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| Nosocomial Infection |
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Introduction :
Infections that are acquired while a patient is in a hospital are referred to as nosocomial infections. Nosocomial infections are diseases that, a heath care professionals, give to their clients. Hospitals and clinics are places where sick people go with the expectation that they will get better. Unfortunately, there is a risk that clients may become infected because of their visits to these places. Often nosocomial infections become apparent while the patient is still in the hospital but in some cases symptoms may not show up until after the affected patient is discharged.
About 30 % of patients admitted to hospitals & nursing homes in the country acquire nosocomial infections as against an impressive 5% in the west, according to Members of Hospital Infection Society (HIS), India. This alarming situation is attributed to hospitals reluctance to invest in infection control, lack of awareness & improper waste management. The invariable outcome is antibiotic intake costing between Rs. 3000/- to Rs. 5000/- prolonged hospital stay & loss of work which affect the health of economic too. In a few instances, nosocomial infections lead to septicemia having a mortality rate of 80%. Worldwide, around 14 lakh people suffer from hospital acquired infections.
Monitoring agencies now recognize that the term "nosocomial infection" should not be limited only to the hospital setting. Patients who have frequented short-term procedure settings or who reside in chronic care facilities such as nursing homes have been found also to develop infections due to the same spectrum of pathogens. Individuals who have recently been discharged from an acute or chronic health care facility, who have some of the risk factors, or who have received prolonged courses of antimicrobial therapy are also at risk. Surveillance, identification of high risk patients, new and better ways of prevention and decontamination as well as consistent and professional implementation of standing procedures will be at the core of curtailing the spread of these diseases from within the hospital doors. |
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The Source :
It is proven that the majority, as much as 80% of nosocomial infections are caused by the microbial flora that patients bring with them upon admission to the hospital. This "stay-at-home" flora appears to be opportunistic to the new environment and is able to take advantage of new routes that medical procedures offer.
Other nosocomial infections, i.e. around 20%, develop following contamination with microbial organisms found within the hospital environment. Person-to-person spread of infections in the health care setting can occur via direct contact, droplet, airborne, fecal-oral, and blood-borne routes. |
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| The Risk Factors : |
1.The increase in occurrence of nosocomial infection rates can be best summed up by three major contributing factors. The first is the overuse of antimicrobials. Antimicrobial resistance is becoming a factor in virtually all hospital-acquired (nosocomial) infections. Many physicians are concerned that several bacterial infections soon may be untreatable.
Increased concern about infections in the 1970's to 1980's led to the increased use of antibiotics, especially cephalosporins. As organisms became resistant to earlier generations of cephalosporin antibiotics, newer generations were developed. Widespread use of cephalosporin antibiotics is often cited as a cause for the emergence of enterococci as nosocomial pathogens. At the same time, MRSA (methicillin-resistant Staphylococcus aureus), perhaps also in response to extensive use of cephalosporin antibiotics, became a major nosocomial threat. This led to the overuse of vancomycin, partly in response to concerns about MRSA and for treatment of vascular catheter associated infections by organisms such as the resistant coagulase-negative staphylococci. Now medical institutions are faced with a resident flora of "super-bugs", resistant to the most aggressive antimicrobial therapies. Fungal pathogens account for a growing proportion of nosocomial infections. Fungal diseases such as candidiasis and Pneumocystis carinii pneumonia are common among AIDS patients, and isolated outbreaks of other fungal diseases in people with normal immune systems have occurred recently. Scientists and clinicians are concerned that the increasing use of antifungal drugs will lead to drug-resistant fungi. In fact, recent studies have documented resistance of Candida species to fluconazole, a drug used widely to treat patients with systemic fungal diseases. An extended stay in an acute or chronic care facility is also a risk factor for acquisition of antibiotic-resistant pathogens because patients may acquire the microorganisms that eventually lead to nosocomial infection from that environment
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2. A second contributing factor is that many hospital personnel fail to follow basic infection control procedures such as hand washing between patient contacts. In ICUs, emergency rooms, urgent care clinics and other areas asepsis is often overlooked in the rush of crisis care. Finally, patients in hospitals are becoming increasingly immunocompromised. The great migration of surgical and specialty care to outpatient centers leaves the very sickest patients in hospitals, which are becoming more and more like large ICUs. This shift has led to a greater prevalence of vascular access-associated bloodstream infections and ventilator-associated pneumonias. |
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3. One last factor posses a problem of potential concern: as hospitals age, repairs and renovations release dust and spores into the air during demolition and construction, which may cause fungal disease. Illness due to other pathogens, such as Legionella pneumophilia and toxic molds, may also result from such disruptions. |
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The Prevention :
Healthcare professionals who care for infected patients also are at risk for acquiring infection. This is especially true of easily transmitted respiratory infections and for personnel who handle contaminated blood products.
Methods of prevention of Nosocomial infections mentioned in various sources includes those listed below.
Changes to hospital staff activities :
• Hand washing - especially between attending different patients
• Avoiding hand contact to eyes or oral area
• Hospital staff education
Changes to the patient environment :
• Isolation of patient
• Education of visitors - to avoid certain types of touching, wash hands, etc.
• Discouragement of ill visitors
Changes to hospital environment :
• Sterilization of equipment
• Air filtration systems
Vaccination - use of certain vaccines may be appropriate for some patients.
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The Types :
Types list : The list of types of Nosocomial infections mentioned in various sources includes:
Nosocomial infections by site :
• Urinary tract infections
• Surgical site infections
• Respiratory tract infections
• Blood stream infections
• Skin infections
• Gastrointestinal tract infections
• Central nervous system infections
Nosocomial fungal infections - fungi cause about 9% of nosocomial infections :
• Candida
• Candida albicans
• Aspergillus
• Fusarium
• Trichosporon
• Malassezia
Nosocomial pneumonia :
• Bacterial pneumonia
• Legionnaires' disease
• Pulmonary aspergillosis
• Mycobacterium tuberculosis
• Viral pneumonias
• Respiratory Syncytial Virus
• Influenza
Nosocomial infections by pathogen :
• Staphylococci
• Pseudomonas
• Escherichia coli
Antibiotic-resistant Nosocomial infections :
• Methicillin resistant staphylococcus aureus (MRSA)
• Vancomycin-resistant staphylococcus aureus
• Vancomycin-resistant enterococci (VRE) |
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