Nosocomial infection

1. NOSOCOMIAL
INFECTIIONS

2. INTRODUCTION
 Nosocomial infection refers to “ hospital acquired”
infection but may be expended to include
infections acquired in other healthcare delivery
settings.

3. DEFINITION
 A nosocomial infection also known as a hospital-
acquired infection or HAI, is an infection whose
development is favoured by a hospital environment,
such as one acquired by a patient during a hospital
visit or one developing among hospital staff. .
Such infections include fungal and
bacterial infections and are aggravated by the
reduced resistance of individual patients.

4.  Nosocomial or hospital-acquired infection:
Infection that is neither present nor incubating
at the time the patient came to the hospital.

5. RISK FACTORS IN NOSOCOMIAL
INFECTION DEVELOPMENT
 ENVIRONMENT:- lack of supervision, poor infection
prevention practices, inappropriate use of resources
and overcrowding of hospitals.
 THERAPEUTIC REGIMEN:- inadequate standards
and practices for operating blood transfusion
• increasing use of invasive medical devices
• use of contaminated intravenous fluids

6.  CLIENT RESISTENT:-
antibiotic resistance due
to overuse of broad
spectrum antibiotics
• unsafe and frequent
unnecessary injections.

7. HIGH RISK CASES
 Advanced age & young
children
( low immunity)
 Immunodeficiency patient
 With drugs such as immuno
suppressive
 Undergoing chemotherapy
 Undergoing radiation
therapy

8.  Any long term illness
 Invasive devices such as incubator tubes,
tracheostomy tubes, catheter, surgical blade
etc.

9. Sources of infection
 Patients
 Health care workers
 Visitors
 Persons with acute illness or infection
 Those who are cases & carriers.
 Inanimate objects such as furniture and medical
equipment can also be sources of
microorganisms.

10. From other
patient, member
of staff,
or from
environment in
the hospital
exogenous
Patients own
flora may invade
the patient’s
tissue
e.g. during
surgical
operation etc.
endogenous
SOURCES OF INFECTION CAN BE

11. Endogenous infection: When normal patient flora
change to pathogenic bacteria because of change of
normal habitat, damage of skin and inappropriate
antibiotic use. About 50% of N.I. are caused by this way.
Exogenous cross-infection: Mainly through hands of
healthcare workers, visitors, other patients.

12. Exogenous environmental infections: several types of
micro-organisms survive well in the hospital
environment (hospital flora): In water, damp areas and
occasionally in sterile products or disinfectants e.g
pseudomonas, Mycobacterium.
On items such as linen, equipments and supplies, in
food, fine dust and droplet nuclei, urinary catheters,
I.V.L, inhalation therapy lines.

13. AGENT
PORTAL OF
EXIT
RESERVOIR
MODE OF
TRANSMISSION
PORTAL OF
ENTRY
SUSCEPTEBLE
HOST
CHAIN OF
INFECTION

14. ROUTE OF TRANSMISSION
 Contact transmission
1. Direct transmission
2. Indirect transmission
 Droplet transmission

15.  Airborne transmission
 Vector born transmission

16. Factors Influencing
infection
The microbial agent
Patient susceptibility
Environmental factors

17. Microbial Agent
 Development of clinical disease
depends on organisms infective dose
and patient resistance.

18. Patient Susceptibility
 Age: Infants and old age have decreased
resistance to infection.
 Immune status: Patients with chronic
diseases as malignancy, leukaemia ,
diabetes mellitus, renal failure or AIDS have
increased risk of infection.

19.  Immunosuppressive drugs: Patients on
these drugs or on radiation therapy.

20. Environmental Factors
 Healthcare setting is environment where
both infected persons and persons at high
risk of infection are present.
 Crowded conditions within hospital,
frequent transfers of patients between units.

21. X represents a positive Enterococcus culture

22. MOST COMMON NOSOCOMIAL
INFECTIONS , THEIR CAUSES &
PREVENTION

23. SURGICAL WOUND INFECTION
CAUSETIVE AGENT:- staph
aureus, E. coli, pseudomonas,
etc.

24. CAUSES
Prolonged surgery
Hospitalization
Delayed wound closure
Excess tissue trauma
Excessive blood loss
Presence of drain, etc.

25. SIGN AND SYMPTOMS
 Fever
 Excessive pain
 Redness around the
wound area
 Presence of pus cell /
drainage
 Delayed wound healing,
etc.

26. PREVENTION OF WOUND INFECTION
PREOPERATIVE PREPARATIONS:-
 Preoperative hospital stay should be as short as
possible
 Preoperative bacterial infections should be treated
and controlled.
 Skin preparation should be done with an antiseptic
solution
 Hair removal should be done immediately before
surgery

27. POST OPERATIVE WOUND CARE
 Use aseptic techniques for wound care and dressing
 Check for presence of exudates, if present then
should be cultured.
PROPHYLACTIC ANTIBIOTICS
 Should be started in cases with high risk of infection.

28. URINARY TRACT INFECTION
 CAUSETIVE AGENTS:- E. coli, Proteus,
staphylococci, enterococci, etc.
 CAUSES:-
Catheterization
Irrigation procedures
Calculi in urinary tract
Post partum state
Cystoscopy, etc.

29. SIGN & SYMPTOMS
 Fever
 Dysuria
 Suprapubic tenderness
 Burning Micturition
 Hematuria

30. PREVENTION OF URINARY TRACT
INFECTION
 Avoid unnecessary catheterization
 Use aseptic techniques for catheterization
 Decrease the duration of indwelling catheter
 Anchor the catheter to stabilize the catheter and
reduce irritation to urethra

31.  Maintain a continual downward flow of urine
 Gently and regularly clean the perineum area
with antiseptic solutions
 Avoid irrigation unless obstruction is removed.
 Use of urinary antiseptic & antibiotics in high
risk cases

32. BACTEREMIA & SEPTICEMIA
CAUSETIVE AGENT:- staph aureus, E. coli,
pseudomonas, etc.
CAUSES
 Thrombophlebitis due to IV cannula
 Use of Immunosuppressant drugs
 Microbial contamination of fluid, etc.

33. SIGN & SYMPTOMS
 Presence of fever
 Headache
 Swelling around the site of cannula
 Shock
 death

34. PREVENTION
 Use aseptic technique while cannula insertion ,
center line insertion and other procedures like
catheterization etc.
 Use upper extremity veins for cannulation.
 Use plastic catheters for cannulation of central
lines.
 Insert new cannula after every 48 to 72 hours

35.  Change center line dressing every 24 hours and
apply antibiotic ointment
 Change IV tubing every 24 hours after infusing
blood products and lipid emulsions.
 Use of prophylactic antibiotics in high risk cases.

36. RESPIRATORY INFECTIONS
 CAUSATIVE AGENTS:-
staph aureus, enterobector, E.
coli, acinobector,
Paeruginosa, etc.

37. CAUSES
 Airway obstruction
 Impairment of mucociliary defence
 Traumatic injury to respiratory tract
 Use of Large volume nebulizers
 Nasogastric and endotracheal tubes

38.  Ventilation equipments
 Bronchoscopy
 Surgical procedures like lung biopsy,
tracheostomy

39. SIGN & SYMPTOMS
 Fever
 Sore throat
 Cough with sputum production
 Dyspnea

40. PREVENTION
 Use sterile, disposable breathing circuits
 Replace circuit for patient on mechanical
ventilation every 24 to 48 hours
 Use high efficiency bacterial filters on ventilators
 Prophylactic antibiotics

41. VENTILATOR ASSOCIATED PNEUMONIA
 CAUSES
Use of unsterile
conditions during
intubation procedure
Use of unsterile
conditions during
suctioning procedure

42. Presence of other infections
Injury to respiratory tract during intubation
procedure, suctioning, etc.

43. SIGN AND SYMPTOMS
 High grade fever
 Increased sputum production
 Dsypnea
 Decreased oxygen saturation, etc

44. PREVENTION
 Use of aseptic techniques for intubation &
suctioning procedures.
 Use of prophylactic antibiotics
 Maintain patient hygiene
 Use sterile, disposable breathing circuits

45.  Replace circuit for patient on mechanical
ventilation every 24 to 48 hours
 Use high efficiency bacterial filters on
ventilators

46. GESTROINTESTINAL INFECTIONS
CAUSATIVE AGENTS: E coli, entero cocci,
salmonella, shigella, etc.
SIGN & SYMPTOMS:
 Abdomen pain
 Diarrhea
 Vomiting
 Fever
 Dehydration
 Weight loss

47. PREVENTION
 Change nasogastric tube after days or according to
the hospital policy.
 Avoid gastric lavage, if possible.
 Avoid gastric irritants.
 Intake of fresh and well cooked food.
 Use of Prophylactic antibiotics.
 Give health education to the patient regarding diet.

48. OTHERS ARE
 Methicillin resistant Staphylococcus aureus (MRSA)
 Hospital-acquired pneumonia (HAP)
 Vancomycin-resistant Enterococcus (VRE)

49. INVESTIGATIONG FOR DIGNOSIS
 Blood culture
 Urine culture
 Sputum culture
 Tissue culture
 CBC
 X-ray

50. PREVENTION OF NOSOCOMIAL INFECTION
Most of these infections can be prevented with readily
available, relatively inexpensive strategies and these
are:
 Adhering to recommended infection prevention
practices, especially
 hand hygiene and wearing gloves;

52.  Paying attention to well-established processes for
decontamination and cleaning of soiled instruments
and other items, followed by either sterilization or
high-level disinfection; and
 Improving safety in operating rooms and other high-
risk areas where the most serious and frequent
injuries and exposures to infectious agents occur.

53. ROLE OF NURSE IN INFECTION CONTROL
 As a Educator: Hand
hygiene promotion
posters can be placed in
visible areas of the
hospital

55.  Hospital infection control teams can be
utilized to provide in-service education to
healthcare workers regarding the importance
of hand hygiene and infection control.
 Placing diagrams above sinks that outline the
proper way to wash hands with soap and
water.

57.  Alcohol based hand rubs with no-touch dispensers
should be available in every patient room, outside
elevators, in waiting rooms and at staff workstations.

58.  There should be a policy regarding fingernails. The
long, artificial or with chipped nail polish should be
banned for all health care workers.
 Rings also reservoir of bacteria. Policies need to be
commenced and enforced on the wearing of rings.

59.  Staff should be encouraged to wipe their
frequently handled Stethoscopes between
patients and should be discouraged from using
cloth covers on their stethoscopes.

60.  Equipment that is handled and used by
healthcare workers for patients should be
cleaned regularly.

61.  Knowing her/his personal immunization status
relevant to the practice setting and taking appropriate
action to ensure client protection
 Knowing a client’s immunization status relevant to
the practice setting and taking appropriate action to
ensure protection of clients, others and self.

62.  Maintaining competence in infection control
practices by accessing appropriate resources.
 Taking appropriate action when a co-worker has a
potentially contagious disease

63.  Adhering to best practices or manufacturer’s
guidelines on the cleaning, disinfecting and
disposal of wastes or hazardous material.
 Follow established guidelines when disposing of
biomedical waste.

64.  Identifying hazards and the potential for injury.
 Intervening and providing appropriate care when
an exposure has occurred to client(s), self or
another health care provider;

68. assign
ment

69. Thank you