Presentation on theme: "S.P Siva Shankari @ Rekha Nosocomial Infection “Infections Are Most Often Transmitted From Patient To Patient On The Hands Of Healthcare Workers…”"— Presentation transcript:
1S.P Siva Shankari @ Rekha Nosocomial Infection“Infections Are Most Often Transmitted From Patient To Patient On The Hands Of Healthcare Workers…”- Dr.William JarvisS.P Siva RekhaM.Sc NanoscienceLady Doak CollegeIva Puspitasari,MD
2Introduction:"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 may manifest during the patient’s stay, after get discharged, Visitors to the hospital also.Also called as “Hospital Acquired Infection” (HAI).
3Arti infeksi nosokomial Pasien yang dirawat di Rumah Sakit dan mendapatkan infeksi di Rumah Sakit yang sebelumnya pasien tidak dalam fase prodromal/inkubasi penyakit tersebut
4Factors Predispose HAI : Hospital PathogenPoor Condition Of HospitalCrowding Of Patient’sInstrumentsExtremes Of AgeImmunityContaminations
5Source Of Nosocomial Infection : EndogenousCause Self Infection Or Auto InfectionExogenousCause Cross Infection Or Environmental Infection
7Air borne transmission : Tiny droplet nuclei (< 5 microns) that remain Suspended in the air.Dusts From Bedding & Floor.Exudates Dispersed From Wound.
8Common vehicle transmission: Transmitted indirectly by material contaminated with the infectious microbes.Example: contaminated food , blood products, water or contaminated instruments & other items.
9CONTACT TRANSMISSION: Most important and frequent mode of transmission of nosocomial infections. It is divided into two subgroups :Direct-contact transmissionIndirect-contact transmission
10Droplet transmission : Droplets generated by :CoughingSneezingRespiratory tract procedures such as bronchoscopySecretions
11Vector transmission :Transmitted through insect & other invertebrate animals.Examples : mosquitoes can transmit “malaria” and “yellow fever”.Fleas can transmit “plague”.
12Nosocomial infection factors : 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 :o The movement of pathogen from individual to individual via various routes.
13Pathological agents important in nosocomial infection: Staphylococcus aureusEscherichia coliPseudomonas aeuroginosa
14Viruses : There is a possibility of nosocomial transmission of, Hepatitis B & C viruses (transfusion , dialysis, injection, endoscopy)Respiratory Synctyial Virus (RSV)Rotavirus
16Parasites & Fungi:Many of them are lethal organisms and cause infection during extended antibiotics treatment and severe immunosuppression.Candida albicans, Aspergillus speciesCryptosporidium, Toxoplasma pneumoniae.
17SITES OF INFECTION :Distribution according to the French national prevalence survey(1996),Following are the most common nosocomial infections:Urinary tractSurgical SiteRespiratory tractBacteraemia
18Surgical 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 : discharges around the wound, or spreading pus from the wound.By Stitches, Umbilical Cuts, Surgery spots.Organisms: S.aureus, P.aeruginosa.
19Risk factor SSI:Advanced ageObesityInfection at a remote site (spread through blood stream)MalnutritionDiabetesExtended preoperative hospital stayGreater than 12 hours between preoperative shaving of site and surgeryExtended time of surgeryInappropriate timing of prophylactic antibiotics
20Nosocomial pneumonia : The most important are patients on ventilators in intensive care units, where the rate of pneumonia is 3% per day .It accounts for 15% and have high mortality (13-55%).Mostly caused by respiratory devices, instruments.Organisms : S. aureus , Streptococcus pneumoniae , Influenzae.
21Urinary Tract Infections : It constitutes 40% of Nosocomial infections.Typically by catheterization, Instruments.Manifests as Cystisis, Urethritis.Organisms : E.coli, Proteus, Klebsilla
23Nosocomial Bacteraemia: These infection represent a small proportion of nosocomial infection (approximately 5-6%).The incidence is increasing , particularly for certain organisms such as Staphylococcus & Candida SpeciesInfection 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.
24Risk factor BSI:Age 1 year of age or younger or 60 years of age and olderMalnutritionImmunosuppressive chemotherapyLoss of skin integrity (burns, decubitus)Severe underlying illnessIndwelling device (catheter)Intensive care unit stayProlonged hospital stay
25Problems of nosocomial infection : Nosocomial infection will become more important as public health problem, as it causes:Additional sufferingProlong hospital stayIncrease the cost of care significantly Nosocomial infection are important contributors to morbidity & mortality
26Results : May cause death Increase emotional stress of the patient Morbidity ,mortality ratioExcess costs on stayCan be transmitted to discharged patients or visitorsHigh antibiotic resistance
28Diagnosis: genotypic Plasmid analysis Restriction endonuclease analysis of chromosomal DNA
29ControlMask, Eye Protection: To prevent splashes, sprays of secretions & excretion transmitting infection.Sterilization :Sterilization of all reusable equipment such as ventilators , humidifiers & any devices that come in contact with the respiratory tract.Linen :Solid, reusable items are placed in biohazard bags to prevent leakage.
30Gloves:On contact with blood, body fluids, wounds.Change of gloves after using it for 1 patientRemoval always in reversal manner so as not to touch surface.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.
31Cleaning of all isolation rooms alter the patients after is discharged controlSegregation of infected patients in private rooms or chorting of patients if private rooms is not availableCleaning of all isolation rooms alter the patients after is dischargedPlacement of cards on the patien’s door specifiying the type of isolation and instruction for visitor and nursing staff
32Category of isolationStrict isolation (chicken pox, pneumoniae plaque, lassa fever)Respiration isolation (measle, haemophilus influenza, Neisseria meningitidis)Enteric precaution (amoebic dysentri, Salmonella, Shigella)Contact isolation for patient infected MDROAFB isolation for patient with M.tuberculosisDrainage and secretion precaution for person with conjunctivitis and burnBlood and body fluid precaution for individual with AIDS
33Tell your doctor everything: All symptoms.Other prescription medications.Previous diseases.Don’t assume it’s not important just because your doctor did not ask.Aprons :Wearing an aprons during patient care reduces the risk of infection . The apron should be disposable.
34Conclusion :There is no official, national approach and no real managerial support from health authorities for control of nosocomial infectionsAll diposable items should be properly diposed in puncture proof bags without touching.Miss use of antibiotics has produced antibiotic resistant organisms and these increase clinical complications of patients, lengthening their hospital stay and adding to treatment costs.Only thing is proper asepsis ,sterilization ,proper washing of hand.
35REFERENCESGerard J. Tortora, Berdell R. Funke, Christine L. case, “Microbiology – An introduction”, 9th edition, pearson and Benjamin Cummings Inc., 2006.BS Nagoba, Asha Pichare , “Medical Microbiology” , 1st edition, Reed Elsevier private Limited, New Delhi,2007.Eugene W Nester, Denise G. Anderson, C. Evans Roberts Jr, Nancy N Pearsall, Martha T. Nester, “Microbiology- A Human Perspective”, 3rd Edition, Mc Graw Hill, North America.