Healthcare-associated (nosocomial infections)

Question 1

1. Define and explain the terms “nosocomial” and iatrogenic.”

Answer 1

nosocomial is a new disorder associated with being treated in a hospital

iatrogenic denotes an unfavorable response to a medical or surgical treatment, induced by the treatment itsself

Question 2

2. Discuss the common types of nosocomial infections, the source of these infections and the most common groups of pathogens involved.

Answer 2

most are bacterial, many are related to medical devices and 50% are preventable

in ICUs: Pseudamonas, MRSA, coagulase negative Staph, toxigenic strains of C. diff, E. coli, Enterococcus, Legionella, Candida, Aspergillus, Fusarium, HBV, HCV, CMV, RSV, Rotabirus and SARS

Question 3

3. Explain the epidemiology and the risk factors for acquiring a nosocomial infection.

Answer 3

most common sites of infection: UTI, surgical wound, LRT, bacteremia or C.diff associated colitis

ICUs and trauma units have highest rates of infection; invasive devices are the number 1 cause of nosocomial infection (endotracheal tubes, urinary catheter and central line catheter)

other: understaffing, overcrowding, surgery (esp decreasing body temp), exposure to antibiotics, lack of surveillance

Question 4

4. Describe the methods available to reduce and prevent the incidence of nosocomial infections.

Answer 4

there has been an increase in antibiotic resistance (VRE, MRSA)

reduce antibiotic pressure, improve infection control, restrict use of invasive devices, use aseptic technique, hand hygiene, follow patient isolation, use HEPA filters for transplant patients

Question 5

5. Explain the new paradigm for controlling these infections.

Answer 5

more effective hand hygiene: waterless alcohol tells and antibacterial soap
barrier precautions on high risk patients
assume all patients are high risk
procedures to minimize device-related infection (disinfect skin- chlrohexidine baths, remove ASAP, follow up)
copper-silver ionization
antibiotic prophylaxis before incision, preoperative hyper oxygenation, intensive insulin therapy in critically ill
semi-recumbent positioning
proper disposal of biohazards, never re-cap needles

Question 6

Name the top sources of nosocomial infections in a hospital.

Answer 6

Airborne (aspergillum, chicken pox, TB, SARS)
water-borne (legionella, pseudamonas)
animate objects (hands of healthcare workers)