View source for 20. Nosocomial infections. Sterilization, disinfection

* Definitions
** Nosocomial disease = disease which is the result of treatment in a hospital
** Nosocomial infection (hospital-acquired infection) = infection which is the result of treatment in a hospital
** Nosocomial epidemic = nosocomial infection that affects two or more patients, and there is a connection between the cases
** Commensal bacteria
*** Bacteria which are normally present, but can cause disease in compromised humans
* 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
* The primary factors of epidemic process for nosocomial infections
** Source of nosocomial infection
*** The patients themselves
**** From commensal bacteria
*** 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
**** Diabetes
**** Cancer
**** Polytrauma
**** Surgical patients
** Secondary factors
*** Crowded rooms
*** Insufficient number of cleaning and nursing staff
*** Lack of medical staff’s preventive approach
* Pathogens
** Bacteria
*** Staph. saprophyticus, Staph. epidermidis
*** E. coli
**** A commensal bacterium
**** May colonize surgical sites, needles, catheters
**** Can be highly antibiotic resistant
*** Clostridium
**** Causes gangrene
*** Staph. aureus, MRSA
**** A commensal bacterium
*** Pseudomonas
**** Likes wet and damp areas
** Viruses
*** Hepatitis B, C
**** Transfusions, dialysis, injections, endoscopy
*** RSV, rotavirus, enterovirus
**** Faecal-oral or hand-to-mouth
** Parasites
*** Giardia lamblia
*** Scabies
** Fungi
*** Often cause infections in immunosuppressed patients
*** Candida albicans
*** Aspergillus
*** Cryptococcus
*** Cryptosporidium
* Diseases
** Pneumonia
*** 15% of nosocomial diseases
*** 20 - 50% mortality rate of healthcare-associated pneumonia
*** S. aureus
*** Pseudomonas
*** Klebsiella
*** Risk
**** Intubation
**** Artificial ventilation
** UTI
*** 35% of nosocomial diseases
*** 0,1% mortality
*** E. coli (endogenous)
*** Risk: Catheter
** Surgical site infections
*** S. aureus
*** E. coli
** Sepsis
*** 23% mortality
*** Risk: Infusion/injection
* Most commonly affected wards
** Surgery
** ICU
** Paediatrics
* Respiratory tract infections and sepsis are the most common cause of mortality in hospitals
* Catheters, surgical wounds, intubation, artificial ventilation are common foci where infection can originate

Preventing nosocomial infections

* Risk stratification
* 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
** Sterilization of equipment
** Limit overuse of antibiotics
* Education and training of medical staff

Multi-resistant bacteria

* MRSA
** Infects skin, wounds, urinary tract, respiratory tract
* ESBL – extended spectrum beta lactamase
** Resistant to cephalosporins, penicillins and aztreonam
** Treatment: carbapenems
** Often in E. coli or Klebsiella pneumoniae

''For this topic you should also known sterilisation and disinfection in detail (everything from them documenting every step (in case of infection, or a potential lawsuit) what type of methods, phenol-coefficient, Joseph Lister, what kind of methods you would use to sterilize fluids to before you administer it (autoclave), biological indicators, etc. Microbiology 1 covered this.''
[[Category:Public health 4 - Preventive medicine]]