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Encyclopedia > Nosocomial infection

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Nosocomial infections are those which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge. Nosocomial comes from the Greek word nosokomeion (νοσοκομείον) meaning hospital (nosos = disease, komeo = to take care of ). The most common nosocomial infections are of the urinary tract, and various pneumonias. For the record label, see Hospital Records. ... The term disease refers to an abnormal condition of an organism that impairs function. ... The urinary system is a system of organs, tubes, muscles, and nerves that work together to create, store, and carry, urine. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ...


Nosocomial infections are even more alarming in the 21st century as antibiotic resistance spreads. Reasons why nosocomial infections are so common include: Antibiotic resistance is the ability of a micro-organism to withstand the effects of an antibiotic. ...

  • Hospitals house large numbers of people who are sick and whose immune systems are often in a weakened state.
  • increased use of outpatient treatment means that people who are in the hospital are sicker on average.
  • medical staff move from patient to patient, providing a way for pathogens to spread.
  • many medical procedures bypass the body's natural protective barriers.
  • routine use of anti-microbial agents in hospitals creates selection pressure for the emergence of resistant strains.[citation needed]

Thorough hand washing and/or use of alcohol rubs by all medical personnel before each patient contact is one of the most effective ways to combat nosocomial infections. More careful use of anti-microbial agents, such as antibiotics, is also considered vital.[citation needed] A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... A medical procedure is a course of action intended to achieve a result in the care of patients, used by medical or paramedical personnel. ... Darwins illustrations of beak variation in the finches of the Galápagos Islands, which hold 13 closely related species that differ most markedly in the shape of their beaks. ... Schoolchildren washing their hands before eating lunch. ... An alcohol rub, also known as an alcohol gel, hand sanitizer or healthcare personnel hand wash is used as a supplement or alternative to hand washing with soap and water. ... An antimicrobial is a substance that kills or slows the growth of microbes like bacteria (antibacterial activity), fungi (antifungal activity), viruses (antiviral activity), or parasites (antiparasitic activity). ... Staphylococcus aureus - Antibiotics test plate. ...


Epidemiology

In the United States, it has been estimated that as many as one hospital patient in ten acquires a nosocomial infection, or 2 million patients a year. Estimates of the annual cost range from $4.5 billion to $11 billion and up. Nosocomial infections contributed to 88,000 deaths in the U.S. in 1995. One third of nosocomial infections are considered preventable. Ms. magazine reports that as many as 90 percent of deaths from hospital infections could be prevented. [1]


In France, the prevalence is 6.87%[2], to 7.5%[3] (some patients are infected twice) : In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ...

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. About 9,000 people die with a nosocomial infection, but about 4,200 would have not died without this infection. A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. ... Beyond overall skin structure, refer below to: See-also. ... The mucous membranes (or mucosae; singular: mucosa) are linings of mostly endodermal origin, covered in epithelium, and are involved in absorption and secretion. ... In medicine, pulmonology (aka pneumology) is the specialty that deals with diseases of the lungs and the respiratory tract. ... Intensive care medicine or critical care medicine is concerned with providing greater than ordinary medical care and observation to people in a critical or unstable condition. ...


In Italy, in the 2000's, about 6.7 % of hospitalized patients were infected, i.e. between 450,000 and 700,000 patients, which caused between 4,500 and 7,000 deaths.[4]


In Switzerland, extrapolations assume about 70'000 hospitalised patients are affected by nosocomial infections (between 2 and 14% of hospitalized patients).[5] [6]


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 transmission -- contact, droplet, airborne, common vehicle, and vectorborne.

  • Contact transmission, the most important and frequent mode of transmission of nosocomial infections, is divided into two subgroups: direct-contact transmission and indirect-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, such as occurs when a person turns a patient, gives a patient a bath, or 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.
    • Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. Additionally, the improper use of saline flush syringes, vials, and bags have been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.[7]
  • Airborne transmission occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air handling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include Mycobacterium tuberculosis and the rubeola and varicella viruses.
  • Common vehicle transmission applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.

A physician visiting the sick in a hospital. ... Different bevels on hypodermic needles. ... A micrometre (American spelling: micrometer, symbol µm) is an SI unit of length equal to one millionth of a metre, or about a tenth of the diameter of a droplet of mist or fog. ... Binomial name Mycobacterium tuberculosis Zopf 1883 Mycobacterium tuberculosis is the bacterium that causes most cases of tuberculosis[1]. It was first described on March 24, 1882 by Robert Koch, who subsequently received the Nobel Prize in physiology or medicine for this discovery in 1905. ... Measles, also known as rubeola, is a common disease caused by a virus of the genus Morbillivirus. ... Varicella is a Latin name for chickenpox. ...

Predisposition to infection

Factors predisposing a patient to infection can broadly be divided into four areas:

  • People in hospitals are usually already in a poor state of health, impairing their defense against bacteria – advanced age or premature birth along with immunodeficiency (due to drugs, illness, or IR radiation) present a general risk, while other diseases can present specific risks - for instance chronic obstructive pulmonary disease can increase chances of respiratory tract infection.
  • Invasive devices, for instance intubation tubes, catheters, surgical drains and tracheostomy tubes all bypass the body’s natural lines of defence against pathogens and provide an easy route for infection. Patients already colonised on admission are instantly put at greater risk when they undergo an invasive procedure.
  • A patient’s treatment itself can leave them vulnerable to infection – immunosuppression and antacid treatment undermine the body’s defences, while antimicrobial therapy (removing competitive flora and only leaving resistant organisms), recurrent blood transfusions.

In most systems of human pregnancy, the condition, premature birth (also known as a preterm birth), occurs when the baby is born within sooner than 36 weeks of completed gestation. ... In medicine, immune deficiency (or immunodeficiency) is a state where the immune system is incapable of defending the organism from infectious disease. ... Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive airway disease (COAD), is a group of diseases characterized by limitation of airflow in the airway that is not fully reversible. ... This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ... Catheter disassembled In medicine, a catheter is a tube that a health professional may insert into part of the body. ... Tracheotomy is a surgical procedure used to cut a hole in the trachea through which a small tube is inserted. ... A pathogen (literally birth of pain from the Greek παθογένεια) is a biological agent that can cause disease to its host. ... Immunosuppression is the medical suppression of the immune system. ... A bottle of antacid tablets An antacid is any substance, generally a base, which counteracts stomach acidity. ... An antimicrobial is a substance that kills or slows the growth of microbes like bacteria (antibacterial activity), fungi (antifungal activity), viruses (antiviral activity), or parasites (antiparasitic activity). ... Simplified schematic of an islands flora - all its plant species, highlighted in boxes. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Blood transfusion is the taking of blood or blood-based products from one individual and inserting them into the circulatory system of another. ...

Isolation

Isolation precautions are designed to prevent transmission of microorganisms by these routes in hospitals. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission.


Handwashing and gloving

Handwashing frequently is called the single most important measure to reduce the risks of transmitting 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. Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Bodily fluids are fluids, which are generally excreted or secreted from the human body. ... Secretion is the process of segregating, elaborating, and releasing chemicals from a cell, or a secreted chemical substance or amount of substance. ... Excretion is the process of eliminating waste products of metabolism and other materials that are of no use. ...


Although handwashing may seem like a simple measure, it is often not used or hand washing is performed incorrectly. Healthcare settings must continually remind practitioners to wash their hands thoroughly. Simple programs, for example - "Henry The Hand", can be used to help healthcare facilities prevent nosocomial infections.


In addition to handwashing, gloves play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, gloves are worn to provide a protective barrier and to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin; the wearing of gloves in specified circumstances to reduce the risk of exposures to bloodborne pathogens is mandated by the OSHA Bloodborne Pathogens final rule. 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, gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or a fomite can transmit these microorganisms to another patient. In this situation, gloves must be changed between patient contacts and hands should be washed after gloves are removed. A blood-borne disease is one that can be spread by contamination by blood. ...


Wearing gloves does not replace the need for handwashing, because gloves may have small, non-apparent 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.


Examples of nosocomial infections include Methicillin Resistant Staphylococcus aureus (MRSA) and Acinetobacter baumanni. Methicillin-resistant Staphylococcus aureus, (MRSA) is a specific strain of the Staphylococcus aureus bacterium that has developed antibiotic resistance, first to penicillin since 1947, and later to methicillin and related anti-staphylococcal drugs (such as flucloxacillin). ... Acinetobacter baumannii is a species of pathogenic bacteria which forms opportunistic infections. ...


Examples of the diseases

Ventilator-associated pneumonia (VAP) refers to pneumonia which occurs in people who have required mechanical ventilation through an endotracheal or tracheostomy tube for at least 48 hours. ... Binomial name Rosenbach 1884 Staphylococcus aureus , (literally Golden Cluster Seed) the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis... Wikipedia does not yet have an article with this exact name. ... Binomial name Pseudomonas aeruginosa (Schroeter 1872) Migula 1900 Synonyms Bacterium aeruginosum Schroeter 1872 Bacterium aeruginosum Cohn 1872 Micrococcus pyocyaneus Zopf 1884 Bacillus aeruginosus (Schroeter 1872) Trevisan 1885 Bacillus pyocyaneus (Zopf 1884) Flügge 1886 Pseudomonas pyocyanea (Zopf 1884) Migula 1895 Bacterium pyocyaneum (Zopf 1884) Lehmann and Neumann 1896 Pseudomonas polycolor... Acinetobacter is a genus of Proteobacteria. ... Binomial name Stenotrophomonas maltophilia Palleroni & Bradbury 1993 Synonyms Pseudomonas maltophilia (ex Hugh and Ryschenkow 1961) Hugh 1981 Xanthomonas maltophilia (Hugh 1981) Swings et al. ... Binomial name Clostridium difficile Hall & OToole, 1935 Clostridium difficile or CDF/cdf (Template:Audo, alternatively ) (also referred to as C. diff or C-diff) is a species of bacteria of the genus Clostridium which are gram-positive, anaerobic, spore-forming rods (bacillus). ... Tuberculosis (abbreviated as TB for tubercle bacillus) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ... A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. ... Hospital-acquired pneumonia (HAP) or Nosocomial pneumonia refers to any pneumonia contracted within 48-72 hours of being admitted in hospital. ...

Mitigation

The most effective of controlling Nosocomial infection is to strategically implementing QA / QC measures to the health care sectors and evidence-based management can be a feasible approach. For those VAP/HAP diseases, controlling and monitoring hospital indoor air quality needs to be on agenda in management. The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ... For the Jurassic 5 album, see Quality Control (album) In engineering and manufacturing, quality control and quality engineering are involved in developing systems to ensure products or services are designed and produced to meet or exceed customer requirements. ... A physician visiting the sick in a hospital. ... Indoor Air Quality (IAQ) deals with the content of interior air that could affect health and comfort of building occupants. ...


References

  1. ^ Ricks, Delthia. "Germ Warfare." Ms. Magazine. Spring 2007. pp 43-45.
  2. ^ enquête nationale de prévalence 2001
  3. ^ Quelle est la prévalence de ces infections ?
  4. ^ L'Italie scandalisée par « l'hôpital de l'horreur », Éric Jozsef, Libération, 15 janvier 2007
  5. ^ http://www.edi.admin.ch/dokumentation/00613/00614/?lang=de&msg-id=2532
  6. ^ http://www.swisshandhygiene.ch/swisshandhygiene/presse/_b/contentFiles/301006_Facts_sheet_F.doc
  7. ^ (July 2005) "Nosocomial malaria and saline flush". Emerging Infectious Diseases [serial on the Internet] 11 (7). 

See also

  • Iatrogenisis, a disease or complication caused by medical treatment

External links

Abedon, Stephen T. (98-05-09). Nosocomial Infections: Supplemental Lecture.


  Results from FactBites:
 
eMedicine - Hospital-Acquired Infections : Article by Quoc V Nguyen (2263 words)
Infections that occur after the patient's discharge from the hospital can be considered to have a nosocomial origin if the organisms were acquired during the hospital stay.
Nosocomial infections are estimated to occur in 5% of all acute-care hospitalizations; the incidence rate is 5 infections per 1,000 patient-days.
Nosocomial infections are caused by viral, bacterial, and fungal pathogens.
Nosocomial infection Summary (0 words)
A nosocomial infection is an infection that is acquired in a hospital.
Nosocomial infections are those which are a result of treatment in a hospital or hospital-like setting, but secondary to the patient's original condition.
Infections tend to be endemic as opposed to epidemic, either coming from another person in the hospital (cross-infection), from an inanimate object recently contaminated by a human source (environmental infection) or may be caused by a patient’s own flora (endogenous infection).
  More results at FactBites »

 
 

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