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| {{SI}} | | __NOTOC__ |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Infobox disease |
| | | Name = Nosocomial infection |
| | | Image = Contaminated surfaces increase cross-transmission.jpg |
| | | Caption = Contaminated surfaces increase cross-transmission |
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| | {{Nosocomial infection}} |
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| {{CMG}} | | {{CMG}} |
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| {{Editor Help}} | | {{SK}} Hospital-acquired infection; HAI |
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| ==Overview== | | ==[[Nosocomial infection overview|Overview]]== |
| '''Nosocomial infections''' are [[infection]]s which are a result of treatment in a [[hospital]] or a healthcare service unit, but secondary to the patient's original condition. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge. ''Nosocomial'' comes from the [[Greek language|Greek]] word ''nosokomeion'' (νοσοκομείον) meaning hospital (''nosos'' = [[disease]], ''komeo'' = to take care of ). This type of infection is also known as a '''hospital-acquired infection'''. The most common nosocomial infections are of the [[urinary tract]], and various [[pneumonia]]s.
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| Nosocomial infections are even more alarming in the 21st century as [[antibiotic resistance]] spreads. Reasons why nosocomial infections are so common include:
| | ==[[Nosocomial infection classification|Classification]]== |
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| *Hospitals house large numbers of people who are sick and whose [[immune system]]s are often in a weakened state;
| | ==[[Nosocomial infection pathophysiology|Pathophysiology]]== |
| *Increased use of outpatient treatment means that people who are in the hospital are sicker on average;
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| *Medical staff move from patient to patient, providing a way for pathogens to spread;
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| *Many [[medical procedure]]s bypass the body's natural protective barriers;
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| *Routine use of anti-microbial agents in hospitals creates [[natural selection|selection pressure]] for the emergence of resistant strains.
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| Thorough [[hand washing]] and/or use of [[alcohol rubs]] by all medical personnel before each patient contact is one of the most effective ways to combat nosocomial infections. More careful use of [[anti-microbial]] agents, such as [[antibiotic]]s, is also considered vital.
| | ==[[Nosocomial infection causes|Causes]]== |
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| == Epidemiology == | | ==[[Nosocomial infection differential diagnosis|Differentiating Nosocomial Infection from other Diseases]]== |
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| In the United States, it has been estimated that as many as one hospital patient in ten acquires a nosocomial infection, or 2 million patients a year. Estimates of the annual cost range from $4.5 billion to $11 billion and up. Nosocomial infections contributed to 88,000 deaths in the U.S. in 1995. One third of nosocomial infections are considered preventable. Ms. magazine reports that as many as 90 percent of deaths from hospital infections could be prevented. <ref>Ricks, Delthia. "Germ Warfare." Ms. Magazine. Spring 2007. pp 43-45.</ref>
| | ==[[Nosocomial infection epidemiology and demographics|Epidemiology and Demographics]]== |
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| In France, the [[prevalence]] is 6.87%<ref>''enquête nationale de prévalence 2001''</ref>, to 7.5%<ref>[http://ecoetsante2010.free.fr/article.php3?id_article=525 Quelle est la prévalence de ces infections ?]</ref> (some patients are infected twice) :
| | ==[[Nosocomial infection risk factors|Risk Factors]]== |
| * [[Urinary tract infection]]: 40%;
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| * infection of the [[skin]] and [[mucous membrane]]: 10.8%;
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| * infections of surgery site: 10.3%;
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| * [[pneumopathy]]: 10%.
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| A ratio of 5 to 19% hospitalized patients are infected, and up to 30% in [[intensive care]] units. The patients must stay in the hospital 4-5 additional days. About 9,000 people die with a nosocomial infection, but about 4,200 would have not died without this infection.
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| In Italy, in the 2000's, about 6.7 % of hospitalized patients were infected, i.e. between {{formatnum:450000}} and {{formatnum:700000}} patients, which caused between {{formatnum:4500}} and {{formatnum:7000}} deaths.<ref>''L'Italie scandalisée par « l'hôpital de l'horreur »'', Éric Jozsef, ''Libération'', 15 janvier 2007</ref>
| | ==[[Nosocomial infection natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| In Switzerland, extrapolations assume about 70'000 hospitalised patients are affected by nosocomial infections (between 2 and 14% of hospitalized patients).<ref>http://www.edi.admin.ch/dokumentation/00613/00614/?lang=de&msg-id=2532</ref> <ref>http://www.swisshandhygiene.ch/swisshandhygiene/presse/_b/contentFiles/301006_Facts_sheet_F.doc</ref>
| | ==Diagnosis== |
| | [[Nosocomial infection history and symptoms|History and Symptoms]] | [[Nosocomial infection physical examination |Physical Examination]] | [[Nosocomial infection laboratory findings|Laboratory Findings]] | [[Nosocomial infection chest x ray|Chest X Ray]] | [[Nosocomial infection other imaging findings|Other Imaging Findings]] | [[Nosocomial infection other diagnostic studies|Other Diagnostic Studies]] |
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| == Transmission == | | ==Treatment== |
| | [[Nosocomial infection medical therapy|Medical Therapy]] | [[Nosocomial infection primary prevention|Primary Prevention]] | [[Nosocomial infection cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Nosocomial infection future or investigational therapies|Future or Investigational Therapies]] |
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| Microorganisms are transmitted in hospitals by several routes, and the same microorganism may be transmitted by more than one route. There are five main routes of transmission -- contact, droplet, airborne, common vehicle, and vectorborne.
| | ==Case Studies== |
| * '''Contact transmission''', the most important and frequent mode of transmission of nosocomial infections, is divided into two subgroups: direct-contact transmission and indirect-contact transmission.
| | [[Nosocomial infection case study one|Case #1]] |
| ** '''Direct-contact transmission''' involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other [[health care|patient-care]] activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.
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| ** '''Indirect-contact transmission''' involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, [[Hypodermic needle|needle]]s, or dressings, or contaminated gloves that are not changed between patients. Additionally, the improper use of saline flush syringes, vials, and bags have been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.<ref name=salineflush>{{cite journal
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| | last =
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| | first =
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| | authorlink =
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| | coauthors = Jain SK, Persaud D, Perl TM, Pass MA, Murphy KM, Pisciotta JM, et al.
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| | title = Nosocomial malaria and saline flush
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| | journal = Emerging Infectious Diseases [serial on the Internet] | |
| | volume = 11
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| | issue = 7
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| | publisher = Centers for Disease Control and Prevention
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| | date = July 2005
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| | url = http://www.cdc.gov/ncidod/EID/vol11no07/05-0092.htm }}</ref>
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| * '''[[Airborne transmission]]''' occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 [[micrometre|µm]] or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air handling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include ''[[Mycobacterium tuberculosis]]'' and the [[rubeola]] and [[varicella]] viruses.
| | ==Related Chapters== |
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| * '''Common vehicle transmission''' applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.
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| ==Predisposition to infection== | |
| Factors predisposing a patient to infection can broadly be divided into four areas:
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| *People in hospitals are usually already in a '''poor state of health''', impairing their defense against bacteria – advanced age or [[premature birth]] along with [[immunodeficiency]] (due to drugs, illness, or IR radiation) present a general risk, while other diseases can present specific risks - for instance [[COPD|chronic obstructive pulmonary disease]] can increase chances of respiratory tract infection.
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| *'''Invasive devices''', for instance [[intubation]] tubes, [[catheters]], surgical drains and [[tracheostomy]] tubes all bypass the body’s natural lines of defence against [[pathogens]] and provide an easy route for infection. Patients already colonised on admission are instantly put at greater risk when they undergo an invasive procedure.
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| *A patient’s '''treatment''' itself can leave them vulnerable to infection – [[immunosuppression]] and [[antacid]] treatment undermine the body’s defences, while [[antimicrobial]] therapy (removing competitive [[flora]] and only leaving resistant organisms) and recurrent [[blood]] [[transfusions]] have also been identified as risk factors.
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| ==Prevention==
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| ===Isolation===
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| Isolation precautions are designed to prevent transmission of microorganisms by common routes in hospitals. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission.
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| ===Handwashing and gloving===
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| Handwashing frequently is called the single most important measure to reduce the risks of transmitting microorganisms from one person to another or from one site to another on the same patient.
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| Washing hands as promptly and thoroughly as possible between patient contacts and after contact with [[blood]], [[body fluid]]s, [[secretion]]s, [[excretion]]s, and equipment or articles contaminated by them is an important component of infection control and isolation precautions.
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| Although handwashing may seem like a simple measure, it is often not used or hand washing is performed incorrectly. Healthcare settings must continually remind practitioners and visitors to wash their hands thoroughly. Simple programs, for example - [http://henrythehand.com/pages/content/infection_control.html "Henry The Hand"], can be used to help healthcare facilities prevent nosocomial infections. All visitors must follow the same procedures as hospital staff for infections to be adequately controlled. Visitors and healthcare personnel are equally important in transmitting infections. Moreover, multi-drug resistant infections can leave the hospital and become part of the community flora if we dont take steps to stop this transmission.
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| In addition to handwashing, gloves play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, gloves are worn to provide a protective barrier and to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin; the wearing of gloves in specified circumstances to reduce the risk of exposures to [[bloodborne pathogen]]s is mandated by the OSHA Bloodborne Pathogens final rule. Second, gloves are worn to reduce the likelihood that microorganisms present on the hands of personnel will be transmitted to patients during invasive or other patient-care procedures that involve touching a patient's mucous membranes and nonintact skin. Third, gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or a [[fomite]] can transmit these microorganisms to another patient. In this situation, gloves must be changed between patient contacts and hands should be washed after gloves are removed.
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| Wearing gloves does not replace the need for handwashing, because gloves may have small, non-apparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Failure to change gloves between patient contacts is an infection control hazard.
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| Examples of nosocomial infections include [[Methicillin_Resistant_Staphylococcus_Aureus|Methicillin Resistant ''Staphylococcus aureus'']] (MRSA) and [[Acinetobacter_baumanni|''Acinetobacter baumanni'']].
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| ===Aprons===
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| Wearing an apron during patient care reduces the risk of infection. The apron should either be disposable or be used only when caring for a specific patient.
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| ===Birth===
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| Proponents of [[home birth]] often cite the benefit of avoiding nosocomial infection by avoiding hospital [[Childbirth|delivery]].
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| == Known diseases ==
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| * [[Ventilator associated pneumonia]]
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| * [[Staphylococcus aureus]]
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| * [[Methicillin-resistant Staphylococcus aureus]]
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| * [[HIV/AIDS]]
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| * [[Pseudomonas aeruginosa]]
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| * Acinetobacter baumannii
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| * [[Stenotrophomonas maltophilia]]
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| * [[Clostridium difficile]]
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| * [[Tuberculosis]]
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| * [[Urinary tract infection]]
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| * [[Hospital-acquired pneumonia]]
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| * [[Gastroenteritis]]
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| == Mitigation ==
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| The most effective of controlling Nosocomial infection is to strategically implementing [[Quality Assurance|QA]] / [[Quality control|QC]] measures to the [[Health care|health care]] sectors and evidence-based management can be a feasible approach. For those VAP/HAP diseases, controlling and monitoring hospital [[Indoor air quality|indoor air quality]] needs to be on agenda in management <ref name=cmhiaq>{{cite journal
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| | last = Leung
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| | first = Michael
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| | coauthors = Alan H. S. Chan
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| | title = Control and management of hospital indoor air quality <internet>
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| | date = 2006
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| | url = http://medscimonit.com/pub/vol_12/no_3/6641.pdf }}</ref> whereas for Nosocomial [[rotavirus]] infection, a hand hygiene protocol has to be enforced <ref name=coprabc>{{cite journal
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| | last = Chan
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| | first = Pei-Chun et al.
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| | authorlink =
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| | coauthors =
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| | title = Control of an Outbreak of Pandrug-Resistant Acinetobacter baumannii Colonization and Infection in a Neonatal Intensive Care Unit <internet>
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| | date = 2007
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| | url = http://www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/513120&erFrom=2955280990361486143Guest }}</ref><sup>,</sup><ref name=pste3>{{cite journal
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| | last = Josie
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| | first = L. et al.
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| | coauthors =
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| | title = Pilot study to evaluate 3 hygiene protocols on the reduction of bacterial load on the hands of veterinary staff performing routine equine physical examinations <internet>
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| | date = 2006
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| | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1482439 }}</ref><sup>,</sup><ref name=hwhd>{{cite journal
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| | last = Katz
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| | first = Jonathan D.
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| | title = Hand washing and hand disinfection: more than your mother taught you <internet>
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| | journal =
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| | date = 2004
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| | url = http://www.aspiruslibrary.org/articles/KJO_anesthesiologyClinicsNAmer.pdf }}</ref>.
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| ==References==
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| <div class="references-small"><references/></div>
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| ==See also==
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| * [[Iatrogenesis]], a disease or complication caused by medical treatment
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| * [[Infectious disease]]
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| * [[Infection control]] | | * [[Infection control]] |
| * [[Sterilization (surgical procedure)]] | | * [[Iatrogenesis]] |
| * [[Cleanroom]] | | * [[Phototherapy]] |
| | * [[Sanitation Standard Operating Procedures|Sanitation standard operating procedures]] |
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| == External links ==
| | {{Intensive care medicine}} |
| *{{cite web
| | [[Category:Disease]] |
| |title=Nosocomial Infections: Supplemental Lecture
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| |date=98-05-09
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| |first=Stephen T.
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| |last=Abedon
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| |url=http://www.mansfield.osu.edu/~sabedon/biol2053.htm }}
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| [[Category:Healthcare]] | | [[Category:Occupational diseases]] |
| [[Category:Nursing]] | | [[Category:Healthcare quality]] |
| [[Category:Surgical procedures]]
| | [[Category:Medical hygiene]] |
| [[Category:Occupational safety and health]]
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| [[Category:Infectious disease]] | |
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| {{SIB}}
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| | [[ar:عدوى المستشفيات]] |
| | [[cs:Nemocniční nákaza]] |
| | [[da:Hospitalsinfektion]] |
| [[de:Nosokomiale Infektion]] | | [[de:Nosokomiale Infektion]] |
| | [[et:Hospitaalinfektsioon]] |
| | [[es:Infección nosocomial]] |
| | [[eu:Infekzio nosokomial]] |
| [[fr:Infection nosocomiale]] | | [[fr:Infection nosocomiale]] |
| | [[id:Infeksi nosokomial]] |
| [[it:Infezione ospedaliera]] | | [[it:Infezione ospedaliera]] |
| | [[he:מחלה נוזוקומיאלית]] |
| | [[nl:Ziekenhuisinfectie]] |
| [[ja:院内感染]] | | [[ja:院内感染]] |
| [[nl:Ziekenhuisinfectie]] | | [[nn:Sjukehusinfeksjon]] |
| [[pl:Zakażenia szpitalne]] | | [[pl:Zakażenie szpitalne]] |
| | [[pt:Infecção hospitalar]] |
| | [[ro:Infecție nosocomială]] |
| | [[ru:Внутрибольничные инфекции]] |
| [[sk:Nemocničná nákaza]] | | [[sk:Nemocničná nákaza]] |
| | [[sl:Bolnišnična okužba]] |
| | [[sr:Болничке инфекције]] |
| [[fi:Sairaalabakteeri]] | | [[fi:Sairaalabakteeri]] |
| | [[sv:Vårdrelaterade infektioner]] |
| [[uk:Внутрішньолікарняна інфекція]] | | [[uk:Внутрішньолікарняна інфекція]] |
| | | [[zh:院內感染]] |
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