Nosocomial Infection

Dr. dr. M.SABIR, MS

 Outline of presentation
Definition of NI
Frequency of NI
Impact of NI
Factors Influencing the development of NI
Transmission of NI
Prevention & Control
Nosocomial surveillance
 Nosocomial Infection

nosus= disease and komeion= to take care of

Hospital acquired infection
An infection acquired in hospital by a patient who was
admitted for a reason other than that infection
Infection that occur during hospitalization but are not
present nor incubating upon hospital admission.
This includes infections acquired in the hospital but
appearing after discharge and also occupational
infections among staff of the facility
 Frequency of NI
Occur worldwide
Prevalence survey: 55 hospitals of 14 countries:
average 8.7% of hospital patients had NI
Most frequent NI: infections of surgical wounds,
UTI and lower respiratory tract infections.
Highest prevalence of NI occurs in ICU and in
acute surgical and orthopaedic wards
Infections rates are higher among patientss with
increased susseptibility because of old age,
underlying disease or chemotheraphy
 Patient in intensive Care Unit

The highest infection rate are in ICU : approximately 3

times higher
 Impact of NI (1)
For Patient
Increase length of stay : LOS
Increase cost
Possibility to get another disease
Increase Gross Death Rate : GDR
 Impact of NI (2)

For hospital
Overload
Increase operational cost
Unsafe on duty : possibility malpractice
Decrease hospital quality : NI rate is an indicator of
quality and safety of care
For Community
Absent
Source of transmission
 Factors influencing the development of
NI

The microbial agent : bacteria, viruses, fungi,

parasites
Patient susceptibility : age, immune status,
underlying disease, diagnostic & therapeutic
interventions
Environmental factors: crowded conditions,
frequent patients transfer, concentration of
patients in one area
Bacterial resistance : the widespread use of
antimicrobials for treatment or prophylaxis
The microbial Agents

Bacteria:
Commensal bacteria
Pathogenic bacteria

Viruses:
Hepatitis B, C
Respiratory syncytial virus
Rotavirus
Enteroviruses
Parasit and fungi : Giardia lamblia, Sarcoptes scabei,
C. albicans, Aspergillus sp, Cryptococcus neoformans
Transmission
1. Self Infection
2. Cross Infection
3. Environmental Infection
 Common NI
UTI: 80% are associated with the use of
indwelling bladder catheter
Surgical wound infection (surgical site
infections): incidens 0.5-15% depending on the
type of operation & underlying patient status
Nosocomial pneumonia. Rate of pneumonia is 3%
per day for patient on ventilators in ICU
Infection with intravascular lines : nosocomial
bacteriemia : 5%
 Urinary tract infection

-tight fixation

Positive urine culture with at least 105 bacteria/ml with or

without clinical symptoms
 Surgical wound infection

Any purulent discharge around the wound or the insertion site of

the drain or spreading cellulitis from the wound
 Nosocomial Pneumonia

Respiratory symptoms with at least two of the following signs

appearing during hospitalization : (1) cough, (2) purulent sputum,
(3) new infiltrate on chest radiograph consistent with infection
Infection with intravascular lines

Inflamation, lymphangitis or purulent discharge at the

insertion site of catheter
Intra venous line
How to prevent and to control
Nosocomial infections?
 Principle

Prevention is better than curative

HOW ?

Cutting the chain of

Nosocomial Infection
Chain of Infection

Reservoir/
Source
Microor
Port of exit
ganism
Infection

Susceptible Mean of
host transmission
Port of entry
 Source of Infection
Treatment
In hospital

Endogenous Environment
Flora & Facilities

Nosocomial
Infection
 Prevention (1)
Reducing person to person
transmission
Hand decontamination
Personal hygiene
Clothing
Mask
Gloves
Safe injection practices
 Prevention (2)
Preventing transmission from the
environment
Cleaning of the hospital
environment
Use of hot/superheated water
Disinfection of patient
equipment
Sterilization
Sterilization
 Hand washing
Running water

Soap / antiseptic

Facilities for drying

without contamination
(disposable towels)

Wash hands thoroughly with soap and water

or use alcohol-based hand rub
Hand Hygiene
 Prevention of UTIs

Proven effective Proven not effective

Systemic antibiotic
Limit duration of prophylaxis
catheter
Bladder irrigation or
Aseptic technique at instillation of normal saline
insertion antiseptic or antibiotic
Maintain closed Antiseptic added to drainage
drainage bag
Antimicrobial-coated
catheter
Daily antiseptic perineal
cleaning
 Prevention of Surgical Site Infections
Proven Effective Proven not effective
Surgical technique
Fumigation
Clean operating
environment Preoperative shaving
Staff attire
Limiting preoperative
hospital stay
Preoperative shower and
local skin preparation of
patient
Aseptic practice in OK
Surgical wound surveillance
 Prevention of Pneumonia
Proven Effective Proven not effective
Ventilator associated
Aseptic intubation and Digestive
suctioning decontamination for all
Limit duration patients
Non-invasive ventilation
Changes of ventilator
Others circuit every 48 or
Influensza vaccination for
staff
Isolation policy
Sterile water for oxygen and
aerosol therapy
Prevention of Legionella and
Aspergillus during
renovations
 Prevention of vascular device infections
Proven Effective Proven not effective
All catheters Antimicrobial creams for
Closed system skin preparation
Limit duration
Local skin preparation
Aseptic technique at insertion
Removal if infection suspected
Central lines
Surgical asepsis for insertion
Limitation of freq of dressing
change
Antibiotic-coated catheter for
short term
 Role of Microbiology Laboratory (1)
Perform antibiotic susceptibility test
Determine which antimicrobials are tested and
reported for each organism
Provide additional antimicrobial testing for selected
resistant isolates as requested
Participate in activities of the Antimicrobial Use
Committee
Role of Microbiology Laboratory
(2)
Monitor and report trends in prevalence of
bacterial resistance to antimicrobial agent
Provide microbiological support for
investigations of clusters of resistant
organism
Notify infection control promptly of any
unusual antimicrobial resistance pattern in
organisms isolated from clinical specimens
 References
Murray,PR., Baron,EJ., Jorgensen, JH., Pfaller,
MA. & Yolken RH. 2007. Manual of Clinical
Microbiology: ASM Press: Washington DC, p
118-128.
WHO.2002. Prevention of Hospital-acquired
infections, a practical guide. 2nd ed. 2002.
available in http:www.who.int/emc
THANK YOU