NOSOCOMIAL INFECTIONS

Presented by Dr. Linda

.A.Kapesa

CONTENTS

1.INTRODUCTION
2.DEFINITION
3.TYPES OF NOSOCOMIAL INFECTIONS
4.SOURCES AND ROUTES OF SPREAD OF
HOSPITAL INFECTIONS
5.COMMON HOSPITAL ACQUIRED INFECTIONS
6.CONSEQUENCES OF HOSPITAL INFECTIONS
7.INVESTIGATIONS
8.PREVENTION
9.STERILIZATION AND DISINFECTION

INTRODUCTION
Nosocomial Infections also known as Hospital
infections often have serious consequences for the
individual,for the hospital community and for the
community at large.
Most infections acquired in hospital are caused by
micro-organisms that are commonly present as
commensals in the general population.
The pattern of hospital infections has changed over
the years reflecting the advances of medicine and the
development of antimicrobial agents.
The development of more potent and broad spectrum
antimicrobials and the increase in invasive medical
techniques has been accompanied by the incidence of
antibiotic resistance Gm +ve organisms and
multidrug resistance Gm ve organism.

INTRODUCTION
Definition:
-Nosocomial infections are any
infections acquired while in hospitals.
-The word Nosocomial comes from the
Greek word nosos means disease and
Komeion means to take care of.
_occurs 48 hours or more after
admission and up to 48 hrs after
discharge.

 Causative agents: Infectious pathogens

-Bacteria(mostly non invasive)
-Viruses
-Protozoa
-Fungi
NB- Community acquired infections - contracted
and developing outside the hospital which require
admission of the patient eg pneumococcal
pneumonia or they become clinically apparent when
the patient has been admitted for other reasons
eg.chicken pox or zoster.
-Incubating while patients are admitted to a
hospital.

 Nosocomial Infections can be acquired

from an
-Exogenous source; another person in the
hospital(cross infection),or contaminated
item of equipment(enviromental infection)
-Endogenous source;Due to Self infection
or auto infection.
*By patients own normal flora
*From another site in the body

FACTORS PREDISPOSE
PATIENTS TO HOSPITAL
INFECTION
Host factors are of critical importance in determining

susceptibility to infections :Low natural resistance to diseases

-AGE; Infants and elderly
-PRE EXISTING DISEASE; such as diabetes,cancer,skin
disorders,renal failure etc.
-SPECIFIC MEDICAMENTS;Immunosuppressive drugs such as
cytotoxic drugs and steroids lower host defense,
*Antibiotics :disturb normal flora and predispose to invasion by
resistant hospital pathogens.
-OTHER INFECTIONS; HIV and other suppresing viral infections
*Influenza patients are prone to secondary bacteria pneumonia
*HSV lesions may become secondary infected with staphlococci
-SPECIFIC IMMUNITY: Patients may lack protective antibodies to
eg.measles,chicken px,whooping cough.
-TRAUMA AND ACCIDENTS like burns,stab, or gunshots,Road traffic
accidents disturb natural host defense mechanisms
-INTENTIONAL; surgery,iv and urinary catheters,peritoneal dialysis
also reduce the host defense.

SOURCES OF INFECTION
Human and contaminated objects are the main
sources of hospital infections.
Human source;- from other patients
-hospital staff and
occasionally visitors.
Human sources maybe:
-people who are themselves infected
-people who are incubating the infection
-Healthy carriers
Enviromental source; from contaminated
objects(fomites)food,water or air.

Routes of transmission
Microorganisms are transmitted in hospitals by several routes, and the
same microorganism may be transmitted by more than one route.
There are five main routes of transmissioncontact, droplet, airborne,
common vehicle, and vectorborne.
1.Contact transmission, the most important and frequent mode of
transmission. is divided into two subgroups: direct-contact
transmission and indirect-contact transmission.
Direct-contact transmission :From person to person
Indirect-contact transmission spread via contaminated hands
or equipment such as contaminated instruments, needles, or
dressings, or contaminated gloves that are not changed between
patients.
2.Droplet transmission occurs when droplets are generated from
the source person mainly during coughing, sneezing, and talking, and
during the performance of certain procedures such as bronchoscopy.
Transmission occurs when droplets containing germs from the infected

person are propelled a short distance through the air and deposited on
the host's body.
3.Airborne transmission Airborne diseases are those diseases which
are caused by pathogenic microbial agents which get discharged
through coughing, sneezing, laughing or through close personal
contact. These pathogens ride on either dust particles or small
respiratory droplets and can stay suspended in air and or are capable
of travelling distances on air currents.Microorganisms transmitted by
airborne transmission include Legionella, Mycobacterium tuberculosis
and the rubeola and varicella viruses.
4.Common vehicle transmission applies to microorganisms
transmitted to the host by contaminated items such as food, water,
medications, devices, and equipment.
5.Vector borne transmission occurs when vectors such as
mosquitoes, flies, rats, and other vermin transmit microorganisms

Hospital infection;source and

spread
Route
source
Example of disease
Airborne(from person)
Droplets
Skin scales

-mouth
-Nose
-skin exudate,infected
lesion

Measles,TB,Pneumonia
-Staphylococcal sepsis
-staphylococcal and
streptococcal sepsis

Airborne(from
inanimate source)

Respiratory equipment -Gram negative

Air condition
R.infection
-Legionnaire
dse,fungal infxns

Contact- (from
person)
-Direct spread

-Respiratory
secretions,
faeces,skin,urine
and wound exudate

-Staphy and strept.

Sepsis
-Enterobacterial
and viral
diarrhorea.

-Indirect Via
equipment

-contaminating
objects
eg.endoscope

Contact(enviromental
source)

-Enterobacterial
Equipement,food,med sepsis(klebsiella,enter
icaments and fluids
obacterial spp) or
ps.aeruginosa and
others.
-Food,
-blood and blood
-salmonella
products
compylobacter
-IV fluids
-HBV and HIV
-Gm negative rods

Common
vehicle(inoculation)

-psedomonas
aeruginosa sepsis

COMMON HOSPITAL ACQUIRED

INFECTIONS

1.Urinary tract infections 16-18%

2.Respiratory tract infections 15-29%
3.Surgical wound infections 8%
4.Bacteremia 30-40%
5.Others 17-19%

UTI
UTI
-The most common hospital acquired
infection.
-Typically related to Urinary catherization
-Mostly frequent causative organisms
E.coli(other Gm ve to a lesser extent),
enterococci,
staphylococci,
candida.

Lower Respiratory Tract

Infections
Ranks second in incidence.
Many patients die of nosocomial
pneumonias related to respiratory
devices that aid breathing or administer
medications
Common organisms;
-pseudomonas aeruginosa(other Gm ve )
-staphyllococci aureus
-Klebsiella spp

SURGICAL WOUND
INFECTIONS
Estimation of 5-12% of all post op patients develop

infections
In operation involving GIT,RT and GUT the infection
rate approaches 30%
Organisms:
-staphylococcus aureus
-Enterococci
-E.coli
-Psudomonas aeruginosa
Causes:length of preoperative stay,presence of
intercurrent infections,nature of operation(Fecal
soiling of tissues),presence of foreign
bodies(shunts,prosthesis)impairs host defence,state
of tissue(poor blood suppy-anaerobes)

Bacteremia
Presence of bacteria in the blood.It accounts for
30-40%
Two types exist-primary and secondary.
Primary:Direct introduction of organisms into
the blood.eg.iv
infusion,catheters,haemodyalisis,parenteral
nutrition,respiratory devices etc
Secondary:From an infection already present in
the body eg.UTI,RT,Surgical wound.
Organisms:Staphylococci
aureus,enterococci,candida,E.coli and other Gm
ve to a lesser extent.

CONSEQUENCES OF HOSPITAL
INFECTIONS
Affect both the patient and the
community.
OUTCOME:
1.Serious illness or death
2.Prolonged hospital stay which costs
money and results in loss of earnings and
hardship for the patient and their family.
3.Multiple drugs-costly-toxicity-resistance
among hospital pathogens.
4.Source of infection for others in the
hospital and in the community.

INVESTIGATIONS
Many hospital infections are epidemics.
Therefore they are detected because the
incidence of an infection is seen to be above
normal levels for that institution.
Investigation must determine:
*Extent of the problem
*source of infection.
*A way in which it spreads
*Identify those at risk
*Propose effective method for control
*Proven day to day Microbiological approaches are
also important like molecular detection methods
and typing methodologies such as sequencing
may be required for epidemiological purposes.

Invest. cont
Whose responsibility is it for investigating hospital
infections????
ANSWER:Infection control committe which includes
an infection control officer and atleast one nurse.
Their ROLE includes :
The surveillance of hospital infection-thr microbilogy
labaratory reports,ward rounds,autopsy reports.
Policies and procedures aiming at preventing
infection eg.catheter care policy,disinfectant
policy,blood borne virus exposure incidence,antibitic
policy etc
The investigation of outbreaks-Tracking the source
and routes of transmission.

Prevention
Once tracking is complete,preventive measures can
be introduced.
Correct knowledge and typing of the causative
agent,oubreak,its characteristics and mode of
transmission allows preventive measures to be taken.
AIM:
-Basic hygiene including effective
handwashing,improved general cleaning,isolation
facilities and the safe disposal of infected
material,effective sterilization of equipments.
-Radical improvement of facilities because some
organisms are widely distributed in the eviroment
eg.P.aeruginosa or occur in water supplies
eg.legionella.

Sterilization and disinfection

Sterilization and disinfection are the
key processes in the control and
prevention of hospital-acquired
infections as well as being central to
many areas of medical practice

Sterilization
Definition: Is the process of killing or
removing all viable organisms.
Achieved by physical and chemical
means; either by:
-Removal of organisms from an object
or
-By killing the organisms in situ
BUT sometimes leaving toxic breakdown
products(pyrogens) in the object.

Steril. cont
Techniques for sterilization
-Heat
-Irradiation(gamma or ultraviolet)
-Filtration
-Chemicals in liquid or gaseous phase.
Other techqhiques not applied in hospital
practice
include:Freezing,lysis,dessication,ultasoni
cation and the use of electrical
discharges.

1.HEAT: Preferred choice for sterilization on the grounds of ease

of use,controllability,cost and efficiency.
Methods
-Dry heat:sterilize by oxidation of the cell components
eg.incineration and the use of lab bunsen burner.
-Moist heat(saturated steam):Most effective agent for
sterilization.
*achieved by using autoclave(steam underpressure-temp in
excess of 100 d.centigrade-increase kiliing of microbes.
*Moist heat in an autoclave is used to sterilize surgical
instruments and dressings and heat resistant pharmaceuticals
-Immersion in boiling water for few mints-rapid emergence to
dissinfect instruments
*kills vegetative bacteria and many but not all spores.
*addition of 2%sodium carbonate to the water potentiate the
sporicidal effect
-Pasteurization:
*uses heat at 62.8-65.6 d.cent for 30 mints
*used for fluids like milk to reduce the number of bacteria
*afterwards storage requires temp below 10 degrees cent to
minimise subsequent bacterial growth

2.IRRADIATION
-gamma irradiation energy is used to sterilize
large batches of small volume items.
-industrial process that works well with
products such as needles,syringes,iv
lines,catheters and gloves.
-can also be used for vaccines to prevent
food spoilage.
-The killing mechanism involves production of
free radicals which breaks the bond in DNA.

3.FILTRATION
-Used to produce particle and pyrogen free fluid.
-heat sterilised soln contains pyrogens which are
capable of producing fever therefore
undesirable in prdcts such as IV fluids.
Therefore filtration or separation of the prdtc is
mandatory.
Modern filters are composed of nitrocellulose
and work by electrostatic attraction and physical
pore size to retain organisms or other particals.
Can be used to recover very small number of
organisms from very large volumes of fluids
eg.legionella from cooling tower water and as a
method for quantifying bacteria in fluids.

4.CHEMICAL AGENTS
The gases ethylene oxide and
formaldehyde kill by damaging
proteins and nucleic acids.

Disinfection
Is a process of removing or killing
most but not all viable organisms.
Disinfection employs either;
-A chemical disinfectant ,which kills
pathogens but may not kill viruses or
spores.eg antiseptics
-A physical process such as boiling
or low pressure steam which reduces
the load of vaible organisms.

THANK YOU