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

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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.

Rise in nosocomial infection as a result of four factor

Crowded hospital conditions New microorganism

Increasing number of people with compromised immune system

Increasing Bacterial resistance

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 INFECTIONS
Following 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 like E 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 epidermidis Strepto pyogenes within a day or two Staphylococci take 4-5 days Gram negative bacilli take 6-7 days Burns 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

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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 staff Nursing 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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