CURRICULUM

DEVELOPMENT TEACHING

NOSOCOMIAL INFECTIONS
(HOSPITAL ACQUIRED INFECTIONS)

OMOTOSHO TOBILOBA. A.
2130019
6TH MAY, 2016
 Learning Objectives
After this study, learners should be able to
• Define Nosocomial Infections and identify their sites
• Identify sources of nosocomial infections
• Understand how nosocomial infections are transmitted
• Know factors that influence the development of
nosocomial infections
• Review preventive steps to reduce nosocomial infections
• State the roles of a nursing staff in infection control

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 LECTURE 1 OUTLINE
• Introduction
• Mode of Transmission
• Nosocomial Infection Sites
• Organisms that Cause Hospital Infections
• Factors that Influence Development of
Nosocomial Infections
• Impacts of Nosocomial Infections
• Prevention of Hospital Infections
• Role of Nursing Staff in Infection Control
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 Introduction
• The easiest way of infection transmission from one person to
another is having many sick people together under one roof
• Also called Hospital Acquired Infections (HAI)
• Infections acquired whilst in hospital is termed ‘nosocomial’
infection (occurring 48 hours or more after admission and up to 48 hours after
discharge)

• These infections mostly manifests while the patient is in hospital

• However, some are not recognized until after the patient has been
discharged e.g. post- operative wound infections
• Hospital infections can be acquired from an exogenous source,
endogenous, or from the environment

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 Mode of Transmission
• Hospital acquired infections can be spread through
– direct contact (staff themselves)
– indirect contact (droplet spread),
– alternative vehicles, such as blood plasma ,food or water.
• Part of the reason hospital acquired infections are very
difficult to stop is because they have many mediums of being
transferred.

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 Important Organisms that Causes
Hospital Infections
• Almost any microorganism can cause nosocomial
infection (although protozoal infections are rare)
• Before the antibiotic era, nosocomial infections were
caused by Gram –positive organisms (Strep. pyogenes,
Staph aureus)
• Now Gram-negative organisms such as E.coli,
pseudomonas aeruginosa are emerging as the causative
agents for hospital infections.

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• Many of these organisms are considered as
‘opportunists’ microbes.
• Viral infections account for more hospital
acquired infections.
• Respiratory viruses, especially influenza
• Varicella-zoster are low risk in general but very
important in paediatric units

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 Nosocomial Infection Sites
RELATIVE FREQUENCIES OF MAJOR HOSPITAL INFECTIONS

5%
18% 11%

bacteraemia 5
LRTI
SWI
24% UTI
others

42%

The relative freq of different hospital infections vary for different patient
groups, but UTI are the most common hospital acquired infections

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• Urinary Infections
– Most common nosocomial infection.
– 80% of infections are associated with the use of an
indwelling urinary catheter.
– Can occasionally lead to bacteraemia and death.
– Bacteria responsible arise from the gut flora, either
normal (E-Coli) or acquired in the hospital (multiresistant
Klebsiella)
• Surgical Site Infections
– Include purulent discharge around the wound or
insertion site of the drain.
– Infection acquired during the operation itself; either
• Exogenously (e.g. From the air, medical equipment, surgeons
and other staff)
• Endogenously (from the flora on the skin or in the operative site)

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• Nosocomial Pneumonia
– Common in patients on ventilators in ICU
– Microorganisms colonize the stomach, upper airway
and bronchi and cause infection in the lungs.
– They are either
• Endogenous (digestive system or nose and throat).
• Exogenous (from contaminated respiratory equipments).

• Nosocomial Bacteraemia
– Represent a small proportion of nosocomial infections
but case fatality rates are high.
– Caused by Staphylococcus and Candida spp. through
e.g. catheterization, cannulation etc.

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Other Nosocomial Infections
– Skin and Soft tissue infections: open sores (ulcers, burns and
bedsores) encourage bacterial colonization and may lead to
systemic infection.
– Gastroenteritis: is the most common nosocomial infection in
children where rotavirus is the chief pathogen

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 Factors Affecting the Development of
Nosocomial Infection
• The Microbial Agent
– Many different bacteria, viruses, fungi and
parasites may cause nosocomial infections.
– Infections may be caused by a micro-organism –
• acquired from another person in the hospital (cross-
infection) OR
• caused by patient’s own flora (endogenous infection)
OR
• acquired from an inanimate object/ substances
recently contaminated from another human source
(environmental infection).
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• Patient susceptibility
– Important patient factors influencing acquisition of infection
include:
• Age (Infancy and Old age)
• Immune Status
• Underlying disease
• Diagnostic and therapeutic interventions
• Environmental Factors
– Health care settings are an environment where both infected
persons and persons at increased risk of infection
congregate.
– The factors include
• Crowded conditions within the hospital
• Frequent transfers of patient from one unit to another
• Concentration of patients highly susceptible to infection in one area
(e.g. newborn infants, burn patients, intensive care)

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 Impacts of Hospital Infections
• Can result in serious illness or death
• Prolonged hospital stay
• Required additional antimicrobial therapy, costly
and exposes the pt to additional risk of toxicity,
resistance strains
• Infected person becoming source of infection for
both the hospital and community

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 PREVENTION OF HOSPITAL
INFECTION
• HOW CAN HOSPITAL INFECTION BE
PREVENTED?

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• Three main strategies
1. Excluding sources of infection from the
hospital environment
– Provision of sterile dressing and instruments, sterile
IV fluids, clean linen, and uncontaminated food.
– Hospital staff must undergo health screening before
employment, and regular health check, should be
encouraged to report any incidences of infection,
appropriate immunization must be offered and in
some cases make mandatory

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2. Interrupting the transmission of infection from
source to susceptible host
– Two elements must be considered here
– The hospital structure and the human
– The hospital and its equipment can prevent airborne
spread of infections: good ventilation systems,
isolation wards
– Facilitating aseptic technique by the staff

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3. Enhancing the host’s ability to resist infection
– The two outlined strategies do not protect the host
from endogenous infection
– Boosting specific immunity by active or passive
immunization
– The proper use of prophylactic antibiotics
– Care of invasive devices, which breaks the natural
defences, e.g. catheters, IV lines
– Attention to the factors that lead to post-operative
infection

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Role of Nursing Staff in Infection Control
• The senior nursing administrator is responsible
for:
– Participating in the infection control committee.
– Developing training programmes for nursing staff
members.
– Supervising the implementation of techniques for the
prevention of infections in specialized areas such as
the operating suite, ICU and maternity unit.
– Monitoring of nursing adherence to policies.

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• The nurse in charge of a ward is responsible for:
– Maintaining hygiene, consistent with hospital policies
and good nursing practice on the ward.
– Monitoring aseptic techniques, including hand washing
and use of isolation
– Reporting promptly to the attending physician any
evidence of infection in patients under the nurse’s care
– Initiating patient isolation and ordering culture
specimens from any patient showing signs of a
communicable disease, when the physician is not
immediately available.
– Maintaining a safe and adequate supply of ward
equipment, drugs and patient care supplies.

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 Summary
• Nosocomial infections often have serious consequences
for the individual, for the hospital community, and the
community at large
• They may be caused by almost any organisms but a few
species cause the majority of infection
• Due to its serious nature, control and prevention of
infection should be given high priority, staff educated in
proper procedures, provision of clean environment and
sterile equipment
• Sterility cannot be 100% in hospitals, nonetheless it is a
corner stone on which modern medicine and surgery
depends.

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 Further Reading
• WHO (2002). Prevention of Hospital-
Acquired Infections – A Practical Guide
(2nd Ed.). WHO, Department of
Communicable Disease, Surveillance and
Response. Switzerland, Geneva.
• Burke, J. P., (2003). “Infection Control- A
Problem for Patient Safety”. The New
England Journal of Medicine February, 13,
2003.

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