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Hospital acquired infection

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  • Hospital acquired infection

    Hospital acquired infection means infection develops 48-27 hours after hospitalization and was not present or incubated at time of admission. However, a new term is used now ; the health care associated infection HCAI which is infection transmitted to patients (and health care workers) as a result of health care procedures

    Types of HCAI
    Central line associated blood stream infections
    Ventilation associated pneumonia
    Catheter associated urinary tract infection
    Surgical site infections

    The most common organisms:

    MRSA
    Clostridium difficile
    E. coli
    Pseudomonas
    Vancomycin resistant enterococci
    Gram negative bacilli with extened spectrum beta lactamases

    Risk factors for HCAI:

    - Immunocompromised patients and/ or those on chemotherapy
    - Usage of medical devices (80% of blood infection occure with IV catheter, 60% of UTI occure with urinary catheters)
    - Hospital environment & behavioral factors (dirty instruments, hygeinic environment
    - Organization factors: Spread of HCAI is increased with:
    1- Bed occupancy rates
    2- Increasing movement of patient within & between hospitals
    3- Shortage in nurse stuff


    Infection control programm
    Each hospital must has its committee of infection control which give s rise to infection control team ( microbiologist, physicians, trained nurses, Infection control specialist if possible
    The goals of this programm are to improve quality of patient care & reduce its cost
    It requires strict survillence and reporting system (for patient infections, health workers infection & communicable diseases) and control & prevention system ( teaching & consulting)
    " و هكذا بعض الأشياء التي نضحك منها في ارتياح
    لأن أعيننا لا تراها كاملة"
    شاعر ألماني

  • #2
    يعطيك العافية على معلوماتك المختصرة

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    • #3
      ربنا يوفقك
      :sm199:

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      • #4
        NOSOCOMIAL INFECTION IN BRIEF

        شكرا جزيلا

        هل تعرفون ماهو الـ NOSOCOMIAL INFECTION

        Hospital acquired infection

        لقد قمت بإلقاء محاضره في هذا الموضوع ارجوا تستفيدوا منه

        الرابط


        http://www.mediafire.com/?ogketwntmrw



        http://www.mediafire.com/file/ogketwntmrw/Nosocomial Infections.pdf

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        • #5
          Nosocomial Infections

          Nosocomial Infections


          Introduction
          Infections that are acquired while a patient is in a hospital are referred to as nosocomial infections; a term derived from 'nosos' the Greek word for 'disease'. Nosocomial infections are diseases that we, as heath care professionals, give to our clients. Hospitals and clinics are places where sick people go with the expectation that they will get better. Unfortunately, there is a risk that clients may become infected because of their visits to these places. Often nosocomial infections become apparent while the patient is still in the hospital but in some cases symptoms may not show up until after the affected patient is discharged. About one patient in ten acquires an infection as a direct result of being hospitalized.
          Monitoring agencies such as the National Nosocomial Infections Surveillance (NNIS) agency now recognize that the term "nosocomial infection" should not be limited only to the hospital setting. Patients who have frequented short-term procedure settings or who reside in chronic care facilities such as nursing homes have been found also to develop infections due to the same spectrum of pathogens. Individuals who have recently been discharged from an acute or chronic health care facility, who have some of the risk factors we will be discussing, or who have received prolonged courses of antimicrobial therapy are also at risk and are now being followed to determine accountability and prevention. Surveillance, identification of high risk patients, new and better ways of prevention and decontamination as well as consistent and professional implementation of standing procedures will be at the core of curtailing the spread of these diseases from within our doors. (Heratige, 2001)
          History
          Modern understanding of nosocomial infection pre-dates the infancy of microbiology as a discipline. The entire concept of infection control is grounded in the work of Ignaz Semmelweis, who in the 1840's demonstrated the importance of hand hygiene for controlling transmission of infection in hospitals. During the 1840's he was working in the Vienna General Hospital. He became concerned with the number of women who died of puerperal fever (infection) following the delivery of an infant. At the time that Semmelweis was working, there were two wards for the delivery of babies with the difference being that medical students attended births in one ward while the second was staffed entirely by midwives. Semmelweis noted that women were much more likely to die if they were delivered in the first ward, attended by medical students, than were women delivered by midwives in the second ward. The death rate was about 10% in the first ward, compared with a rate of less than 3% for the second ward.
          Semmelweis investigated the procedures in each unit and found no differences worthy of note, beyond the presence of medical students in the ward with the high infection rate. His investigations led him to conclude that medical students were carrying "cadaveric material" from the dissecting classrooms on their hands and that it was this material that led to the deadly infections. After considerable struggle with the Viennese medical establishment, he insisted on a strict protocol of hand washing in chlorine water after dissection and before moving to the delivery ward. The effect was a dramatic reduction in the mortality rate. (Heratige, 2001)
          Despite such dramatic results, infection control efforts remained spotty for almost a century. In 1976, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) published accreditation standards for infection control, creating the impetus and need for hospitals to provide administrative and financial support for infection control programs. In 1985, the Centers for Disease Control and Prevention (CDC) published a study on the Efficacy of Nosocomial Infection Control. The study reported that hospitals with four key infection control components - an effective hospital epidemiologist, one infection control practitioner for every 250 beds, active surveillance mechanisms, and ongoing control efforts - had reduced nosocomial infection rates by approximately one third. (Weinstein, 1998)
          The Problem
          Over the past 25 years, the CDC's National Nosocomial Infections Surveillance (NNIS) system has received monthly reports of nosocomial infections from a nonrandom sampling of more than 270 hospitals in the United States. They have found that the nosocomial infection rate has remained remarkably stable with approximately 5 to 6 hospital-acquired infections for every 100 admissions. However, the end rate of nosocomial infections per 1,000 patient days has actually increased from 7.2 in 1975 to 9.8 in 1995, a 36% growth. As of 1995, nosocomial infections cost $4.5 billion and have contributed to more than 88,000 deaths - one death every 6 minutes. These numbers have grown with each passing year. (Weinstein, 1998)
          It is believed that the majority, perhaps as much as 80% of nosocomial infections are caused by the microbial flora that clients bring with them upon admission to the hospital. This "stay-at-home" flora appears to be opportunistic to the new environment and is able to take advantage of new routes that medical procedures offer.
          Other nosocomial infections, perhaps 10% to 20%, develop following contamination with microbial organisms found within the hospital environment, often via the hands or instruments of health care workers or contact with contaminated hospital materials. Examples of this include transfer of Staphylococcus aureus or Streptococcus pneumoniae from one patient to another via the hands of a hospital worker, successful colonization on the new host, followed by development of symptomatic illness later during the hospitalization. Handwashing with antiseptics such as povidone-iodine and the use of disinfectants on inanimate objects and environmental surfaces have been shown to decrease the spread of potential pathogens to patients. Finally, person-to-person spread of infections in the health care setting can occur via direct contact, droplet, airborne, fecal-oral, and blood-borne routes. (Liu, 2001)
          A number of risk factors have been linked with the development of nosocomial infections, especially the organisms with antibiotic-resistant properties. Perhaps the most important is prior treatment with antibiotics, especially broad-spectrum agents. Such therapy has been shown to suppress normal microbial flora and select for microorganisms resistant to the antibiotics used. The presence of a persistent focus of infection (i.e. a prosthetic device, abscess, large wound, or decubitus) also contributes to the selection of treatment resistant flora. An extended stay in an acute or chronic care facility is also a risk factor for acquisition of antibiotic-resistant pathogens because patients may acquire the microorganisms that eventually lead to nosocomial infection from that environment.
          Individuals may also have one or more risk factors that predispose them toward particular nosocomial infections. These risk factors overlap, but may be considered broadly as underlying host defects (i.e. immunosuppression, implanted foreign bodies, chronic lung disease, aging, etc), and mechanical predispositions (being bedridden, invasive medical devises, intravascular catheters, etc.). Some clients tend to have multiple risk factors and are accordingly at very high risk for nosocomial infection.
          The increase in occurrence of nosocomial infection rates can be best summed up by three major contributing factors. The first is the overuse of antimicrobials. Increased concern about infections in the 1970's to 1980's led to the increased use of antibiotics, especially cephalosporins. As organisms became resistant to earlier generations of cephalosporin antibiotics, newer generations were developed. Widespread use of cephalosporin antibiotics is often cited as a cause for the emergence of enterococci as nosocomial pathogens. At the same time, MRSA (methicillin-resistant Staphylococcus aureus), perhaps also in response to extensive use of cephalosporin antibiotics, became a major nosocomial threat. This led to the overuse of vancomycin, partly in response to concerns about MRSA and for treatment of vascular catheter associated infections by organisms such as the resistant coagulase-negative staphylococci. Now medical institutions are faced with a resident flora of "super-bugs", resistant to the most aggressive antimicrobial therapies.
          A second contributing factor is that many hospital personnel fail to follow basic infection control procedures such as hand washing between patient contacts. In ICUs, emergency rooms, urgent care clinics and other areas asepsis is often overlooked in the rush of crisis care. Finally, patients in hospitals are becoming increasingly immunocompromised. The great migration of surgical and specialty care to outpatient centers leaves the very sickest patients in hospitals, which are becoming more and more like large ICUs. This shift has led to a greater prevalence of vascular access-associated bloodstream infections and ventilator-associated pneumonias.
          One last factor posses a problem of potential concern: as hospitals age, repairs and renovations release dust and spores into the air during demolition and construction, which may cause fungal disease. Illness due to other pathogens, such as Legionella pneumophilia and toxic molds, may also result from such disruptions.
          Seeking Solutions
          Every attempt should be made to correct risk factors for infection. Approaches include improving patient nutrition, sterilizing and disinfecting medical supplies, utilizing proper standard precautions with handwashing being emphasized and minimizing the use of indwelling vascular catheters and urinary tract drainage devices. Reducing of the number of microorganisms present on the patient's body surface with povidone-iodine or chlorhexidine preparations has also been found to be helpful in preventing many types of infection.
          Procedures
          In order to minimize and/or eliminate nosocomial infections it is important to follow Standard Precautions (the new term for Universal Precautions) and the policies and procedures established by the institutional setting you are practicing in. The CDC advises that reusable medical devices or patient-care equipment that enters either normally sterile tissue or the vascular system, or through which blood flows, should be sterilized before each use. Sterilization in this context means the use of physical or chemical procedures to destroy all microbial life, including highly resistant bacterial endospores.
          Sterilizing Agents
          The major sterilizing agents used in hospitals are a) moist heat by steam autoclaving, b) ethylene oxide gas, and c) dry heat. There are also a variety of chemical germicides (sterilants) that have been used for purposes of reprocessing reusable heat-sensitive medical devices that appear to be effective when used appropriately (i.e., according to manufacturer's instructions). These chemicals are rarely used for sterilization, but appear to be effective for high-level disinfection of medical devices that come into contact with mucous membranes during use (e.g., flexible fiberoptic endoscopes).
          Disinfection
          When sterilization is not possible, disinfection should be achieved. Disinfection means the use of a chemical procedure to eliminate virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial endospores or prions) on inanimate objects. There are three levels of disinfection, high, intermediate, and low. High-level disinfection kills all organisms, except high levels of bacterial spores, which should be treated with a chemical germicide cleared for marketing as a sterilant by the Food and Drug Administration (FDA). Intermediate-level disinfection kills mycobacterium and most viruses and bacteria, using a chemical germicide registered as a "tuberculocide" by the Environmental Protection Agency (EPA). Low-level disinfection kills some viruses and bacteria with a chemical germicide registered as a hospital disinfectant by the EPA. Heat-stable reusable medical devices that enter the blood stream or enter normally sterile tissue should always be reprocessed using heat-based methods of sterilization (e.g., steam autoclave or dry heat oven).
          Laparoscopic or arthroscopic telescopes (optic portions of the endoscopic set) should be subjected to a sterilization procedure before each use. When this is not feasible, they should receive high-level disinfection. Heat stable accessories to the endoscopic set (e.g., trocars, operative instruments) should be sterilized by heat-based methods (e.g., steam autoclave or dry heat oven).
          Any reusable devices or items that touch mucous membranes should, at a minimum, receive high-level disinfection between patients. These devices include reusable flexible endoscopes, endotracheal tubes, anesthesia breathing circuits, and respiratory therapy equipment. Medical devices that require sterilization or disinfection must be thoroughly cleaned to reduce organic material or bioburden before being exposed to the germicide. The germicide and the manufacturer's instructions should be closely followed.
          Items that do not ordinarily touch the patient or touch only intact skin are not usually involved in disease transmission, and generally do not necessitate disinfection between uses on different patients. These items include crutches, bedboards, blood pressure cuffs, and a variety of other medical accessories. Consequently, depending on the particular piece of equipment or item, washing with a detergent or low-level disinfectant may be sufficient when decontamination is needed. If noncritical items are grossly soiled with blood or other body fluids, then the items should be cleaned and disinfected using a low level agent, or handled according to the policies of your facility. (CDC, 2002)
          Prevention
          Infection control can be very cost-effective. Approximately one third of nosocomial infections are preventable. To meet and exceed this level of prevention, we need to pursue several strategies simultaneously. Prevention begins by identifying those who have risk factors for nosocomial infections. Then handwashing, proper use of gloves, and careful attention to protecting endotracheal tubes and other devices from contamination are crucial in decreasing microbial contamination of the patient. Local skin care and use of topical antiseptics are very important with wounds or indwelling catheters of any type. Povidone-iodine solutions have been effective in preventing infections via both preoperative skin preparation of invasive procedure sites and postoperative care of surgical sites. If patients are experiencing decreased mobility the use of incentive spirometry and deep coughing is very important. Preventative measures are best tailored to the patient's acute and chronic disorders and should be employed comprehensively and consistently.
          As states earlier, handwashing combined with proper materials processing is perhaps the greatest prevention of all. Plain soap and water can physically reduce the number of microorganisms present on the skin and further reductions can be achieved with the use of antiseptic agents. On skin, alcohols, such as a 70% isopropyl alcohol solution, tend to act quickly but tend to be drying and irritating, and their beneficial actions are relatively transient. Chlorhexidine has activity against many microorganisms, is generally well tolerated and has persistent activity. It is less effective against gram-negative bacteria than gram-positive bacteria, only fair against fungi, and minimally active against Mycobacterium tuberculosis. Hexachlorophene is a long-acting agent when used regularly, but has a slow onset of action and minimal gram-negative activity. The potential for absorption with resultant neurotoxicity has appropriately limited its use. Para-chloro-meta-xylenol has good activity against gram-positive organisms, is rapid acting, and is only minimally affected by organic matter. Unfortunately, it is less effective than chlorhexidine or iodophors in reducing skin flora and is neutralized by nonionic surfactants. Triclosan has a broad-spectrum antibacterial activity that is persistent on skin, but is a poor fungicide and may be irritating. It is often used in low concentrations in over-the-counter soaps but there is less experience with the higher concentrations that would more commonly be used in health care settings. (Liu, 2001)
          In addition to those listed above, several other agents can be used on a client's skin surface. Old fashioned tincture of iodine can be used as a preoperative skin preparation but needs to be removed after drying in order to prevent skin irritation. Currently iodophors, notably povidone-iodine, are used in handwashing, surgical scrubs, and skin preparation and are well tolerated. These are complexes of iodine in combination with a carrier molecule. The "free iodine", which is the antiseptic agent, is released from this molecular "reservoir" and is active against many gram-positive and gram-negative bacteria, as well as fungi, Mycobacterium tuberculosis and viruses. There is also some activity against bacterial spores. The potential for skin irritation is much lower for povidone-iodine than tincture of iodine, however patient allergy to iodine and reduction of antimicrobial activity in the presence of organic materials such as blood or sputum are considerations that should affect usage. (Larson, 1995)
          Conclusion
          As heath care providers we are responsible for preventing and containing nosocomial infections. By identifying clients at risk, following standard precautions, handwashing and protecting through sterilization and disinfection procedures we can control and eliminate many of the infections that we cause. All employees play an essential roll in this effort including those that touch the skin of an individual client as well as those who sterilize, disinfect and store the materials and supplies being used. Together, we can make a safer environment, one free from the diseases found within our doors.
          Take the Test
          References
          "Sterilization or Disinfection of Medical Devices: General Principles." Centers for Disease Control. http://www.cdc.gov/ncidod/hip/Sterile/Sterilgp.htm. July 2002.
          Heratige, J. "Tutorial on Nosocomial Infections." http://www.bmb.leeds.ac.uk/mbiology. January 2001.
          Larson, E. "American Practitioners in Infection Control guideline for hand washing and hand antisepsis in health-care settings." American Journal Infection Control. 1995.
          Liu, H. "Nosocomial Infections A Multidisciplinary Approach to Management." Purduepharma. http://www.powerpak.com. 2001.
          Weinstein, R. "Nosocomial Infection Update." Emerging Infectious Diseases. July 1998. http://www.cdc.gov/ncidod/eid/

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