1. S.P Siva Shankari @ Rekha
Nosocomial Infection
“Infections Are Most Often Transmitted From Patient To Patient On The Hands Of Healthcare Workers…”
- Dr.William Jarvis
S.P Siva Rekha
M.Sc Nanoscience
Lady Doak College
Iva Puspitasari,MD

2. Introduction:
"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).

3. Arti infeksi nosokomial
Pasien yang dirawat di Rumah Sakit dan mendapatkan infeksi di Rumah Sakit yang sebelumnya pasien tidak dalam fase prodromal/inkubasi penyakit tersebut

4. Factors Predispose HAI :
Hospital Pathogen
Poor Condition Of Hospital
Crowding Of Patient’s
Instruments
Extremes Of Age
Immunity
Contaminations

5. Source Of Nosocomial Infection :
Endogenous
Cause Self Infection Or Auto Infection
Exogenous
Cause Cross Infection Or Environmental Infection

6. Routes of transmission:
Airborne Transmission
Common vehicle Transmission
Contact Transmission
Droplet Transmission
Vector borne Transmission

7. Air borne transmission :
Tiny droplet nuclei (< 5 microns) that remain Suspended in the air.
Dusts From Bedding & Floor.
Exudates Dispersed From Wound.

8. Common vehicle transmission:
Transmitted indirectly by material contaminated with the infectious microbes.
Example: contaminated food , blood products, water or contaminated instruments & other items.

9. CONTACT TRANSMISSION:
Most important and frequent mode of transmission of nosocomial infections. It is divided into two subgroups :
Direct-contact transmission
Indirect-contact transmission

10. Droplet transmission :
Droplets generated by :
Coughing
Sneezing
Respiratory tract procedures such as bronchoscopy
Secretions

11. Vector transmission :
Transmitted through insect & other invertebrate animals.
Examples : mosquitoes can transmit “malaria” and “yellow fever”.
Fleas can transmit “plague”.

12. Nosocomial 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.

13. Pathological agents important in nosocomial infection:
Staphylococcus aureus
Escherichia coli
Pseudomonas aeuroginosa

14. Viruses : There is a possibility of nosocomial transmission of,
Hepatitis B & C viruses (transfusion , dialysis, injection, endoscopy)
Respiratory Synctyial Virus (RSV)
Rotavirus

15. Cytomegalovirus
Herpes virus
Influenza

16. Parasites & Fungi:
Many of them are lethal organisms and cause infection during extended antibiotics treatment and severe immunosuppression.
Candida albicans, Aspergillus species
Cryptosporidium, Toxoplasma pneumoniae.

17. SITES OF INFECTION :
Distribution according to the French national prevalence survey(1996),
Following are the most common nosocomial infections:
Urinary tract
Surgical Site
Respiratory tract
Bacteraemia

18. 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 : discharges around the wound, or spreading pus from the wound.
By Stitches, Umbilical Cuts, Surgery spots.
Organisms: S.aureus, P.aeruginosa.

19. Risk factor SSI:
Advanced age
Obesity
Infection at a remote site (spread through blood stream)
Malnutrition
Diabetes
Extended preoperative hospital stay
Greater than 12 hours between preoperative shaving of site and surgery
Extended time of surgery
Inappropriate timing of prophylactic antibiotics

20. Nosocomial 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.

21. Urinary Tract Infections :
It constitutes 40% of Nosocomial infections.
Typically by catheterization, Instruments.
Manifests as Cystisis, Urethritis.
Organisms : E.coli, Proteus, Klebsilla

22. Risk factor uti:
Advanced age
Female gender
Severe underlying diasese
Placement of indwelling urine catheter

23. Nosocomial 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 Species
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.

24. Risk factor BSI:
Age 1 year of age or younger or 60 years of age and older
Malnutrition
Immunosuppressive chemotherapy
Loss of skin integrity (burns, decubitus)
Severe underlying illness
Indwelling device (catheter)
Intensive care unit stay
Prolonged hospital stay

25. 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

26. Results : May cause death Increase emotional stress of the patient
Morbidity ,mortality ratio
Excess costs on stay
Can be transmitted to discharged patients or visitors
High antibiotic resistance

27. Diagnosis : phenotypic
Biotyping
Phage typing
Serotyping
Plasmid profile
Antibiogram

28. Diagnosis: genotypic Plasmid analysis
Restriction endonuclease analysis of chromosomal DNA

29. Control
Mask, 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. 

30. Gloves:
On contact with blood, body fluids, wounds.
Change of gloves after using it for 1 patient
Removal 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. 

31. Cleaning of all isolation rooms alter the patients after is discharged
control
Segregation of infected patients in private rooms or chorting of patients if private rooms is not available
Cleaning of all isolation rooms alter the patients after is discharged
Placement of cards on the patien’s door specifiying the type of isolation and instruction for visitor and nursing staff

32. Category of isolation
Strict 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 MDRO
AFB isolation for patient with M.tuberculosis
Drainage and secretion precaution for person with conjunctivitis and burn
Blood and body fluid precaution for individual with AIDS

33. Tell 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.

34. Conclusion :
There is no official, national approach and no real managerial support from health authorities for control of nosocomial infections
All 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.

35. REFERENCES
Gerard 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.

36. Thank You !!! 