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Nosocomial Infection

Nosocomial Infection. “Infections Are Most Often Transmitted From Patient To Patient On The Hands Of Healthcare Workers…” - Dr.William Jarvis. S.P Siva Shankari @ Rekha M.Sc Nanoscience Lady Doak College Iva Puspitasari,MD. Introduction:.

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Nosocomial Infection

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  1. Nosocomial Infection “Infections Are Most Often Transmitted From Patient To Patient On The Hands Of Healthcare Workers…” - Dr.William Jarvis S.P Siva Shankari @ Rekha M.Sc Nanoscience Lady DoakCollege Iva Puspitasari,MD

  2. Introduction: • "Nosocomial" comes from two Greek words - "nosus" meaning "disease" + "komeion" meaning "to take care of" -disease contracted by a patient while under medical care. • Infection may manifest during the patient’s stay, after get discharged, Visitors to the hospital also. • Also called as “Hospital Acquired Infection” (HAI).

  3. Artiinfeksinosokomial • Pasien yang dirawatdiRumahSakitdanmendapatkaninfeksidiRumahSakit yang sebelumnyapasientidakdalamfaseprodromal/inkubasipenyakittersebut

  4. Factors Predispose HAI : • Hospital Pathogen • Poor Condition Of Hospital • Crowding Of Patient’s • Instruments • Extremes Of Age • Immunity • Contaminations

  5. Source Of Nosocomial Infection : Source Endogenous Cause Self Infection Or Auto Infection Exogenous Cause Cross Infection Or Environmental Infection

  6. Routes of transmission: • Airborne Transmission • Common vehicle Transmission • Contact Transmission • Droplet Transmission • Vector borne Transmission

  7. Air borne transmission : • Tiny droplet nuclei (< 5 microns) that remain Suspended in the air. • Dusts From Bedding & Floor. • Exudates Dispersed From Wound.

  8. Common vehicle transmission: • Transmitted indirectly by material contaminated with the infectious microbes. • Example: contaminated food , blood products, water or contaminated instruments & other items.

  9. CONTACT TRANSMISSION: • Most important and frequent mode of transmission of nosocomial infections. It is divided into two subgroups : • Direct-contact transmission • Indirect-contact transmission

  10. Droplet transmission : • Droplets generated by : • Coughing • Sneezing • Respiratory tract procedures such as bronchoscopy • Secretions

  11. Vector transmission : • Transmitted through insect & other invertebrate animals. • Examples : mosquitoes can transmit “malaria” and “yellow fever”. • Fleas can transmit “plague”.

  12. Nosocomial infection factors : • High prevalence of pathogen . • High prevalence of compromised hosts . • Efficient mechanisms of transmission from one to another. • This is also known as chain of transmission : • o The movement of pathogen from individual to individual via various routes.

  13. Pathological agents important in nosocomial infection: Staphylococcus aureus Escherichia coli Pseudomonas aeuroginosa

  14. Viruses : • There is a possibility of nosocomial transmission of, • Hepatitis B & C viruses (transfusion , dialysis, injection, endoscopy) • Respiratory Synctyial Virus (RSV) • Rotavirus

  15. Cytomegalovirus • Herpes virus • Influenza

  16. Parasites & Fungi: • Many of them are lethal organisms and cause infection during extended antibiotics treatment and severe immunosuppression. • Candida albicans, Aspergillus species • Cryptosporidium, Toxoplasma pneumoniae.

  17. SITES OF INFECTION : • Distribution according to the French national prevalence survey(1996), • Following are the most common nosocomial infections: • Urinary tract • Surgical Site • Respiratory tract • Bacteraemia

  18. Surgical site infection: • They are also frequent : the incidence varies from 0.5 to15% depending on the type of operation & underlying patient status. • The definition is mainly clinical : discharges around the wound, or spreading pus from the wound. • By Stitches, Umbilical Cuts, Surgery spots. • Organisms: S.aureus, P.aeruginosa.

  19. Risk factor SSI: • Advanced age • Obesity • Infection at a remote site (spread through blood stream) • Malnutrition • Diabetes • Extended preoperative hospital stay • Greater than 12 hours between preoperative shaving of site and surgery • Extended time of surgery • Inappropriate timing of prophylactic antibiotics

  20. Nosocomial pneumonia : • The most important are patients on ventilators in intensive care units, where the rate of pneumonia is 3% per day . • It accounts for 15% and have high mortality (13-55%). • Mostly caused by respiratory devices, instruments. • Organisms : S. aureus , Streptococcus pneumoniae , Influenzae.

  21. Urinary Tract Infections : • It constitutes 40% of Nosocomial infections. • Typically by catheterization, Instruments. • Manifests as Cystisis, Urethritis. • Organisms : E.coli, Proteus, Klebsilla

  22. Risk factor uti: • Advanced age • Female gender • Severe underlying diasese • Placement of indwelling urine catheter

  23. Nosocomial Bacteraemia: • These infection represent a small proportion of nosocomial infection (approximately 5-6%). • The incidence is increasing , particularly for certain organisms such as Staphylococcus & Candida Species • Infection may occur at the skin entry site of the intravascular device , or in the subcutaneous path of the catheter ,organisms colonizing the catheter within the vessel may produce bacteraemia without visible external infection.

  24. Risk factor BSI: • Age 1 year of age or younger or 60 years of age and older • Malnutrition • Immunosuppressive chemotherapy • Loss of skin integrity (burns, decubitus) • Severe underlying illness • Indwelling device (catheter) • Intensive care unit stay • Prolonged hospital stay

  25. Problems of nosocomial infection : • Nosocomial infection will become more important as public health problem, as it causes: • Additional suffering • Prolong hospital stay • Increase the cost of care significantly Nosocomial infection are important contributors to morbidity & mortality

  26. Results : • May cause death • Increase emotional stress of the patient • Morbidity ,mortality ratio • Excess costs on stay • Can be transmitted to discharged patients or visitors • High antibiotic resistance

  27. Diagnosis : phenotypic • Biotyping • Phage typing • Serotyping • Plasmid profile • Antibiogram

  28. Diagnosis: genotypic • Plasmid analysis • Restriction endonuclease analysis of chromosomal DNA

  29. Control Mask, Eye Protection: To prevent splashes, sprays of secretions & excretion transmitting infection. Sterilization : Sterilization of all reusable equipment such as ventilators , humidifiers & any devices that come in contact with the respiratory tract. Linen : Solid, reusable items are placed in biohazard bags to prevent leakage. 

  30. Gloves: • On contact with blood, body fluids, wounds. • Change of gloves after using it for 1 patient • Removal always in reversal manner so as not to touch surface. • Hand washing: • Is the single most important measure to reduce the risk of transmitting microorganisms from one person to another or from one site to another on the same patient. 

  31. control • Segregation of infected patients in private rooms or chorting of patients if private rooms is not available • Cleaning of all isolation rooms alter the patients after is discharged • Placement of cards on the patien’s door specifiying the type of isolation and instruction for visitor and nursing staff

  32. Category of isolation • Strict isolation (chicken pox, pneumoniae plaque, lassa fever) • Respiration isolation (measle, haemophilus influenza, Neisseriameningitidis) • Enteric precaution (amoebic dysentri, Salmonella, Shigella) • Contact isolation for patient infected MDRO • AFB isolation for patient with M.tuberculosis • Drainage and secretion precaution for person with conjunctivitis and burn • Blood and body fluid precaution for individual with AIDS

  33. Tell your doctor everything: • All symptoms. • Other prescription medications. • Previous diseases. • Don’t assume it’s not important just because your doctor did not ask. • Aprons : • Wearing an aprons during patient care reduces the risk of infection . The apron should be disposable.

  34. Conclusion : • There is no official, national approach and no real managerial support from health authorities for control of nosocomial infections • All diposable items should be properly diposed in puncture proof bags without touching. • Miss use of antibiotics has produced antibiotic resistant organisms and these increase clinical complications of patients, lengthening their hospital stay and adding to treatment costs. • Only thing is proper asepsis ,sterilization ,proper washing of hand.

  35. REFERENCES • Gerard J. Tortora, Berdell R. Funke, Christine L. case, “Microbiology – An introduction”, 9th edition, pearson and Benjamin Cummings Inc., 2006. • BS Nagoba, Asha Pichare , “Medical Microbiology” , 1st edition, Reed Elsevier private Limited, New Delhi,2007. • Eugene W Nester, Denise G. Anderson, C. Evans Roberts Jr, Nancy N Pearsall, Martha T. Nester, “Microbiology- A Human Perspective”, 3rd Edition, McGraw Hill, North America. • http://en.wikipedia.org/wiki/hospital_acquired_infection

  36. Thank You !!! 

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