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	Nosocomial infection
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ICD-10	Y95

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Revision as of 18:48, 26 November 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A nosocomial infection, also known as a hospital-acquired infection or HAI, is an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. Such infections include fungal and bacterial infections and are aggravated by the reduced resistance of individual patients.^[1]

In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year.^[2] In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital.^[2]

Known nosocomial infections

Epidemiology

Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some medical procedures bypass the body's natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as vectors.

Categories and treatment

Among the categories of bacteria most known to infect patients are the category MRSA (resistant strain of S. aureus), member of Gram-positive bacteria and Acinetobacter (A. baumannii), which is Gram-negative. While antibiotic drugs to treat diseases caused by Gram-positive MRSA are available, few effective drugs are available for Acinetobacter. Acinetobacter bacteria are evolving and becoming immune to existing antibiotics, so in many cases, polymyxin-type antibacterials need to be used. "In many respects it’s far worse than MRSA," said a specialist at Case Western Reserve University.^[2]

Another growing disease, especially prevalent in New York City hospitals, is the drug-resistant, Gram-negative Klebsiella pneumoniae. An estimated more than 20% of the Klebsiella infections in Brooklyn hospitals "are now resistant to virtually all modern antibiotics, and those supergerms are now spreading worldwide.^[2]

The bacteria, classified as Gram-negative because of their reaction to the Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream, and other parts of the body. Their cell structures make them more difficult to attack with antibiotics than Gram-positive organisms like MRSA. In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. "For Gram-positives we need better drugs; for Gram-negatives we need any drugs," said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-UCLA Medical Center, and the author of Rising Plague, a book about drug-resistant pathogens.^[2]

One-third of nosocomial infections are considered preventable. The CDC estimates 2 million people in the United States are infected annually by hospital-acquired infections, resulting in 20,000 deaths.^[3] The most common nosocomial infections are of the urinary tract, surgical site and various pneumonias.^[4]

Epidemiology

The methods used differ from country to country (definitions used, type of nosocomial infections covered, health units surveyed, inclusion or exclusion of imported infections, etc.), so the international comparisons of nosocomial infection rates should be made with the utmost care.

United States

The Centers for Disease Control and Prevention (CDC) estimated roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year.^[5] Other estimates indicate 10%, or 2 million, patients a year become infected, with the annual cost ranging from $4.5 billion to $11 billion. In the USA, the most frequent type of infection hospitalwide is urinary tract infection (36%), followed by surgical site infection (20%), and bloodstream infection and pneumonia (both 11%).^[2]

France

Estimates ranged from 6.7% in 1990 to 7.4% (patients may have several infections).^[6] At national level, prevalence among patients in health care facilities was 6.7% in 1996,^[7] 5.9% in 2001^[8] and 5.0% in 2006.^[9] The rates for nosocomial infections were 7.6% in 1996, 6.4% in 2001 and 5.4% in 2006.

In 2006, the most common infection sites were urinary tract infections (30,3%), pneumopathy (14,7%), infections of surgery site (14,2%). Infections of the skin and mucous membrane (10,2%), other respiratory infections (6,8%) and bacterial infections / blood poisoning (6,4%).^[10] The rates among adult patients in intensive care were 13,5% in 2004, 14,6% in 2005, 14,1% in 2006 and 14.4% in 2007.^[11]

Nosocomial infections are estimated to make patients stay in the hospital four to five additional days. Around 2004-2005, about 9,000 people died each year with a nosocomial infection, of which about 4,200 would have survived without this infection.^[12]

Italy

Since 2000, estimates show about a 6.7% infection rate, i.e. between 450,000 and 700,000 patients, which caused between 4,500 and 7,000 deaths.^[13] A survey in Lombardy gave a rate of 4.9% of patients in 2000.^[14]

United Kingdom

Estimates show a 10% infection rate,^[15] with 8.2% estimated in 2006.^[16]

Switzerland

Estimates range between 2 and 14%.^[17] A national survey gave a rate of 7.2% in 2004.^[18]

Finland

Rate were estimated at 8.5% of patients in 2005.^[19]

Transmission

The drug-resistant Gram-negative bacteria, for the most part, threaten only hospitalized patients whose immune systems are weak. They can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters, and ventilators.^[2]

Main routes of transmission
Route	Description
Contact transmission	The most important and frequent mode of transmission of nosocomial infections is by direct contact.
Droplet transmission	Transmission occurs when droplets containing microbes from the infected person are propelled a short distance through the air and deposited on the host's body; droplets are generated from the source person mainly by coughing, sneezing, and talking, and during the performance of certain procedures, such as bronchoscopy.
Airborne transmission	Dissemination can be either airborne droplet nuclei (small-particle residue {5 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 Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.
Common vehicle transmission	This applies to microorganisms transmitted to the host by contaminated items, such as food, water, medications, devices, and equipment.
Vector borne transmission	This occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.

Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact transmission.

Routes of contact transmission
Route	Description
Direct-contact transmission	This 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 when a person turns a patient, gives a patient a bath, or performs other 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.
Indirect-contact transmission	This involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.^[20]

Risk factors

Factors predisposing a patient to infection can broadly be divided into three areas:

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 irradiation) present a general risk, while other diseases can present specific risks - for instance, chronic obstructive pulmonary disease can increase chances of respiratory tract infection.
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 invasive procedures.
Patients' treatments 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.

Prevention

Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventive measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections.^[21] More careful use of antimicrobial agents, such as antibiotics, is also considered vital.^[22]

Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotics and other antimicrobial drugs to help treat illness; this may increase the selection pressure for the emergence of resistant strains.

Sterilization

Sterilization goes further than just sanitizing. It kills all microorganisms on equipment and surfaces through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure.

Isolation

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.

Handwashing and gloving

Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient. Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions. The spread of nosocomial infections, among immunocompromised patients is connected with health care workers' hand contamination in almost 40% of cases, and is a challenging problem in the modern hospitals. The best way for workers to overcome this problem is conducting correct hand-hygiene procedures; this is why the WHO launched in 2005 the GLOBAL Patient Safety Challenge.^[23] Two categories of micro-organisms can be present on health care workers' hands: transient flora and resident flora. The first is represented by the micro-organisms taken by workers from the environment, and the bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group is represented by the permanent micro-organisms living on the skin surface (on the stratum corneum or immediately under it). They are capable of surviving on the human skin and to grow freely on it. They have low pathogenicity and infection rate, and they create a kind of protection from the colonization from other more pathogenic bacteria. The skin of workers is colonized by 3.9 x 10⁴ – 4.6 x 10⁶ cfu/cm². The microbes comprising the resident flora are: Staphylococcus epidermidis, S. hominis, and Microccocus, Propionibacterium, Corynebacterium, Dermobacterium, and Pitosporum spp., while in the transitional could be found S. aureus, and Klebsiella pneumoniae, and Acinetobacter, Enterobacter and Candida spp. The goal of hand hygiene is to eliminate the transient flora with a careful and proper performance of hand washing, using different kinds of soap, (normal and antiseptic), and alcohol-based gels. The main problems found in the practice of hand hygiene is connected with the lack of available sinks and time-consuming performance of hand washing. An easy way to resolve this problem could be the use of alcohol-based hand rubs, because of faster application compared to correct hand washing.^[24]

Although handwashing may seem like a simple process, it is often performed incorrectly. Healthcare settings must continuously remind practitioners and visitors on the proper procedure to comply with responsible handwashing. Simple programs such as Henry the Hand, and the use of handwashing signals can assist healthcare facilities in the prevention of nosocomial infections.

All visitors must follow the same procedures as hospital staff to adequately control the spread of infections. Visitors and healthcare personnel are equally to blame in transmitting infections.^{[citation needed]} Moreover, multidrug-resistant infections can leave the hospital and become part of the community flora if steps are not taken to stop this transmission.

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, they 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. In the USA, the Occupational Safety and Health Administration has mandated wearing gloves to reduce the risk of bloodborne pathogen infections.^[25] Second, gloves are worn to reduce the likelihood 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, they are worn to reduce the likelihood the hands of personnel contaminated with micro-organisms from a patient or a fomite can be transmitted to another patient. In this situation, gloves must be changed between patient contacts, and hands should be washed after gloves are removed.

Wearing gloves does not replace the need for handwashing, because gloves may have small, inapparent 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.

Surface sanitation

Sanitizing surfaces is an often overlooked, yet crucial, component of breaking the cycle of infection in health care environments. Modern sanitizing methods such as NAV-CO2 have been effective against gastroenteritis, MRSA, and influenza agents. Use of hydrogen peroxide vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria, such as Clostridium difficile, where alcohol has been shown to be ineffective.^[26]

Antimicrobial surfaces

Micro-organisms are known to survive on inanimate ‘touch’ surfaces for extended periods of time.^[27] This can be especially troublesome in hospital environments where patients with immunodeficiencies are at enhanced risk for contracting nosocomial infections.

Touch surfaces commonly found in hospital rooms, such as bed rails, call buttons, touch plates, chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper towel, soap), dressing trolleys, and counter and table tops are known to be contaminated with Staphylococcus, MRSA (one of the most virulent strains of antibiotic-resistant bacteria) and vancomycin-resistant Enterococcus (VRE).^[28] Objects in closest proximity to patients have the highest levels of MRSA and VRE. This is why touch surfaces in hospital rooms can serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to patients.

Copper alloy surfaces have intrinsic properties to destroy a wide range of micro-organisms. In the interest of protecting public health, especially in heathcare environments with their susceptible patient populations, an abundance of peer-reviewed antimicrobial efficacy studies have been and continue to be conducted around the world regarding copper’s efficacy to destroy E. coli O157:H7, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus, Clostridium difficile, influenza A virus, adenovirus, and fungi.^[29]

Much of this antimicrobial efficacy work has been or is currently being conducted at the University of Southampton and Northumbria University (United Kingdom), University of Stellenbosch (South Africa), Panjab University (India), University of Chile (Chile), Kitasato University (Japan), the Instituto do Mar^[30] and University of Coimbra (Portugal), and the University of Nebraska and Arizona State University (USA). A summary of the antimicrobial copper touch surfaces clinical trials to date is available.^[31]

In 2007, U.S. Department of Defense’s Telemedicine and Advanced Technologies Research Center began to study the antimicrobial properties of copper alloys in a multisite clinical hospital trial conducted at the Memorial Sloan-Kettering Cancer Center (New York City), the Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center (South Carolina).^[32] Commonly touched items, such as bed rails, over-the-bed tray tables, chair arms, nurse's call buttons, IV poles, etc. were retrofitted with antimicrobial copper alloys in certain patient rooms (i.e., the “coppered” rooms) in the intensive care units (ICUs). Early results disclosed in 2011 indicated the coppered rooms demonstrated a 97% reduction in surface pathogens versus the control rooms. This reduction is the same level achieved by “terminal” cleaning regimens conducted after patients vacated their rooms. Furthermore, of critical importance to health care professionals, the preliminary results indicated the patients in the coppered ICUs had a 40.4% lower risk of contracting a hospital-acquired infection versus patients in the control ICUs.^[33]^[34]^[35] The US Department of Defense investigation contract, which is ongoing, will also evaluate the effectiveness of copper alloy touch surfaces to prevent the transfer of microbes to patients and the transfer of microbes from patients to touch surfaces, as well as the potential efficacy of copper alloy-based components to improve indoor air quality.

In the US, the Environmental Protection Agency (EPA) regulates the registration of antimicrobial products. After extensive antimicrobial testing according to the agency’s stringent test protocols, 355 copper alloys, including many brasses, were found to kill more than 99.9% of MRSA, E. coli O157:H7, Pseudomonas aeruginosa, S. aureus, Enterobacter aerogenes, and VRE within two hours of contact.^[36]^[37] Normal tarnishing was found to not impair antimicrobial effectiveness.

On February 29, 2008, the EPA granted its first registrations of five different groups of copper alloys as “antimicrobial materials” with public health benefits.^[38] The registrations granted antimicrobial copper as "a supplement to and not a substitute for standard infection control practices." Subsequent registration approvals of additional copper alloys have been granted. The results of the EPA-supervised antimicrobial studies, demonstrating copper's strong antimicrobial efficacies across a wide range of alloys, have been published.^[39] These copper alloys are the only solid surface materials to be granted “antimicrobial public health claims” status by EPA.

The EPA registrations state laboratory testing has shown, when cleaned regularly:

Antimicrobial copper alloy surfaces (ACAs) continuously reduce bacterial contamination, achieving 99.9% reduction within two hours of exposure.
ACAs kill greater than 99.9% of Gram-negative and Gram-positive bacteria within two hours of exposure.
ACAs deliver continuous and ongoing antibacterial action, remaining effective in killing greater than 99% of bacteria within two hours, and continue even after repeated contamination.
ACAs help inhibit the buildup and growth of bacteria within two hours of exposure between routine cleaning and sanitizing steps.
Testing demonstrates effective antibacterial activity against S. aureus, E. aerogenes, MRSA, E. coli O157:H7, and Pseudomonas aeruginosa.

The registrations state, “antimicrobial copper alloys may be used in hospitals, other healthcare facilities, and various public, commercial and residential buildings.”

Aprons

Wearing an apron during patient care reduces the risk of infection.^{[citation needed]} The apron should either be disposable or be used only when caring for a specific patient.

Mitigation

The most effective technique for controlling nosocomial infection is to strategically implement QA/QC measures to the health care sectors, and evidence-based management can be a feasible approach. For those with ventilator-associated or hospital-acquired pneumonia, controlling and monitoring hospital indoor air quality needs to be on agenda in management,^[40] whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced.^[41]^[42]^[43] Other areas needing management include ambulance transport.^{[citation needed]}

References

↑ "Nosocomial Infection". A Dictionary of Nursing. Oxford Reference Online. 2008. Retrieved 2011-08-15.
↑ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 ^2.6 Pollack, Andrew. "Rising Threat of Infections Unfazed by Antibiotics" New York Times, Feb. 27, 2010
↑ Ricks, Delthia (2007). "Germ Warfare". Ms. Magazine: 43–5.
↑ Klevens RM, Edwards JR, Richards CL; et al. (2007). "Estimating health care-associated infections and deaths in U.S. hospitals, 2002". Public Health Rep. 122 (2): 160–6. PMC 1820440. PMID 17357358.
↑ Klevens, R Monina et al. "Estimating Health Care-associated Infections and Deaths in U.S. Hospitals, 2002." Public Health Reports 122.2 (2007): 160–166.
↑ Quenon JL, Gottot S, Duneton P, Lariven S, Carlet J, Régnier B, Brücker G. Enquête nationale de prévalence des infections nosocomiales en France : Hôpital Propre (octobre 1990). BEH n° 39/1993.
↑ Comité technique des infections nosocomiales (CTIN), Cellule infections nosocomiales, CClin Est, CClin Ouest, CClin Paris-Nord, CClin Sud-Est, CClin Sud-Ouest, avec la participation de 830 établissements de santé. Enquête nationale de prévalence des infections nosocomiales,1996, BEH n° 36/1997, 2 sept. 1997, 4 pp.. Résumé.
↑ Lepoutre A, Branger B, Garreau N, Boulétreau A, Ayzac L, Carbonne A, Maugat S, Gayet S, Hommel C, Parneix P, Tran B pour le Réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (Raisin). Deuxième enquête nationale de prévalence des infections nosocomiales, France, 2001, Surveillance nationale des maladies infectieuses, 2001-2003. Institut de veille sanitaire, sept. 2005, 11 pp. Résumé.
↑ Institut de veille sanitaire Enquête nationale de prévalence des infections nosocomiales, France, juin 2006, Volume 1 – Méthodes, résultats, perspectives, mars 2009, ii + 81 pp. Volume 2 – Annexes, mars 2009, ii + 91 pp. Synthèse des résultats, Mars 2009, 11 pp.
↑ Institut de veille sanitaire Enquête nationale de prévalence des infections nosocomiales, France, juin 2006, Vol. 1, Tableau 31, p. 24.
↑ Réseau REA-Raisin « Surveillance des infections nosocomiales en réanimation adulte. France, résultats 2007 », Institut de veille sanitaire, Sept. 2009, ii + 60 pp.
↑ Vasselle, Alain « Rapport sur la politique de lutte contre les infections nosocomiales », Office parlementaire d'évaluation des politiques de santé, juin 2006, 290 pp. (III.5. Quelle est l’estimation de la mortalité attribuable aux IN ?).
↑ L'Italie scandalisée par "l'hôpital de l'horreur", Éric Jozsef, Libération, January 17, 2007 Template:Fr
↑ Liziolia A, Privitera G, Alliata E, Antonietta Banfi EM, Boselli L, Panceri ML, Perna MC, Porretta AD, Santini MG, Carreri V. Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003;54:141-8.
↑ Aodhán S Breathnacha, Nosocomial infections, Medicine, 2005: 33, 22-26
↑ Press release for The Third Prevalence Survey of Healthcare-associated Infections in Acute Hospitals. Hospital Infection Society, Londres, 27/10/06.
↑ Facts sheet - Swiss Hand Hygiene Campaign. (.doc)
↑ Sax H, Pittet D pour le comité de rédaction de Swiss-NOSO et le réseau Swiss-NOSO Surveillance. Résultats de l’enquête nationale de prévalence des infections nosocomiales de 2004 (snip04). Swiss-NOSO 2005;12(1):1-4.
↑ Lyytikainen O, Kanerva M, Agthe N, Mottonen T and the Finish Prevalence Survey Study Group. National Prevalence Survey on Nosocomial Infections in Finnish Acute Care Hospitals, 2005. 10th Epiet Scientific Seminar. Mahon, Menorca, Spain, 13–15 October 2005 [Poster].
↑ Jain SK, Persaud D, Perl TM; et al. (2005). "Nosocomial malaria and saline flush". Emerging Infect. Dis. 11 (7): 1097–9. PMID 16022788. Unknown parameter |month= ignored (help)
↑ McBryde ES, Bradley LC, Whitby M, McElwain DL (2004). "An investigation of contact transmission of methicillin-resistant Staphylococcus aureus". J. Hosp. Infect. 58 (2): 104–8. doi:10.1016/j.jhin.2004.06.010. PMID 15474180. Unknown parameter |month= ignored (help)
↑ Lautenbach E (2001). "Chapter 14. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance—Clostridium difficile and Vancomycin-resistant Enterococcus (VRE)". In Markowitz AJ. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Agency for Healthcare Research and Quality.
↑ World Alliance for patient safety. WHO Guidelines on Hand Hygiene in Health Care. http://www.who.int/rpc/guidelines/9789241597906/en/. 2009
↑ Hugonnet S, Perneger TV, Pittet D. Alcohol based hand rub improves compliance with hand hygiene in intensive care units. Arch Intern med 2002; 162: 1037-1043.
↑ "Occupational Exposure to Bloodborne Pathogens;Needlestick and Other Sharps Injuries; Final Rule. - 66:5317-5325". Osha.gov. Retrieved 2011-07-11.
↑ Otter JA, French GL (2009). "Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor". J. Clin. Microbiol. 47 (1): 205–7. doi:10.1128/JCM.02004-08. PMC 2620839. PMID 18971364. Unknown parameter |month= ignored (help)
↑ Wilks, S.A., Michels, H., Keevil, C.W., 2005, The Survival of Escherichia Coli O157 on a Range of Metal Surfaces, International Journal of Food Microbiology, Vol. 105, pp. 445–454. and Michels, H.T. (2006), Anti-Microbial Characteristics of Copper, ASTM Standardization News, October, pp. 28-31
↑ U.S. Department of Defense-funded clinical trials, as presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, D.C., October 28, 2008
↑ Copper Touch Surfaces
↑ http://www.imar.pt
↑ Antimicrobial copper-alloy touch surfaces#Clinical trials of antimicrobial copper alloy touch surfaces in healthcare facilities
↑ http://www.biomedcentral.com/content/pdf/1753-6561-5-s6-o53.pdf and http://www.coppertouchsurfaces.org
↑ http://www.biomedcentral.com/content/pdf/1753-6561-5-s6-o53.pdf
↑ http://www.coppertouchsurfaces.org/press/releases/20110701.html
↑ World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland on July 1st, 2011
↑ EPA registers copper-containing alloy products, May 2008, http://www.epa.gov/opp00001/factsheets/copper-alloy-products.htm
↑ 355 Copper Alloys Now Approved by EPA as Antimicrobial, Jun 28, 2011, http://www.appliancemagazine.com/news.php?article=1498614&zone=0&first=1
↑ EPA registers copper-containing alloy products, May 2008
↑ Collery, Ph., Maymard, I., Theophanides, T., Khassanova, L., and Collery, T., Editors, Metal Ions in Biology and Medicine: Vol. 10., John Libbey Eurotext, Paris © 2008, Antimicrobial regulatory efficacy testing of solid copper alloy surfaces in the USA, by Michels, Harold T. and Anderson, Douglas G. (2008), pp. 185-190.
↑ Leung M, Chan AH (2006). "Control and management of hospital indoor air quality". Med. Sci. Monit. 12 (3): SR17–23. PMID 16501436. Unknown parameter |month= ignored (help)
↑ Chan PC, Huang LM, Lin HC; et al. (2007). "Control of an outbreak of pandrug-resistant Acinetobacter baumannii colonization and infection in a neonatal intensive care unit". Infect Control Hosp Epidemiol. 28 (4): 423–9. doi:10.1086/513120. PMID 17385148. Unknown parameter |month= ignored (help)
↑ Traub-Dargatz JL, Weese JS, Rousseau JD, Dunowska M, Morley PS, Dargatz DA (2006). "Pilot study to evaluate 3 hygiene protocols on the reduction of bacterial load on the hands of veterinary staff performing routine equine physical examinations". Can. Vet. J. 47 (7): 671–6. PMC 1482439. PMID 16898109. Unknown parameter |month= ignored (help)
↑ Katz JD (2004). "Hand washing and hand disinfection: more than your mother taught you". Anesthesiol Clin North America. 22 (3): 457–71, vi. doi:10.1016/j.atc.2004.04.002. PMID 15325713. Unknown parameter |month= ignored (help)

Template:External causes of morbidity and mortality

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[1] "Nosocomial Infection". A Dictionary of Nursing. Oxford Reference Online. 2008. Retrieved 2011-08-15.

[NYT-2] 2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 ^2.6 Pollack, Andrew. "Rising Threat of Infections Unfazed by Antibiotics" New York Times, Feb. 27, 2010

[3] Ricks, Delthia (2007). "Germ Warfare". Ms. Magazine: 43–5.

[4] Klevens RM, Edwards JR, Richards CL; et al. (2007). "Estimating health care-associated infections and deaths in U.S. hospitals, 2002". Public Health Rep. 122 (2): 160–6. PMC 1820440. PMID 17357358.

[5] Klevens, R Monina et al. "Estimating Health Care-associated Infections and Deaths in U.S. Hospitals, 2002." Public Health Reports 122.2 (2007): 160–166.

[6] Quenon JL, Gottot S, Duneton P, Lariven S, Carlet J, Régnier B, Brücker G. Enquête nationale de prévalence des infections nosocomiales en France : Hôpital Propre (octobre 1990). BEH n° 39/1993.

[7] Comité technique des infections nosocomiales (CTIN), Cellule infections nosocomiales, CClin Est, CClin Ouest, CClin Paris-Nord, CClin Sud-Est, CClin Sud-Ouest, avec la participation de 830 établissements de santé. Enquête nationale de prévalence des infections nosocomiales,1996, BEH n° 36/1997, 2 sept. 1997, 4 pp.. Résumé.

[8] Lepoutre A, Branger B, Garreau N, Boulétreau A, Ayzac L, Carbonne A, Maugat S, Gayet S, Hommel C, Parneix P, Tran B pour le Réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (Raisin). Deuxième enquête nationale de prévalence des infections nosocomiales, France, 2001, Surveillance nationale des maladies infectieuses, 2001-2003. Institut de veille sanitaire, sept. 2005, 11 pp. Résumé.

[9] Institut de veille sanitaire Enquête nationale de prévalence des infections nosocomiales, France, juin 2006, Volume 1 – Méthodes, résultats, perspectives, mars 2009, ii + 81 pp. Volume 2 – Annexes, mars 2009, ii + 91 pp. Synthèse des résultats, Mars 2009, 11 pp.

[10] Institut de veille sanitaire Enquête nationale de prévalence des infections nosocomiales, France, juin 2006, Vol. 1, Tableau 31, p. 24.

[11] Réseau REA-Raisin « Surveillance des infections nosocomiales en réanimation adulte. France, résultats 2007 », Institut de veille sanitaire, Sept. 2009, ii + 60 pp.

[12] Vasselle, Alain « Rapport sur la politique de lutte contre les infections nosocomiales », Office parlementaire d'évaluation des politiques de santé, juin 2006, 290 pp. (III.5. Quelle est l’estimation de la mortalité attribuable aux IN ?).

[13] L'Italie scandalisée par "l'hôpital de l'horreur", Éric Jozsef, Libération, January 17, 2007 Template:Fr

[14] Liziolia A, Privitera G, Alliata E, Antonietta Banfi EM, Boselli L, Panceri ML, Perna MC, Porretta AD, Santini MG, Carreri V. Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003;54:141-8.

[15] Aodhán S Breathnacha, Nosocomial infections, Medicine, 2005: 33, 22-26

[16] Press release for The Third Prevalence Survey of Healthcare-associated Infections in Acute Hospitals. Hospital Infection Society, Londres, 27/10/06.

[17] Facts sheet - Swiss Hand Hygiene Campaign. (.doc)

[18] Sax H, Pittet D pour le comité de rédaction de Swiss-NOSO et le réseau Swiss-NOSO Surveillance. Résultats de l’enquête nationale de prévalence des infections nosocomiales de 2004 (snip04). Swiss-NOSO 2005;12(1):1-4.

[19] Lyytikainen O, Kanerva M, Agthe N, Mottonen T and the Finish Prevalence Survey Study Group. National Prevalence Survey on Nosocomial Infections in Finnish Acute Care Hospitals, 2005. 10th Epiet Scientific Seminar. Mahon, Menorca, Spain, 13–15 October 2005 [Poster].

[salineflush-20] Jain SK, Persaud D, Perl TM; et al. (2005). "Nosocomial malaria and saline flush". Emerging Infect. Dis. 11 (7): 1097–9. PMID 16022788. Unknown parameter |month= ignored (help)

[21] McBryde ES, Bradley LC, Whitby M, McElwain DL (2004). "An investigation of contact transmission of methicillin-resistant Staphylococcus aureus". J. Hosp. Infect. 58 (2): 104–8. doi:10.1016/j.jhin.2004.06.010. PMID 15474180. Unknown parameter |month= ignored (help)

[22] Lautenbach E (2001). "Chapter 14. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance—Clostridium difficile and Vancomycin-resistant Enterococcus (VRE)". In Markowitz AJ. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Agency for Healthcare Research and Quality.

[23] World Alliance for patient safety. WHO Guidelines on Hand Hygiene in Health Care. http://www.who.int/rpc/guidelines/9789241597906/en/. 2009

[24] Hugonnet S, Perneger TV, Pittet D. Alcohol based hand rub improves compliance with hand hygiene in intensive care units. Arch Intern med 2002; 162: 1037-1043.

[25] "Occupational Exposure to Bloodborne Pathogens;Needlestick and Other Sharps Injuries; Final Rule. - 66:5317-5325". Osha.gov. Retrieved 2011-07-11.

[26] Otter JA, French GL (2009). "Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor". J. Clin. Microbiol. 47 (1): 205–7. doi:10.1128/JCM.02004-08. PMC 2620839. PMID 18971364. Unknown parameter |month= ignored (help)

[27] Wilks, S.A., Michels, H., Keevil, C.W., 2005, The Survival of Escherichia Coli O157 on a Range of Metal Surfaces, International Journal of Food Microbiology, Vol. 105, pp. 445–454. and Michels, H.T. (2006), Anti-Microbial Characteristics of Copper, ASTM Standardization News, October, pp. 28-31

[28] U.S. Department of Defense-funded clinical trials, as presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, D.C., October 28, 2008

[29] Copper Touch Surfaces

[30] ttp://www.imar.pt

[31] Antimicrobial copper-alloy touch surfaces#Clinical trials of antimicrobial copper alloy touch surfaces in healthcare facilities

[32] ttp://www.biomedcentral.com/content/pdf/1753-6561-5-s6-o53.pdf and http://www.coppertouchsurfaces.org

[33] ttp://www.biomedcentral.com/content/pdf/1753-6561-5-s6-o53.pdf

[34] ttp://www.coppertouchsurfaces.org/press/releases/20110701.html

[35] World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland on July 1st, 2011

[36] EPA registers copper-containing alloy products, May 2008, http://www.epa.gov/opp00001/factsheets/copper-alloy-products.htm

[37] 355 Copper Alloys Now Approved by EPA as Antimicrobial, Jun 28, 2011, http://www.appliancemagazine.com/news.php?article=1498614&zone=0&first=1

[38] EPA registers copper-containing alloy products, May 2008

[39] Collery, Ph., Maymard, I., Theophanides, T., Khassanova, L., and Collery, T., Editors, Metal Ions in Biology and Medicine: Vol. 10., John Libbey Eurotext, Paris © 2008, Antimicrobial regulatory efficacy testing of solid copper alloy surfaces in the USA, by Michels, Harold T. and Anderson, Douglas G. (2008), pp. 185-190.

[cmhiaq-40] Leung M, Chan AH (2006). "Control and management of hospital indoor air quality". Med. Sci. Monit. 12 (3): SR17–23. PMID 16501436. Unknown parameter |month= ignored (help)

[coprabc-41] Chan PC, Huang LM, Lin HC; et al. (2007). "Control of an outbreak of pandrug-resistant Acinetobacter baumannii colonization and infection in a neonatal intensive care unit". Infect Control Hosp Epidemiol. 28 (4): 423–9. doi:10.1086/513120. PMID 17385148. Unknown parameter |month= ignored (help)

[pste3-42] Traub-Dargatz JL, Weese JS, Rousseau JD, Dunowska M, Morley PS, Dargatz DA (2006). "Pilot study to evaluate 3 hygiene protocols on the reduction of bacterial load on the hands of veterinary staff performing routine equine physical examinations". Can. Vet. J. 47 (7): 671–6. PMC 1482439. PMID 16898109. Unknown parameter |month= ignored (help)

[hwhd-43] Katz JD (2004). "Hand washing and hand disinfection: more than your mother taught you". Anesthesiol Clin North America. 22 (3): 457–71, vi. doi:10.1016/j.atc.2004.04.002. PMID 15325713. Unknown parameter |month= ignored (help)

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Nosocomial infection: Difference between revisions

Revision as of 18:48, 26 November 2012

Overview

Known nosocomial infections

Epidemiology

Categories and treatment

Epidemiology

United States

France

Italy

United Kingdom

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Finland

Transmission

Risk factors

Prevention

Sterilization

Isolation

Handwashing and gloving

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+__NOTOC__
+{{Infobox disease
+ | Name           = Nosocomial infection
+ | Image          = Contaminated surfaces increase cross-transmission.jpg
+ | Caption        = Contaminated surfaces increase cross-transmission
+ | DiseasesDB     =
+ | ICD10          = {{ICD10|Y|95||y|90}}
+ | ICD9           =
+ | OMIM           =
+ | MedlinePlus    =
+ | MeshID         =
+}}{{Wiktionary|nosocomial}}
 {{SI}}
+{{CMG}}
+==Overview==
+A '''nosocomial infection''', also known as a '''hospital-acquired infection''' or '''HAI''', is an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. Such infections include fungal and bacterial infections and are aggravated by the reduced resistance of individual patients.<ref>{{cite web|title=Nosocomial Infection|url=http://www.oxfordreference.com/views/ENTRY.html?subview=Main&entry=t62.e6134|work=A Dictionary of Nursing|publisher=Oxford Reference Online|accessdate=2011-08-15|year=2008}}</ref>
+In the [[United States]], the [[Centers for Disease Control and Prevention]] estimated roughly 1.7 million hospital-associated infections, from all types of [[microorganism]]s, including [[bacteria]], combined, cause or contribute to 99,000 deaths each year.<ref name=NYT/> In [[Europe]], where hospital surveys have been conducted, the category of [[Gram-negative]] infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe [[pneumonia]] and infections of the [[Urinary tract infection|urinary tract]], [[blood infection|bloodstream]] and other parts of the body. Many types are difficult to attack with [[antibiotics]], and [[antibiotic resistance]] is spreading to [[Gram-negative]] bacteria that can infect people outside the hospital.<ref name=NYT/>
-{{CMG}}
+== Known nosocomial infections ==
+* [[Ventilator-associated pneumonia]]
+* ''[[Staphylococcus aureus]]''
+* [[Methicillin Resistant Staphylococcus Aureus|Methicillin resistant ''Staphylococcus aureus'']]
+* ''[[Candida albicans]]''
+* ''[[Pseudomonas aeruginosa]]''
+* ''[[Acinetobacter baumannii]]''
+* ''[[Stenotrophomonas maltophilia]]''
+* ''[[Clostridium difficile]]''
+* [[Tuberculosis]]
+* [[Urinary tract infection]]
+* [[Hospital-acquired pneumonia]]
+* [[Gastroenteritis]]
+* [[Vancomycin-resistant Enterococcus|Vancomycin-resistant ''Enterococcus'']]
+* [[Legionnaires' disease]]
+== Epidemiology ==
+{{Refimprove|paragraph|date=January 2012}}
+Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of [[outpatient]] treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some [[medical procedure]]s bypass the body's natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as vectors.
+===Categories and treatment===
+Among the categories of bacteria most known to infect patients are the category [[MRSA]] (resistant strain of ''S. aureus''), member of [[Gram-positive bacteria]] and ''[[Acinetobacter]]'' (''A. baumannii''), which is [[Gram-negative bacteria|Gram-negative]]. While antibiotic drugs to treat diseases caused by Gram-positive MRSA are available, few effective drugs are available for ''Acinetobacter''. ''Acinetobacter'' bacteria are evolving and becoming immune to existing antibiotics, so in many cases, [[polymyxin]]-type antibacterials need to be used. "In many respects it’s far worse than MRSA," said a specialist at [[Case Western Reserve University]].<ref name=NYT/>
-==Overview==
+Another growing disease, especially prevalent in [[New York City]] hospitals, is the drug-resistant, Gram-negative ''[[Klebsiella pneumoniae]]''. An estimated more than 20% of the ''Klebsiella'' infections in [[Brooklyn]] hospitals "are now resistant to virtually all modern antibiotics, and those supergerms are now spreading worldwide.<ref name=NYT>Pollack, Andrew. [http://www.nytimes.com/2010/02/27/business/27germ.html?em=&adxnnl=1&adxnnlx=1267412412-yP2bfl/3pu4+g34XVmluJA "Rising Threat of Infections Unfazed by Antibiotics"] New York Times, Feb. 27, 2010</ref>
-'''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.
-Nosocomial infections are even more alarming in the 21st century as [[antibiotic resistance]] spreads. Reasons why nosocomial infections are so common include:
+The bacteria, classified as Gram-negative because of their reaction to the [[Gram stain]] test, can cause severe [[pneumonia]] and infections of the [[urinary tract]], bloodstream, and other parts of the body. Their cell structures make them more difficult to attack with antibiotics than Gram-positive organisms like MRSA. In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. "For Gram-positives we need better drugs; for Gram-negatives we need any drugs," said Dr. Brad Spellberg, an infectious-disease specialist at [[Harbor-UCLA Medical Center]], and the author of ''Rising Plague'', a book about drug-resistant pathogens.<ref name=NYT/>
-*Hospitals house large numbers of people who are sick and whose [[immune system]]s are often in a weakened state;
+One-third of nosocomial infections are considered preventable. The CDC estimates 2 million people in the United States are infected annually by hospital-acquired infections, resulting in 20,000 deaths.<ref>{{cite journal |author=Ricks, Delthia |title=Germ Warfare |journal=Ms. Magazine |pages=43–5 |year=2007 |url=http://www.msmagazine.com/spring2007/germwarfare.asp}}</ref> The most common nosocomial infections are of the [[urinary tract]], surgical site and various [[pneumonia]]s.<ref>{{cite journal |author=Klevens RM, Edwards JR, Richards CL, ''et al.'' |title=Estimating health care-associated infections and deaths in U.S. hospitals, 2002 |journal=Public Health Rep |volume=122 |issue=2 |pages=160–6 |year=2007 |pmid=17357358 |pmc=1820440 }}</ref>
-*Increased use of outpatient treatment means that people who are in the hospital are sicker on average;
-*Medical staff move from patient to patient, providing a way for pathogens to spread;
-*Many [[medical procedure]]s bypass the body's natural protective barriers;
-*Routine use of anti-microbial agents in hospitals creates [[natural selection|selection pressure]] for the emergence of resistant strains.
-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.
+===Epidemiology===
+The methods used differ from country to country (definitions used, type of nosocomial infections covered, health units surveyed, inclusion or exclusion of imported infections, etc.), so the international comparisons of nosocomial infection rates should be made with the utmost care.
-== Epidemiology ==
+====United States====
+The [[Centers for Disease Control and Prevention]] (CDC) estimated roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year.<ref>Klevens, R Monina et al. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820440 "Estimating Health Care-associated Infections and Deaths in U.S. Hospitals, 2002."] Public Health Reports 122.2 (2007): 160–166.</ref> Other estimates indicate 10%, or 2 million, patients a year become infected, with the annual cost ranging from $4.5 billion to $11 billion. In the USA, the most frequent type of infection hospitalwide is urinary tract infection (36%), followed by surgical site infection (20%), and bloodstream infection and pneumonia (both 11%).<ref name=NYT/>
-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>
+====France====
+Estimates ranged from 6.7% in 1990 to 7.4% (patients may have several infections).<ref>Quenon JL, Gottot S, Duneton P, Lariven S, Carlet J, Régnier B, Brücker G. Enquête nationale de prévalence des infections nosocomiales en France : Hôpital Propre (octobre 1990). BEH n° 39/1993.</ref> At national level, prevalence among patients in health care facilities was 6.7% in 1996,<ref>Comité technique des infections nosocomiales (CTIN), Cellule infections nosocomiales, CClin Est, CClin Ouest, CClin Paris-Nord, CClin Sud-Est, CClin Sud-Ouest, avec la participation de 830 établissements de santé. [http://www.invs.sante.fr/beh/1997/9736/beh_36_1997.pdf Enquête nationale de prévalence des infections nosocomiales,1996], BEH n° 36/1997, 2 sept. 1997, 4 pp.. [http://www.invs.sante.fr/beh/1997/9736/index.html Résumé].</ref> 5.9% in 2001<ref>Lepoutre A, Branger B, Garreau N, Boulétreau A, Ayzac L, Carbonne A, Maugat S, Gayet S, Hommel C, Parneix P, Tran B pour le Réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (Raisin). [http://www.invs.sante.fr/publications/2005/snmi/pdf/infections_noso_enquete.pdf Deuxième enquête nationale de prévalence des infections nosocomiales, France, 2001], Surveillance nationale des maladies infectieuses, 2001-2003. Institut de veille sanitaire, sept. 2005, 11 pp. [http://www.invs.sante.fr/publications/2005/snmi/infections_noso_enquete.html Résumé].</ref> and 5.0% in 2006.<ref>Institut de veille sanitaire ''Enquête nationale de prévalence des infections nosocomiales, France, juin 2006'', [http://www.invs.sante.fr/publications/2009/enquete_prevalence_infections_nosocomiales/enquete_prevalence_infections_nosocomiales_vol1.pdf Volume 1 – Méthodes, résultats, perspectives], mars 2009, ii + 81 pp. [http://www.invs.sante.fr/publications/2009/enquete_prevalence_infections_nosocomiales/enquete_prevalence_infections_nosocomiales_vol2.pdf Volume 2 – Annexes], mars 2009, ii + 91 pp. [http://www.invs.sante.fr/publications/2009/enquete_prevalence_infections_nosocomiales/enquete_prevalence_infections_nosocomiales_plaq.pdf Synthèse des résultats], Mars 2009, 11 pp.</ref> The rates for nosocomial infections were 7.6% in 1996, 6.4% in 2001 and 5.4% in 2006.
-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) :
+In 2006, the most common infection sites were [[urinary tract infection]]s (30,3%), [[pneumopathy]] (14,7%), infections of surgery site (14,2%). Infections of the [[skin]] and [[mucous membrane]] (10,2%), other respiratory infections (6,8%) and bacterial infections / blood poisoning (6,4%).<ref>Institut de veille sanitaire ''Enquête nationale de prévalence des infections nosocomiales, France, juin 2006'', Vol. 1, Tableau 31, p. 24.</ref> The rates among adult patients in [[intensive care]] were 13,5% in 2004, 14,6% in 2005, 14,1% in 2006 and 14.4% in 2007.<ref>Réseau REA-Raisin [http://www.invs.sante.fr/publications/2009/rea_raisin_resultats_2007/rea_raisin_resultats_2007.pdf « Surveillance des infections nosocomiales en réanimation adulte. France, résultats 2007 »], Institut de veille sanitaire, Sept. 2009, ii + 60 pp.</ref>
-* [[Urinary tract infection]]: 40%;
-* infection of the [[skin]] and [[mucous membrane]]: 10.8%;
-* infections of surgery site: 10.3%;
-* [[pneumopathy]]: 10%.
-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.
-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 infections are estimated to make patients stay in the hospital four to five additional days. Around 2004-2005, about 9,000 people died each year with a nosocomial infection, of which about 4,200 would have survived without this infection.<ref>Vasselle, Alain [http://www.senat.fr/rap/r05-421/r05-4211.pdf « Rapport sur la politique de lutte contre les infections nosocomiales »], Office parlementaire d'évaluation des politiques de santé, juin 2006, 290 pp. (III.5. Quelle est l’estimation de la mortalité attribuable aux IN ?).</ref>
-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>
+====Italy====
+Since 2000, estimates show about a 6.7% infection rate, 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'', January 17, 2007 {{fr}}</ref> A survey in Lombardy gave a rate of 4.9% of patients in 2000.<ref>Liziolia A, Privitera G, Alliata E, Antonietta Banfi EM, Boselli L, Panceri ML, Perna MC, Porretta AD, Santini MG, Carreri V. Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003;54:141-8.</ref>
-== Transmission ==
+====United Kingdom====
+Estimates show a 10% infection rate,<ref>Aodhán S Breathnacha, Nosocomial infections, Medicine, 2005: 33, 22-26</ref> with 8.2% estimated in 2006.<ref>Press release for [http://www.his.org.uk/content_display.cfm?cit_id=461 The Third Prevalence Survey of Healthcare-associated Infections in Acute Hospitals]. Hospital Infection Society, Londres, 27/10/06.</ref>
-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.
+====Switzerland====
-* '''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.
+Estimates range between 2 and 14%.<ref>[http://www.swisshandhygiene.ch/swisshandhygiene/presse/_b/contentFiles/301006_Facts_sheet_F.doc Facts sheet - Swiss Hand Hygiene Campaign.] (.doc)</ref> A national survey gave a rate of 7.2% in 2004.<ref>Sax H, Pittet D pour le comité de rédaction de Swiss-NOSO et le réseau Swiss-NOSO Surveillance. [http://www.chuv.ch/swiss-noso/f121a1.htm Résultats de l’enquête nationale de prévalence des infections nosocomiales de 2004 (snip04)]. Swiss-NOSO 2005;12(1):1-4.</ref>
-** '''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.
-** '''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
-| last =
-| first =
-| authorlink =
-| coauthors = Jain SK, Persaud D, Perl TM, Pass MA, Murphy KM, Pisciotta JM, et al.
-| title = Nosocomial malaria and saline flush
-| journal = Emerging Infectious Diseases [serial on the Internet]
-| volume = 11
-| issue = 7
-| publisher = Centers for Disease Control and Prevention
-| date = July 2005
-| url = http://www.cdc.gov/ncidod/EID/vol11no07/05-0092.htm }}</ref>
-* '''[[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.
+====Finland====
+Rate were estimated at 8.5% of patients in 2005.<ref>Lyytikainen O, Kanerva M, Agthe N, Mottonen T and the Finish Prevalence Survey Study Group. National Prevalence Survey on Nosocomial Infections in Finnish Acute Care Hospitals, 2005. 10th Epiet Scientific Seminar. Mahon, Menorca, Spain, 13–15 October 2005 [Poster].</ref>
-* '''Common vehicle transmission''' applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.
+=== Transmission ===
+The drug-resistant Gram-negative bacteria, for the most part, threaten only hospitalized patients whose immune systems are weak. They can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters, and ventilators.<ref name=NYT/>
+{| class="wikitable"
+|+Main routes of transmission
+!Route
+!Description
+|-
+|Contact transmission
+|The most important and frequent mode of transmission of nosocomial infections is by direct contact.
+|-
+|Droplet transmission
+|Transmission occurs when droplets containing microbes from the infected person are propelled a short distance through the air and deposited on the host's body; droplets are generated from the source person mainly by coughing, sneezing, and talking, and during the performance of certain procedures, such as bronchoscopy.
+|-
+|[[Airborne transmission]]
+|Dissemination can be 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 ''[[Legionella]]'', ''[[Mycobacterium tuberculosis]]'' and the [[rubeola]] and [[varicella]] viruses.
+|-
+|Common vehicle transmission
+|This applies to microorganisms transmitted to the host by contaminated items, such as food, water, medications, devices, and equipment.
+|-
+|Vector borne transmission
+|This occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.
+|}
-==Predisposition to infection==
+Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact transmission.
-Factors predisposing a patient to infection can broadly be divided into four areas:
+{| class="wikitable"
-*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.
+|+Routes of contact transmission
+!Route
+!Description
+|-
+|Direct-contact transmission
+|This 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 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.
+|-
+|Indirect-contact transmission
+|This 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. In addition, the improper use of saline flush syringes, vials, and bags has 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
+|author=Jain SK, Persaud D, Perl TM, ''et al.'' |title=Nosocomial malaria and saline flush |journal=Emerging Infect. Dis. |volume=11 |issue=7 |pages=1097–9 |year=2005 |month=July |pmid=16022788 |url=http://www.cdc.gov/ncidod/EID/vol11no07/05-0092.htm}}</ref>
+|}
-*'''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.
+===Risk factors===
-*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.
+Factors predisposing a patient to infection can broadly be divided into three areas:
+*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 irradiation) present a general risk, while other diseases can present specific risks - for instance, [[chronic obstructive pulmonary disease]] can increase chances of respiratory tract infection.
+*Invasive devices, for instance [[intubation]] tubes, [[catheters]], [[surgical drain]]s, 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 invasive procedures.
+*Patients' treatments 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.
 ==Prevention==
+Hospitals have sanitation protocols regarding [[scrubs (clothing)|uniforms]], equipment [[Sterilization (microbiology)|sterilization]], washing, and other preventive measures. Thorough [[hand washing]] and/or use of [[Hand sanitizer|alcohol rubs]] by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections.<ref>{{cite journal |author=McBryde ES, Bradley LC, Whitby M, McElwain DL |title=An investigation of contact transmission of methicillin-resistant Staphylococcus aureus |journal=J. Hosp. Infect. |volume=58 |issue=2 |pages=104–8 |year=2004 |month=October |pmid=15474180 |doi=10.1016/j.jhin.2004.06.010 }}</ref> More careful use of [[antimicrobial]] agents, such as [[antibiotic]]s, is also considered vital.<ref>{{cite book |title=Making Health Care Safer: A Critical Analysis of Patient Safety Practices |author=Lautenbach E |chapter=Chapter 14. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance—''Clostridium difficile'' and Vancomycin-resistant Enterococcus (VRE) |url=http://www.ahrq.gov/clinic/ptsafety/ |editor=Markowitz AJ |year=2001 |publisher=Agency for Healthcare Research and Quality |chapterurl= http://www.ahrq.gov/clinic/ptsafety/chap14.htm}}</ref>
+Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotics and other antimicrobial drugs to help treat illness; this may increase the [[natural selection|selection pressure]] for the emergence of resistant strains.
+===Sterilization===
+Sterilization goes  further than just sanitizing. It kills all microorganisms on equipment and surfaces through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure.
 ===Isolation===
 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.
 ===Handwashing and gloving===
-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.
+Handwashing frequently is called the single most important measure to reduce the risks of transmitting [[skin flora|skin microorganism]]s from one person to another or from one site to another on the same patient. 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.
+The spread of nosocomial infections, among immunocompromised patients is connected with health care workers' hand contamination in almost 40% of cases, and is a challenging problem in the modern hospitals. The best way for workers to overcome this problem is conducting correct hand-hygiene procedures; this is why the WHO launched in 2005 the GLOBAL Patient Safety Challenge.<ref>World Alliance for patient safety. WHO Guidelines on Hand Hygiene in Health Care. http://www.who.int/rpc/guidelines/9789241597906/en/. 2009</ref>
+Two categories of micro-organisms can be present on health care workers' hands: transient flora and resident flora. The first is represented by the micro-organisms taken by workers from the environment, and the bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group is represented by the permanent micro-organisms living on the skin surface (on the stratum corneum or immediately under it). They are capable of surviving on the human skin and to grow freely on it. They have low pathogenicity and infection rate, and they create a kind of protection from the colonization from other more pathogenic bacteria. The skin of workers is colonized by 3.9 x 10<sup>4</sup> – 4.6 x 10<sup>6</sup> cfu/cm<sup>2</sup>. The microbes comprising the resident flora are: ''Staphylococcus epidermidis'', ''S. hominis'', and ''Microccocus'', ''Propionibacterium, Corynebacterium, Dermobacterium'', and ''Pitosporum'' spp., while in the transitional could be found ''S. aureus'', and ''Klebsiella pneumoniae'', and ''Acinetobacter, Enterobacter'' and ''Candida'' spp. The goal of hand hygiene is to eliminate the transient flora with a careful and proper performance of hand washing, using different kinds of soap, (normal and antiseptic), and alcohol-based gels. The main problems found in the practice of hand hygiene is connected with the lack of available sinks and time-consuming performance of hand washing. An easy way to resolve this problem could be the use of alcohol-based hand rubs, because of faster application compared to correct hand washing.<ref>Hugonnet S, Perneger TV, Pittet D. Alcohol based hand rub improves compliance with hand hygiene in intensive care units. Arch Intern med 2002; 162: 1037-1043.</ref>
+Although handwashing may seem like a simple process, it is often performed incorrectly. Healthcare settings must continuously remind practitioners and visitors on the proper procedure to comply with responsible handwashing. Simple programs such as [http://henrythehand.com Henry the Hand], and the use of handwashing signals can assist healthcare facilities in the prevention of nosocomial infections.
-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.
+All visitors must follow the same procedures as hospital staff to adequately control the spread of infections. Visitors and healthcare personnel are equally to blame in transmitting infections.{{Citation needed|date=June 2011}} Moreover, multidrug-resistant infections can leave the hospital and become part of the community [[flora (microbiology)|flora]] if steps are not taken to stop this transmission.
-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.
+In addition to handwashing, [[medical gloves|gloves]] play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, they 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. In the [[USA]], the [[Occupational Safety and Health Administration]] has mandated wearing gloves to reduce the risk of [[bloodborne pathogen]] infections.<ref>{{cite web|url=http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=16265&p_table=FEDERAL_REGISTER |title=Occupational Exposure to Bloodborne Pathogens;Needlestick and Other Sharps Injuries; Final Rule. - 66:5317-5325 |publisher=Osha.gov |date= |accessdate=2011-07-11}}</ref> Second, gloves are worn to reduce the likelihood 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, they are worn to reduce the likelihood the hands of personnel contaminated with micro-organisms from a patient or a [[fomite]] can be transmitted to another patient. In this situation, gloves must be changed between patient contacts, and hands should be washed after gloves are removed.
-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.
+Wearing gloves does not replace the need for handwashing, because gloves may have small, inapparent 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.
-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.
+===Surface sanitation===
+Sanitizing surfaces is an often overlooked, yet crucial, component of breaking the cycle of infection in health care environments. Modern sanitizing methods such as [[NAV-CO2]] have been effective against gastroenteritis, MRSA, and influenza agents. Use of [[hydrogen peroxide]] vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria, such as ''Clostridium difficile'', where alcohol has been shown to be ineffective.<ref>{{cite journal |author=Otter JA, French GL |title=Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor |journal=J. Clin. Microbiol. |volume=47 |issue=1 |pages=205–7 |year=2009 |month=January |pmid=18971364 |doi=10.1128/JCM.02004-08 |pmc=2620839 }}
+</ref>
-Examples of nosocomial infections include [[Methicillin_Resistant_Staphylococcus_Aureus|Methicillin Resistant ''Staphylococcus aureus'']] (MRSA) and [[Acinetobacter_baumanni|''Acinetobacter baumanni'']].
+===Antimicrobial surfaces===
+[[Micro-organisms]] are known to survive on inanimate ‘touch’ surfaces for extended periods of time.<ref>Wilks, S.A., Michels, H., Keevil, C.W., 2005, The Survival of Escherichia Coli O157 on a Range of Metal Surfaces, International Journal of Food Microbiology, Vol. 105, pp. 445–454. and Michels, H.T. (2006), Anti-Microbial Characteristics of Copper, ASTM Standardization News, October, pp. 28-31</ref> This can be especially troublesome in hospital environments where patients with [[immunodeficiencies]] are at enhanced risk for contracting nosocomial infections.
-===Aprons===
+Touch surfaces commonly found in hospital rooms, such as bed rails, call buttons, touch plates, chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper towel, soap), dressing trolleys, and counter and table tops are known to be contaminated with ''[[Staphylococcus]]'', [[MRSA]] (one of the most virulent strains of antibiotic-resistant bacteria) and [[Vancomycin-resistant Enterococcus|vancomycin-resistant ''Enterococcus'']] (VRE).<ref>U.S. Department of Defense-funded clinical trials, as presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, D.C., October 28, 2008</ref> Objects in closest proximity to patients have the highest levels of  MRSA and VRE. This is why touch surfaces in hospital rooms can serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to patients.
+{{main|Antimicrobial copper touch surfaces}}
+{{main|Antimicrobial properties of copper}}
+Copper alloy surfaces have intrinsic properties to destroy a wide range of micro-organisms. In the interest of protecting public health, especially in heathcare environments with their susceptible patient populations, an abundance of peer-reviewed antimicrobial efficacy studies have been and continue to be conducted around the world regarding copper’s efficacy to destroy ''[[Escherichia coli|E. coli]]'' O157:H7, [[methicillin]]-resistant ''[[Staphylococcus aureus]]'' (MRSA), ''[[Staphylococcus]]'', ''[[Clostridium difficile]]'', [[influenza A virus]], [[Adenoviridae|adenovirus]], and [[Fungus|fungi]].<ref>[http://coppertouchsurfaces.org/antimicrobial/bacteria/index.html Copper Touch Surfaces]</ref>
+Much of this antimicrobial efficacy work has been or is currently being conducted at the [[University of Southampton]] and [[Northumbria University]] ([[United Kingdom]]), [[University of Stellenbosch]] ([[South Africa]]), [[Panjab University]] ([[India]]), [[University of Chile]] ([[Chile]]), [[Kitasato University]] ([[Japan]]), the Instituto do Mar<ref>http://www.imar.pt</ref> and [[University of Coimbra]] ([[Portugal]]), and the [[University of Nebraska]] and [[Arizona State University]] ([[USA]]). A summary of the antimicrobial copper touch surfaces clinical trials to date is available.<ref>[[Antimicrobial copper-alloy touch surfaces#Clinical trials of antimicrobial copper alloy touch surfaces in healthcare facilities]]</ref>
+In 2007, [[U.S. Department of Defense]]’s Telemedicine and Advanced Technologies Research Center began to study the antimicrobial properties of copper alloys in a multisite clinical hospital trial conducted at the [[Memorial Sloan-Kettering Cancer Center]] (New York City), the [[Medical University of South Carolina]], and the Ralph H. Johnson VA Medical Center (South Carolina).<ref>http://www.biomedcentral.com/content/pdf/1753-6561-5-s6-o53.pdf and http://www.coppertouchsurfaces.org</ref> Commonly touched items, such as bed rails, over-the-bed tray tables, chair arms, nurse's call buttons, IV poles, etc. were retrofitted with antimicrobial copper alloys in certain patient rooms (i.e., the “coppered” rooms) in the [[intensive care unit]]s (ICUs). Early results disclosed in 2011 indicated the coppered rooms demonstrated a 97% reduction in surface [[pathogens]] versus the control rooms. This reduction is the same level achieved by “terminal” cleaning regimens conducted after patients vacated their rooms. Furthermore, of critical importance to health care professionals, the preliminary results indicated the patients in the coppered ICUs had a 40.4% lower risk of contracting a hospital-acquired infection versus patients in the control ICUs.<ref>http://www.biomedcentral.com/content/pdf/1753-6561-5-s6-o53.pdf</ref><ref>http://www.coppertouchsurfaces.org/press/releases/20110701.html</ref><ref>World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland on July 1st, 2011</ref> The US Department of Defense investigation contract, which is ongoing, will also evaluate the effectiveness of copper alloy touch surfaces to prevent the transfer of microbes to patients and the transfer of microbes from patients to touch surfaces, as well as the potential efficacy of copper alloy-based components to improve [[indoor air quality]].
+In the US, the [[Environmental Protection Agency]] (EPA) regulates the registration of antimicrobial products. After extensive antimicrobial testing according to the agency’s stringent test protocols, 355 [[copper alloys]], including many brasses, were found to kill more than 99.9% of MRSA, ''E. coli'' O157:H7, ''[[Pseudomonas aeruginosa]]'', ''S. aureus'', ''[[Enterobacter aerogenes]]'', and VRE within two hours of contact.<ref>EPA registers copper-containing alloy products, May 2008, http://www.epa.gov/opp00001/factsheets/copper-alloy-products.htm</ref><ref>355 Copper Alloys Now Approved by EPA as Antimicrobial, Jun 28, 2011, http://www.appliancemagazine.com/news.php?article=1498614&zone=0&first=1</ref> Normal tarnishing was found to not impair antimicrobial effectiveness.
+On February 29, 2008, the EPA granted its first registrations of five different groups of copper alloys as “antimicrobial materials” with public health benefits.<ref>[http://www.epa.gov/pesticides/factsheets/copper-alloy-products.htm EPA registers copper-containing alloy products], May 2008</ref> The registrations granted antimicrobial copper as "a supplement to and not a substitute for standard infection control practices." Subsequent registration approvals of additional copper alloys have been granted. The results of the EPA-supervised antimicrobial studies, demonstrating copper's strong antimicrobial efficacies across a wide range of alloys, have been published.<ref>Collery, Ph., Maymard, I., Theophanides, T., Khassanova, L., and Collery, T., Editors, Metal Ions in Biology and Medicine: Vol. 10., John Libbey Eurotext, Paris © 2008, Antimicrobial regulatory efficacy testing of solid copper alloy surfaces in the USA, by Michels, Harold T. and Anderson, Douglas G. (2008), pp. 185-190.</ref> These copper alloys are the only solid surface materials to be granted “antimicrobial public health claims” status by EPA.
-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.
+{{see also|Antimicrobial_copper-alloy_touch_surfaces#Approved_products}}
-===Birth===
+The EPA registrations state laboratory testing has shown, when cleaned regularly:
-Proponents of [[home birth]] often cite the benefit of avoiding nosocomial infection by avoiding hospital [[Childbirth|delivery]].
+*Antimicrobial copper alloy surfaces (ACAs) continuously reduce bacterial contamination, achieving 99.9% reduction within two hours of exposure.
+*ACAs kill greater than 99.9% of Gram-negative and Gram-positive bacteria within two hours of exposure.
+*ACAs deliver continuous and ongoing antibacterial action, remaining effective in killing greater than 99% of bacteria within two hours, and continue even after repeated contamination.
+*ACAs help inhibit the buildup and growth of bacteria within two hours of exposure between routine cleaning and sanitizing steps.
+*Testing demonstrates effective antibacterial activity against ''S. aureus, E. aerogenes,'' MRSA, ''E. coli'' O157:H7, and ''Pseudomonas aeruginosa''.
+The registrations state, “antimicrobial copper alloys may be used in hospitals, other healthcare facilities, and various public, commercial and residential buildings.”
-== Known diseases ==
+===Aprons===
-* [[Ventilator associated pneumonia]]
+Wearing an apron during patient care reduces the risk of infection.{{Citation needed|date=August 2008}} The apron should either be disposable or be used only when caring for a specific patient.
-* [[Staphylococcus aureus]]
-* [[Methicillin-resistant Staphylococcus aureus]]
-* [[HIV/AIDS]]
-* [[Pseudomonas aeruginosa]]
-* Acinetobacter baumannii
-* [[Stenotrophomonas maltophilia]]
-* [[Clostridium difficile]]
-* [[Tuberculosis]]
-* [[Urinary tract infection]]
-* [[Hospital-acquired pneumonia]]
-* [[Gastroenteritis]]
 == Mitigation ==
-The most effective of controlling Nosocomial infection is to strategically implementing QA / 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
+{{Expand section|date=December 2009}}
-| last = Leung
+The most effective technique for controlling nosocomial infection is to strategically implement [[Quality Assurance|QA]]/[[Quality control|QC]] measures to the [[health care]] sectors, and evidence-based management can be a feasible approach. For those with ventilator-associated or hospital-acquired pneumonia, controlling and monitoring hospital [[indoor air quality]] needs to be on agenda in management,<ref name=cmhiaq>{{cite journal
-| first = Michael
+|author=Leung M, Chan AH |title=Control and management of hospital indoor air quality |journal=Med. Sci. Monit. |volume=12 |issue=3 |pages=SR17–23 |year=2006 |month=March |pmid=16501436 |url=http://www.medscimonit.com/fulltxt.php?ICID=447117}}</ref> whereas for nosocomial [[rotavirus]] infection, a [[Hand washing|hand hygiene]] protocol has to be enforced.<ref name=coprabc>{{cite journal
-| authorlink =
+|author=Chan PC, Huang LM, Lin HC, ''et al.'' |title=Control of an outbreak of pandrug-resistant ''Acinetobacter baumannii'' colonization and infection in a neonatal intensive care unit |journal=Infect Control Hosp Epidemiol |volume=28 |issue=4 |pages=423–9 |year=2007 |month=April |pmid=17385148 |doi=10.1086/513120 }}</ref><ref name=pste3>{{cite journal
-| coauthors = Alan H. S. Chan
+|author=Traub-Dargatz JL, Weese JS, Rousseau JD, Dunowska M, Morley PS, Dargatz DA |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 |journal=Can. Vet. J. |volume=47 |issue=7 |pages=671–6 |year=2006 |month=July |pmid=16898109 |pmc=1482439 }}</ref><ref name=hwhd>{{cite journal
-| title = Control and management of hospital indoor air quality <internet>
+|author=Katz JD |title=Hand washing and hand disinfection: more than your mother taught you |journal=Anesthesiol Clin North America |volume=22 |issue=3 |pages=457–71, vi |year=2004 |month=September |pmid=15325713 |doi=10.1016/j.atc.2004.04.002 }}</ref> Other areas needing management include [[ambulance]] transport.{{Citation needed|date=December 2009}}
-| journal =
-| volume =
-| issue =
-| publisher =
-| date = 2006
-| 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
-| last = Chan
-| first = Pei-Chun et al.
-| authorlink =
-| coauthors =
-| title = Control of an Outbreak of Pandrug-Resistant Acinetobacter baumannii Colonization and Infection in a Neonatal Intensive Care Unit <internet>
-| journal =
-| volume =
-| issue =
-| publisher =
-| date = 2007
-| url = http://www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/513120&erFrom=2955280990361486143Guest }}</ref><sup>,</sup><ref name=pste3>{{cite journal
-| last = Josie
-| first = L. et al.
-| authorlink =
-| coauthors =
-| 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>
-| journal =
-| volume =
-| issue =
-| publisher =
-| date = 2006
-| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1482439 }}</ref><sup>,</sup><ref name=hwhd>{{cite journal
-| last = Katz
-| first = Jonathan D.
-| authorlink =
-| coauthors =
-| title = Hand washing and hand disinfection: more than your mother taught you <internet>
-| journal =
-| volume =
-| issue =
-| publisher =
-| date = 2004
-| url = http://www.aspiruslibrary.org/articles/KJO_anesthesiologyClinicsNAmer.pdf }}</ref>.
-==References==
-<div class="references-small"><references/></div>
 ==See also==
-* [[Iatrogenesis]], a disease or complication caused by medical treatment
+* [[Cubicle curtain]]
-* [[Infectious disease]]
 * [[Infection control]]
-* [[Sterilization (surgical procedure)]]
+* [[Iatrogenesis]]
-* [[Cleanroom]]
+* [[PatientPak]]
+* [[Phototherapy]]
+* [[Sanitation Standard Operating Procedures]]
-== External links ==
+==References==
-*{{cite web
+{{Reflist|32em}}
-|title=Nosocomial Infections: Supplemental Lecture
-|date=98-05-09
-|first=Stephen T.
-|last=Abedon
-|url=http://www.mansfield.osu.edu/~sabedon/biol2053.htm }}
-[[Category:Healthcare]]
-[[Category:Nursing]]
-[[Category:Surgical procedures]]
-[[Category:Occupational safety and health]]
-[[Category:Infectious disease]]
+{{Intensive care medicine}}
+{{External causes of morbidity and mortality}}
+[[Category:Occupational diseases]]
+[[Category:Healthcare quality]]
+[[Category:Infectious diseases]]
+[[Category:Medical hygiene]]
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+[[et:Hospitaalinfektsioon]]
+[[es:Infección nosocomial]]
+[[eu:Infekzio nosokomial]]
+[[fr:Infection nosocomiale]]
+[[id:Infeksi nosokomial]]
+[[it:Infezione ospedaliera]]
+[[he:מחלה נוזוקומיאלית]]
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+[[ja:院内感染]]
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+[[pl:Zakażenie szpitalne]]
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+[[fi:Sairaalabakteeri]]
+[[sv:Vårdrelaterade infektioner]]
+[[uk:Внутрішньолікарняна інфекція]]
+[[zh:院內感染]]


Nosocomial infection
Classification and external resources
Contaminated surfaces increase cross-transmission
ICD-10	Y95