1. Hospital

2. Hospital hygiene. Hygienic
requirements to special
hospitals with high
epidemiological risk.
Prevention of nosocomial
infections.

3. Norfolk and Norwich University
Hospital in the East of England. The UK has a
publicly funded health care system called the
National Health Service

4. All India Institute of Medical
Sciences in Delhi, India

5.  Hospitals are usually funded by the public
sector, by health organizations (for profit or
nonprofit), health insurance companies, or
charities, including direct charitable donations.
Historically, hospitals were often founded and
funded by religious orders or charitable
individuals and leaders. Today, hospitals are
largely staffed by professional physicians,
surgeons, and nurses, whereas in the past, this
work was usually performed by the founding
religious orders or by volunteers. However,
there are various Catholic religious orders, such
as the Alexians and the Bon Secours Sisters,
which still focus on hospital ministry today.
A hospital is a health care institution providing patient
treatment by specialized staff and equipment. Hospitals
often, but not always, provide for inpatient care or longer-
term patient stays.

6. In accord with the original meaning
of the word, hospitals were originally
"places of hospitality", and this
meaning is still preserved in the
names of some institutions such as
the Royal Hospital Chelsea,
established in 1681 as a retirement
and nursing home for veteran
soldiers.
There are over 17,000 hospitals in
the world.

7. During the Middle Ages hospitals served
different functions to modern institutions, being
almshouses for the poor, hostels for pilgrims, or
hospital schools. The word hospital comes from
the Latin hospes, signifying a stranger or
foreigner, hence a guest. Another noun derived
from this, hospitium came to signify hospitality,
that is the relation between guest and shelterer,
hospitality, friendliness, hospitable reception.
By metonymy the Latin word then came to mean
a guest-chamber, guest's lodging, an inn.[2]
Hospes is thus the root for the English words
host (where the p was dropped for convenience
of pronunciation) hospitality, hospice, hostel
and hotel.
Etymology

8.  The latter modern word derives from Latin via
the ancient French romance word hostel, which
developed a silent s, which letter was
eventually removed from the word, the loss of
which is signified by a circumflex in the modern
French word hôtel. The German word 'Spital'
shares similar roots.
 Grammar of the word differs slightly depending
on the dialect. In the U.S., hospital usually
requires an article; in Britain and elsewhere, the
word normally is used without an article when it
is the object of a preposition and when referring
to a patient ("in/to the hospital" vs. "in/to
hospital"); in Canada, both uses are found.
Etymology

9. Lehigh Valley Hospital in Allentown,
Pennsylvania
Types

10. Some patients go to a hospital just for
diagnosis, treatment, or therapy and
then leave ('outpatients') without
staying overnight; while others are
'admitted' and stay overnight or for
several days or weeks or months
('inpatients'). Hospitals usually are
distinguished from other types of
medical facilities by their ability to admit
and care for inpatients whilst the others
often are
Types

11. The best-known type of hospital is the
general hospital, which is set up to deal
with many kinds of disease and injury,
and normally has an emergency
department to deal with immediate and
urgent threats to health. Larger cities
may have several hospitals of varying
sizes and facilities. Some hospitals,
especially in the United States, have
their own ambulance service.
General

12. A district hospital typically is the
major health care facility in its
region, with large numbers of beds
for intensive care and long-term care;
and specialized facilities for surgery,
plastic surgery, childbirth, bioassay
laboratories, and so forth.
District

13. McMaster University Medical Centre, a
teaching hospital in Canada
Specialized

14. Types of specialized hospitals include
trauma centers, rehabilitation
hospitals, children's hospitals,
seniors' (geriatric) hospitals, and
hospitals for dealing with specific
medical needs such as psychiatric
problems (see psychiatric hospital),
certain disease categories such as
cardiac, oncology, or orthopedic
problems, and so forth.
Specialized

15. A hospital may be a single building or a
number of buildings on a campus. Many
hospitals with pre-twentieth-century
origins began as one building and
evolved into campuses. Some hospitals
are affiliated with universities for
medical research and the training of
medical personnel such as physicians
and nurses, often called teaching
hospitals. Worldwide, most hospitals are
run on a nonprofit basis by governments
or charities.
Specialized

16. A teaching hospital combines
assistance to patients with teaching
to medical students and nurses and
often is linked to a medical school,
nursing school or university.
Teaching

17. A medical facility smaller than a
hospital is generally called a clinic,
and often is run by a government
agency for health services or a
private partnership of physicians (in
nations where private practice is
allowed). Clinics generally provide
only outpatient services.
Clinics

18. Resuscitation room bed after a
trauma intervention, showing the
highly technical equipment of modern
hospitals
Departments

19. Hospitals vary widely in the services
they offer and therefore, in the
departments they have. They may have
acute services such as an emergency
department or specialist trauma centre,
burn unit, surgery, or urgent care. These
may then be backed up by more
specialist units such as cardiology or
coronary care unit, intensive care unit,
neurology, cancer center, and obstetrics
and gynecology.
Departments

20. Some hospitals will have outpatient
departments and some will have
chronic treatment units such as
behavioral health services, dentistry,
dermatology, psychiatric ward,
rehabilitation services, and physical
therapy.
Departments

21. Common support units include a
dispensary or pharmacy, pathology, and
radiology, and on the non-medical side,
there often are medical records
departments, release of information
departments, Information Management
(IM)(aka IT or IS), Clinical Engineering
(aka Biomed), Facilities Management,
Plant Ops (aka Maintenance), Dining
Services, and Security departments.
Departments

22. Clinical Hospital Dubrava Modern
Medical Center in Zagreb, Croatia.
Funding

23. Funding
In the modern era, hospitals are,
broadly, either funded by the
government of the country in which
they are situated, or survive
financially by competing in the
private sector (a number of hospitals
also are still supported by the
historical type of charitable or
religious associations).

24. In the United Kingdom for example, a
relatively comprehensive, "free at the
point of delivery" health care system
exists, funded by the state. Hospital
care is thus relatively easily available
to all legal residents, although free
emergency care is available to
anyone, regardless of nationality or
status. As hospitals prioritize their
limited resources, there is a tendency
for 'waiting lists' for non-crucial
treatment in countries with such
systems, as opposed to letting
higher-payers get treated first, so
sometimes those who can afford it
take out private health care to get
treatment more quickly.

25. As the quality of health care has increasingly
become an issue around the On the other hand,
many countries, including the USA, have in the
twentieth century followed a largely private-
based, for-profit-approach to providing hospital
care, with few state-money supported 'charity'
hospitals remaining today.[ Where for-profit
hospitals in such countries admit uninsured
patients in emergency situations (such as
during and after Hurricane Katrina in the USA),
they incur direct financial losses, ensuring that
there is a clear disincentive to admit such
patients.world, hospitals have increasingly had
to pay serious attention to this matter.
Funding

26. Independent external assessment of quality
is one of the most powerful ways to assess
this aspect of health care, and hospital
accreditation is one means by which this is
achieved. In many parts of the world such
accreditation is sourced from other
countries, a phenomenon known as
international healthcare accreditation, by
groups such as Accreditation Canada from
Canada, the Joint Commission from the
USA, the Trent Accreditation Scheme from
Great Britain, and Haute Authorité de santé
(HAS) from France.
Funding

27. The National Health Service Norfolk
and Norwich University Hospital in
the UK, showing the utilitarian
architecture of many modern
hospitals.
Buildings
Architecture

28. Hospital chapel at Fawcett
Memorial Hospital, a for-profit
facility operated by HCA.

29. The Horton General Hospital in
Banbury, during 2010. It was built in
1872 and slightly expanded in both
1964 and 1972 and was nearly closed
early in 2005.
Buildings
Architecture

30. Modern hospital buildings are designed to
minimize the effort of medical personnel
and the possibility of contamination while
maximizing the efficiency of the whole
system. Travel time for personnel within the
hospital and the transportation of patients
between units is facilitated and minimized.
The building also should be built to
accommodate heavy departments such as
radiology and operating rooms while space
for special wiring, plumbing, and waste
disposal must be allowed for in the design.
Buildings
Architecture

31.  However, the reality is that many hospitals,
even those considered 'modern', are the product
of continual and often badly managed growth
over decades or even centuries, with utilitarian
new sections added on as needs and finances
dictate. As a result, Dutch architectural
historian Cor Wagenaar has called many
hospitals:
 "... built catastrophes, anonymous institutional
complexes run by vast bureaucracies, and
totally unfit for the purpose they have been
designed for ... They are hardly ever functional,
and instead of making patients feel at home,
they produce stress and anxiety."
Buildings
Architecture

32. Some newer hospitals now try to re-
establish design that takes the patient's
psychological needs into account, such
as providing more fresh air, better views
and more pleasant colour schemes.
These ideas hearken back to the late
eighteenth century, when the concept of
providing fresh air and access to the
'healing powers of nature' were first
employed by hospital architects in
improving their buildings.
Buildings
Architecture

33. The research of British Medical Association
is showing that good hospital design can
reduce patient's recovery time. Exposure to
daylight is effective in reducing depression.
Single sex accommodation help ensure that
patients are treated in privacy and with
dignity. Exposure to nature and hospital
gardens is also important - looking out
windows improvies patient's mood, reduces
blood pressure and stress level. Eliminating
long corridors can reduce nurses' fatigue
and stress.
Buildings
Architecture

34. Another ongoing major development is the
change from a ward-based system (where
patients are accommodated in communal
rooms, separated by movable partitions) to one
in which they are accommodated in individual
rooms. The ward-based system has been
described as very efficient, especially for the
medical staff, but is considered to be more
stressful for patients and detrimental to their
privacy. A major constraint on providing all
patients with their own rooms is however found
in the higher cost of building and operating such
a hospital; this causes some hospitals to charge
for private rooms.
Buildings
Architecture

35. Nosocomial infection

36. Classification and external resources
Contaminated surfaces increase cross-transmission

37. A nosocomial infection (nos-oh-koh-mi-
al), also known as a hospital-acquired
infection or HAI, is an infection whose
development is favoured by a hospital
environment, such as one acquired by a
patient during a hospital visit or one
developing among hospital staff. Such
infections include fungal and bacterial
infections and are aggravated by the
reduced resistance of individual
patients.
Nosocomial infection

38. In the United States, the Centers for Disease Control
and Prevention estimate that roughly 1.7 million
hospital-associated infections, from all types of
microorganisms, including bacteria, combined, cause
or contribute to 99,000 deaths each year. In Europe,
where hospital surveys have been conducted, the
category of Gram-negative infections are estimated
to account for two-thirds of the 25,000 deaths each
year. Nosocomial infections can cause severe
pneumonia and infections of the urinary tract,
bloodstream and other parts of the body. Many types
are difficult to attack with antibiotics, and antibiotic
resistance is spreading to Gram-negative bacteria
that can infect people outside the hospital.
Nosocomial infection

39.  Ventilator associated pneumonia
(VAP)
 Staphylococcus aureus
 Methicillin resistant Staphylococcus
aureus (MRSA)
 Candida albicans
 Pseudomonas aeruginosa
 Acinetobacter baumannii
Known nosocomial infections

40.  Stenotrophomonas maltophilia
 Clostridium difficile
 Tuberculosis
 Urinary tract infection
 Hospital-acquired pneumonia (HAP)
 Gastroenteritis
 Vancomycin-resistant Enterococcus
(VRE)
 Legionnaires' disease
Known nosocomial infections

41. This paragraph needs
additional citations for
verification. Please help
improve this article by
adding citations to reliable
sources. Unsourced material
may be challenged and
removed.
Epidemiology

42. Nosocomial infections are commonly
transmitted when hospital officials become
complacent and personnel do not practice
correct hygiene regularly. Also, increased use of
outpatient treatment means that people who
are hospitalized are more ill and have more
weakened immune systems than may have been
true in the past. Moreover, some medical
procedures bypass the body's natural protective
barriers. Since medical staff move from patient
to patient, the staff themselves serve as a
means for spreading pathogens. Essentially, the
staff act as vectors.
Epidemiology

43. Among the categories of bacteria most
known to infect patients are the category
MRSA, Gram-positive bacteria and
Helicobacter, which is Gram-negative. While
there are antibiotic drugs that can treat
diseases caused by Gram-positive MRSA,
there are currently few effective drugs for
Acinetobacter. However, Acinetobacter
germs are evolving and becoming immune
to existing antibiotics. "In many respects
it’s far worse than MRSA," said a specialist
at Case Western Reserve University.
Categories and treatment

44. Another growing disease, especially
prevalent in New York City hospitals,
is the drug-resistant Gram-negative
germ, Klebsiella pneumoniae. An
estimated more than 20 percent of
the Klebsiella infections in Brooklyn
hospitals "are now resistant to
virtually all modern antibiotics. And
those supergerms are now spreading
worldwide."
Categories and treatment

45. The bacteria, classified as Gram-negative
because of their reaction to the Gram stain test,
can cause severe pneumonia and infections of
the urinary tract, bloodstream, and other parts
of the body. Their cell structures make them
more difficult to attack with antibiotics than
Gram-positive organisms like MRSA. In some
cases, antibiotic resistance is spreading to
Gram-negative bacteria that can infect people
outside the hospital. "For Gram-positives we
need better drugs; for Gram-negatives we need
any drugs," said Dr. Brad Spellberg, an
infectious-disease specialist at Harbor-UCLA
Medical Center, and the author of Rising Plague,
a book about drug-resistant pathogens.
Categories and treatment

46. One-third of nosocomial infections
are considered preventable. The CDC
estimates 2 million people in the
United States are infected annually
by hospital-acquired infections,
resulting in 20,000 deaths. The most
common nosocomial infections are of
the urinary tract, surgical site and
various pneumonias.
Categories and treatment

47.  The methods used differ from
country to country (definitions used,
type of nosocomial infections
covered, health units surveyed,
inclusion or exclusion of imported
infections, etc.), so that international
comparisons of nosocomial infection
rates should be made with the utmost
care.
Country estimates

48. United States: The Centers for Disease Control
and Prevention (CDC) estimates that roughly
1.7 million hospital-associated infections, from
all types of bacteria combined, cause or
contribute to 99,000 deaths each year. Other
estimates indicate that 10%, or 2 million,
patients a year become infected, with the
annual cost ranging from $4.5 billion to $11
billion. In the USA the most frequent type of
infection hospitalwide is urinary tract infection
(36%), followed by surgical site infection
(20%), bloodstream infection (BSI), and
pneumonia (both 11%).
Country estimates

49. France: estimates ranged from 6.7%
in 1990 to 7.4% (patients may have
several infections). At national level,
prevalence among patients in health
care facilities was 6.7% in 1996,
5.9% in 2001 and 5.0% in 2006. The
rates for nosocomial infections were
7.6% in 1996, 6.4% in 2001 and
5.4% in 2006.
Country estimates

50. In 2006, the most common infection sites were
urinary tract infections (30,3%), pneumopathy
(14,7%), infections of surgery site (14,2%).
infections of the skin and mucous membrane
(10,2%), other respiratory infections (6,8%)
and bacterial infections / blood poisoning
(6,4%). The rates among adult patients in
intensive care were 13,5% in 2004, 14,6% in
2005, 14,1% in 2006 and 14.4% in 2007.
Country estimates

51. It has also been estimated that
nosocomial infections make
patients stay in the hospital 4-5
additional days. Around 2004-
2005, about 9,000 people died
each year with a nosocomial
infection, of which about 4,200
would have survived without
this infection.
Country estimates

52.  Italy: since 2000, estimates show
that about 6.7% infection rate, i.e.
between 450,000 and 700,000
patients, which caused between
4,500 and 7,000 deaths. A survey in
Lombardy gave a rate of 4.9% of
patients in 2000.
 United Kingdom: estimates of 10%
infection rate,with 8.2% estimated in
2006.
Country estimates

53.  Switzerland: estimates
range between 2 and
14%. A national survey
gave a rate of 7.2% in
2004.
 Finland: estimated at
8.5% of patients in 2005
Country estimates

54. The drug-resistant Gram-
negative germs for the most
part threaten only hospitalized
patients whose immune
systems are weak. The germs
can survive for a long time on
surfaces in the hospital and
enter the body through wounds,
catheters, and ventilators.
Transmission

55.  Contact transmission
 the
most important and frequent
mode of transmission of
nosocomial infections.
Main routes of transmission
Route
Description

56.  Droplet transmission
 occurs when droplets are generated
from the source person mainly during
coughing, sneezing, and talking, and
during the performance of certain
procedures such as bronchoscopy.
Transmission occurs when droplets
containing germs from the infected
person are propelled a short distance
through the air and deposited on the
host's body.
Main routes of transmission
Route
Description

57.  Airborne transmission
 occurs by dissemination of either airborne droplet nuclei
(small-particle residue {5 µm or smaller in size} of
evaporated droplets containing microorganisms that
remain suspended in the air for long periods of time) or
dust particles containing the infectious agent.
Microorganisms carried in this manner can be dispersed
widely by air currents and may become inhaled by a
susceptible host within the same room or over a longer
distance from the source patient, depending on
environmental factors; therefore, special air handling and
ventilation are required to prevent airborne transmission.
Microorganisms transmitted by airborne transmission
include Legionella, Mycobacterium tuberculosis and the
rubeola and varicella viruses.
Main routes of transmission
Route
Description

58.  Common vehicle transmission
 applies to microorganisms
transmitted to the host by
contaminated items such as food,
water, medications, devices, and
equipment.
Main routes of transmission
Route
Description

59.  Vector borne transmission
 occurswhen vectors such as
mosquitoes, flies, rats, and other
vermin transmit microorganisms.
Main routes of transmission
Route
Description

60. Contact transmission is
divided into two
subgroups: direct-contact
transmission and indirect-
contact transmission.
Transmission

61.  Direct-contact transmission
 involves a direct body surface-to-body surface
contact and physical transfer of microorganisms
between a susceptible host and an infected or
colonized person, such as occurs when a person
turns a patient, gives a patient a bath, or
performs other patient-care activities that
require direct personal contact. Direct-contact
transmission also can occur between two
patients, with one serving as the source of the
infectious microorganisms and the other as a
susceptible host.
Routes of contact transmission
Route
Description

62.  Indirect-contact transmission
 involves contact of a susceptible host with a
contaminated intermediate object, usually
inanimate, such as contaminated instruments,
needles, or dressings, or contaminated gloves
that are not changed between patients. In
addition, the improper use of saline flush
syringes, vials, and bags has been implicated in
disease transmission in the US, even when
healthcare workers had access to gloves,
disposable needles, intravenous devices, and
flushes.
Routes of contact transmission
Route
Description

63. People in hospitals are usually already in
a poor state of health, impairing their
defense against bacteria – advanced age
or premature birth along with
immunodeficiency (due to drugs, illness,
or irradiation) present a general risk,
while other diseases can present specific
risks - for instance, chronic obstructive
pulmonary disease can increase chances
of respiratory tract infection.
Risk factors
Factors predisposing a patient to infection can
broadly be divided into three areas:

64. Invasive devices, for instance
intubation tubes, catheters, surgical
drains, and tracheostomy tubes all
bypass the body’s natural lines of
defence against pathogens and
provide an easy route for infection.
Patients already colonised on
admission are instantly put at greater
risk when they undergo an invasive
procedure.
Risk factors
Factors predisposing a patient to infection can
broadly be divided into three areas:

65. A patient’s treatment itself can leave
them vulnerable to infection –
immunosuppression and antacid
treatment undermine the body’s
defences, while antimicrobial therapy
(removing competitive flora and only
leaving resistant organisms) and
recurrent blood transfusions have
also been identified as risk factors.
Risk factors
Factors predisposing a patient to infection can
broadly be divided into three areas:

66. Hospitals have sanitation protocols
regarding uniforms, equipment
sterilization, washing, and other
preventative measures. Thorough hand
washing and/or use of alcohol rubs by
all medical personnel before and after
each patient contact is one of the most
effective ways to combat nosocomial
infections. More careful use of
antimicrobial agents, such as antibiotics,
is also considered vital.
Prevention

67. Despite sanitation protocol, patients
cannot be entirely isolated from
infectious agents. Furthermore,
patients are often prescribed
antibiotics and other antimicrobial
drugs to help treat illness; this may
increase the selection pressure for
the emergence of resistant strains.
Prevention

68. Sterilization goes further than
just sanitizing. Sterilizing kills
all microorganisms on
equipment and surfaces
through exposure to
chemicals, ionizing radiation,
dry heat, or steam under
pressure.
Sterilization

69. Isolation precautions are
designed to prevent transmission
of microorganisms by common
routes in hospitals. Because agent
and host factors are more difficult
to control, interruption of transfer
of microorganisms is directed
primarily at transmission.
Isolation

70. Handwashing frequently is called the
single most important measure to reduce
the risks of transmitting skin
microorganisms from one person to
another or from one site to another on the
same patient. Washing hands as promptly
and thoroughly as possible between
patient contacts and after contact with
blood, body fluids, secretions, excretions,
and equipment or articles contaminated
by them is an important component of
infection control and isolation
precautions.
Handwashing and gloving

71. Although handwashing may seem like a
simple process, it is often performed
incorrectly. Healthcare settings must
continuously remind practitioners and
visitors on the proper procedure in
washing their hands to comply with
responsible handwashing. Simple
programs such as Henry the Hand, and
the use of handwashing signals can
assist healthcare facilities in the
prevention of nosocomial infections.
Handwashing and gloving

72. In addition to handwashing, gloves play an
important role in reducing the risks of
transmission of microorganisms. Gloves are
worn for three important reasons in
hospitals. First, gloves are worn to provide
a protective barrier and to prevent gross
contamination of the hands when touching
blood, body fluids, secretions, excretions,
mucous membranes, and nonintact skin. In
the USA, the Occupational Safety and Health
Administration has mandated wearing
gloves to reduce the risk of bloodborne
pathogen infection.
Handwashing and gloving

73. Second, gloves are worn to reduce
the likelihood that microorganisms
present on the hands of personnel
will be transmitted to patients during
invasive or other patient-care
procedures that involve touching a
patient's mucous membranes and
nonintact skin.
Handwashing and gloving

74. Third, gloves are worn to reduce the
likelihood that hands of personnel
contaminated with microorganisms
from a patient or a fomite can
transmit these microorganisms to
another patient. In this situation,
gloves must be changed between
patient contacts, and hands should be
washed after gloves are removed.
Handwashing and gloving

75. Wearing gloves does not replace the
need for handwashing, because
gloves may have small, non-apparent
defects or may be torn during use,
and hands can become contaminated
during removal of gloves. Failure to
change gloves between patient
contacts is an infection control
hazard.
Handwashing and gloving

76. The most effective technique of controlling
nosocomial infection is to strategically
implement QA/QC measures to the health
care sectors and evidence-based management
can be a feasible approach. For those
VAP/HAP diseases (ventilator-associated
pneumonia, hospital-acquired pneumonia),
controlling and monitoring hospital indoor air
quality needs to be on agenda in management
whereas for nosocomial rotavirus infection, a
hand hygiene protocol has to be enforced.
Other areas that the management needs to be
covered include ambulance transport.
Mitigation

77. Thank you