HOSPITAL ACQUIRED

INFECTIONS

-NISHMITA T.J 33

INTRODUCTION

• Hospital acquired infection is cross infection of one patient by another or by doctors, nurses and other hospital staff while in the hospital.

• A high frequency of HAI is an evidence of a poor quality health service delivery.

• Nosocomial infections are wide spread.• They are an important contribution to

morbidity and mortality.

DEFINITION

• Nosocomial infections or hospital acquired infections are infections acquired during hospital care which are not present at the time of admission.

• Infections occuring more than 48 hours after admission are considered nosocomial.

• They have become important as a public health problem because:

• Increasing number and crowding of people.• More frequent impaired immunity.• New micro organisms.• Increasing bacterial resistance to antibiotics.

• A prevalence survey conducted by WHO in 55 hospitals of 14 countries showed an average of 8.7% of hospital patients had nosocomial infection.

• Over 1.4 million people worldwide suffer from nosocomial infections.

• Nosocomial infections are considered either endemic or epidemic.

• Endemic infections are more common.• Epidemic infections occur during outbreaks,

defined as an unusual increase above the baseline of a specific infection or infecting organism.

French National Prevalence Survey

TYPES OF NOSOCOMIAL INFECTION

• Surgical site infection: Any purulent discharge, abcess or spreading cellulitis at the surgical site during the month after the operation.

• Urinary infection: Positive urine culture with atleast 10 5 bacteria per ml, with or without clinical symptoms.

• Respiratory infection: Prespiratory symptoms with atleast two of the following signs appearing during hospitalisation:

• Cough• Purulent sputum• New infiltrate on chest radiograph consistent

with infection.

• Vascular catheter infection: Inflamation, lymphangitis or purulent discharge at insertion site of catheter.

• Sepicaemia: Fever or rigours and atleast one positive blood culture.

CAUSES

• HAI is usually due to failure to observe aseptic precautions while carrying out hospital procedures such as surgical operations, iv infusion, dressing of wounds, lumbar puncture, giving injections etc.

Predisposing Factors

• Development of resistance by the organisms to commonly used drugs.

• Owercrowding of the hospital.• Poor environmentg of the hospital both inside

and outside.• Decreased resistance and increased

susceptibility of the vulnerable groups of patients such as those suffering from tb, leprosy, severe PEM, anemia, cardiac patients, old age.

ETIOLOGICAL AGENTS

• 50% of HAI are due to Staphylococci and about 45% are due to gram negative bacilli like E.coli, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella etc.

• Remaining 5% are caused by viruses, protozoa, fungi etc.

• Among the viruses emergence of HBV and HIV have worsened the condition.

PROBLEM STATEMENT IN INDIA

• Research on hospital infections in India reveals several concerning trends.

• In Indian ICUs, the rate of vancomycin-resistant enterococcus (VRE), a dangerous hospital infection, is five times the rate in the rest of the world.

• Rates of methicillin-resistant Staphylococcus aureus in Indian ICUs are also high, with one study finding over 80% of S. aureus samples testing positive for resistance to methicillin and closely related antibiotics.

• Antibiotic resistant infections are difficult, and sometimes impossible, to treat.

• They lead to longer hospital stays, increased treatment costs, and in some cases, death. GARP research estimates that of the approximately 190,000 neonatal deaths in India each year due to sepsis.

• Over 30% are attributable to antibiotic resistance. Antibiotic resistant hospital infections can be especially deadly because antibiotics are used intensely in hospitals compared with the community, and frequent use drives the development of highly resistant bacteria.