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APPLIED MICROBIOLOGY

Nosocomial Infections

By virtue of definition Nosocomial infections are the infections which develop during hospitalization and
were not incubating or present at the time of admission to the hospital. The source of causative infecting
organism may be exogenous-from another patient or a member of hospital staff or from the inanimate
environment in the hospital. It may be endogenous from the patient's own flora which at the time of
infection may invade the patient's tissues spontaneously or be introduced into them by surgical
operation, instrumental manipulations and nursing procedures
The source of causative infecting organism may be exogenous-from another patient or a member of
hospital staff or from the inanimate environment in the hospital. It may be endogenous- from the
patient's own flora which at the time of infection may invade the patient's tissues spontaneously or be
introduced into them by surgical operation, instrumental manipulations and nursing procedures.

Predisposing Factors for Nosocomial infections:

• Hospital environment is heavily laden with a variety of pathogens. Organisms present in air, dust,
antiseptic lotion, water and food or may spread from shedding from the patients.
• Hospital microbial flora is usually multi-drug resistant. Patients have impaired defence mechanism
due to: Disease therapy and investigations in the hospital.
• Instrumentation in hospitals may introduce infection.
• Blood, blood products and intravenous fluids may transmit many infections.
• Accidental inoculation of infectious material

Modes of Spread:
Various modes of spread of Nosocomial infections are:
a. Airborne
b. Infection by contact
c. Infections acquired from food.
d. Infections associated with water.
e. From hospital equipment
f. Infections by inoculation.
Common Types of Hospital Infections Include:

a. Wound infections
b. Urinary tract infections
c. Respiratory infections
d. Skin infections
e. Bacteraemia and septicaemia
f. Gastrointestinal infections.

Organisms causing nosocomial infections:

Gram-positive: Gram-negative:

Staphylococcus aureus Klebsiella


Streptococcus pyogenes Serratia
Staphylococcus epidermidis Enterobacter
Streptococcus pneumoniae Proteus
Clostridium difficile Pseudomonas
Clostridium perfringens Legionella
Clostridium tetani Escherichia coli
Citrobacter

Viruses: Fungi:

Hepatitis B Aspergillus
Hepatitis C Candida albicans
Hepatitis D
HIV
Herpes viruses Parasites:
Cytomegalovirus Toxoplasma gondii
Influenza virus Entamoeba
Enteroviruses histolytica
SARS Co V Pneumocystis jiroveci
(earlier known as P.
carinii)

Role of microbiology laboratory in prevention and control of Nosocomial infections


include:

a. Working with other hospital personnel in infection control activities


b. Accurately identifying organisms responsible for nosocomial infection
c. Timely reporting of laboratory data relevant to infection control
d. Supporting investigation of specific hospital infection
e. Conducting studies of hospital personnel or environment.

Diagnosis of Hospital Infection:


Aetiological diagnosis is made by routine diagnostic procedures depending upon the suspected
pathogens. Outbreak situation should be dealt with as rapidly as possible. Investigations of an outbreak
of nosocomial infection may require isolation and identification of isolates not only in specimens from
patients but also in those taken from personnel who might be colonized with the outbreak strain and from
environmental objects implicated by epidemiological investigation. The cultures may have to be made
from blood products, transfusion fluids, and intravascular therapy equipment, from tubes, containers,
surfaces, disinfectants, antiseptics, cultures from floor and equipment and water, ice and other food
articles. Use of selective media may be made to reduce the workload in the laboratory. Nosocomial
pathogens isolated should be stored for future reference.
Environmental or employee surveys are not recommended. Monitoring of sterilization and periodical
sampling of disinfected equipment is recommended. Carriers (e.g. typhoid carriers) should be detected
and suitably treated.

Prevention of nosocomial infections

• Hand washing
• Intelligent use of instrumentation
• Limitation of use of antibiotics
• Prophylactic antibiotics in specific situations for short periods Limitations of transfusions
• Barrier precautions
• Surveillance
• Frequent change of intravenous lines

Blood Transfusion associated Infections are caused by:

Parasites: Bacteria:
Plasmodium vivax, P. falciparum Treponema pallidum, Brucella
P. malariae, P. ovale abortus, Proteus species
Toxoplasma gondii Esch. Coli, Klebsiella species
Trypanosoma cruzi Micrococcus, Enterobacter
Wuchereria bancrofti Salmonella cholerasuis,
Brugia malayi, Loa loa Pseudomonas species, Staph.
Leishmania donovani, B. microti Epidermidis, R. rickettsii

Viruses: Fungi:
Hepatitis B virus, Hepatitis C virus Aspergillus
Hepatitis D virus, HIV 1 and 2
HTLV I & II, Hepatitis A virus Penicillium
Cytomegalovirus, Epstein-Barr virus
Parvovirus, Ebola virus, Hormodendrum
Lassa virus,Yellow fever virus
Dengue virus