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| {{Nosocomial infection}} | | {{Nosocomial infection}} |
| | '''For patient information click [[{{Nosocomial infection}} (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} |
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| ==Prevention== | | ==[[Nosocomial infection overview|Overview]]== |
| 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>
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| 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.
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| ===Sterilization===
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| 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.
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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 [[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.
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| 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>
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| 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>
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| 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.
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| 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.
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| 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.
| | ==[[Nosocomial infection classification|Classification]]== |
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| 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.
| | ==[[Nosocomial infection pathophysiology|Pathophysiology]]== |
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| ===Surface sanitation=== | | ==[[Nosocomial infection causes|Causes]]== |
| 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 }}
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| </ref>
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| ===Antimicrobial surfaces=== | | ==[[Nosocomial infection differential diagnosis|Differentiating Nosocomial Infection from other Diseases]]== |
| [[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. | |
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| 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.
| | ==[[Nosocomial infection epidemiology and demographics|Epidemiology and Demographics]]== |
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| {{main|Antimicrobial copper touch surfaces}}
| | ==[[Nosocomial infection natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| {{main|Antimicrobial properties of copper}}
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| 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>
| | ==Diagnosis== |
| | [[Nosocomial infection history and symptoms|History and Symptoms]] | [[Nosocomial infection physical examination |Physical Examination]] | [[Nosocomial infection laboratory findings|Laboratory Findings]] | [[Nosocomial infection other diagnostic studies|Other Diagnostic Studies]] |
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| 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>
| | ==Treatment== |
| | [[Nosocomial infection medical therapy|Medical Therapy]] | [[Nosocomial infection primary prevention|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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| 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]].
| | ==Case Studies== |
| | [[Nosocomial infection case study one|Case #1]] |
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| 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.
| | ==Related Chapters== |
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| 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.
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| {{see also|Antimicrobial_copper-alloy_touch_surfaces#Approved_products}}
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| The EPA registrations state laboratory testing has shown, when cleaned regularly:
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| *Antimicrobial copper alloy surfaces (ACAs) continuously reduce bacterial contamination, achieving 99.9% reduction within two hours of exposure.
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| *ACAs kill greater than 99.9% of Gram-negative and Gram-positive bacteria within two hours of exposure.
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| *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.
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| *ACAs help inhibit the buildup and growth of bacteria within two hours of exposure between routine cleaning and sanitizing steps.
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| *Testing demonstrates effective antibacterial activity against ''S. aureus, E. aerogenes,'' MRSA, ''E. coli'' O157:H7, and ''Pseudomonas aeruginosa''.
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| The registrations state, “antimicrobial copper alloys may be used in hospitals, other healthcare facilities, and various public, commercial and residential buildings.”
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| ===Aprons===
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| 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.
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| ==See also==
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| * [[Cubicle curtain]] | | * [[Cubicle curtain]] |
| * [[Infection control]] | | * [[Infection control]] |
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| {{Intensive care medicine}} | | {{Intensive care medicine}} |
| {{External causes of morbidity and mortality}} | | {{External causes of morbidity and mortality}} |
| | | [[Category:Disease]] |
| | [[Category:Infectious disease]] |
| [[Category:Occupational diseases]] | | [[Category:Occupational diseases]] |
| [[Category:Healthcare quality]] | | [[Category:Healthcare quality]] |
| [[Category:Infectious disease]]
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| [[Category:Medical hygiene]] | | [[Category:Medical hygiene]] |
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