Infections caught in the hospital

A nosocomial infection is contracted because of an infection or toxin that exists in a certain

location, such as a hospital. People now use nosocomial infections interchangeably with the
terms health-care associated infections (HAIs) and hospital-acquired infections. For a HAI, the
infection must not be present before someone has been under medical care.

One of the most common wards where HAIs occur is the intensive care unit (ICU), where
doctors treat serious diseases. About 1 in 10 of the people admitted to a hospital will contract a
HAI. Theyre also associated with significant morbidity, mortality, and hospital costs.
As medical care becomes more complex and antibiotic resistance increases, the cases of HAIs
will grow. The good news is that HAIs can be prevented in a lot of healthcare situations. Read on
to learn more about HAIs and what they may mean for you.

What are symptoms of nosocomial infections?

For a HAI, the infection must occur:

up to 48 hours after hospital admission

up to 3 days after discharge
up to 30 days after an operation
in a healthcare facility when someone was admitted for reasons other than the infection
Symptoms of HAIs will vary by type. The most common types of HAIs are:

urinary tract infections (UTIs)

surgical site infections
gastroenteritis
 meningitis
pneumonia
The symptoms for these infections may include:

discharge from a wound

fever
cough, shortness of breathing
burning with urination or difficulty urinating
headache
nausea, vomiting, diarrhea
People who develop new symptoms during their stay may also experience pain and irritation at
the infection site. Many will experience visible symptoms.

What causes nosocomial infections?

Bacteria, fungus, and viruses can cause HAIs. Bacteria alone cause about 90 percent of these
cases. Many people have compromised immune systems during their hospital stay, so theyre
more likely to contract an infection. Some of the common bacteria that are responsible for HAIs
are:
Bacteria Infection type

Staphylococcus aureus (S. aureus) blood

Escherichia coli (E. coli) UTI

Enterococci blood, UTI, wound

Pseudomonas aeruginosa (P. aeruginosa) kidney, UTI, respiratory

Of the HAIs, P. aeruginosa accounts for 11 percent and has a high mortality and morbidity rate.

Bacteria, fungi, and viruses spread mainly through person-to-person contact. This includes
unclean hands, and medical instruments such as catheters, respiratory machines, and other
 hospital tools. HAI cases also increase when theres excessive and improper use of antibiotics.
This can lead to bacteria that are resistant to multiple antibiotics.

Part 4 of 9

Who is at risk for nosocomial infections?

Anyone admitted to a healthcare facility is at risk for contracting a HAI. For some bacteria, your
risks may also depend on:

your hospital roommate

age, especially if youre more than 70 years old
how long youve been using antibiotics
whether or not you have a urinary catheter
prolonged ICU stay
if youve been in a coma
if youve experienced shock
any trauma youve experienced
your compromised immune system
Your risk also increases if youre admitted to the ICU. The chance of contracting a HAI in
pediatric ICUs is 6.1 to 29.6 percent. A study found that nearly 11 percent of roughly 300 people
who underwent operations contracted a HAI. Contaminated areas can increase your risk for HAIs
by almost 10 percent.
HAIs are also more common in developing countries. Studies show that five to 10 percent of
hospitalizations in Europe and North America result in HAIs. In areas such as Latin America,
Sub-Saharan Africa, and Asia, its more than 40 percent.

Part 5 of 9

How are nosocomial infections diagnosed?

Many doctors can diagnose a HAI by sight and symptoms alone. Inflammation and/or a rash at
the site of infection can also be an indication. Infections prior to your stay that become
complicated dont count as HAIs. But you should still tell your doctor if any new symptoms
appear during your stay.

You also may be required to talk a blood and urine test as to identify the infection.

Part 6 of 9

How are nosocomial infections treated?

Treatments for these infections depend on the infection type. Your doctor will likely recommend
antibiotics and bed rest. Also, theyll remove any foreign devices such as catheters as soon as
medically appropriate.

To encourage a natural healing process and prevent dehydration, your doctor will encourage a
healthy diet, fluid intake, and rest.

Part 7 of 9

What is the outlook for nosocomial infections?

Early detection and treatment are vital for HAIs. Many people are able to make a full recovery
with treatment. But people who get HAIs usually spend 2.5 times longer in the hospital.
In some cases, a HAI can seriously increase your risk for life-threatening situations. The Centers
for Disease Control and Prevention (CDC) estimate that around 2 million people contract HAIs.
About 100,000 of those cases result in death.
Part 8 of 9

Preventing nosocomial infections

 The responsibility of HAI prevention is with the healthcare facility. Hospitals and healthcare
staff should follow the recommended guidelines for sterilization and disinfection. Taking steps to
prevent HAIs can decrease your risk of contracting them by 70 percent or more. However, due to
the nature of healthcare facilities, its impossible to eliminate 100 percent of nosocomial
infections.
Some general measures for infection control include:

Screening the ICU to see if people with HIAs need to be isolated.

Identifying the type of isolation needed, which can help to protect others or reduce
chances of further infection.
Observing hand hygiene, which involves washing hands before and after touching people
in the hospital.
Wearing appropriate gear, including gloves, gowns, and face protection.
Cleaning surfaces properly, with recommended frequency.
Making sure rooms are well ventilated.
To reduce the risk of UTIs, your healthcare provider can:

Follow the aseptic insertion technique to minimize infection.

Insert catheters only when needed and remove when no longer needed.
Change catheters or bags only when medically indicated.
Make sure the urinary catheter is secured above the thigh and hanging below the bladder
for unobstructed urine flow.
Keep a closed drainage system.
Talk to your doctor about any concerns you have during a procedure.

Part 9 of 9

Takeaway
Nosocomial infections, or healthcare associated infections occur when a person develops an
infection during their time at a healthcare facility. Infections that appear after your hospital stay
must meet certain criteria in order for it to qualify as a HAI.
If new symptoms appear within 48 hours of admission, three days after discharge, or 30 days
after an operation, talk to your doctor. New inflammation, discharge, or diarrhea could be a
symptom of a HAI. Visit the CDC website to see what your states healthcare facilities do to
prevent HAIs.

Prevention of hospital-acquired infections A practical guide 2nd edition, WHO World

Health Organization Department of Communicable Disease, Surveillance and
Response, 2002

Anosocomial infection also called hospitalacquired infection can be defined as:

An infection acquired in hospital by a patient who was admitted for a reason other
than that infection (1). An infection occurring in a patient in a hospital or other
health care facility in whom the infection was not present or incubating at the time
of admission. This includes infections acquired in the hospital but appearing after
discharge, and also occupational infections among staff of the facility (2). Patient
care is provided in facilities which range from highly equipped clinics and
technologically advanced university hospitals to front-line units with only basic
facilities. Despite progress in public health and hospital care, infections continue to
develop in hospitalized patients, and may also affect hospital staff. Many factors
promote infection among hospitalized patients: decreased immunity among
patients; the increasing variety of medical procedures and invasive techniques
creating potential routes of infection; and the transmission of drug-resistant
bacteria among crowded hospital populations, where poor infection control practices
may facilitate transmission.
Factors influencing the development of nosocomial infections

The microbial agent, Patient susceptibility, Environmental factors, Bacterial

resistance

Nosocomial infections are widespread. They are important contributors to morbidity

and mortality. They will become even more important as a public health problem
with increasing economic and human impact because of: Increasing numbers and
crowding of people. More frequent impaired immunity (age, illness, treatments).
New microorganisms. Increasing bacterial resistance to antibiotics (13).
TABLE 1. Simplified criteria for
surveillance of
nosocomial infections
Type of nosocomial Simplified criteria
infection
Surgical site infection Any purulent
discharge, abscess, or
spreading cellulitis at the surgical
site during the month after the
operation
Urinary infection Positive urine culture
(1 or 2 species) with at least
105
bacteria/ml, with or without
clinical symptoms
Respiratory infection Respiratory
symptoms with at
least two of the following signs
appearing during hospitalization:
cough
purulent sputum
new infiltrate on chest
radiograph consistent with
infection
Vascular catheter Inflammation,
lymphangitis or
infection purulent discharge at the
insertion
Role of the hospital pharmacist

The hospital pharmacist is responsible for: obtaining, storing and distributing

pharmaceutical preparations using practices which limit potential transmission of
infectious agents to patients
 dispensing anti-infectious drugs and maintaining relevant records (potency,
incompatibility, conditions of storage and deterioration)

obtaining and storing vaccines or sera, and making them available as appropriate

maintaining records of antibiotics distributed to the medical departments

providing the Antimicrobial Use Committee and Infection Control Committee with
summary reports and trends of antimicrobial use

having available the following information on disinfectants, antiseptics and other

anti-infectious agents: active properties in relation to concentration, temperature,
length of action, antibiotic spectrum toxic properties including sensitization or
irritation of the skin and mucosa substances that are incompatible with
antibiotics or reduce their potency physical conditions which unfavourably affect
potency during storage: temperature, light, humidity harmful effects on
materials. The hospital pharmacist may also participate in the hospital sterilization
and disinfection practices through: participation in development of guidelines for
antiseptics, disinfectants, and products used for washing and disinfecting the hands
participation in guideline development for reuse of equipment and patient
materials participation in quality control of techniques used to sterilize equipment
in the hospital including selection of sterilization equipment (type of appliances) and
monitoring.

Peran apoteker rumah sakit

mengadakan, menyimpan dan mendistribusikan sediaan farmasi menggunakan
praktek farmasi yg baik dgn membatasi potensi penularan agen infeksi kepada
pasien
dispensing obat anti-infeksi dan membuat catatan yang relevan (potensi,
inkompatibilitas, kondisi penyimpanan dan pencegahan kerusakan)
mengadakan dan menyimpan vaksin atau sera, dan selalu menjaga
ketersedianya.
Membuat catatan antibiotik yg didistribusikan ke masing masing departemen
Membuat Komite Penggunaan antimikroba dan Komite Pengendalian Infeksi serta
membuat laporan ringkasan dan tren penggunaan antimikroba
 Memiliki informasi lengkap yg berhubungan dengan desinfektan, antiseptik dan
agen anti-infeksi lainya berupa :
- sifat aktif dalam kaitannya dengan konsentrasi, suhu, lama tindakan,
spektrum antibiotik
- sifat toksik termasuk yg menyebabkan sensitisasi atau iritasi pada kulit dan
mukosa
- zat yang tidak kompatibel dengan antibiotik atau mengurangi potensi
mereka
- kondisi penyimpanan yg mempengaruhi potensi : suhu, cahaya,
kelembaban
- efek berbahaya dari bahan.

Apoteker juga dapat berpartisipasi dalam sterilisasi rumah sakit dan praktek
desinfeksi melalui:
partisipasi dalam pengembangan pedoman untuk antiseptik, desinfektan, dan
produk yang digunakan untuk mencuci dan Alcuta
Berpartisipasi dalam membuat guideline penanganan alat yg reuse untuk pasien
Berpartisipasi dalam kontrol kualitas yang digunakan untuk mensterilkan
peralatan di rumah sakit termasuk pemilihan peralatan sterilisasi (jenis peralatan)
dan monitoring.

Transmission[edit]
Indwelling catheters have recently been identified with hospital acquired infections. Procedures
using Intravascular Antimicrobial Lock Therapy can reduce infections that are unexposed to blood-
borne antibiotics. Introducing antibiotics, including ethanol, into the catheter (without flushing it into
the bloodstream) reduces the formation of biofilms.[1]

Main routes of transmission

Route Description

Contact Cara penularan yg paling berbahaya dan paling sering adalah melalui kontak
transmission langsung

Penularan terjadi ketika droplets yang mengandung mikroba dari

orang yang terinfeksi terciprat melalui udara dan disimpan pada
Droplet tubuh objek; droplets biasanya bersumber dari orang yg batuk,
transmission bersin, dan berbicara, dan selama pelaksanaan prosedur tertentu,
seperti bronkoskopi.

Airborne Penyebaran dapat berasal dari droplet diudara {5 m or smaller in size} yg

transmission menguap yang mengandung mikroorganisme yang tetap tersuspensi di udara
untuk jangka waktu yang lama) atau partikel debu yang mengandung agen
infeksi. Mikroorganisme dengan cara ini dapat tersebar secara luas oleh arus
udara dan bisa menjadi terhirup oleh host yang rentan dalam ruangan yang
 sama atau pada jarak lebih jauh dari pasien sumber, tergantung pada faktor-
faktor lingkungan; Oleh karena itu, sirkulasi udara dan ventilasi diperlukan untuk
mencegah penularan melalui udara. Mikroorganisme yang ditularkan oleh
transmisi udara termasuk Legionella, Mycobacterium tuberculosis dan rubeola
dan varicella virus.

Common Cara ini berlaku untuk mikroorganisme ditransmisikan ke host oleh barang-
vehicle barang yang terkontaminasi, seperti makanan, air, obat-obatan, perangkat, dan
transmission peralatan.

Vector borne Cara ini terjadi disebabkan vektor seperti nyamuk, lalat, tikus, dan serangga
transmission pengirim lainnya.

Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact
transmission.

Routes of contact transmitssion

Route Description

This involves a direct body surface-to-body surface contact and physical transfer
of microorganisms between a susceptible host and an infected or colonized
Direct-contact person, such as when a person turns a patient, gives a patient a bath, or
transmission performs other patient-care activities that require direct personal contact. Direct-
contact transmission also can occur between two patients, with one serving as
the source of the infectious microorganisms and the other as a susceptible host.

This involves contact of a susceptible host with a contaminated intermediate

object, usually inanimate, such as contaminated instruments, needles, or
Indirect-contact dressings, or contaminated gloves that are not changed between patients. In
transmission addition, the improper use of saline flush syringes, vials, and bags has been
implicated in disease transmission in the US, even when healthcare workers had
access to gloves, disposable needles, intravenous devices, and flushes. [2]

Prevention[edit]
Controlling nosocomial infection is to implement QA/QC measures to the health care sectors, and
evidence-based management can be a feasible approach. For those with ventilator-associated or
hospital-acquired pneumonia, controlling and monitoring hospital indoor air quality needs to be on
agenda in management,[3] whereas for nosocomial rotavirus infection, a hand hygiene protocol has to
be enforced.[4][5][6]
To reduce HAIs, the state of Maryland implemented the Maryland Hospital-Acquired Conditions
Program that provides financial rewards and penalties for individual hospitals based on their ability to
avoid HAIs. An adaptation of the Centers for Medicare & Medicaid Services payment policy causes
poor-performing hospitals to lose up to 3% of their inpatient revenues, whereas hospitals that are
able to avoid HAIs can earn up to 3% in rewards. During the programs first 2 years, complication
rates fell by 15.26 percent across all hospital-acquired conditions tracked by the state (including
those not covered by the program), from a risk-adjusted complication rate of 2.38 per 1,000 people
in 2009 to a rate of 2.02 in 2011. The 15.26-percent decline translates into more than $100 million in
cost savings for the health care system in Maryland, with the largest savings coming from avoidance
of urinary tract infections, septicemia and other severe infections, and pneumonia and other lung
infections. If similar results could be achieved nationwide, the Medicare program would save an
estimated $1.3 billion over 2 years, while the health care system as a whole would save $5.3 billion. [7]
Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and other
preventive measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel
before and after each patient contact is one of the most effective ways to combat nosocomial
infections.[8] More careful use of antimicrobial agents, such as antibiotics, is also considered vital.[9]
Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore,
patients are often prescribed antibiotics and other antimicrobial drugs to help treat illness; this may
increase the selection pressure for the emergence of resistant strains.[citation needed]

Upaya pencegahan INOS maka hendaknya Rumah sakit memiliki

protokol sanitasi
mengenai seragam,
peralatan sterilisasi,
mencuci, dan
tindakan pencegahan lainnya.

mencuci tangan dengan teliti dan / atau penggunaan alkohol

menggosok oleh semua tenaga medis sebelum dan setelah kontak
dengan pasien merupakan salah satu cara yang paling efektif untuk
memerangi infeksi nosokomial. [8] Penggunaan lebih berhati-hati
dari agen antimikroba, seperti antibiotik, juga dianggap penting. [9]
Meskipun protokol sanitasi, pasien tidak bisa sepenuhnya
terisolasi dari agen infeksi. Selain itu, pasien sering diresepkan
antibiotik dan obat antimikroba lainnya untuk membantu mengobati
penyakit; ini dapat meningkatkan tekanan seleksi bagi munculnya
strain resisten

Sterilization[edit]
Sterilization goes further than just sanitizing. It kills all microorganisms on equipment and surfaces
through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure. [citation needed]

Isolation[edit]
Main article: Isolation (health care)
Isolation is the implementation of isolating precautions designed to prevent transmission of
microorganisms by common routes in hospitals. (See Universal precautions and Transmission-
based precautions.) Because agent and host factors are more difficult to control, interruption of
transfer of microorganisms is directed primarily at transmission for example isolation of infectious
cases in special hospitals and isolation of patient with infected wounds in special rooms also
isolation of joint transplantation patients on specific rooms.

Handwashing[edit]
Handwashing frequently is called the single most important measure to reduce the risks of
transmitting skin microorganisms from one person to another or from one site to another on the
same patient. Washing hands as promptly and thoroughly as possible between patient contacts and
after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated
by them is an important component of infection control and isolation precautions. The spread of
nosocomial infections, among immunocompromised patients is connected with health care workers'
hand contamination in almost 40% of cases, and is a challenging problem in the modern hospitals.
The best way for workers to overcome this problem is conducting correct hand-hygiene procedures;
this is why the WHO launched in 2005 the GLOBAL Patient Safety Challenge. [10] Two categories of
micro-organisms can be present on health care workers' hands: transient flora and resident flora.
The first is represented by the micro-organisms taken by workers from the environment, and the
bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group
is represented by the permanent micro-organisms living on the skin surface (on the stratum corneum
or immediately under it). They are capable of surviving on the human skin and to grow freely on it.
They have low pathogenicity and infection rate, and they create a kind of protection from the
colonization from other more pathogenic bacteria. The skin of workers is colonized by 3.9 x 10 4 4.6
x 106 cfu/cm2. The microbes comprising the resident flora are: Staphylococcus epidermidis, S.
hominis, and Microccocus, Propionibacterium, Corynebacterium, Dermobacterium,
and Pitosporum spp., while in transient organisms are S. aureus, and Klebsiella pneumoniae,
and Acinetobacter, Enterobacter and Candida spp. The goal of hand hygiene is to eliminate the
transient flora with a careful and proper performance of hand washing, using different kinds of soap,
(normal and antiseptic), and alcohol-based gels. The main problems found in the practice of hand
hygiene is connected with the lack of available sinks and time-consuming performance of hand
washing. An easy way to resolve this problem could be the use of alcohol-based hand rubs, because
of faster application compared to correct hand-washing. [11]
All visitors must follow the same procedures as hospital staff to adequately control the spread of
infections. Moreover, multidrug-resistant infections can leave the hospital and become part of the
community flora if steps are not taken to stop this transmission.
It is unclear whether or not nail polish or rings affected surgical wound infection rates. [12]

Gloves[edit]
In addition to hand washing, gloves play an important role in reducing the risks of transmission of
microorganisms. Gloves are worn for three important reasons in hospitals. First, they are worn to
provide a protective barrier for personnel, preventing large scale contamination of the hands when
touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. In the
United States, the Occupational Safety and Health Administration has mandated wearing gloves to
reduce the risk of bloodborne pathogen infections.[13] Second, gloves are worn to reduce the
likelihood that microorganisms present on the hands of personnel will be transmitted to patients
during invasive or other patient-care procedures that involve touching a patient's mucous
membranes and nonintact skin. Third, they are worn to reduce the likelihood that the hands of
personnel contaminated with micro-organisms from a patient or a fomite can transmit those micro-
organisms to another patient. In this situation, gloves must be changed between patient contacts,
and hands should be washed after gloves are removed.
Wearing gloves does not replace the need for handwashing, because gloves may have small,
undtectable defects or may be torn during use, and hands can become contaminated during removal
of gloves. Failure to change gloves between patient contacts is an infection control hazard. [citation needed]

Surface sanitation[edit]
Sanitizing surfaces is part of nosocomial infection in health care environments. Modern sanitizing
methods such as Non-flammable Alcohol Vapor in Carbon Dioxide systems have been effective
against gastroenteritis, MRSA, and influenza agents. Use of hydrogen peroxide vapor has been
clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective
against endospore-forming bacteria, such as Clostridium difficile, where alcohol has been shown to
be ineffective.[14][non-primary source needed]Ultraviolet cleaning devices may also be used to disinfect the rooms of
patients infected with Clostridium difficile after discharge.[15][non-primary source needed]

Antimicrobial surfaces[edit]
Micro-organisms are known to survive on inanimate touch surfaces for extended periods of time.
[16]
This can be especially troublesome in hospital environments where patients
with immunodeficiencies are at enhanced risk for contracting nosocomial infections.
Touch surfaces commonly found in hospital rooms, such as bed rails, call buttons, touch plates,
chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper
towel, soap), dressing trolleys, and counter and table tops are known to be contaminated
with Staphylococcus, MRSA (one of the most virulent strains of antibiotic-resistant bacteria)
and vancomycin-resistant Enterococcus (VRE).[17] Objects in closest proximity to patients have the
highest levels of MRSA and VRE. This is why touch surfaces in hospital rooms can serve as
sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to
patients.
A number of compounds can decrease the risk of bacteria growing on surfaces
including: copper, silver, and germicides.[18]

Treatment[edit]
Among the categories of bacteria most known to infect patients are the category MRSA (resistant
strain of S. aureus), member of gram-positive bacteria and Acinetobacter (A. baumannii), which
is gram-negative. While antibiotic drugs to treat diseases caused by gram-positive MRSA are
available, few effective drugs are available for Acinetobacter. Acinetobacter bacteria are evolving
and becoming immune to existing antibiotics, so in many cases, polymyxin-type antibacterials need
to be used. "In many respects its far worse than MRSA," said a specialist at Case Western Reserve
University.[19]
Another growing disease, especially prevalent in New York City hospitals, is the drug-resistant,
gram-negative Klebsiella pneumoniae. An estimated more than 20% of the Klebsiella infections
in Brooklyn hospitals "are now resistant to virtually all modern antibiotics, and those supergerms are
now spreading worldwide."[19]
The bacteria, classified as gram-negative because of their reaction to the Gram stain test, can cause
severe pneumonia and infections of the urinary tract, bloodstream, and other parts of the body. Their
cell structures make them more difficult to attack with antibiotics than gram-positive organisms like
MRSA. In some cases, antibiotic resistance is spreading to gram-negative bacteria that can infect
people outside the hospital. "For gram-positives we need better drugs; for gram-negatives we need
any drugs," said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-UCLA Medical
Center, and the author of Rising Plague, a book about drug-resistant pathogens.[19]
One-third of nosocomial infections are considered preventable. The CDC estimates 2 million people
in the United States are infected annually by hospital-acquired infections, resulting in 20,000 deaths.
[20]
The most common nosocomial infections are of the urinary tract, surgical site and
various pneumonias.[21]