nosocomial infection

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NOSOCOMIAL INFECTION

Presented by,Dr. Ashish Jawarkar MD

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History

• Semmelweis could control infection during hospital deliveries (peurperal sepsis) by hand washing

• Lister could control surgical site infections by phenol sprays

INTRODUCTION

• Nosocomial infection comes from Greek words “nosus” meaning disease and “ komeion” meaning to take care of

• Also called as HOSPITAL ACQUIRED INFECTION

• Infections are considered nosocomial if they first appear 48hrs or more after hospital admission or within 30 days after discharge.

• Crowded hospital conditions

• New microorganism

• Increasing number of people with compromised immune system

• Increasing Bacterial resistance

Rise in nosocomial infection as a result of four factor

EPIDEMIOLOGY• Nosocomial infections can

be exogenous (external organism) and endogenous (opportunist normal flora)

• Host susceptibility Is an important factor in the development of nosocomial infection.

• Medical equipments and procedures (surgery) are often responsible for infections

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COMMON INFECTIONSFollowing are the most common nosocomial

infections:• Urinary tract infection

• Pneumonia

• Blood stream infections

• Surgical site infections

COMMON SITES OF INFECTION

Common agents

• Gram positive – Methicillin resistant staph aureus

• Gram negative – E coli, proteus, pseudomonas

• Virus – HIV, Hepatitis B and C• Fungi like Candida• Protozoa like plasmodium

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URINARY TRACT INFECTIONS

• It is the most common cause of nosocomial infections

• 80% of the infections are associated with indwelling catheters.

• Main agents – Gram negative bacilli likeE coli, proteus, Pseudomonas

NOSOCOMIAL PNEUMONIA

• The most important are patients on ventilators/tubes in ICU.Also known as VAP (ventilator

associated pneumonia)

Most commonly caused by drug resistant Staphylococcus aureus and pseudomonas with acinetonacter baumanii.

NOSOCOMIAL BACTERAEMIA

• Infections may occurs at the skin entry site of the IV device or in the sub cutaneous path of catheter.

• Gram negative bacilli are most common pathogens

SURGICAL SITE INFECTIONS

• The definition is mainly clinical (purulent discharge around wounds or the insertion site of drain, or spreading cellulites from wounds

within a week of surgery)Stich abcess – S epidermidisStrepto pyogenes – within a day or

twoStaphylococci – take 4-5 daysGram negative bacilli – take 6-7 daysBurns patients - psuedomonas

Diagnosis

• Routine methods – smear, staining, microscopy, culture, antibiotic sensitivity testing

• When an outbreak occurs – hospital personell, inanimate objects, water, air or food can be tested

• Test sterilization techniques like defective autoclaves, improper chemicals used

PREVENTION AND CONTROL

FORMATION OF HOSPITAL INFECTION CONTROL COMMITTEE

Consist of

Lab head (microbiologist/pathologist)

Medical staff

Nursing staff

Hospital administrator

Functions of HICC• Forming guidelines for admission, handling

infectious patients• Surveillance of sterilization techniques• Determining antibiotic policies• Educating patients and hospital staff

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Prevention and control of hospital acquired infections

• Hand washing

• Preventing UTI

• Preventing surgical site infections

• Preventing nosocomial pneumonia

• Preventing bacteremia

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Hand washing

• Simple and most effective way

• Often overlooked

• Soap and water are enough

• If not an alcohol based hand steriliser can be used

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Soap and water

• Wash for atleast 15-20 seconds

• Wash hands before eating, changing diapers, after coughing/sneezing, blowing nose, using bathroom, before and after attending to a patient

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Preventing UTI

• Limit duration of catheter

• Aseptic technique of insertion

• Closed drainage

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Preventing Surgical site infections

• Clean technique

• Clean OT

• Preoperative shower and preparation of patient

• Antibiotic prophylaxis

• Wound surveillance post operatively

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Preventing pneumonia

• Aseptic intubation

• Limited duration

• Use sterile water for oxygen therapy

• Isolation policy

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Preventing Bacteremia

• Limit duration of use

• Local skin preparation

• Removal if infection suspected

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Role of nursing staffNursing head

• Participate in HICC meets

• Train staff

• Supervise implementation of infection control measures in wards, OT, ICU and maternity , neonatal units

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Ward incharge

• Enforce hygiene, hand washing

• Report promptly to doctor if any evidence of infection

• Limit patient exposure to visitors, staff and other patients

• Proper waste disposal

• Maintain adequate supply of drugs

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Work restrictions for nurses

• Conjuctivitis – No direct patient contact until discharge ceases

• Diarrhoea – acute illness – no patient contact till further evaluation; typhoid – no contact till stool culture negative

• Sore throat (streptococci) – no contact till after 24 hours of start of antibiotic therapy

• Chicken pox – No contact till incubation period ceases

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• Herpes simplex– Genital – no restrictions– Hands – no contact till heals– Orofacial – no contact till heals

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• Respiratory infections (like cold/influenza)– Masks– No contact in initial phase

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Questions that can be asked in exam

• Nosocomial infections – define, organisms responsible, prevention

• What is the role of nurses in preventing HAI

• Hand hygiene

• Organisms causing – nosocomial UTI, pneumonia, surgical site infections, bacteremia

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