Nosocomial Infections

-Larissa Pereira Mohit Lodhi Pallavi Rane Sneha Phalle

(11) (13) (14) (23)

Contents
1. Epidemiology: Definition Causative microbes Reservoir & Transmission Infection sites 2. Dealing with outbreaks 3. Survelliance 4. Prevention & Precaution

Epidemiology
"nosus" = disease "komeion" = to take care of Hospital acquired infections Acquired during hospital care, which were not present or incubating at the time of Admission (after 48 hrs) Includes infections acquired in hospital, but appearing after discharge. (30 days)

Also, Occupational infections.

Factors influencing development of infections

Microbial agents Patient susceptibility Environmental factors Bacterial resistance

Other important infections

Skin and soft tissue infections: open sores (ulcers, burns and bedsores) encourage bacterial colonization and may lead to systemic infection Gastroenteritis is the most common nosocomial Infection in children, where rotavirus is a chief Pathogen. Sinusitis and other enteric infections, infections of the eye and conjunctiva. Endometritis and other infections of the reproductive organs following childbirth.

Nosocomial infections are widespread. Important contributors to morbidity and mortality are: Increasing numbers and crowding Impaired immunity New micro-organisms Bacterial resistance to antibiotics

Microorganisms
Bacteria 1. Commensal : found in the normal flora of Healthy humans but cause infections in Compromised humans. Eg: E. coli causing UTI 2. Pathogenic having greater virulence: cause Sporadic/ epidemic infections. Eg : gram +ve S.aureus, gram ve E.coli.

 Virus 1.Hepatitis B and C (transfusion, dialysis, Injections, endoscopy) 2.Rotavirus & enterovirus (transmitted hand-mouth and via faecel-oral route) 3.HIV, Influenza virus, Herpes simplex virus
Parasites and Fungi 1. C.albicans, Aspergillus spp. (opportunistic) 2. Sarcoptes scabies is an ectoparasite causing outbreaks.

Reservoirs and Transmission

People are at the centre of the phenomenon: as main reservoir and source of microorganisms as main transmitter, notably during treatment as receptor for microorganisms, thus becoming a new reservoir.

Routes of transmission.
1. Contact Transmission Direct Indirect 2.Droplet Transmission

3. Airborne Transmission
4. Common vehicle Transmission

5. Vector borne Transmission

Chain of infection

Infection Sites

Other nosocomial infections

Skin and soft tissue infections: open sores (ulcers, burns and bedsores) encourage bacterial colonization and may lead to systemic infection. Gastroenteritis is the most common nosocomial infection in children, where rotavirus is a chief pathogen: Clostridium difficile is the major cause of nosocomial gastroenteritis in adults in developed countries. Sinusitis and other enteric infections, infections of the eye and conjunctiva. Endometritis and other infections of the reproductive organs following childbirth.

Surveillance
The ultimate aim is the reduction of nosocomial infections, and their costs. Desired characteristics of a nosocomial infection surveillance system Characteristics of the system: timeliness, simplicity, flexibility acceptability, reasonable cost representativeness (or exhaustiveness) Quality of the data provided: sensitivity, specificity predictive value (positive and negative) usefulness, in relation to the goals of the surveillance (quality indicators)

Prevalence rate Number of infected patients at the time of the study / Number of patients exposed at the same time X100 Prevalence (%) of UTI for 100 patients with a urinary catheter. Attack rate (cumulative incidence rate) Number of new infections acquired in a period / Number of patients exposed in the same period X100 Attack rate (%) of surgical site infections (SSI) for 100 operated patients. Incidence rate Number of new device-associated nosocomial infections in a period / Total device-days for the same period X1000 Eg. Incidence of ventilator-associated pneumonia for 1000 ventilation-days

Prevention
Hospitals can adopt an infection control progam such as the CDC

Prevention and Precaution

Sterilization : kills all microorganisms on equipment and surface through exposure to chemicals, ionizing radiation, dry heat or steam under pressure. Isolation: prevent transmission by common routes. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission. Handwashing & gloving: single most important measure to reduce the risks of transmitting skin microorganisms. Gloves play an important role in reducing the risks of transmission of microorganisms. Surface sanitation Aprons

Prevention of Catheter Infection Use of antibacterial coated venous catheter that destroys bacteria before they can get into blood stream. Use of silver alloy coated urinary catheters that destroy bacteria before they can migrate upto the bladder Remove nasogastric and endotracheal tubes as soon as possible.

 Dr F D Dastur, Director, Medical education, P D Hinduja, Hospital: Nosocomial control programme is at a nascent stage in Indian hospitals, with some yet to establish a central sterilization and supply department (CSSD) and appoint an infection control nurse
ASIAN HEART INSTITUTE (AHI) Dr Vijay D Silva, director, critical care, Asian Heart Institute (AHI): Suggestions to strengthen the infection control programme is turned down by the management of most hospitals as spending on infection control does not generate revenue.

Thank You