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Nosocomial Infection and Infection Control

Prepared by Dr. Jhason John J. Cabigon

1. Nosocomial Infection those that are acquired within hospitals or other

healthcare facilities; including those that erupt within 14 days of discharge; 5% of

total hospitalizations Iatrogenic infections induced by physician or other healthcare personnel

Most common causes of Nosocomial Infections

a. Gram-positive cocci

Staphylococcus aureusCoagulase-negative staphylococci (Staphylococcus epidermidis)

Enterococcus spp.

b. Gram-negative bacilli

Escherichia coliPseudomonas aeroginosa

Enterobacterspp.

Klebsiella spp. Most common Types of Nosocomial Infections

a. UTI

b. Surgical wound infectionsc. Lower respiratory tract infections

d. Bloodstream infections

Patients most likely to Develop Nosocomial Infections

a. Elderly patientb. Women in labor and delivery

c. Premature infants and newborns

d. Surgical and Burn patients

e. Diabetic and Cancer patientsf. Patients receiving treatment w/ steroids, anticancer drugs, antilymphocyte

serum, and radiation

g. Immunosuppressed patientsh. Patients who are paralyzed or are undergoing renal dialysis

Major factors Contributing to Nosocomial Infections

a. Increasing number of drug-resistant pathogensb. Failure of healthcare personnel to follow infection control guidelines

c. Increasing number of Immunocompromised patients

d. Indiscriminate use of antimicrobial agentse. A false sense of security about antimicrobial agents

f. Lengthy, more complicated surgeryg. Overcrowding of hospitals, as well as shortage of staff

h. Increased use of less-highly trained healthcare workersi. Increased use of anti-inflammatory and immunosuppressant agents

j. Overuse and improper use of Indwelling medical devices

2. Infection ControlA. Medical Asepsis clean technique; involves procedures and practices that

reduce the number and transmission of pathogens; to exclude pathogens

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B. Surgical Asepsis sterile technique; practices used to render and keep

objects and areas sterile; to exclude ALL microorganisms

C. Standard Precautions used by ALL hospitals regardless of diagnosis;prevents pathogens transmitted by blood, body fluids, secretions,

excretions and contaminated items

1. Handwashing most important and most basic2. Gloves

3. Masks, Eye Protection, Face Shields and Gowns

4. Patient-care equipment if soiled, not used to other patients5. Environmental Control

6. Linens

7. Occupational Health and Bloodborne Pathogens (NEVER recap

used needles)8. Patient Placement

D. Transmission-based Precautions

1. Airborne Precautions

a. Patient Placement use private rooms w/ negative air pressureand HEPA filters

b. Respiratory Protection use masks when entering patientsroom; susceptible persons should not enter room

c. Patient Transport limit patient transport; use surgical mask on

patient during transport2. Droplet Precautions

a. Patient Placement at least 3 feet from next patient

b. Mask wear mask if within 3 feet of patient

c. Patient Transport - limit patient transport; use surgical mask onpatient during transport

3. Contact Precautions

a. Patient Placement private if possibleb. Gloves

c. Wash

d. Gowne. Patient Transport - limit patient transport

f. Patient-Care Equipment dedicate the use of equipment to a

single patient

E. Isolation1. Source Isolation to protect other people

2. Protective/Reverse Isolation to protect vulnerable patients

F. Handling1. Food and Eating Utensils

2. Fomites any non-living or inanimate objects other than food that

may harbor and transmit microbesG. Medical Waste Disposal receptacle must be equipped w/ a solid, tight-

fitting cover; includes disposal of sharps