUTE

18. OTHER IMPORTANT CAUSES
 Inadequate ventilation
 Faulty design of wards and departments
 Non-availability of isolation rooms
 Dirty utility rooms and faulty house keeping
 Over crowding
 Inadequate and substandard aseptic procedures
 Poor kitchen and laundry service
 Inadequate sterilization standards

19. CONTROL AND PREVENTION
 Formulation of Hospital infection control
committee
 Surveillance
 Training and education
 Universal aseptic precautions
 Efficient House Keeping
 Antibiotic Policy

20. CONTROL AND
PREVENTION…cont
• Satisfactory Dietary Services
• Efficient Linen and Laundry Services
• Central Sterile Supply Department (CSSD)
• Security
• Engineering Design
• Nursing Care
• Waste Disposal

21. HOSPITAL INFECTION
CONTROL COMMITTEE (HICC)
 Composition
 Role and function

22. COMPOSITION
 Chairman
– Hospital Superintendent or his representative
 Hospital Infection Control Officer
– Microbiologist/ Bacteriologist
 Members
– Surgeon
– Physician
– Anesthetist
– Pediatrician
– Gynecologist
– Nursing Matron
– House Keeping Staff
– Engineer Service representative
– Dietician

23. ROLE AND FUNCTIONS
 Investigations of all hospital infections
 Establish surveillance programme
 Provide guidance and leadership in the prevention
and control of hospital infection
 Establishing reporting system
 Periodical meeting
 Formulation of standards of aseptic procedures
 Preparation of manual for control of infection
 Training programme of health personnel
 Decision taking in the event of sudden rise
hospital infection rate

24. SURVEILLANCE
 Detect and record all Hospital Acquired Infections
(HAI)
 Weekly, monthly and yearly reporting
 Analysis of report in terms of incidence rates and
period prevalence rates
 Development of the most effective possible
strategies for action
 Formulation of Standard operative
procedures(SOP)
 Special care during high risk procedures

25. TRAINING AND EDUCATION
 Improving knowledge ,skills and behavior of all
categories of hospital staff for prevention of HAI
 On going training programme regarding universal
aseptic precautions
– lectures
– Demonstration
 Special programmes for Sister Incharge of
– OT
– ICU
– Labour rooms
– post operative wards

26. EFFICIENT HOUSE KEEPING
 Clean supply of bed linen and patients dress
 Proper bed arrangement
 Frequent mopping and periodic washing of
floors
 Provision of isolation facilities

27. Use of
Universal Aseptic Precautions
 Availability of barrier precautions
– Gloves, mask, face shields, eyewear, gowns aprons
 Use of barrier precautions
 Hand washing and use of recommended
disinfectants
 No bending ,recapping of sharps
 Disposal of sharps in puncture resistant containers
 Judicious use of blood and blood products.

28. GENERAL STANDARDS OF
HYGIENE
 Cover any fresh cuts with water proof dressing
 Wash hands thoroughly after possible
contamination
 Wear non-sterile disposable latex gloves
 Dispose of all contaminated sharps in puncture
proof containers
 Clear up spillages of blood and body fluids with
1% sodium hypochlorite
 Hepatitis B vaccination
 Reporting to appropriate authority and initiation of
post exposure prophylaxis in case of accidental
needlestick injury

29. SAFE WASTE DISPOSAL
 Division of waste into
– Household waste
– Infected sharps and infected waste
– Infected hospital waste other than sharps
 Incineration
 Deep burial
 Free availability of plastic bags for disposal

30. ANTIBIOTIC POLICY
 Checking of indiscriminate use of antibiotics
 Establish prophylactic, empirical and therapeutic
guidelines
 Monitor patterns of antibiotic susceptibility and
trends in antibiotic use.
 Audit the use of specific antibiotics.
 Checking proportion of prophylactic to therapeutic
 Antiobiotic usage in monotherapy or combination
therapy

31. CENTRAL STERILE SUPPLY
DEPARTMENT (CSSD)
 Sterilization by autoclaving heat, ionizing
radiations, chemical and filtration
 Periodical monitoring of sterilizing efficacy
of autoclave

32. SATISFACTORY DIETARY
SERVICES
 Should be organized kitchen services
– Minimum handling of foods
– Adequate water supply and washing facilities
– Sanitation of kitchen
– Provision of food trolleys
– Periodic medical examination of cooks and
food handlers

33. EFFICIENT LINEN AND
LAUNDRY
 Prior disinfections of clothes before giving
to dhobies
 Aseptic transportation of clothes to laundry
 Minimum handling


34. SECURITY
 Restriction of visitors
 Fixed hours for visitors
 Total restriction in ICU, Post- operative
areas

35. ENGINEERING DESIGN
 Provision of better ventilation and light
 Aircontioning especially in OT, ICU,
Nurseries, Labour Rooms.


36. NURSING CARE
 Aseptic nursing care
– Strict personal hygiene
– Hand washing
– Use of mask, gloves etc
 Special nursing care

37. REFERENCES
 Hospital Infection Control - John Philpott – Howard and
Mark Casewell, W.B Saunders Company Ltd., London
 Text book of Prevention and Social Medicine - Park K,
Banarasi Das Bhanot Publishers, Jabalpur
 Training Module of IGNOU for PGDHHM-05 Vol 3
Safety and Risk Management
 Harrison’s Principles of Internal Medicine, 15th Edition,
Mc Graw Hill
 Bacteremia in surgical patients with intravenous devices
– a European multicenter incidence, Journal of hospital
infection 1983.
 Principles of Hospital Administration and Planning,
Sakhakar B.M, Jaypee Brothers New Delhi