NOSOCOMIAL INFECTIONS

Microbiology & Parasitology

BSN 1A | PROF. Raquel Fernandez
INFECTIOUS DISEASES
Categories:
1. Hospital Acquired or Nosocomial Infections
2. Community Acquired Infections
3. Iatrogenic Infections (physician-induced)
FREQUENCY OF NOSOCOMIAL INFECTIONS
● About 5% of the total hospitalizations
● About 1 death every 6 minutes
PATHOGENS INVOLVED
● Staphylococcus aureus
● Coagulase negative Staphylococcus
● Enterococcus spp.
● Escherichia coli
● Pseudomonas aeruginosa
● Enterobacter spp.
● Klebsiella spp.
● Increased number of immunocompromised
patients
● Indiscriminate use of antimicrobial agents
● Neglect of aseptic techniques
● More complicated types of surgery
● Overcrowding of hospitals and other
healthcare facilities
● Shortages of staff
● Increased use of inadequately trained
healthcare workers
● Overuse and improper use of indwelling
medical devices
● Increased use of anti-inflammatory and
immunosuppressant agents
CONTROL OF NOSOCOMIAL INFECTIONS
● Strict compliance with infection control
guidelines (e.g. handwashing)

MOST COMMON TYPES OF NOSOCOMIAL

INFECTIONS
● UTI
● Post surgical wound infections
● Lower respiratory tract infections
● Septicemia

PATIENTS MOST LIKELY TO DEVELOP

NOSOCOMIAL INFECTIONS
● Elderly patients
● Women in labor and delivery
● Premature infants and newborns
● Surgical and burn patients
● Diabetic and cancer patients
● Patients receiving treatment (steroids,
anti-Ca, radiation)
● Immunosuppressed patients
● Paralyzed patients
● Patients undergoing dialysis or
catheterization

FACTORS CONTRIBUTING
● Increasing number of drug resistant
pathogens
● Failure of health care personnel to follow
infection control guidelines
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez

INTRODUCTION
● Microorganisms are the agents of
contamination, infection, and decay.
● Hence it becomes necessary to remove
them from materials and areas.
● Early civilization practiced salting, smoking,
pickling and exposure to sunlight.

TWO TYPES OF ASEPSIS

1. Medical asepsis or clean technique
● Involves procedures and practices
that reduce the number and
transmission of pathogens.
● The goal of medical asepsis is to
exclude pathogens.
2. Surgical asepsis or sterile technique
● Involves practices used to render
and keep objects and areas sterile.
● The goal of surgical asepsis is to
exclude all microorganisms

DEFINITION OF TERMS
● Sterilization
RADIATION
○ The process of freeing an article
from microorganisms including their Two types of radiation are used:
spores. 1. Non-ionizing
● Disinfection 2. Ionizing
○ Reducing the number of pathogenic
microorganisms to the point where NON-IONIZING RADIATION
they no longer cause diseases.
● Bacteriostatic agent: ● Electromagnetic rays with longer
○ An agent that inhibits the growth of wavelength
bacteria, but does not necessarily kill ● Absorbed as heat
them. ● Can be considered as hot air sterilization
○ Bactericide: ● Used in rapid mass sterilization of pre
🠚 An agent that kills bacteria. packaged syringes and catheters (e.g. UV
Most do not kill endospores rays)
○ Sporicide:
🠚 An agent that kills spores. IONIZING RADIATION
● X-rays, gamma rays & cosmic rays.
● High penetrative power
● No appreciable increase in the temperature:
Cold Sterilization
● Sterilize plastic syringes, catheters, grease
fabrics, and metal foils
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez

ULTRASONIC AND SONIC VIBRATION ● Chlorine and its compounds have been
used as disinfectants in water supplies &
● Bactericidal swimming pools.
● Microorganisms vary in their sensitivity,
hence no practical value in sterilization and
disinfection. PHENOLS
● Obtained by distillation of coal tar
● Phenols are powerful microbicidal
substances
● Phenolic derivatives have been widely used
as disinfectants for various purposes in
hospitals
● E.g. Lysol, cresol

GASSES

COMMONLY USED HOSPITAL ETHYLENE OXIDE

DISINFECTANTS: CHEMICAL AGENTS ● Colorless, highly penetrating gas with a
sweet ethereal smell.
● Effective against all types of
ALCOHOLS microorganisms including viruses and
spores.
● Ethanol/Isopropyl alcohol are frequently
used FORMALDEHYDE GAS
● No action on spores
● Concentration recommended 60-90% in ● Widely employed for fumigation of operation
water theaters and other rooms.
● Uses:
○ Disinfection of clinical thermometer.
○ Disinfection of the skin:
Venipuncture

ALDEHYDES
● Formaldehyde & Glutaraldehyde are
frequently used
● Formaldehyde is bactericidal, sporicidal &
has a lethal effect on viruses.
● Glutaraldehyde is effective against tubercle
bacilli, fungi and viruses

HALOGENS
● Iodine in aqueous and alcoholic solution has
been used widely as a skin disinfectant
● Actively bactericidal with moderate against
spores
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez

● Properly dispose single use items

INFECTION CONTROL: STANDARD ● Visibly contaminated articles should be
PRECAUTIONS bagged

HANDWASHING
Healthcare Personnel Must:
● Wash their hands thoroughly between
patient contacts
● Wash their hands between tasks and
procedures on the same patient
● Wash their hands after touching blood, body
fluids, secretions, excretions and
contaminated items even when gloves are
worn
● Wash their hands immediately after gloves
are removed
GLOVES
● Must be worn when touching blood, body
fluids, secretions, excretions and
contaminated items
● Must be worn before touching mucous
membranes or non-intact skin
● Must be changed between tasks and
procedures on the same patient
● Remove gloves after use and before going
to another patients
● Wash hands thoroughly after removing
gloves
MASKS, EYE PROTECTION, FACE SHIELDS AND
GOWNS
● Wear gowns and masks or eye protection
during procedures that are likely to generate
splashes or sprays of blood
● Approved respirator must be worn when
working with patients in which airborne
precautions are required
ENVIRONMENTAL CONTROL
● Hospitals and its employees must comply
with adequate procedures for the routine
care, cleaning and disinfection of
environmental surfaces, beds, bed rails,
equipment etc.
LINENS
● Must be handled, transported and
processed in a manner that prevents
contaminating yourself, your clothing, or
prevents transfer of microorganisms to other
patients or other areas
OCCUPATIONAL HEALTH AND BLOODBORNE
PATHOGENS
● Never resheathed used needles using both
hands, use one handed scoop technique
● Do not remove used needles from
disposable syringes
● Do not attempt to bend or break used
needles
● Place used disposable syringes in
puncture-proof containers
PATIENT PLACEMENT
● Use private rooms for patients who
contaminate the hospital environment

PATIENT CARE EQUIPMENT

● Ensure that reusable equipment is not used
for the care of another patient until it has
been appropriately cleaned, disinfected or
sterilized
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez
INFECTION CONTROL: TRANSMISSION BASED
PRECAUTIONS
● Work practices that are used when the route
of transmission of an infectious agent is not
interrupted by using standard precautions
alone
● Use transmission-based precautions when
caring for patients known or suspected of
being infected with agents transmitted by
contact, droplet or airborne
● Visitors must be given information about
correct procedures when transmission
based precautions are in place.
TYPES OF TRANSMISSION BASED
PRECAUTIONS
1. Airborne
2. Droplet
3. Contact
DROPLET PRECAUTIONS
● Occurs when droplets (larger than 5μm in
diameter) containing microorganisms are
propelled a short distance through the air
and become deposited on another person’s
conjunctiva, nasal mucosa, or mouth
● Must be used for patients with pneumonia,
meningococcal meningitis, strep throat,
whooping cough, influenza
● Patient is placed on a private room or
placed with the patient with the same case
but no other infection
● Special air handling and ventilation not
required
● Persons working within 3 feet of the patient
must wear a mask
● A surgical mask must be worn by the patient
during patient’s transport
● Droplets do not readily penetrate the lower
(alveolar) respiratory system
● The maximum distance for cross
transmission from droplets has not been
definitively determined, although a distance
of approximately 1 meter (3 feet) around the
infected individual has frequently been
reported in the medical literature as the area
of risk.
● Droplets can become aerosols through
evaporation
● Examples of infectious agents transmissible
by the droplet route include Bordetella
pertussis (whooping cough), influenza virus,
adenovirus, rhinovirus, Mycoplasma
pneumoniae, coronavirus and Neiserria
meningitides
● Single patient room with ensuite. Consult
infection control if none is available.
● Staff to put on surgical mask when entering
the room and remove and dispose of mask
after leaving the room and perform hand
hygiene.
● Instruct patients about respiratory hygiene
and cough etiquette.
● Limit patient movement outside the room to
medically-necessary purposes
● Patient to put on a surgical mask when
leaving room
AIRBORNE PRECAUTIONS
● Fine airborne particles containing infective
agents are dispersed over long distances by
air currents and can be inhaled by
susceptible persons.
● Patient is placed in a private room with
negative air pressure and from which air is
either discharged outdoors or(if recirculated)
passed through HEPA filters.
● Or patient is placed with other patient with
the same case but with no other infection
● Persons entering the patient’s room must
wear respiratory protection unless known to
be immune to the pathogen (N95 respirator)
● A surgical mask is placed on the patient
whenever it is necessary to transport the
patient from the room
● Single negatively pressurized room with
ensuite
● Door to remain closed
● Staff to put on N95/P2 mask when entering
patient room and remove and dispose of
mask and perform hand hygiene after
leaving the room.
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez
● Instruct patients about respiratory hygiene
and cough etiquette.
● Patient to put on surgical mask when
leaving room.
CONTACT PRECAUTIONS
● Single patient room
● Ensuite preferred. Consult infection control
if none is available.
● Staff to perform hand hygiene. Put on gown
and gloves prior to entering patient room or
when anticipating contact with the patient
● Clean and disinfect non-disposable
equipment and items when removed from
the patient room
● Remove gown/apron and gloves and
perform hand hygiene after leaving the
room.
● Used for patients with Clostridium difficile
associated diseases, RSV infections in
children, scabies, impetigo, chicken pox,
shingles, viral hemorrhagic fevers
● Patient is placed on a private room or
placed with the patient with the same case
but no other infection
● Wear gown and gloves when entering
patient’s room
● Change gloves after having contact with
infective material (fecal material or wound
drainage)
● Remove gloves before leaving the room and
wash hands immediately with an antiseptic
agent
● Limit transport of patient to essential
purposes only
● No sharing of equipment
SOURCE ISOLATION
● Patients with contagious disease are placed
into isolation
● Protects other people from becoming
infected
● Isolation rooms are usually under negative
air pressure to prevent room air from
entering the hallway when door is opened
● Air evacuated from isolation rooms passes
through HEPA filters to remove pathogens
PROTECTIVE ISOLATION
● Also called reverse isolation or neutropenic
isolation
● Patients are placed in a TPE (Total
Protected Environment) where it is a:
○ Private room equipped with HEPA
filters
○ Room under positive pressure to
prevent hallway air from entering
when the door is opened
○ Room thoroughly cleaned and
disinfected before patient is admitted
○ Room where all items coming in
contact with the patient must be
disinfected or sterilized
○ Room where all persons entering the
room must wear sterile gowns,
masks, gloves, caps and shoe
covers
○ Proper handwashing procedures
must be followed before entering the
room
HANDLING FOOD AND EATING UTENSILS
● Use high quality fresh food
● Properly refrigerate and store food
● Properly wash, prepare and cook food
● Properly dispose leftover food
● Thoroughly wash hands and fingernails
before handling food and after visiting a
restroom
● Properly dispose nasal and oral secretions
in tissues and hand wash thoroughly
● Cover hair and wear clean clothes and
aprons
● Provide periodic health examination for
kitchen workers
● Prohibit anyone with respiratory or
gastrointestinal disease from handling food
or eating utensils
● Keep all cutting boards and other surfaces
scrupulously clean
● Rinse and then wash cooking and eating
utensils in a dishwasher in which the water
temperature is greater than 80°C
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez
HANDLING FOMITES
● Use disposable equipment and supplies
wherever possible
● Disinfect or sterilize equipment as soon as
possible after use
● Use individual equipment for each patient
● Use electronic or glass thermometers fitted
with one time use, disposable covers or use
disposable single use thermometers.
Electronic and glass thermometers must be
cleaned and sterilized on a regular basis.
● Empty bedpans and urinals, wash them in
hot water and store them in a clean cabinet
between uses
● Place bed linen and soiled clothing in bags
to be sent to the laundry
MEDICAL WASTE DISPOSAL
● Any receptacle used for decomposable solid
or liquid waste must be constructed so that
it does not leak and must be maintained in a
sanitary condition
● All sweepings, solid or liquid wastes and
garbage shall be removed and maintained
in a sanitary condition
● The facility’s infection control program must
address the handling and disposal of
potentially contaminated items
INFECTION CONTROL COMMITTEE AND
PROFESSIONALS
● Composed of representatives from most of
the hospital’s departments
● The chairperson is usually an infection
control professional such as physician,
infection control nurse, a microbiologist or
someone knowledgeable about infection
control
● The committee reviews the hospital’s
infection control program and incidence of
nosocomial infections
● It is a policy making and review body that
may take drastic action when needed
● Responsible for patient surveillance,
environmental surveillance, investigation of
outbreak and education of hospital staff
regarding infection control
● Works to maintain safe hospital
environment
ROLES OF THE MICROBIOLOGY LABORATORY
IN HOSPITAL EPIDEMIOLOGY AND INFECTION
CONTROL
● Monitoring the types and numbers of
pathogens isolated from hospitalized
patients
● Notifies ICP’s about unusual pathogen or
unusually high number of isolated of a
common pathogen
● Initiate investigation of an outbreak
● Process environmental samples including
from hospital employees that pinpoint the
exact source of the pathogen causing the
outbreak
INFECTION CONTROL: IMMUNIZATION
VACCINES
● Defined as a material that can artificially
induce immunity to an infectious disease,
usually following injection or in some cases,
ingestion of the material
● Harmless version of a pathogen (or toxin) to
produce antibodies and memory cells
● Will not cause disease in the person
● The immune system is primed to mount a
strong protective response should the actual
pathogen or toxin be encountered
CHARACTERISTICS OF AN IDEAL VACCINE
● Contains enough antigens to protect against
infection by the pathogen
● Contains antigens from all the strains of the
pathogen that cause that disease
● Has few side effects
● Does not cause disease in the vaccinated
person
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez

HOW VACCINE WORK ➔ Smallpox

➔ Yellow fever
● Stimulate the recipient’s immune system to ○ Attenuated Bacterial Vaccines:
produce protective antibodies ➔ BCG
● The protective antibodies and/or memory ➔ Cholera
cells remain in the recipient’s body to ➔ Tularemia
counteract particular pathogens should the ➔ Typhoid fever (oral vaccines)
particular pathogen enter the recipient’s
body
● Some vaccines stimulate the body to INACTIVATED VACCINES
produce protective antibodies against ● Vaccines made from pathogens that have
surface antigens, against bacterial pili, etc. been killed by heat or chemicals
● Protective antibodies attached to surface ● Can be produced faster and more easily but
antigens act as opsonins enabling less effective than live vaccines
phagocytosis or activate the complement ● EXAMPLES:
cascade resulting in the lysis of the ○ Inactivated Viral Vaccines:
pathogen. ➔ Hepa A
➔ Japanese Encephalitis
TYPES OF VACCINES ➔ Other encephalitis vaccines
(EEE, WEE, Russian)
1. Attenuated vaccines ➔ Polio (SQ Salk vaccine)
2. Inactivated vaccines ➔ Rabies
3. Subunit vaccines ○ Inactivated Bacterial Vaccines:
4. Conjugate vaccines ➔ Anthrax
5. Toxoid vaccines ➔ Typhoid fever (SQ vaccine)
6. DNA vaccines ➔ Q fever
7. Autogenous vaccines
SUBUNIT OR ACELLULAR VACCINES
ATTENUATED VACCINES
● One that uses antigenic portions of a
● Most live vaccines ar avirulent pathogen rather than the whole pathogen
(non-pathogenic) mutant strains of (e.g. pili of N. gonorrhoeae)
pathogens that have been derived from the ● EXAMPLES:
virulent organisms ○ Hepa B
● Attenuation is accomplished by growing ○ Lyme disease
them for many generations under various ○ Whooping cough
conditions or by exposing them to
mutagenic chemicals or radiation.
● Should not be administered to CONJUGATE VACCINES
immunosuppressed persons ● Made by conjugating bacterial capsular
● EXAMPLES: antigens to molecules that stimulate the
○ Attenuated Viral Vaccines: immune system to produce antibodies
➔ Adenovirus against the less antigenic capsular antigens
➔ Varicella (chickenpox) ● EXAMPLES:
➔ Rubeola (measles) ○ HIB
➔ Mumps ○ Meningococcal meningitis (N.
➔ Rubella (german measles) meningitidis serogroup C)
➔ Polio (oral Sabin) ○ Pneumococcal pneumoniae
➔ Rotavirus
INFECTION CONTROL
Microbiology & Parasitology
BSN 1A | PROF. Raquel Fernandez

TOXOID VACCINES SCHEDULE OF VACCINES

● An exotoxin that has been inactivated Before birth and entry to the school:
(made non-toxic) by heat or chemicals ● Hepatitis B vaccine
● Can be injected safely to stimulate ● DPT
production of antitoxins (antibodies that ● HIB
neutralize exotoxins of a pathogen) ● Inactivated poliovirus (IPV) vaccine
● Serum containing antitoxins is called ● MMR
antiserum ● Varicella (chickenpox)
● Antiserum containing antitoxins are used to ● Pneumococcal conjugate vaccine (PCV)
treat diseases such as tetanus and botulism ● Hep A
● EXAMPLES: ● Influenza vaccine
○ Diphtheria
○ Tetanus

DNA OR GENE VACCINES

● Currently only experimental
● A particular gene from a pathogen is
inserted into plasmids, plasmids are injected
into skin or muscle tissue
● Inside the host, the genes direct the
synthesis of a particular microbial protein
(antigen). Copies of the protein will then
stimulate production of antibodies against
the protein which protect the person from
infection with the pathogen.
● EXAMPLE:
○ Successful induction of cellular
immune response in humans to
malarial parasite antigen have been
published.

AUTOGENOUS VACCINES
● One that has been prepared from bacteria
isolated from a localized infection, such as
furuncle.
● The pathogens are killed and then injected
into the same person to induce production
of more antibodies.