Nosocomial infection
Dr. Christina Poon
christinapoon@[Link]
Lecture outcome:
Infections
Nosocomial Community-acquired
infections (Lecture 12)
infections
Public health agencies
• World Health Organization (WHO)
- Specialized agency of the United Nations,
founded in 1948
- Promote technical cooperation for health
among nations
- Carry out programs to control and
eradicate diseases
- Improve the quality of human life
Public health agencies
• Centers for Disease Control and Prevention (CDC)
Founded in 1946
- Focus on communicable diseases
- Collaborate to create the expertise, information,
and tools that people and communities need to
protect their health through health promotion,
prevention of disease, injury and disability, and
preparedness for new health threats
- CDC epidemiologists travel to areas, wherever and
whenever an epidemic disease is occurring, to
investigate and attempt to control
- Prepares a weekly publication entitled Morbidity
and Mortality Weekly Report (MMWR): Notifiable
infectious diseases must be reported to CDC
Public health agencies in HK
• Centre for Health Protection
(CHP)
Founded in 2003
Vision: To be a centre of
excellence in disease prevention
and control
Mission: To achieve effective
prevention and control of
diseases in Hong Kong in
collaboration with major local
and international stakeholders.
• Nosocomial infections:
Healthcare-associated infections (HAIs or HCAIs) -
Infections that are acquired within hospitals or other
healthcare facilities
or within 14 days of hospital discharge
Example:
Iatrogenic infection – results from medical or surgical treatment,
caused by a surgeon, another physician, or some other healthcare workers
Surgical site infections (SSIs)
Urinary tract infections (UTIs)
Lower respiratory tract infections (Pneumonia)
Bloodstream infections (Septicemia)
Antibiotic-associated diarrhea (AAD)
Pseudomembranous colitis (PMC)
The following bacteria are the most
common causes of HAIs:
• Gram-positive cocci:
- Staphylococcus aureus (including methicillin-resistant strains of
Staphylococcus aureus [MRSA])
- Enterococcus spp. (including vancomycin-resistant enterococci)
• Gram-positive bacillus:
- Clostridium difficile
• Gram-negative bacilli:
- Escherichia coli
- Pseudomonas aeruginosa
- Enterobacter spp.
- Klebsiella spp.
Approximately 70% of HAIs involve drug-resistant bacteria!
Patients most likely to develop HAIs
• Elderly patients
• Women in labor and delivery
• Premature infants and newborns
• Surgical and burn patients
• Patients with cystic fibrosis, diabetes or cancer
• Patients having an organ transplant
• Patients receiving treatment with steroids, anticancer drugs,
antilymphocyte serum, or radiation
• Immunosuppressed patients (patients whose immune systems are
not functioning properly)
• Patients who are paralyzed or are undergoing renal dialysis
• Patients are undergoing catheterization or endotracheal tubes
3 major factors contributing to HAIs
•Increased number of drug-resistant
pathogens
•The failure of healthcare personnel to
follow infection control guidelines
•Increased number of
immunocompromised patients
Additional contributing factors:
• The indiscriminate use of antimicrobial agents
• A false sense of aseptic techniques and other infection
control procedures
• Lengthy, more complicated types of surgery
• Overcrowding of hospitals and other healthcare facilities, as
well as shortages of staff
• Increased use of less-highly trained healthcare workers
• Increased use of anti-inflammatory and immunosuppressant
agents
• Overuse and improper use of indwelling medical devices
3 Principle routes of transmission
involved in HAIs
Contact Transmission
• In direct contact transmission, pathogens are
transferred from one infected person to another
person without a contaminated intermediate object
or person.
• Indirect contact transmission happens when
pathogens are transferred via a contaminated
intermediate object or person.
3 Principle routes of transmission
involved in HAIs
Droplet Transmission ( > 5 µm in size)
• Respiratory droplets carrying pathogens transmit
infection when they travel from the respiratory tract
of an infectious individual (by sneezing or coughing)
to susceptible mucosal surfaces of a recipient.
3 Principle routes of transmission
involved in HAIs
Airborne Transmission (less than or equal 5 µm in size)
Medical Asepsis VS Surgical Asepsis
• Medical asepsis is a clean technique that reduce the
number and transmission of pathogens.
• Surgical asepsis is a sterile technique that exclude
all microbes.
• Surgical aseptic techniques are practiced in
operating rooms, in labor and delivery areas.
1. Airborne infection isolation room
2. Protective Environment
Revision sessions
(Lecture 3, 4, 5)
1. Pasteurization is an example of what kind
of technique?
A. antiseptic
B. disinfection
C. sterilization
D. Surgical aseptic
2. Which of the following is not a common
mechanism by which antimicrobial drugs kill
or inhibit the growth of bacteria?
A. Damage to cell membranes
B. Destruction of capsules
C. Inhibition of cell wall synthesis
D. Inhibition of protein synthesis
3. All the following antimicrobial drugs work
by inhibiting cell wall synthesis except?
A. cephalosporins
B. chloramphenicol
C. penicillin
D. vancomycin
4. All the following antimicrobial drugs work
by inhibiting protein synthesis except?
A. erythromycin
B. chloramphenicol
C. imipenem
D. tetracycline
5. Which of the following terms best
describes influenza?
A. Arthropod-borne disease
B. Sporadic disease
C. Epidemic disease
D. Endemic disease
6. Which of the following are considered
reservoirs of infection?
A. carriers
B. Animals and arthropods
C. Contaminated food and drinking water
D. All of the above
Next Lecture:
Revision sessions
(Lecture 6, 11, 12)
