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Nosocomial infection

A nosocomial infection, also called healthcare-associated or hospital-acquired infections, refers to an infection which was not present during the time of admission, that the patient has acquired in an institution like a hospital. A nosocomial epidemic is a nosocomial infection that affects two or more patients, and there is a connection between the cases.

Problems with nosocomial infections:

  • Many people in small area
  • Hospitalized people often have impaired immunity or condition
  • Microorganisms in the hospital often have increased resistance to antibiotics
  • Microorganisms in the hospital are often more virulent than microorganisms in the community

Although intensive care units (ICUs) account for fewer than 10% of total beds in most hospitals, more than 20% of all nosocomial infections are acquired in ICUs. ICU-acquired infections account for substantial morbidity, mortality, and expense. Most bacterial infections that occur on the ICU have some sort of anti-microbial resistance.

Primary and secondary factors

Primary factors:

  • Source of nosocomial infection
    • The patients themselves
    • Other patients
    • Staff
    • Visitors
    • Medical equipment
    • Bedsheets
  • Route of transmission
    • Direct contact
    • Indirect
      • Airborne
      • Waterborne
      • Foodborne
      • Objects, instruments
        • Clothing
        • Bedsheets
  • Susceptible population
    • High number of susceptible people
    • Infants
    • Elderly
    • Immunocompromised

Secondary factors:

  • Crowded rooms
  • Insufficient number of cleaning and nursing staff
  • Lack of medical staff’s preventive approach

Types

Most common infections:

Pathogens

Most problematic pathogens:

Risk factors

  • Patients in poor condition
  • Invasive interventions and devices
  • Older age
  • Comorbidities
  • Long duration of hospitalization
  • Antibiotic use

Prevention

  • Risk stratification
  • Avoid invasive procedures when possible
  • Discontinue indwelling sources of infection when possible
  • Reducing person-to-person transmission
    • Disinfection of hands
      • Before, during and after patient contact
      • Disinfection = reduce the number of microorganisms, killing most harmful microorganisms
      • Sterilization = kill all microorganisms
    • Personal hygiene
    • Protective equipment
  • Preventing transmission from the environment
    • Asepsis, antisepsis, isolation of patients
    • Ensure sterility during procedures
    • Sterilization of equipment
    • Limit overuse of antibiotics
  • Education and training of medical staff

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