Hospital Acquired Infection: Transmission And Prevention

Modes of transmission:

• Direct person to person transmission: (Infected patient, staff members, or visitors)
• Indirect transmission through (Equipment, hospital producers)
• Transmission through air

Anyone who goes to the hospital and gets their medical treatment has the risk of Nosocomial infection, some people are at higher risk than others, including the following:

• premature babies and very sick children.
• the elderly.
• People with certain medical conditions – such as diabetes.
• immunocompromised patients: from disease, or due to they are getting treatments that weaken their immune system. Cancer treatments, like chemotherapy, or radiation, or steroids are treatments that can weaken the immune system.

Reasons:

• A long hospital stay.
• Surgery – long and complicated surgery.
• Handwashing techniques – inadequate hand washing by hospital staff, visitors, and patients.
• Antibiotics – overuse of antibiotics can lead to resistant bacteria, which means that antibiotics become less effective and do not work as well.
• Equipment – medical equipment that enters the body can introduce bacteria and infection into the body. For example, urinary catheters, intravenous drips and infusions, respiratory equipment, and drain tubes.
• Wounds – wounds, incisions (surgical cuts), burns, and skin ulcers are all prone to infection.
• High-risk patient care areas – some patient care areas are more likely to have infections, such as hospital intensive care units.

So we should do prevention to decrease the cases of nosocomial infections.

Prevention of nosocomial infections requires an integrated, monitored, programme which is :

• limiting transmission of organisms between patients indirect patient care through adequate handwashing and glove use, and appropriate aseptic practice, isolation strategies, sterilization and disinfection practices, and laundry
• controlling environmental risks for infection:
• protecting patients with appropriate use of pro- phylactic antimicrobials, nutrition, and vaccinations
• limiting the risk of endogenous infections by minimizing invasive procedures, and promoting optimal antimicrobial use
• surveillance of infections, identifying and control- ling outbreaks
• prevention of infection in staff members
• enhancing staff patient care practices, and continuing staff education.

And specifically:

Prevention of Central Line-Associated Bloodstream Infections

• Compliance with hand hygiene.
• Using maximal barrier precautions (large drape,cap, mask, gloves)
• using sterile techniques and antiseptic products (2% chlorhexidine..) for disinfecting
• Selecting an optimal site for the catheter.
• with the daily review, and removing when it is not necessary.

Specifically, Prevention of Surgical Site Infections (SSI):

• limit number of personnel in room, and isolation
• Protect a closed incision for 24-48.
• using a sterile dressing
• Wash hand before and after dressing changes, and any contact with the surgical site.

Prevention of Catheter-Associated Urinary Tract Infections (CAUTI)

• Limit use and duration of indwelling urinary catheters.
• Insert urinary catheters using an aseptic technique.
• Maintain sterility of the urine collection system
• Use one urinal/cylinder for each patient to empty the collection bag
• Replace urine collection system when required
• Clean catheter tubing at the perineal area at least daily and as needed with soap and water.
• maintaining appropriate aseptic practice during urinary catheter insertion and other invasive urological procedures (e.g. cystoscopy, urodynamic testing, cystography)
• hygienic handwash or rub prior to insertion and following catheter or drainage bag manipulation
• sterile gloves for insertion
• perineal cleaning with an antiseptic solution prior to insertion.
• non-traumatic urethral insertion using an appropriate lubricant
• maintaining a closed drainage system.

Other practices which are recommended, but not proven to decrease infection include:

• maintaining good patient hydration
• appropriate perineal hygiene for patients with catheters
• appropriate staff training in catheter insertion and care
• maintaining unobstructed drainage of the bladder to the collection bag, with the bag below the level of the bladder.

These infections occur worldwide both in developed and developing countries. Nosocomial infections account for 7% in developed and 10% in developing countries. As these infections occur during a hospital stay, they cause prolonged stay, disability, and economic burdens. The nosocomial infection affects a huge number of patients globally, elevating mortality rate and financial losses significantly. According to the estimate reported by WHO, approximately 15% of all hospitalized patients suffer from these infections. These infections are chargeable for 4%–56% of all death caused in neonates, with an incidence rate of 75% in South-East Asia and Sub-Saharan Africa. The incidence is high enough in high-income countries i.e. between 3.5% and 12% whereas it varies between 5.7% and 19.1% in middle and low-income countries. The frequency of overall infections in low-income countries is three times higher than in high-income countries whereas this incidence is 3–20 times higher in neonates. A multistate point prevalence survey of healthcare-associated infections involving 11,282 patients from 183 US hospitals published by the CDC in 2014 had 4% of inpatients suffering from at least one of the healthcare-associated infections giving an estimated 648,000 inpatients suffering from 721,800 infections in 2011. Pneumonia (21.8%) and surgical site infections (21.8%) were the leading causes, followed by gastrointestinal infections (17.1%), urinary tract infection (12.9%) and primary bloodstream infection (9.9%). Among the pathogens causing hospital-acquired infections, C. difficile (12.1%) is the leading cause followed by Staphylococcus aureus (10.7%), Klebsiella (9.9%) and Escherichia coli (9.3%).

Due to greater awareness and preventative measures, there has been some progress in the reduction in the incidence of some types of hospital-acquired infections. From 2008 through 2014, there was a 50% decrease in central line-associated bloodstream infections. There was a 17% decrease in surgical site infections related to specific procedures. From 2011 through 2014, there was an 8% decrease in C. difficile infections. There was a 13% decrease in methicillin-resistant S. aureus (MRSA) bacteremia between 2011 through 2014.

Conclusion:

Nosocomial infections have a big impact on the length of hospital stay and treatment cost. Extra costs of nosocomial infections resulted not only from prolongation of hospital stay but also other medical costs. Infection control for preventing nosocomial infections may play a vital role in reducing medical costs, hospital stay, and mortality in hospitalized patients. So we should always be controlling and prevent.