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NOSOCOMIAL

INFECTION
Aryan Morita
Biomedika KG

Nosocomial Infection
Infections appearing in conection with in both: in and
out patients stay in hospital.
They are also known as a hospital-acquired infection.
They may occur either during or after hospitalization
(48 hours or more after hospital admission or within 30
days after discharge).
Result of treatment in a hospital or hospital-like setting,
but secondary to the patients original condition.
One third of n.i. are considered preventable.

A ratio of 5 to 19% hospitalized patients


are infected, and up to 30% in intensive
care units.
The patients must stay in the hospital 4-5
additional days.
Prevalence of nosocomial infections in
CR:
1 2% reported cases, 4 7% by target
monitoring, but: in intensive care units:
18%, in urology dep.: 10 40%.

Type of Nosocomial
Infection

Non Spesific Nosocomial


Infection
infections common among the
normal population (respiratory
diseases, children exanthematic
diseases, alimentary infections, etc.)
they follow a current regional
epidemiological situation
they do not need specific preventive
arrangements

Spesific Nosocomial
Infection
Resulting from diagnostical or
therapeutical procedures (eg.
inoculation or implantation the agens into
host organism).
Caused by :
*

due to lack of personal hygiene of staff,

wrong therapeutic technique,

unsuitable
arrangement

working

and

building

Source of Nosocomial
Infection

Endogenous Nosocomial
Infection
decreased defence mechanisms as an
occasional result of contemporary
treatment or illness.
penetration of normally nonpathogenic
organisms into the susceptible tissues:
blood, peritoneal cavity, cerebrospinal
fluid, joints cavities, etc.
Many medical procedures bypass the
bodys natural protective barriers.

Pathological Agents
Fungi
Parasites
Viruses
Bacteria

Bacteria
Commensal bacteria
found in the normal flora of healthy people.
These have a significant protective role by
preventing colonization by pathogenic
microorganisms.
Some commensal bacteria may cause
infection if the natural host is compromised.
Staphylococcus epidermidis (cause of i.v.
infections), Escherichia coli (cause of
urinary infections).

Pathogenic bacteria
they have greater virulence, and cause
infections (sporadic or epidemic) regardless of
host status
Gram positive: Staphylococus aureus
cutaneous bacteria that colonize the skin, nose
and throat of patients and hospital staff. They
cause a wide variety of lung, bone, heart and
bloodstream infections and are frequently
resistant to antibiotics.
In hospitals commonly 40-50% of S. aureus
isolates are MRSA.

Streptococci: Streptococcus betahemolyticus,


Streptococcus Pyogenes.
Anaerobic Gram-positive rods (e.g.
Clostridium) cause gangrene.

Gramnegative bacteria:
Enterobacteriaceae (e.g. E. coli, Proteus, Klebsiella,
Enterobacter, Serratia marcescens) may colonize
sites when the host defences are compromised.
They may also be highly antibiotic resistant.
Pseudomonas spp. Are often isolated in water and
damp areas. They may colonize the digestive tract
of hospitalized patients.
Legionella species may cause pneumonia
(sporadic or endemic) through inhalation of
aerosols containing contaminated water (air
conditioning, showers, therapeutic aerosols).

Viruses
There is the possibility of nosocomial
transmission of hepatitis B and C viruses
(transfusions, dialysis, injections, endoscopy),
respiratory syncytial virus (RSV), rotavirus,
and enteroviruses (transmitted by hand-tomouth contact and via the fecal-oral route).
Other viruses such as cytomegalovirus , HIV,
Ebola, influenza viruses, herpes simplex
virus, and varicella-zoster virus, may also be
transmitted.

Fungi and Parasites


Many of them are opportunistic organisms
and cause infections during extended
antibiotic treatment and severe
immunosuppression (Candida albigans,
Aspergillus spp., Cryptococcus
neoformans, Cryptosporidium,
Pneumocystis carini, Toxoplasma
pneumoniae).
Sarcoptes scabies (scabies) is an
ectoparasite outbreaks in health care
facilities.

Elements
transmission

Source
Human sources: patients, medical
staff, visitors
Human sources may include
- persons with acute disease,
- persons in the incubation period
of a disease,
- persons who are chronic carriers of
an infectious agent.

Transmission
Common vehicle
Airborne
Droplet
Contact
Vectorborne

Contact Transmission
direct-contact transmission involves a direct
body surface-to-body surface contact and
physical transfer of microorganisms between a
susceptible host and an infected or colonized
person (during various patient-care activities
that require direct personal contact)
indirect-contact transmission involves contact
of susceptible host with a contaminated
instruments, needles, or dressings, or
contaminated hands of hospital staff

Droplet Transmission
during coughing, sneezing, and
talking, and during performance of
certain procedures (suctioning,
bronchoscopy)
on the hosts conjunctivae, nasal
mucosa, or mouth

Airborne Transmission
occurs by dissemination of either airborne
droplet nuclei
small particles (equal or smaller 5 m) of
evaporated droplets containing
microorganisms that remain suspended in
the air for long periods of time)
dust particles containing the infectious
agents.
Such particles are dispread widely
Prevention of airborne transmission special air handling and ventilation

Vehicle Transmission
by contaminated items such as food,
water, medications, devices,
equipment

Vectorborne
Transmission
occurs when vectors such as
mosquitoes, flies or rats transmit
microorganisms

Predisposition Factors
Poor state
Acute
Invasive
Patients
disease
device
treatment
of health

Preventive Measures
proper means of disinfection and sterilisation
(physical, chemical and biological tests)
disposable instruments (cost/effectiveness!)
separation or/and exclusion of suspect sources
(patients, visitors)
strict rules in handling the bedclothes, meals and
hospital wastes,
hospital committee for nosocomial infections
evidence, surveillance
omitting of washing the hands between the
contact with two different patients

MRSA

MRSA
Typically associated with nosocomial
infection
Chronically ill patients with multiple
courses of antibiotics
Increasing incidence in hospitalized
patients
Typically multidrug resistant

Types of MRSA Infections


Community aquired

Community Aquired
MRSA
commonly causes skin and soft tissue
infections, frequently in young and otherwise
health individuals
The most affected population groups are those
in a close person-to-person contact
environment and poor hygienic conditions:
homeless people, prisoners, military personnel,
athletes, and day care nurseries
Young age, diabetics, immunocompromised
individuals, eczema and similar skin disorders
are additional risk factors

Hospital Aquired MRSA


- usually causes bacteraemia and systemic
infection in older and ill patients
- The percentage of healthy individuals
colonised by S. aureus is about 25-50 %,
with higher numbers in risk groups such
as diabetics, HIV-infected, patients on
dialysis, patients with skin problems,
immunocompromised patients
(neutropenic), and the critically ill

Prevention of MRSA
primary
secondary
tertiary

Handwash Procedures

THANK YOU