Chapter 29- Barbara Kozier, Glenora Erb, Audrey Berman, Sherly Snyder

Nosocomial Infections are classified as infectious that are associated with the delivery of health
care services in a health care facility. Nosocomial infections can either develop during a clients stay in a
facility or manifest after discharge. Nosocomial microorganism (e.g tuberculosis and HIV) may also be
acquired by health personnel working in the facility and can cause significant illness and time lost from
work.
Nosocomial infections have received increasing attention in recent years and are believed to
involve about 2 million clients per year. The most common settings where nosocomial infections
develop are hospital surgical or medical intensive care units. Reports from the National Nosocomil
Infection Surveillance (NNIS) System have revealed that the urinary tract, the respiratory tract,
bloodstream and wounds are the most common nosocomial infection sites. The microorganism that
cause nosocomial infections can originate from the clients themselves (an endogenous source) or from
hospital environment and hospital personnel (exogenous sources) most nosocomial infections appear to
have endogenous sources. Eacherichia coli, staphylococcus aureus and enterococci are the most
common infecting microorganism.
A number of factors contribute to nosocomial infections. Iatrogenic infections are the direct
result of diagnostic or therapeutic procedures. One example of an iatrogenic infection is bacteremia that
results from an intravascular line. Not all nosocomial infection are iatrogenic, nor are all nosocomial
infection are preventable.
Another factor contributing to the development of nosocomial infections is the compromised
host, that is, a client whose normal defenses have been covered by surgery or illness.
The hands of personnel are a common vehicle for the spread of microorganism. Insufficient
hand washing is thus an important factor contributing to the spread of nosocomial microorganism.
The cost of nosocomial infections to the client, the facility and funding sources (e.g insurance
companies and federal, state or local) is great. Nosocomial infections extend hospitalization time,
increase clients time away from work, cause disability and discomfort and even result in loss of life.


Handbook of Common Communicable and Infectious disease, Dionisia Mondejar-Navales, R.N. MAed
Despite decades of dramatic progress in their treatment and prevention, infectious diseases
remain the major cause of death and debility. They are responsible for the worsening living conditions of
millions of people around the world. That risk of exposure to a wide range of infectious disease
increases and threatens the overall health structure of people in communities. Newly discovered and
emergy infectious agents appear to have been brought into contact with human by changes in the
environment and movement of population.
The primary role of the nurse in the prevention of the disease transmission is disinfection.
Knowledge of the secretions that harbor the causative organisms requires concentrated effects in
destroying these secretions before they can be scattered.
One public health educator stated that we should think of the point as sending forth every force
in continuous supply through every gateway; our lives and the lives of others depend on how we fight
against these enemies. In this war, as in any other, the outcome depends on the strategies used. The
enemy is at a great disadvantage if forces are centered on the gateways and enemies are not allowed to
come forth in great numbers around us. They must be killed as they come into the open. All secretions
that harbor the causative organism of the disease must be destroyed as readily as they left the human
body. However, totally efficient concurrent disinfection is a practical impossibility. But then, it is possible
to destroy a greater number of organisms before they can do any harm. We must remember the three
Fs. Fingers must be watched carefully. They are the worst traitors. They fight the enemy willingly
enough, but also bring back the enemy with them, unless we cultivate the value of aseptic technique.
Food supply must be protected from possible contamination. Flies are the third F.
Knowing these, it is a must therefore to: a) keep things other than food away from the mouth;
b) wash hands often and always before eating: c) keep hands from cuts, scratches, chapping, hangnails,
and abrasions of any sort because many diseases are contracted though broken skin; wash hands
thoroughly before putting them into the pockets and e) keep hands away from face.



Nosocomial infections; hand washing compliance; comparing hand hygiene protocols; sensor-operator
faucets-Evidence for Practice
AORN Journal, March 2006 by Zuzanne C. Beyea
This prospective study was conducted in eight-medium sized hospital and examined the effect
of appropriate quality management activities on nosocomial infection rates during a 26-month passed.
(1) The study focuses on surgical departments intensive care units (ICUs) were included to capture data
for patients requiring this type of treatment after surgery. The intervention group comprised of 4
hospital of the control group comprised 4 hospitals.


Journal of Anti Microbial Chemotherapy
Major Trends in the Microbial Etiology of Nosocomial Infection
Dennis R. Schaberg, MD, Ann Anbor Michigan, David H. Culver, Ph.D., Robert P. Gayner, M.D
Nosocomial infection remains a significant consequence of hospitalization. Estimates are that
from 3 to 5 of patients have the hospital having acquired infection, depending on case mix, hospital size
and multiple other factors. Examination of the microbial etiology of these infections provides important
information in day-to-day decision making in individual hospitals regarding potential outbreaks, unusual
pathogen, anti microbial resistance, and local trends in the etiology infection.
September 16, 1991 The American Journal of Medicine Volume 91.






1. Journal- Nursing Journal of India, March 2005 by Parvez, Saroj,
http://fingarticles.com/particles . 03April 2011
Nosocomail infections are the infections acquired during hospital stay. These infections
concerns. 5.15 % (estimated 2 million cases annually) of hospitalized patients and can lead to
complication is 25.33 of those admitted in ICU. Despite overall progress, hospital acquired infections
(HAI) are problem in both developed and developing countries. These are an important cause of death
and economic cost are considerable which include cost of additional stay in hospital drugs, delayed
discharges. About 25% of the infections can be prevented by health care workers taking proper
precautions when caring patients.
A localized or systemize conditions that results from adverse reactions to the preserve
of an infectious agent that was not present or incubating at the true of admission to the hospital for the
center for disease control (CDC).
Causes
-urinary catheterization
-respiratory procedures
-surgery and wounds
-intravenous procedures
2. Risk Factors
All hospitalized patients are susceptible to contracting a nosocomial infection. Some patients are
at greater risk than others-young children. The elderly and person with compromised immune system
are more likely to get an infection.
Other risk factors are:
-use of indwelling catheter
-failure of health worker to wash hands
-over use of antibiotics
-mechanical ventilation
-serious disease
-route of transmission
There are mainly three routes of transmission of nosocomial infections:
1. Contact route-there are two types of contact routes
Direct contact-it requires physical contact between the infections indidual or contaminated
object and the susceptible host
Indirect contact-this requires mechanical transfer of pathogens between patients though a
health worker or a medical kit.
2. Airborne droplet route-droplets are particles of respiration, secretion that can carry pathogen
though the air can only remain in the air for short period of time.
1. Airborne dust route-dust particles are particles that carry dust and can remain in the air for
long period of time.
Various Hospital Infections
Surgical Wounds: infection of surgical wounds in important numerically and as a cause of
morbidity and prolonged hospital stay. In a prevalence survey by Emerson et al 1996 at is
accounted for 12.3% of HAI. In USA in study of surgical wound accounted for 24% of nosocomial
infection. Several factors influence the occurrence of surgical wound infections, such as the site,
duration of surgery, health of patient and skill of the operator.
Respiratory tract infection: these represent significant proportion of hospital acquired infection
about 15-20 % of all hospital acquired infection are of the lower respiratory tract which are the
leading causes of mortality. Aspiration in unconscious patients and pulmonary ventilation or
instrumentation may lead to nosocomial pneumonia. Gran negative bacilli and staphylococcus
aureus are the common pathogens.
Uninary tract infection: most of the hospital acquired UTI (80%) is catheter associated. Even the
single passage of catheter, is associated with a definite though usually ,low infection risk (Kunim
1987). Even c adequate precautions, catheterization in hospital leads to UTI in about 20; c
indwelling catheter the rate goes up to 50% or none. Mixed infection is common, infection can
be prevented by strict asepsis during catheterization, indwelling catheter to be used only when
unavoidable and only c proper closed drainage.
Bacteraemia and septicemia: although bactereraenium is not the most common hospital
acquired infection or the most significant in adding to costs; it is of greatest importance as it is a
caus of serious illness and death. These may be consequence of infection at any site but
commonly caused by infected intravenous can. Extensive studies in USA have reported, hospital
acquired bacterenia in 0.2-0.4% of hospital admission much higher rates have been reported for
tertiary care referral centers that for general hospital.
Prevention and Control of Hospital Acquired Infections
Infection control practices need to be integrated into the nursing procedures of each hospital
Nursing care must be planned c awareness of the measures that increase infection risk and the
use of these techniques balanced against the possible benefits.
Emphasis on hand-washing, one of aseptic technique in invasive procedure, care of catheter,
intravenous sites, surgical wounds and improvement of disinfection and sterilization procedures
in respective areas.
Routine cleaning of environment including floors, toilets, bathrooms, washing basins, locker
tops and other furniture by adequately trained and supervised staff.
Wear gown, cap and masj in high risk areas such as ICUs etc. there is need to discontinue
common practice of hanging mask around the neck.
No berrowing. Only wet mopping and damp dusting must be done
Detection and treatment by nasal carriage of all the health care workers for staphylococcus
aureus.
Regular screening and kitchen staff and food handlers for carriage of pathogens
Proper waste disposed management
Compliance and adherence to infection control practices by everyone
Isolation of patients constituting an infection risk e.g patients c swear for pulmonary
tuberculosis
A continuous training programme for all categories of health care workers to train them in safe
health care practices and hospitals acquired infection control measures

Knocking out nosocomial infections
Nursing, November 2004 by Avalos-Bock, Steven, Campbell, Valanie
The most common complication threatening hospitalization patients today, nosocomial
infections affect approximately 2 million patients each year and kill 90, 000. In acute care hospitals, up
to 10% of patients acquire one or nine of these infections. By understanding how the causative
pathogens identified and tested for antibiotic sensitivity. You can help ensure that your patient sets
effective treatment.
More thean 80% of nosocomial infections fall into one of the following four categories
Urinary tract infection (usually catheter-related)
Surgical site infection
Bloodstream infection (usually associated c an intravascular device)
Pneumonia (usually ventilator-related)
Although almost any virus of bacterium can cause problems, nine bacteria for over 70% of all
nosocomial infections in adult.