Nosocomial Infection


Nosocomial infections (NI) - also called hospital-acquired infections (HAI) - are when patients acquire an infection from the healthcare environment within at least 2 to 3 days of entering the hospital (Vincent, 2003). Nosocomial infections - there are many kinds - can cause complications in the treatment of hospitalized patients. NIs often originate from intensive care units (ICUs) and thus frequently affect critically ill patients (Asensio et al., 2000). NI are common worldwide and affect around 10% of the population in developing countries and about 7% in developed countries (Khan et al., 2017). According to WHO estimates, around 15% of patients under medical care suffer from nosocomial infections, worldwide. And the risk of a patient developing a nosocomial infection has greatly increased in the last decade (Agaba et al., 2017).

Various viruses, bacteria and fungal parasites are associated with nosocomial infections. The most common bacterial species that have been isolated from frequently occurring NIs include Staphylococci (especially methicillin-resistant S. aureus, MRSA), Pseudomonas species, Acinetobacter species and members of Enterobacteriaceae family (including Escherichia coli and Klebsiella pneumonia). Most of these gram-positive and negative bacteria are antibiotic resistant and can quickly spread to immunocompromised patients, especially ones that are critically ill. It has been estimated that around 70% of all nosocomial infections are caused by any of the above-mentioned bacterial species (Chambers, 2005).

The most common nosocomial infections include pneumonia, bloodstream infection, surgical site infections (SSIs), and urinary tract infection (UTIs). These NIs account for about 60% of hospital-acquired infections and are transferred through contaminated hospital equipment and apparatus. For instance, nosocomial pneumonia is acquired when patients use contaminated ventilators; bloodstream infections are associated with intravascular devices, and UTI have been found to be associated with the use of infected catheters (Richards et al., 2000).

The common symptoms of nosocomial infection include fever, difficulty in breathing, cough, headache, burning sensation when urinating, nausea, diarrhea, discharge from wounds, and vomiting.

Many the nosocomial infections are caused by endogenous bacterial populations - i.e. bacteria already in the patient’s body that is moved to another part of the body it shouldn’t be in. Critically ill patients are more prone to colonization with resistant pathogenic strains from the healthcare environment.

UTIs account for around 40% of nosocomial infections, while nosocomial pneumonia accounts for 25% of NIs (Lockhart et al., 2007). Surgical site infections account for an alarming rate of 17% of all healthcare-associated infections (Napolitano, 2010). Apart from the role of contaminated medical equipment in the spread of NIs, various studies implicate health-care workers in the spread of NIS. These include physicians, nurses, respiratory therapists, radiology technicians, electrocardiogram technicians, housekeepers, paramedics, research assistants and security personnel who not knowingly serve as a vector in the transmission of infection from one patient to another. Many incidents of nosocomial transmission of respiratory ailments such as severe acute respiratory syndrome (SARS) and other infections have been reported to be transferred through these routes (Webb et al., 2004; Kwok et al., 2007).

Nosocomial infections are considered as a medical nuisance, as they lead to a prolonged hospital stay, extensive use of medicine, possible disability, and economic burdens. That’s why so many are concerned about instituting preventive measures to minimize the infection rate. Hygienists, nurses, and others concerned with public health have found that to prevent the spread of nosocomial illnesses, it is necessary to prevent the mechanical and physical transmission of infection inside the healthcare facility. Several measures can be taken to avoid the spread of nosocomial infections, the most important is the proper disposing of hospital waste. One estimate is that around 25% of hospital waste can potentially spread life-threatening infections (Khan et al., 2017).

Further, the use of standard operating protocols (SOPs) and universal precautions for infection control and ensuring checks and balances in use of antibiotics can reduce the drive toward microbial resistance and ultimately reduce the spread of nosocomial infections (Khan et al., 2017). The SOPs for infection control include frequent hand washing by health care workers, Hand washing is considered as the simplest and most important intervention in infection control. Use of masks, gloves, and gowns can also help prevent the spread of nosocomial infections (Saloojee, and Steenhoff 2001). Further, proper ventilation of rooms, cleaning and decontamination of wards reduces the risks of nosocomial infections.

Various species of microbes are associated with nosocomial infections, including viruses, bacteria and fungal parasites. The most common bacterial species that have been isolated from frequently occurring NIs include Staphylococci (especially methicillin-resistant S. aureus, MRSA), Pseudomonas species, Acinetobacter species and members of Enterobacteriaceae family (including Escherichia coli and Klebsiella pneumonia). Most of these gram-positive and negative bacteria are antibiotic resistant and can quickly spread to immunocompromised critically ill patients. It has been estimated that around 70% of all nosocomial infections are caused by any of the above-mentioned bacterial species (Chambers, 2005).

The most common nosocomial infections include pneumonia, bloodstream infection, surgical site infections (SSIs) and urinary tract infection (UTIs). These three NIs account for about 60% of the hospital-acquired infections and are transferred through contaminated hospital equipment and apparatus. For instance, nosocomial pneumonia is acquired using the contaminated ventilator; bloodstream infections are associated with intravascular device and UTI have been found to be associated with the use of infected catheters (Richards et al., 2000).

The common symptoms of nosocomial infection include fever, difficulty in breathing, cough, headache, burning sensation when urinating, nausea, diarrhea, discharge from wound and vomiting. However, mostly the nosocomial infections are caused by endogenous bacterial population, but the critically ill patients are more prone to colonization with resistant pathogenic strains. The UTI account for around 40% of all nosocomial infections, while nosocomial pneumonia accounts for 25% of NIs (Lockhart et al., 2007). The ratio of surgical site infections is also very high and have an alarming rate of 17% of all healthcare-associated infections (Napolitano, 2010).

Apart from the role of contaminated medical equipment in the spread of NIs, various studies support the role of health-care workers in the spread of NIS. These include physicians, nurses, respiratory therapists, radiology technicians, electrocardiogram technicians, housekeepers, paramedics, research assistants and security personnel who not knowingly serve as a vector in the transmission of infection from one patient to another. Many incidents of nosocomial transmission of respiratory ailments such as severe acute respiratory syndrome (SARS) and other infections have been reported to be transferred through these routes (Webb et al., 2004; Kwok et al., 2007).

Nosocomial infections are considered as a medical nuisance, as they lead to a prolonged hospital stay, extensive use of medicine, possible disability, and economic burden. It has become the need of time that proper preventive measures should be developed to minimize the rate of nosocomial infections. It has been found that to prevent the spread of nosocomial infections, it is necessary to prevent the transmission of infection. Several measures can be taken to avoid the spread of nosocomial infections, the most important is the proper disposing-off of hospital waste. According to an estimate, around 25% of hospital waste falls under the category of hazardous and can spread various kind of life threating infections (Khan et al., 2017).

Further, the use of standard operating protocols (SOPs) for infection control and ensuring check and balance in use of antibiotics can decrease the origin of microbial resistance and ultimately reduce the spread of nosocomial infections (Khan et al., 2017). The SOPs for infection control include frequent hand washing by health care workers and is considered as the simplest and most important intervention in infection control. Careful usage of masks, gloves and gowns can also contribute to preventing the spread of nosocomial infections (Saloojee, and Steenhoff 2001). Further, proper ventilation of rooms, cleaning and decontamination of wards is critical in minimizing the risks of nosocomial infections.

REFERENCES

Agaba, P., Tumukunde, J., Tindimwebwa, J., & Kwizera, A. (2017). Nosocomial bacterial infections and their antimicrobial susceptibility patterns among patients in Ugandan intensive care units: a cross sectional study. BMC research notes, 10(1), 349. doi:10.1186/s13104-017-2695-5
Asensio, A., Oliver, A., González-Diego, P., Baquero, F., Perez-Diaz, J. C., Ros, P., . . . Cantón, R. (2000). Outbreak of a multiresistant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as risk factor for colonization and infection. Clinical Infectious Diseases, 30(1), 55-60
Chambers, H. F. (2005). Community-associated MRSA—resistance and virulence converge: Mass Medical Soc.
Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478-482. doi: https://doi.org/10.1016/j.apjtb.2017.01.019
Kwok, K. O., Leung, G. M., Lam, W. Y., & Riley, S. (2006). Using models to identify routes of nosocomial infection: a large hospital outbreak of SARS in Hong Kong.
Proceedings. Biological sciences, 274(1610), 611–617. doi:10.1098/rspb.2006.0026
Lockhart, S. R., Abramson, M. A., Beekmann, S. E., Gallagher, G., Riedel, S., Diekema, D. J., . . . Doern, G. V. (2007). Antimicrobial resistance among Gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004. Journal of clinical microbiology, 45(10), 3352-3359.
Richards, M. J., Edwards, J. R., Culver, D. H., Gaynes, R. P., & System, N. N. I. S. (2000). Nosocomial infections in combined medical-surgical intensive care units in the United States. Infection Control & Hospital Epidemiology, 21(8), 510-515.
Napolitano, L. M. (2010). Perspectives in surgical infections: what does the future hold? Surgical infections, 11(2), 111-123.
Saloojee, H., & Steenhoff, A. (2001). The health professional's role in preventing nosocomial infections. Postgraduate medical journal, 77(903), 16-19
Vincent, J.-L. (2003). Nosocomial infections in adult intensive-care units. The Lancet, 361(9374), 2068-2077.
Webb G.F, Blaser M.J, Zhu H.P, Ardal S, Wu J.H. Critical role of nosocomial transmission in the Toronto SARS outbreak. Math. Biosci. Eng. 2004;1:1–13

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