Nosocomial Infections Flashcards
Nosocomial infection, also called “…………..” can be defined as: ……………………….
◼ This includes…………………..
Nosocomial infection also called “hospital acquired infection (HAI)” can be defined as: An infection acquired by a patient during hospital care which was not present or incubating at the time of admission.
◼ This includes infections acquired in the hospital but appearing after discharge.
Some nosocomial infections occur in……. (……)
– but majority are…….
Some infections occur in outbreaks or clusters (10%)
– but majority are endemic
Examples of diagnostic or therapeutic procedures that result in nosocomial infections
Catheters in bladder or blood vessel, surgery
Major sites of infection in medical
ICU
PNE
UTI
BSI
SOURCES OF PATHOGENS IN NI (endogenous)
normal commensals of the skin,
respiratory, GI, GU tract
SOURCES OF PATHOGENS IN NI (exogenous)
Inanimate environment: Aspergillus from hospital construction, Legionella from contaminated water
❑ Animate environment: hospital staff, visitors, other patients
MECHANISMS OF TRANSMISSION of nosocomial infections
Contact
Airborne
Common-vehicle
Droplet
SITES OF NOSOCOMIAL INFECTIONS
Urinary tract 40%
◼ Pneumonia 20%
◼ Surgical site 17%
◼ Bloodstream (IV) 8%
What is NOSOCOMIAL PNEUMONIA?
Lower respiratory tract infection that develops during hospitalization but is not present or incubating at time of admission
◼ Does not become manifest in the first 48-
72 hours of admission
Leading cause of death from NI
NOSOCOMIAL PNEUMONIA
Early onset of Nos. pneu. (first 3-4 days of mechanical ventilation)
Antibiotic sensitive, community organisms
(S. pneumoniae, H. influenzae, S. aureus
Late onset of Nos. pneu.
Antibiotic resistant, nosocomial organisms (MRSA, Ps. aeruginosa, Acinetobacter spp, Enterobacter spp)
What are some predisposing factors for Nos. Pneu.?
Endotracheal intubation!!!!!!!!!!!!!!
◼ ICU
◼ Antibiotics
◼ Surgery
◼ Chronic lung disease
◼ Advanced age
◼ immunosuppression
Hospitalized pts have high rates of……….. colonization
Hospitalized pts have high rates of gram negative colonization
Clinical diagnosis of Nos. Pneu.
fever, change in O2, change in sputum, CXR
How can Nos. Pneu. be prevented?
Change position q 2 hours
❑ Elevate head to 30-45 degrees
◼ Deep breathing, incentive spirometry
◼ Frequent suctioning
◼ Bronchoscopy to remove mucous plugging
Nosocomial Urinary Tract Infections are…… related to……..
◼ Associated with…… of cases of nosocomial…………..
Nosocomial Urinary Tract Infections are 80% related to urinary catheters
◼ Associated with 2/3 of cases of nosocomial gram negative bacteremias
Source of uropathogens
❑ Endogenous
catheter insertion
- retrograde movement up the urethrea (70-80%)
- patient’s own enteric flora (E.coli)
Source of uropathogens (Exogenous)
cross contamination of drainage systems
- may cause clusters of UTI’s
What are some major risk factors for getting Nos. UTI’s?
1) Pathogenic bacteria in periurethral area
2) Indwelling urinary catheter
❑ Duration of catheterization
ETIOLOGIC AGENTS: catheter associated UTI
E. coli 32%
Proteus spp 14%
Enterococcus 12%
Klebsiella 9%
Nos. UTI treatment
No antibiotic treatment for bacteriuria
- resolves with catheter removal
-7-10 days of therapy for UTI
◼ Empiric therapy typically initiated pending microbiologic results
Prevention of Nosocomial UTIs
Avoid catheter when possible &
discontinue ASAP- MOST IMPORTANT
◼ Aseptic insertion by trained HCWs
◼ Maintain closed system of drainage
◼ Ensure dependent drainage
◼ Minimize manipulation of the system
◼ Silver coated catheters
What are Incisional infections?
❑ Infection at surgical site
❑ Within 30 days of surgery
❑ Involves skin, subcutaneous tissue, or muscle above fascia
