this is a series of lectures on microbiology, useful for undergraduate and post graduate medical and paramedical students.. this lecture is on hospital acquired infection

1. NOSOCOMIAL
INFECTION
Presented by,
Dr. Ashish Jawarkar MD
Page 1

2. History
• Semmelweis could control infection during
hospital deliveries (peurperal sepsis) by
hand washing
• Lister could control surgical site infections
by phenol sprays
Page 2

3. INTRODUCTION
• Nosocomial infection comes
from Greek words “nosus”
meaning disease and “ komeion”
meaning to take care of
• Also called as HOSPITAL
ACQUIRED INFECTION
• Infections are considered
nosocomial if they first appear
48hrs or more after hospital
admission or within 30 days
after discharge.

4. Rise in nosocomial infection as a result of
four factor
• Crowded hospital
conditions
• New microorganism
• Increasing number of
people with
compromised immune
system
• Increasing Bacterial
resistance

5. EPIDEMIOLOGY
• Nosocomial infections
can be exogenous
(external organism) and
endogenous (opportunist
normal flora)
• Host susceptibility Is an
important factor in the
development of
nosocomial infection.
• Medical equipments and
procedures (surgery) are
often responsible for
infections

6. Page 6

7. COMMON INFECTIONS
Following are the most common nosocomial
infections:
• Urinary tract infection
• Pneumonia
• Blood stream infections
• Surgical site infections

8. COMMON SITES OF INFECTION

9. Common agents
• Gram positive – Methicillin resistant staph
aureus
• Gram negative – E coli, proteus,
pseudomonas
• Virus – HIV, Hepatitis B and C
• Fungi like Candida
• Protozoa like plasmodium

10. Page 10

11. URINARY TRACT INFECTIONS
• It is the most common cause of
nosocomial infections
• 80% of the infections are associated
with indwelling catheters.
• Main agents – Gram negative bacilli like
E coli, proteus, Pseudomonas

12. NOSOCOMIAL PNEUMONIA
• The most important are patients
on ventilators/tubes in ICU.
Also known as VAP (ventilator
associated pneumonia)
Most commonly caused by drug
resistant Staphylococcus aureus
and pseudomonas with
acinetonacter baumanii.

13. NOSOCOMIAL BACTERAEMIA
• Infections may occurs at the skin
entry site of the IV device or in the
sub cutaneous path of catheter.
• Gram negative bacilli are most common
pathogens

14. SURGICAL SITE INFECTIONS
• The definition is mainly clinical
(purulent discharge around wounds
or the insertion site of drain, or
spreading cellulites from wounds within
a week of surgery)
Stich abcess – S epidermidis
Strepto pyogenes – within a day or two
Staphylococci – take 4-5 days
Gram negative bacilli – take 6-7 days
Burns patients - psuedomonas

15. Diagnosis
• Routine methods – smear, staining, microscopy,
culture, antibiotic sensitivity testing
• When an outbreak occurs – hospital personell,
inanimate objects, water, air or food can be tested
• Test sterilization techniques like defective autoclaves,
improper chemicals used

16. PREVENTION AND CONTROL
FORMATION OF HOSPITAL INFECTION
CONTROL COMMITTEE
Consist of
Lab head (microbiologist/pathologist)
Medical staff
Nursing staff
Hospital administrator

17. Functions of HICC
• Forming guidelines for admission, handling
infectious patients
• Surveillance of sterilization techniques
• Determining antibiotic policies
• Educating patients and hospital staff

18. Prevention and control of hospital
acquired infections
•
•
•
•
•
Hand washing
Preventing UTI
Preventing surgical site infections
Preventing nosocomial pneumonia
Preventing bacteremia
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19. Hand washing
•
•
•
•
Simple and most effective way
Often overlooked
Soap and water are enough
If not an alcohol based hand steriliser can
be used
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20. Soap and water
• Wash for atleast 15-20 seconds
• Wash hands before eating, changing
diapers, after coughing/sneezing, blowing
nose, using bathroom, before and after
attending to a patient
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21. Preventing UTI
• Limit duration of catheter
• Aseptic technique of insertion
• Closed drainage
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22. Preventing Surgical site infections
• Clean technique
• Clean OT
• Preoperative shower and preparation of
patient
• Antibiotic prophylaxis
• Wound surveillance post operatively
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23. Preventing pneumonia
•
•
•
•
Aseptic intubation
Limited duration
Use sterile water for oxygen therapy
Isolation policy
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24. Preventing Bacteremia
• Limit duration of use
• Local skin preparation
• Removal if infection suspected
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25. Role of nursing staff
Nursing head
• Participate in HICC meets
• Train staff
• Supervise implementation of infection
control measures in wards, OT, ICU and
maternity , neonatal units
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26. Ward incharge
• Enforce hygiene, hand washing
• Report promptly to doctor if any evidence
of infection
• Limit patient exposure to visitors, staff and
other patients
• Proper waste disposal
• Maintain adequate supply of drugs
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27. Work restrictions for nurses
• Conjuctivitis – No direct patient contact
until discharge ceases
• Diarrhoea – acute illness – no patient
contact till further evaluation; typhoid – no
contact till stool culture negative
• Sore throat (streptococci) – no contact till
after 24 hours of start of antibiotic therapy
• Chicken pox – No contact till incubation
period ceases
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28. • Herpes simplex
– Genital – no restrictions
– Hands – no contact till heals
– Orofacial – no contact till heals
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29. • Respiratory infections (like cold/influenza)
– Masks
– No contact in initial phase
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30. Questions that can be asked in
exam
• Nosocomial infections – define, organisms
responsible, prevention
• What is the role of nurses in preventing
HAI
• Hand hygiene
• Organisms causing – nosocomial UTI,
pneumonia, surgical site infections,
bacteremia
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