nosocomial infection

NOSOCOMIAL INFECTION

Presented by,Dr. Ashish Jawarkar MD

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

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

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

Prevention and control of hospital acquired infections

• Hand washing

• Preventing UTI

• Preventing surgical site infections

• Preventing nosocomial pneumonia

• Preventing bacteremia

Hand washing

• Simple and most effective way

• Often overlooked

• Soap and water are enough

• If not an alcohol based hand steriliser can be used

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

Preventing UTI

• Limit duration of catheter

• Aseptic technique of insertion

• Closed drainage

Preventing Surgical site infections

• Clean technique

• Clean OT

• Preoperative shower and preparation of patient

• Antibiotic prophylaxis

• Wound surveillance post operatively

Preventing pneumonia

• Aseptic intubation

• Limited duration

• Use sterile water for oxygen therapy

• Isolation policy

Preventing Bacteremia

• Limit duration of use

• Local skin preparation

• Removal if infection suspected

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

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

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

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

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

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

nosocomial infection

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