Nosocomial Infection and Infection Control Prepared by Dr. Jhason John J. Cabigon 1.

Nosocomial Infection those that are acquired within hospitals or other healthcare facilities; including those that erupt within 14 days of discharge; 5% of total hospitalizations Iatrogenic infections induced by physician or other healthcare personnel Most common causes of Nosocomial Infections a. Gram-positive cocci Staphylococcus aureus Coagulase-negative staphylococci (Staphylococcus epidermidis) Enterococcus spp. b. Gram-negative bacilli Escherichia coli Pseudomonas aeroginosa Enterobacter spp. Klebsiella spp. Most common Types of Nosocomial Infections a. UTI b. Surgical wound infections c. Lower respiratory tract infections d. Bloodstream infections Patients most likely to Develop Nosocomial Infections a. Elderly patient b. Women in labor and delivery c. Premature infants and newborns d. Surgical and Burn patients e. Diabetic and Cancer patients f. Patients receiving treatment w/ steroids, anticancer drugs, antilymphocyte serum, and radiation g. Immunosuppressed patients h. Patients who are paralyzed or are undergoing renal dialysis Major factors Contributing to Nosocomial Infections a. Increasing number of drug-resistant pathogens b. Failure of healthcare personnel to follow infection control guidelines c. Increasing number of Immunocompromised patients d. Indiscriminate use of antimicrobial agents e. A false sense of security about antimicrobial agents f. Lengthy, more complicated surgery g. Overcrowding of hospitals, as well as shortage of staff h. Increased use of less-highly trained healthcare workers i. Increased use of anti-inflammatory and immunosuppressant agents j. Overuse and improper use of Indwelling medical devices 2. Infection Control A. Medical Asepsis clean technique; involves procedures and practices that reduce the number and transmission of pathogens; to exclude pathogens

B. Surgical Asepsis sterile technique; practices used to render and keep objects and areas sterile; to exclude ALL microorganisms C. Standard Precautions used by ALL hospitals regardless of diagnosis; prevents pathogens transmitted by blood, body fluids, secretions, excretions and contaminated items 1. Handwashing most important and most basic 2. Gloves 3. Masks, Eye Protection, Face Shields and Gowns 4. Patient-care equipment if soiled, not used to other patients 5. Environmental Control 6. Linens 7. Occupational Health and Bloodborne Pathogens (NEVER recap used needles) 8. Patient Placement D. Transmission-based Precautions 1. Airborne Precautions a. Patient Placement use private rooms w/ negative air pressure and HEPA filters b. Respiratory Protection use masks when entering patients room; susceptible persons should not enter room c. Patient Transport limit patient transport; use surgical mask on patient during transport 2. Droplet Precautions a. Patient Placement at least 3 feet from next patient b. Mask wear mask if within 3 feet of patient c. Patient Transport - limit patient transport; use surgical mask on patient during transport 3. Contact Precautions a. Patient Placement private if possible b. Gloves c. Wash d. Gown e. Patient Transport - limit patient transport f. Patient-Care Equipment dedicate the use of equipment to a single patient E. Isolation 1. Source Isolation to protect other people 2. Protective/Reverse Isolation to protect vulnerable patients F. Handling 1. Food and Eating Utensils 2. Fomites any non-living or inanimate objects other than food that may harbor and transmit microbes G. Medical Waste Disposal receptacle must be equipped w/ a solid, tightfitting cover; includes disposal of sharps