nosocomial infection

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Seminar on NOSOCOMIAL INFECTION : 

diagnosis & control presented by : Kanchan. Seminar on NOSOCOMIAL INFECTION

Index : 

Index Definition Methods of transmission Pathological agents Sites of infection Problems of N.C.I. Diagnosis of N.C.I. Prevention & controle of N.C.I.

What’s meant by Nosocomial infections? Any infection causing illness that wasn’t present or in it’s incubation period when the subject entered hospital or received treatment in outpatient clinic "Nosocomial" comes from two Greek words -- "nosus" meaning "disease" + "komeion" meaning "to take care of" -- disease contracted by a patient while under medical care. Infection are considered Nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge

Nosocomial infection: : 

Nosocomial infection:

There are five main routes of transmission: : 

Contact Droplet Airborne Common vehicle Vector borne The same microorganism may be transmitted by more than one route. There are five main routes of transmission: Note

Methods of transmition in the health care setting : : 

Droplet transmission : Droplets generated by coughing , sneezing, or respiratory tract procedures such as broncoscopy , or suction. Vector transmission : Transmitted through insect & other invertebrate animals ( e.g. mosquitoes can transmit malaria & yellow fever, fleas can transmit plague) Methods of transmition in the health care setting :

Air borne transmission : : 

Tiny droplet nuclei (< 5 microns) that remain Suspended in the air. Common vehicle transmission: Transmitted indirectly by material contaminated with the infectious (e.g. contaminated food , blood products, water or contaminated instruments & other items) Air borne transmission :

Nosocomial infection are the result of three factors occurring in tandem : 

High prevalence of pathogen . High prevalence of compromised hosts . Efficient mechanisms of transmission from one to another. This is also known as chain of transmission : The movement of pathogen from individual to individual via various routes. Nosocomial infection are the result of three factors occurring in tandem

Why do nosocomial infection occur? : 

Why do nosocomial infection occur?

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We are here

Pathological agents important nosocomial infection: : 

Commensal bacteria Found in the normal flora of healthy people . These have significant protective role by preventing colonization by pathogenic microorganisms. Staphylococcus epidermis (cause of i.v. infection), Escherichia coli (cause of urinary infection). They have greater virulence , & cause infections(sporadic or epidemic) regardless of host status Pathological agents important nosocomial infection:

Pathogenic bacteria : 

Gram – Positive : Staphylococcus aureus : Cutaneous bacteria that colonize the skin, Nose & throat of patients ,Hospital staff. They cause a wide variety of lung, bone , heart & bloodstream infections & are frequently resistant to antibiotics. MRSA(55%),anaerobic Gram positive rods(e.g. Clostridium) cause gangrene. Gram – negative : Enterobacteriaceae (e.g. E.coli, Proteus, klebsiella, Enterobacter, Serratia marcescens) may colonize sites when the host defences are compromised . They may also be highly antibiotic resistant. Pathogenic bacteria

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METHICILLIN – RESISTANT STAPHYLOCOCCUS AUREUS A COLONISED SEM MRSA ELECTRON MICROGRAPH OF MRSA

Acinetobacter spp. – cause of bloodstream infection : 

Acinetobacter spp. – cause of bloodstream infection

Nosocomial infection : 

Nosocomial infection Pseudomonas spp. Are often isolated in water & damp areas. They may colonize the digestive tract of hospitalized patients. Legionella species may cause pneumonia (sporadic or endemic) through inhalation of aerosols containing contaminated water (air conditioning, showers, therapeutic aerosols.).

Viruses : : 

There is a possibility of nosocomial transmission of HEPATITIS B & C viruses (transfusion , dialysis, injection, endoscopy),respiratory synctyial virus (RSV),rotavirus ,& enteroviruses (transmitted by hand-to-mouth contact& via the fecal –oral route). Hepatitis virus B &C Viruses :

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Rotavirus RSV

Continued……….. : 

Continued……….. Viral diarrhea & chickenpox . Cytomegalovirus Herpes virus Influenza Enteroviruses : Coxsackievirus Arenaviruse

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Influenza (Flu) Virus Herpes virus

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Coxsackievirus Arenaviruse

Parasites & fungi: : 

Many of them are opportunistic organisms & cause infection during extended antibiotics treatment & severe immunosuppression. Candida albicans, Aspergillus spp. Cryptosporidium, Toxoplasma pneumoniae. Scabies is an ectoparasite – outbreaks in health care facilities. Parasites & fungi:

SITES OF INFECTION : 

Sites for the most common nosocomial infections: distribution according to the French national prevalence survey(1996) SITES OF INFECTION

Surgical site infection: : 

They are also frequent : the incidence varies from 0.5 to15% depending on the type of operation & underlying patient status. The definition is mainly clinical : purulent discharge around the wound or the insertion site of the drain , or spreading cellulites from the wound. The infection is acquired is exogenously (e.g. from the air medical equipment ),or endogenously from the flora on the skin or rarely , from blood used in surgery. Surgical site infection:

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Surgical wound infection

Nosocomial pneumonia : 

The most important are patients on ventilators in intensive care units, where the rate of pneumonia is 3% per day . Recent & progressive radiological opacities of the pulmonary parenchyma, purulent sputum,& recent onsite fever ,it’s more specific using broncoscopy methods. Microorganisms are often endogenous (digestive system or nose & throat) ,but may be exogenous ,often from contaminated respiratory equipment. Nosocomial pneumonia

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Nosocomial pneumonia

Nosocomial Bacteraemia: : 

These infection represent a small proportion of nosocomial infection (approximately 5%). The incidence is increasing , particularly for certain organisms such as multiresistant coagulase –negative Staphylococcus & Candida spp. Infection may occur at the skin entry site of the intravascular device , or in the subcutaneous path of the catheter ,organisms colonizing the catheter within the vessel may produce bacteraemia without visible external infection. Nosocomial Bacteraemia:

Problems of nosocomial infection : 

Nosocomial infection will become more important as public health problem, as it causes: Additional suffering . Prolong hospital stay. Increase the cost of care significantly. Nosocomial infection are important contributors to morbidity & mortality. Problems of nosocomial infection

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May cause death Increase emotional stress of the patient Morbidity ,mortality & excess costs Can be transmitted to discharged patients or visitors Antibiotic resistance Known diseases Nosocomial infection results in:

Diagnosis of N.C.I. : 

Diagnosis of N.C.I. Physical examination Antibiogram & resistogram . Biotyping Phage typing Bacteriocin typing Serotyping Serum opacity factor (analysis of marker protein ,analysis of enzyme production,e.g. staphylococcus aureus. RNA electrophoresis as is done in rotavirus . Cytotoxicity assay e.g. proteus mirabills. Reverse phage typing .e.g. staph.aureus . Plasmid profile.

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prevention isolation Ask question Tell your doctor everything Sterilization Hand washing Aprans Get involved Prevention & control of N.C.I.

Isolation : : 

To prevent transmission of microorganism by common route in hospitals. Isolation of patients e.g. Plague, Influenza, Measles etc. 2.Sterilization : Sterilization of all reusable equipment such as ventilators , humidifiers,& any devices that come in contact with the respiratory tract. Isolation :

3. Hand washing: : 

Is the single most important measure to reduce the risk of transmitting microorganisms from one person to another or from one site to another on the same patient 3. Hand washing:

4.Gloves: : 

They are worn for two important reasons: 1- provide a protective barrier & to prevent contamination of hands. 2-Reduce the likelihood that microorganisms present on the Hands will be transmitted to patients during invasive or other patient –care procedures & vise versa. 4.Gloves:

5.Tell your doctor everything: : 

All symptoms. Other prescription medications. Other over-the-counter medications. Other alternative treatments. Previous diseases. Don’t assume it’s not important just because your doctor did not ask. 5.Tell your doctor everything: Note

6-Aprons : : 

Wearing an aprons during patient care reduces the risk of infection . The apron should be disposable or be used only when caring for a specific patient. 7-Ask questions: Make sure you understand everything & ensure that you have been told all your options. 6-Aprons :

8.Get educated : : 

Learning about your condition & its treatment is the best way to prevent an error. 9.Get involved: Be assertive about your right to be part of the decision process for your medical care. 8.Get educated :

CONCLUSION : 

CONCLUSION Some of the serious but avoidable aspects of this largely ignored but vital issue of nosocomial infections. Miss use of antibiotics has produced antibiotic resistant organisms such as MRSA and these increase clinical complications of patients, lengthening their hospital stay and adding to treatment costs. There is no official, national approach and no real managerial support from health authorities for control of nosocomial infections. Only thing is proper asepsis ,sterilization ,proper washing of hands..

REFERENCES : 

Pelczar MJJr, Chan ECS & Krieg NR. In Microbiology- Concepts and Applications www.rmj.org.pk/RMJ_JUL_DEC_2006/Review_articl... Remove frame  http://www.authorstream.com/ R. Ananthnnarayanan,C.K.Jayaram Panikar. Textbook of microbiology Fourth Edition Satish Gupte .Textbook of Medical Microbiology. Samuel Baron . Medical Microbiology –Forth Edition REFERENCES

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Thank you