HOSPITAL ACQUIRED INFECTION NOTES FOR NURSING STUDENTS

This topic is from infection control in nursing foundation subject

1. HOSPITAL-ACQUIRED INFECTION

2. INTRODUCTION A hospital-acquired infection (HAI) is an infection that develops 48 hours or more after hospital admission , which was not present or incubating at the time of admission. These infections are among the most common complications of hospital care, increasing morbidity, mortality, and healthcare costs. HAIs are a major concern in healthcare settings such as hospitals, clinics, long-term care, and rehabilitation centers.

3. DEFINITION According to the World Health Organization (WHO): “A hospital-acquired infection is an infection occurring in a patient during the process of care in a hospital or other healthcare facility which was not present or incubating at the time of admission.”

4. INCUBATION PERIOD AND TIME FRAME Usually develops after 48 hours of admission May also appear within 30 days after discharge (especially surgical site infections) Infection acquired from a healthcare setting, devices, or procedures

5. COMMON HOSPITAL-ACQUIRED INFECTION Urinary Tract Infection (UTI) – due to indwelling catheters Surgical Site Infection (SSI) – post-operative wounds Ventilator pneumonia (VAP), Respiratory Tract Infection / Pneumonia – especially ventilator-associated pneumonia Blood Stream Infection (BSI) – often related to intravenous catheters

6. COMMON CAUSATIVE MICROORGANISM Type of Microorganism Common Examples Bacteria Staphylococcus aureus (MRSA), Pseudomonas aeruginosa , E. coli , Klebsiella pneumoniae , Enterococcus faecalis Viruses Hepatitis B & C, Influenza, Norovirus Fungi Candida albicans , Aspergillus species Parasites Giardia lamblia , Entamoeba histolytica (rare in hospitals)

7. SOURCES OF INFECTION Endogenous source – infection arises from the patient’s own flora (e.g., skin bacteria infecting a wound) Exogenous source – from the external environment, such as: Contaminated instruments Healthcare workers’ hands Air, water, or surfaces Visitors or other patients

8. MODE OF TRANSMISSION Mode Example Contact transmission Direct: touching patient; Indirect: via instruments, dressings Airborne transmission Droplet nuclei or dust particles (e.g., TB, measles) Droplet transmission Coughing, sneezing (e.g., influenza, COVID-19) Vector-borne transmission Rare; e.g., mosquitoes in hospital compounds

9. RISK FACTOR Patient related factor Age (infants, elderly) Immunocompromised status Chronic diseases (diabetes, renal failure) Malnutrition Hospital related factor Prolonged hospital stay Invasive procedures (catheters, IV lines, ventilators) Poor infection control practices Overcrowding and understaffing Inadequate sterilization of equipment

10. CLINICAL MANIFESTATION Fever , chills, malaise Pus or discharge from wounds or catheter sites Redness, swelling, pain at surgical sites Respiratory distress in ventilator-associated infections Burning micturition in catheter-associated UTI Sepsis in bloodstream infections

11. DIAGNOSIS Clinical Examination – observing symptoms and signs Laboratory Tests: Culture and sensitivity (urine, blood, wound swab) Gram staining Complete blood count (CBC) CRP (C-reactive protein) and ESR levels Radiological Investigations: Chest X-ray for pneumonia Ultrasound for abscess detection

12. PREVENTION AND CONTROL MEASURE

13. ROLE OF NURSE IN PREVENTION AND CONTROL Maintain strict hand hygiene Follow aseptic techniques during procedures Use sterile equipment and ensure proper sterilization Educate patients and relatives on infection prevention Monitor and report signs of infection early Participate in infection control audits Practice safe waste segregation Maintain proper documentation and surveillance records Ensure environmental cleaning and disinfection

14. MANAGEMENT OF HAI Identify the source and isolate infected patient if needed Start empirical antibiotics as per hospital policy Remove or replace infected catheters, IV lines, or tubes Supportive therapy (fluids, oxygen, nutrition) Infection control team to trace and correct the cause

15. COMPLICATION Sepsis and septic shock Multidrug-resistant organisms (MDROs) Prolonged hospitalization Increased healthcare costs Organ failure or death in severe case

16. SURVEILLANCE AND REPORTING Regular monitoring of infection rates Maintenance of infection registers Data analysis and feedback Implementation of corrective measures