Hospital-Acquired Infections

Hospital-acquired infection (HAI) is also known as hospi-

tal-associated infection or hospital infection or nos-

ocomial infection. It is infection developing in patients

after admission to the hospital. It is not present or in

incubation at the time of admission to the hospital. It is

acquired as a result of the hospital stay.

Factors influencing Hospital-Acquired Infection

Several factors contribute to the occurrence and severity

of hospital infection.

Patients with impaired defence mechanisms due to

their pre-existing diseases such as diabetes and immu-.

nosuppression, and patients with prosthetic implants

are more susceptible to hospital infections.

Hospital environment is heavily laden with a wide vari-

ety of organisms. These microorganisms may be present

in contaminated equipment, air, water, food, dust, and

even antiseptic lotions.

Slightest lapse in asepsis during diagnostic or thera-

peutic interventions such as insertion of catheters may

introduce infections.

If not properly screened, blood, blood products, and

intravenous fluids used in transfusion may lead to

infection.
Hospital-acquired infections are difficult to treat because

the infecting agents are usually multidrug resistant.

Sources

Endogenous

Patients' own normal flora may invade their tissue during

some surgical operations or investigative procedures.

Exogenous

Most of the hospital-acquired infections are exogenous in

nature.

The most important sources are other patients and hospi-

tal staff suffering from infection or asymptomatic carriers.

• Medical equipment, bedding, linen, utensils, bed pans,

etc., act as inanimate sources of infection.

• Air, water, food, surfaces contaminated by patient's

secretions, excretions, blood, and body fluids form the

environmental sources of infection.

Mode of Transmission

Transmission of microorganisms from one person to

another by contact of hands and clothing of hospital

personnel. Examples: Staphylococcus aureus and Strepto-

coccus pyogenes,

Instruments such as endoscope, bronchoscope, and cys-

toscope if not properly disinfected may transmit micro-

organisms. Example: Pseudomonas aeruginosa

Droplets of respiratory infections are transmitted from

person to person by inhalation. Examples: Pneumonia,

staphylococcal sepsis, tuberculosis,

• Respiratory tract may be infected through aerosols pro-

duced by nebulizers, humidifiers, and air conditioning

apparatus. Example: Legionella pneumophilia.

Exudates dispersed from a wound during dressing, dust

from bedding, floor, etc., may spread infection. Exam-

ples: S. aureus, P. aeruginosa.

• Gastrointestinal organisms resistant to antibiotics may

be transmitted through hospital food. Examples: P. aeru-

ginosa, Escherichia coli, Klebsiella spp.

Certain infections may be transmitted by blood trans-

fusion, tissue donation, contaminated blood products,

and infusion fluids. Examples: Hepatitis B, HIV.Microorganisms Associated with Hospital-

Acquired Infections

Any microorganism can cause hospital-acquired infec-

tion. But those that survive in hospital environment and

develop resistance to antibiotics are of great importance.

• Methicillin resistant S. aureus and S. epidermidis are the

common causes of hospital infections.

• In recent years, E. coli, Klebsiella, Enterobacter, Proteus,

and Serratia have also become important hospital

pathogens.

• P. aeruginosa species have always been associated with

hospital infections because of their resistance to most of

the antibiotics and also to disinfectants.

• Tetanus spores survive in dust and contaminate many

items. Hospital tetanus is mainly due to lapses in asepsis

and poor sterilisation procedures.

• HIV, hepatitis B and C are transmitted by contaminated

blood or blood products and also by the use of shared

syringes and needles.

Common Hospital-Acquired Infections

Urinary tract infection

These are associated with catheterisation or instrumenta-

tion of urethra, bladder, or kidneys. Causative agents are

E. coli, Klebsiella, Serratia, Proteus, Pseudomonas, staphylo-

cocci, enterococci, and Candida albicans.

Respiratory infection

These hospital-acquired infections are of the lower respi-

ratory tract and are usually associated with aspiration or

pulmonary ventilation. Important pathogens are S. aureus,

Klebsiella, E. coli, Enterobacter, P.aeruginosa, Acinetobacter, and

Legionella pneumophilia.Wound infection

Post-operative wound infection is the most common hos-

pital-acquired infection. Important pathogens are S. aureus,

P. aeruginosa, E. coli, Proteus, and enterococci.

Gastrointestinal infections

These are associated with food poisoning and Salmonella

infection.

Bacteraemia and septicaemia

These are consequences of infections at any site but are

commonly caused by infected intravenous cannulae.

Gram-negative bacilli are the common pathogens.

Laboratory Diagnosis

Laboratory diagnosis is done by routine bacteriological

methods of smear, culture, isolation, and susceptibility

testing. In case of outbreaks of hospital-acquired infec-

tions, samples from possible sources of infection such as

hospital personnel, instruments, water, air, food, walls,

and floor must be tested.

Prevention of Hospital-Acquired Infections

Hospital-acquired infection can be prevented by

Use of sterile instruments, dressings, surgical gloves,

face masks, and IV fluids.

Thorough hand washing after every procedure that

involves contact with the patient or infected material.

Proper sterilisation and disinfection of inanimate

objects.

Early detection of and antibiotic therapy for hospital

staff who are earners of infection.

• Proper disposal of hospital waste.

Proper preoperative disinfection of patient's skin.

Early diagnosis of hospital-acquired infections and

treatment of patients.

Hospital-Acquired Infection Control Committee

(HAICC)

• Infection control programme should be a permanent

ongoing activity in every hospital. Every hospital must

have an Infection Control Committee consisting

of the hospital superintendent, microbiologist, and

representatives of medical, paramedical, nursing, and

administrative staff.

• HAICC must meet once a month to review the infection

control activities, emergence of drug resistance, proper

use of antimicrobial agents, proper sterilisation and dis-

infection procedures, incidence and types of infections,

commonly isolated pathogens, and antimicrobial sus-

ceptibility pattern.Standard Universal Precautions

These are a set of guidelines formulated to protect the

health care workers in hospitals from exposure to infec-

tions, particularly blood borne infections such as HIV and

hepatitis. The guidelines are as follows:

• Consider all specimens or patients as potentially infec-

tious or susceptible to blood borne infections.

• All hospital personnel should wear protective equip-

ment such as gloves, lab coats, gargles, shoe covers, and

masks.

All blood specimens or body fluids should be placed in

leak-proof containers while transporting.

• When there is a spillage of blood or body fluids, the

area should be decontaminated immediately with suit-

able disinfectant.

• Utmost care should be taken while using needles and

other sharp items.

All infected materials of the laboratory should be decon-

taminated before disposal.

• Hands should be washed thoroughly with soap and

water after completion the work.

All protective clothing should be removed before leav-

ing the laboratory