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Patient may acquire infection before admission to the
hospital = Community acquired infection.
Patient may get infected inside the hospital =
Nosocomial infection.
!t includes infections
not present nor incubating at admission,
infections that appear more than 48 hours after admission,
those acquired in the hospital but appear after discharge
also occupational infections among staff.
The risk of infection is always present.
INFECTION
Definition: !njurious contamination of body or parts
of the body by bacteria, viruses, fungi, protozoa and
rickettsia or by the toxin that they may produce.
!nfection may be local or generalized and spread
throughout the body.
Once the infectious agent enters the host it begins
to proliferate and reacts with the defense
mechanisms of the body producing infection
symptoms and signs: pain, swelling, redness,
functional disorders, rise in temperature and pulse
rate and leucocytosis.
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Nosocomial infections occur worldwide.
The incidence is about S8 of hospitalized
patients, 1/3 of which is preventable.
The highest frequencies are in East
Nediterranean and SouthEast Asia.
A high frequency of N.!. is evidence of poor
quality health service delivered.
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They lead to functional disability and
emotional stress to the patient.
They lead to disabling conditions that reduce
the quality of life.
They are one of the leading causes of death.
The increased economic costs are high:
!ncreased length of hospital stay (SS! 8.2
days), extra investigations, extra use of drugs
and extra health care by doctors and nurses.
Organisms causing N.!. can be transmitted to
the community through discharged patients,
staff and visitors. !f organisms are multi
resistant they may cause significant disease
in the community.
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The cost varies according to the type and
severity of these infections.
An estimated 1 to 4 extra days for a urinary
tract infection, 7 - 8 days for a surgical site
infection, 7 - 21 days for a blood stream
infection, and 7 - 30 days for pneumonia.
The CDC has recently reported that US$S
billion are added to US health costs every
year as a result of N!.
!n Egypt one LE spent for infection control
saves LE 60 spent on N!.
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Urinary tract infection: most common type of
N ! (3040 of reported cases), associated
with an indwelling urinary catheter or
instrumentation.
Lower respiratory and surgical wound
infections are the next ( each about 1S).
Less frequent include bacteraemia (S),
intravenous site infection, gastrointestinal
tract and skin infections.
Criteria oI Nosocomial InIections
Surgical site infection Any purulent discharge, abscess or
spreading cellulitis at the surgical
site during the month after operation
Urinary infection Positive urine culture (1 or 2
species) with at least 100000
bacteria/ml, with or without clinical
symptoms
Respiratory infection Respiratory symptoms with at least
2 signs: cough; purulent sputum;
new infiltrate on chest, appearing
during hospitalization
Vascular catheter
infection
nflammation, lymphangitis or
purulent discharge at the insertion
site
Septicaemia Fever or rigours and at least one
positive blood culture
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The microbial agent
Patient susceptibility
Environmental factors
Chain oI inIection:
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Nany sick people are treated in a closed area,
microorganisms, frequent contact between
carriers S susceptible, contaminated waste,
equipment and supplies to be handled.
Developing of clinical disease depends on
organism s virulence, infective dose and
patient resistance
acteria are the most common pathogens.
1. Commensal bacteria: found in normal flora of
healthy humans, prevent pathogenic bacterial
colonization eg skin, colon, vagina
2. Pathogenic bacteria: have great virulence and
cause infection as :
Anaerobic gram +ve rods e.g Clostridium
causing gangrene.
Cram +ve bacteria: Staph. aureus found on skin
Snose. eta hemolytic Strep.
Cram ve bacteria as E.coli, Proteus, Klebsiella.
legionella species.
iruses: H!, H, HC can be also be
transmitted through blood S F
(transfusion, injections, dialysis)
respiratory syncytial virus, rota virus,
ebola, infleunza, herpes simplex viruses.
Parasites S Fungi: e.g. Ciardia lamblia is
easily transmitted between adults or
children, Aspergillus sp. affecting
imunocompromised.
Scabies an ectoparasite causing outbreak.
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>e: infants and old age have decreased
resistance to infection.
>44ne stats: Patients with chronic
diseases as malignancy, leukaemia,
diabetes mellitus, renal failure or A!DS
have increased susceptibility to infection.
>!mmunosuppressive drugs or irradiation
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Healthcare settings are environment
where both infected persons and persons
at high risk of infection congregate.
Crowded conditions within hospital,
frequent transfers of patients between
units.
Nicrobial flora may contaminate objects,
devices and materials which subsequently
contact susceptible body sites of patients.
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- here do nosocomial infection come from?
ndoenos infection: hen normal
patient flora change to pathogenic bacteria
because of change of normal habitat, damage
of skin and inappropriate antibiotic use.
About S0 of N.!. Are caused by this way.
oenos crossinfection: Nainly
through hands of healthcare workers, visitors,
patients.
,oenos environ4ental infections:
several types of microorganisms survive well in
the hospital environment (hospital flora):
* !n water, damp areas and occasionally in
sterile products or disinfectants eg pseudomonas,
Acinetobacter, Nycobacterium.
* On items such as linen, equipment and supplies
* !n food.
* !n fine dust and droplet nuclei
,&o4e procedres that save life may increase
risk of infection e.g urinary catheters, !..L
inhalation therapy, surgery.
,nappropriate se of antibiotics.
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Prevention of nosocomial infection is the
responsibility of all individuals and services
provided by healthcare setting.
To practice good asepsis, one should
always know: what is dirty, what is clean,
what is sterile and keep them separate.
Hospital policies S procedures are applied
to prevent spread of infection in hospital
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A comprehensive, effective and supported
program is essential for reducing infection
risk and increasing hospital safety.
!t should include surveillance, preventive
activities and staff training.
. Nutionul progrum developed by
Ministry oI Heulth: to support hospital
programs. It sets national objectives,
develops and updates guidelines
recommended for health care.
. Hospitul progrums incloding:
1) major preventive efforts, keeping in mind
patients and staff.
2) !t must be supported by senior management and
provided with sufficient resources.
3) !t must develop a yearly work plan to assess and
promote all good health care activities.
nfection Conrtol Team nfection control committee nfection control manual
Hospital Program
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The optimal structure varies with hospitals
types, needs and resources.
Hospital can appoint epidemiologist or
infectious disease specialist, microbiologist
to work as infection control physician.
!nfection control nurse who is interested
and has experience in infection control
issues.
Team should have authority to manage an
effective control program.
Team should have a direct reporting with
senior administration.
!nfection control team members or are
responsible for daytoday functions of !C and
preparing the yearly work plan.
They should be expert and creative in their
job.
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!t is a multidisciplinary committee responsible for
monitoring program policies implementation and
recommend corrective actions.
!t includes representatives from different
concerned hospital departments S management.
They meet bimonthly.
!t establishes standards for patient care, it
reviews and assesses !C reports and identifies
areas of intervention.
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WEvery Hospital should have a nosocomial
infection prevention manual compiling
recommended instructions and practices for
patient care.
WThis manual should be developed and
updated in a timely manner by the infection
control team.
W!t is to be reviewed and accepted by
infection control committee.
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%ole of every hospital department and
service units must be identified, documented
as manuals kept in accessible place.
]ob description of every hospital staff,
defining details of his duties must be
discussed before employment. !nfection
control precautions should be part of the
routine work and stressed for that.
Surveillance Preventive Activities Staff Training
Program Components
NOSOCOMIAL INFECTION
SURVEILLANCE
Nosocomial inIection rate in a hospital is an
indicator oI quality and saIety oI care
Surveillance to monitor this rate is essential to
identiIy problems and evaluate control activities
The ultimate aim is the reduction oI inIection rate
and their costs
The term surveillance implies that observational
data are regularly analyzed
ey points in Surveillance
Active surveillance (Prevalence and incidence studies)
Targeted surveillance (site, unit, priority-oriented)
Appropriately trained investigators
Standardized methodology
Risk- adjusted rates Ior comparisons
Organization Ior surveillance
ard activity
devices or procedures
fever & inf. signs
antibiotics & charts
Laboratory reports
culture& sensitivity
resistance patterns
serologic tests
Data elements &analysis
patient data & infection
population & risks
computerization of data
Data collection and analysis
Organization Ior surveillance
prompt, relevent to target group Meetings & disscussions Dissemenation by committee
Feedback & dissemenation
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iming at preventing spread of infection:
Standard precautions: these measures must be
applied during every patient care, during
exposure to any potentially infected material
or body fluids as blood and others.
Components:
A. Hand washing.
. arrier precautions.
C. Sharp disposal.
D. Handling of contaminated material.
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