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Microbiology, Lecture 16

Microbiology, Lecture 16

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Published by: Mohamed Harun B. Sanoh on Apr 28, 2011
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05/28/2012

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Today we’ll talk about Nosocomial Infections and Healthcare Epidemiology, chapter 12 from the text book 
Let’s begin with some definitions:
Healthcare Epidemiology
is the study of the occurrence, odeterminants and distribution of health and disease within healthcarefacilities, and includes any activities designed to improve patient careoutcomes.The primary focus of healthcare epidemiology is on infection control andthe prevention of healthcare- associated infectionsSo generally speaking, people can acquire two types of infections:1- There are diseases or infections that people acquire outside thehealthcare settings and these are called
community-acquired infections
and these aren’t the focused of these talk.2- You have infections that you can acquire during your stay at thehealth facilities such as a hospital or a clinic and these are called
healthcare-associated infections
and another common name for them is
Nosocomial Infections.
 Nosocomial Infections are very serious problem, for example, in theUnited States -which obviously has high standards with health care- evenin that country, out of 40 million people who end up being hospitalized,2 million people end up acquiring an infection during the hospital stayand many of these people end up with serious diseases and mightactually died from these type of infections.So there are certain strains of bacteria more commonly associated withnosocomial infections and I want you to memorize these names. So wehave bacteria that are Gram-positive and Gram-negative that cause thesetypes of infections and
-
we’ll begin with the Gram-positive ones We have Staphylococcusaureus, coagulase-negative staphylococci, and Enterococcus spp.
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For the Gram-negative, we have Escherichia coli, Pseudomonasaeruginosa, Enterobacter spp., and Klebsiella spp.So these bacteria can come from variety of sources, sometimes they can be taken or they cause infections because their part of the normal flora of the patient himself, so if you have a surgical wound, that surgical woundcan be contaminated from the patient’s skin. Sometimes these bacteriacan be derived from health care workers and from surfaces in the lab.And a major problem of these infections is that most of the bacteria thatcause the infections are drug-resistant bacteria, so that they only causeinfections in immune compromised people but also they are very hard totreat with the regular or usual types of anti-microbial agents.The diseases caused by these bacteria in a descending order of frequency, most commonly we have:1- Urinary tract infections2- Surgical site infections3- Lower respiratory infections (primarily pneumonia)4- Finally, we have Bloodstream infections or Septicemia (leastcommon)Also we have other causes of disease in the hospital sitting; an exampleis Clostridium difficile- associated disease which usually appears if youtake course of antimicrobial agents for many periods of time.
Patients at risk of developing human or health care associatedinfections
:Basically any person who undergoes invasive procedures, invasivesurgical procedures or catheterization or people with Immunesuppressions, these people are more like to develop or acquire hospital-acquired infections, for example:1- Elderly patients2- Women in labor and delivery
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3- Premature infants and newborns4- Surgical and burn patients5- Diabetic and cancer patients6- Patients receiving treatment with steroids, anticancer drugs, antlymphocyte serum, and radiation7- Immunosuppressed patients in general8- Patients who are paralyzed or are undergoing renal dialysis or catheterizationSo we have lots of factors to acquiring the health care associatedinfections but the three most common factors are:1- We have increasing numbers of drug-resistant pathogens that areemerging in the community2- Failure of healthcare professionals to follow infection controlguidelines, for example: they might not be washing their hands properlyor they might not be washing their hands frequently between patients, soyou can’t handle a patient with a severe infection then go and handleanother person without washing your hands.And finally more people are surviving these days with immune-suppressed status; so people now with cancer can survive for a long time,so these people can acquire more easily the nosocomial infections.Then we have additional factors that play a role and these basically arecommon sense:- Overcrowding of hospitals and shortages of healthcare staff.- The indiscriminate use of antimicrobial agents and the false sense of security about antimicrobial agents; so people now keep saying if yougo to any small clinic at any town and you tell them you have streptthroat they will give you amoxicylin ,without testing the bacteria so nowthey are giving antimicrobial agents without doing the proper steps and
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