nosocomial infection are those healthcare associated infection which a patient can get during hospitalization . a majority of these infections are preventable . as these infections pose a very delitirious affect on the patient recovery and also increases the financial burden. each and every paramedical and medical professional is expected to be aware about prevention and control of nosocomial infection.
2. DEFINITION
THE INFECTION WHICH ARE NEWLY ACQUIRED WITHIN THE HOSPITAL SETTINGS .
SUCH INFECTION CAN BE ACQUIRED IN HOSPITAL, NURSING HOME , REHABILITATION CENTNOSOCOMIAL
INFECTIONS ALSO KNOWN AS HEALTHCARE ACQUIRED INFECTION (HAIs)
THEY ARE RE AND OTHER CLINICAL SETTINGS
3. CONSEQUENCES OF HAIs
HOSPITAL STAY PROLONGATION
INCREASED MORBIDITY AND MORTALITY
LONG TERM CONSEQUENCES ON THE HEALTH OF PATIENT
INCREASE IN COST OF TREATMENT
4. RELEVANT DATA TO NOSOCOMIAL INFECTION
ACCORDING TO WHO OUT OF TOTAL ADMITTED PATIENTS 15% DEVELOPS
HEALTHCARE ACQUIRED INFECTIONS
IN A RECENT STUDY IT HAS BEEN STATED THAT HAIs ARE MOSTLY OCCUR IN ICU
(INTENSIVE CARE UNIT ) OUT OF EVERY 10 PATIENTS IN ICU 1 WILL DEVELOP HAIs
AND THE MOST COMMON HAIs IS URINARY TRACT INFECTIONS
5. CRITERIA FOR HOSPITAL ACQUIRED INFECTION
INFECTION MUST OCCUR
UPTO 48hrs AFTER HOSPITALISATION
UPTO 3 DAYS AFTER DISCHARGE
UPTO 30 DAYS AFTER SURGERY
IN CLINICAL SETTING , WHERE PATIENT IS ADMITTED FOR REASON OTHER THAN INFECTION
6. PRACTICAL CRITERIA TO NOSOCOMIAL
INFECTION
EVIDENCE TO SAY PATIENT HAS THIS INFECTION NOT SIMPLY COLONISATION
PATIENT WAS NOT INFECTED AT THE TIME OF ADMISSION OR INCUBATING
HAD ENOUGH OF TIME TO DEVELOP INFECTION
7. RISK FACTORS OF NOSOCOMIAL
INFECTIONS
INCREASED SUSCEPTIBILITY INVASIVE DEVICES MEDICATIONS OR TREATMENT
ELDERLY URINARY CATHETARS PROLONG USE OF ANTIBIOTICS
PREMATURE BABIES ENDITRACHEAL INTUBATION REPEATED BLOOD TRANSFUSIONS
POOR STATE OF HEALTH CENTRAL VENOUS CATHETAR LINES SURGERY
IMMUNOCOMPROMISED STATE ENDOSCOPES PATIENT UNDER RADIOTHERAPY ,
OR CHEMOTHERAPY
UNCONTROLLED METABOLIC
DISEASED CONDITION
SURGICAL DRAINS TREATMENT LIKE DIALYSIS . ECMO
8. PRINCIPLE PATHOGENS OF HAIs
INFECTION AGENT EXAMPLE
BACTERIA Staphylococcus aureus
Pseudomonas aeruginosa
Streptococcus pyogenes
Flavobacterium species
E.coli
VIRUS Hepatitis b virus
Cytomegalo virus
FUNGI Candida albicans
Aspergilla
Saprophytic fungi
PARASITE Pneumocystitis carinii
9. SOURCES OF THESE INFECTION AGENTS
OWN FLORA OF PATIENT
CROSS INFECTION FROM HEALTHCARE PROFESSIONALS
CROSS INFECTION FROM OTHER PATIENTS
HOSPITAL ENVIRONMENT , INANIMATE NON LIVING OBJECTS LIKE BEDPANS , ENDOSOPES . INSTRUMENTS
ETC.
10. EXOGENOUS SOURCES AND TYPE OF
INFECTION THAT CAN BE ACQUIRED
SOURCE PATHOGEN ROUTE OF TRANSMISSION
PERSONS Staphylococcus aureus airborne
Hospital staff hands and clothes Staphylococcus aureus
Gram –ve bacteria
airborne
contact
fomites Same as above contact
Inadequately sterilised instruments Same as above
clostridia
contact
Food Escheria coli
Salmonella
Other gram –ve bacteria
contact
11. ENDOGENOUS SOURCES AND TYPE OF
INFECTION
SOURCE PATHOGEN TYPE OF INFECTION
skin Staphylococcus aureus Wound infection
Skin sepsis
intestine Enterobacteriasease
clostridia
Urinary tract infections
Respiratory tract infections
Septicemia
Gas gangrene
Post op wound infections
Female genital tract Gram negative bacteria Urinary tract infections
14. MODES OF TRANSMISSION
AIRBORNE
DROPLETS
FROM OTHER
PATIENTS
BY INHALATION
DUST
FROM BED, FLOOR
, SKIN
Eg pseudomonas
Aeruginosa
AEROSOLS
FROM NEBULIZERS
HUMIDIFIERS
Eg legionella
pneumophila
15. COMMON TYPES OF NOSOCOMIAL
INFECTIONS
URINARY
TRACT
INFECTIONS
BLOOD
STREAM
INFECTIONS
TETANUS
INFECTION
GI
TRACT
INFECTIONS
SURGICAL
SITE OR
WOUND
INFECTIONS
RESPIRATORY
TRACT
INFECTIONS
16. OVERVIEW OF COMMON NOSOCOMIAL
INFECTIONS
ACQUIRED THROUGH CAUSE
URINARY TRCT INFECTION INDWELLING CATHETAR ,
INSTRUMENTATION OF URINARY
TRACT
E. Coli , klebsiella , serratia
PNEUMONIA ASPIRATION , PROLONGED
INTUBATION
Staph aureus , proteus
WOUND AND SKIN SEPSIS SUGICAL PROCEDURES Enterococci , pseudomonas ,
clostridium
GASTROINTESTINAL INFECTION CONTAMINATED FOOD Salmonella , shigella
BACTERIMIA
SEPTICEMIA
INVASIVE PROCEDURES INVOLVING
BLOODSTREAM
Gram negative bacilli
TETANUS IMPROPER WOUND HANDLING Clostridium tetani
20. PREVENTION OF NOSOCOMIAL INFECTION
HAND HYGIENE AND STANDARD PRECAUTIONS
USE AND CARE OF URINARY CATHETAR
USE AND CARE OF VASCULAR ACCESS
PREVENTION OF CROSS INFECTION
21. HAND HYGIENE
BEFORE EVERY INVASIVE AND NON INVASIVE PROCEDURES
AFTER EVERY INVASIVE AND NON INVASIVE PROCEDURES
AFTER CONTACT WITH BODY FLUIDS , WOUNDS ETC
AFTER TOUCHING ANY EQUIPMENT O ARTICLE OF PATIENT UNIT
AFTER REMOVING GLOVES
BEFORE OPENING ANY MEDICAL DEVICES OR ARTICLE
25. SURFACE DISINFECTION
DISINFECTION OF ALL CONTAMINATED AND CLEAN SURFACES TO REDUCE CHANCES OF INFECTION
PROPER TIME SHOULD BE GIVEN FOR DISINFECTION
EDUCATION TO STAFF , FAMILY VISITORS ABOUT INFECTION CONTROL
29. ESTABLISHMENT OF HAICC (HOSPITAL
ACQUIRED INFECTION CONTROL COMMITTEE )
PROTECT THE PATIENT
PROTECT THE STAFF AND VISITORS
DO ABOVE WORK IN A SYSTEMATIC AND
COST EFFECTIVE WAY