Nosocomial infections of the human body 1

Nosocomial

1. NOSOCOMIAL
INFECTIONS AND
THEIR
PREVENTION

2. Nosocomial infections
(Hospital acquired infections (HAI)
anyclinicallysignificantinfectious
diseasethataffectsthepatientasaresult
ofhospitalizationoravisittoahospital
fortreatmentandmedicalstaff,whether
manifestornotthesymptomsofthe
diseaseatthetimeofstayinginthe
hospital.

3. •Hospital acquired infections (HAI) known also
as hospital-associated infections, and hospital
infections , medically termed as nosocomial
infections, are infections that are acquired by
patients admitted in the hospital wards, as well as
by hospital staff, including doctors and nurses
who work at the hospital. The most common
HAI are caused by bacteria, fungi and viruses
also cause HAI, but to a far lesser extent.

4. •Nosocomial infections are widespread.
•About 5-15% or all hospitalized patients acquire
nosocomial infections.
•They are important contributors to morbidity and mortality.
They will become even more important as a public health
problem with increasing economic and human impact
because of:
•Increasing numbers and crowding of people.
•More frequent impaired immunity (age, illness, treatments).
•New microorganisms.
•Increasing bacterial resistance to antibiotics.

5. Nosocomial infections:
•aggravate the general condition of patients
•increase the length of stay on the bed in 2-3 times
•the risk of death increases in 5-7 times
•reduce the quality of life and reputation of the
hospital

6. •There are two forms:
•Endogenous infection, self-infection, or auto-infection. The
causative agent of the infection is present in the patient at the time of
admission to hospital but there are no signs of infection. The
infection develops during the stay in hospital as a result of the
patients altered resistance.
•Cross-contaminationfollowed by cross-infection. During the stay
in hospital the patient comes into contact with new infective agents,
becomes contaminated, and subsequently develops an infection.
•While there is no clinically significant difference between the
endogenous self-infection and the exogenous cross-infection, the
distinction is important from the standpoint of epidemiology and
prevention.

7. •Healthy people are naturally contaminated.
•Faeces contain about 10
13
bacteria per gram, and the number of
microorganisms on skin varies between 100 and 10000 per
cm2. Many species of microorganisms live on mucous
membranes where they form a normal flora. None of these
tissues, however, is infected. Microorganisms that penetrate the
skin or the mucous membrane barrier reach subcutaneous
tissue, muscles, bones, and body cavities (e.g. peritoneal cavity,
pleural cavity, bladder), which are normally sterile (i.e. contain
no detectable organisms). If a general or local reaction to this
contamination develops, with clinical symptoms, there is an
infection.

8. The causes of nosocomial infections
•The creation of large hospital complexes.
•The large number of sources of infectious agents.

9. •Forming an artificial mechanism of transmission of infectious
agents.
•Activation of the natural mechanisms of transmission of
infectious agents.
•Formation a large number of hospital strains of microorganisms
resistant to antibiotics, disinfectants, ultraviolet radiation.
•The appearance a wide range of disinfectants.
•The difficulty of the disinfection and sterilization of modern
medical equipment.
•Violation of sanitation in hospitals.
•Lack of effective the antiepidemic measures.
•Lack of knowledge of staffs about prevention of nosocomial
•infections.
•Patients with underlying disease, newborn babies, and the
elderly have less resistance and will probably develop an
infection after contamination

10. Three factors contribute to
nosocomial infections:
•Microorganisms in the hospital
•A compromised host
•The chain of transmission

11. •The 10 most common infection-causing pathogens, accounting for
84% of HAIs, arenegative staphylococci (15%),Staphylococcus
aureus (15%),Enterococcus species (12%),Candida species
(11%),Escherichia coli (10%),Pseudomonas aeruginosa
(8%),Klebsiella pneumoniae (6%),Enterobacter species
(5%),Acinetobacter baumannii(3%) and Klebsiella oxytoca(2%).
And the major cause of HAI is bacterial infections, which account for
about 90% of all HAI.
Micro-organisms associated with HAI
•Bacteria-Salmonella, Shigella, Escherichia coli,
Staphylococcus aureus,etc.
•Viruses-hepatitis B and C viruses, human immunodeficiency
virus (HIV), rotaviruses, herpes simplex virus, influenza virus,
etc.
•Fungi -Candida albicans, Aspergillus spp., etc.
•etc.).
•Parasites–Giardia lamblia, Cryptosporidium.
HAI Pathogens
(The etiological structure of nosocomial infections)

12. Classification of pathogenic germs
•Conventional pathogens
•Cause disease in healthy individuals in the absence of specific immunity.
•Examples: Staphylococcus aureus, Streptococcus pyogenes, Salmonella spp.,
Shigella spp., Corynebacterium diphtheriae, Mycobacterium tuberculosis,
Bordetella pertussis, hepatitis A and B viruses, rubella virus, rotaviruses,
human immunodeficiency virus (HIV).
•Conditional pathogens
•Cause disease, other than trivial local infections, only in persons with reduced
resistance to infection (including newborn infants) or when implanted directly
into tissue or a normally sterile body area.
•Examples: Streptococcus agalactiae, Enterococcus spp., Clostridium tetani,
Escherichia coli, Klebsiella spp., Serratia marcescens, Acinetobacter
baumanii, Pseudomonas aeruginosa, Candida spp.
•Opportunistic pathogens
•Cause generalized disease, but only in patients with profoundly diminished
resistance to infection.
•Examples: atypical mycobacteria, Nocardia asteroides, Pneumocystis carinii.

13. Sources of infection:
•a person (patient, staff, visitor)
•sometimes an animals and insects (ticks, mosquitoes,
and others).
•The source of an outbreak of nosocomial infection may
also be a health person who is infected or colonized (a
carrier). A symptomless carrier, however, is
contaminated or colonized by potentially pathogenic
organisms but does not develop any infection. A typical
example is Staphylococcus aureus, which may be
carried in the nasal passages of 30-60% of personnel.

14. The mechanisms of transmission of
infectious agents:
•natural(airborne, fecal-oral, direct or indirect
contact, vector-borne transmission (insects),
vertical from women to newborns)
•artificial (associated with therapeutic and
diagnostic procedures).

15. •Nosocomial infections are transmitted by direct contact
between staff members and patients and between
patients.
•Fomites such as catheters, syringes, and respiratory
devices can transmit nosocomial infections.
•Infections may be caused by a microorganism acquired
from another person in the hospital (cross-infection) or
may be caused by the patient’s own flora (endogenous
infection).
•The Compromised Host Patients with burns, surgical
wounds, and suppressed immune systems are the most
susceptible to nosocomial infections.

16. Types of Hospital Acquired Infections
•Bloodstream Infection (BSI): This type of infection is
technically termed as septicemia. It occurs when an infection
in any part of the body enters the bloodstream and spreads
rapidly to other parts of the body. Septicemia can be life-
threatening and must be treated quickly. Catheter-related
bloodstream infections (CRBI) are very common in a hospital
setting.
•Ventilator-associated Pneumonia (VAP): This type of
infection occurs in patients who are on mechanical ventilator
support in an intensive care unit (ICU). The patients are
usually critically ill and elderly, who are highly susceptible to
respiratory infections like pneumonia.

17. •Urinary Tract Infection (UTI): This type of infection
affects the urinary tract. UTI is usually caused by bacteria.
In certain cases, it is caused by fungi and occasionally by
viruses. Infection can occur in the lower urinary tract,
involving the bladder (cystitis) or the upper urinary tract,
involving the kidneys (pyelonephritis). In a hospital setting,
UTI can occur as a result of not using aseptic techniques
during insertion of a urinary catheter for men/women.
•Surgical Site Infection (SSI): This is one of the most
common types of infection in the operating room. SSI can
be caused as a result of not following strict aseptic practices,
before, during, and after the surgery.

18. •The signs and symptoms of HAI are closely linked to the type
of infection involved and the organ-system affected. The
common symptoms include the following:
•Fever
•Headache
•Rashes
•Burning sensation during urination
•Difficulty urinating
•Redness, warmth, swelling, and pain from a surgical incision
•Oozing of fluid (blood and/or pus) from a surgical wound
•Severe coughing
•Shortness of breath
•Nausea and vomiting
•Diarrhea

19. Some of the associated major risk factors of
Hospital Acquired Infections:
•Prolonged stay (>3 days)
•Age above 70 years
•Prior use (or misuse/abuse) of antibiotics
•Coma
•Trauma
•Indwelling catheters
•Ventilator support
•Surgery
•Drugs affecting the immune system (steroids,
chemotherapy)

20. Prevention of HAI
•Reducing person-to-person transmission
•Hand decontamination and appropriate aseptic practice
•Personal hygiene
•Clothing, Masks & Gloves
•Safe injection practices
•Isolation strategies
•Preventing transmission from the environment
•Cleaning of the hospital environment
•Disinfection of patient equipment
•Sterilization of medical devices, linens

21. Prevention of HAI
•Protecting patients with appropriate use of prophylactic
antimicrobials, nutrition, and vaccinations
•Limiting the risk of endogenous infections by minimizing
invasive procedures , and promoting optimal
antimicrobial use
•Surveillance of infections, identifying and controlling
outbreaks
•Prevention of infection in staff members
•Enhancing staff patient care practices, and continuing
staff education.

22. Measures for Prevention of common
nosocomial infections
•UTI
•Limit duration of catheter
•Aseptic technique at insertion
•Maintain closed drainage
•SSI
•Surgical technique
•Clean operating environment
•Staff attire
•Limiting preoperative hospital stay
•Preoperative shower and local skin preparation of patient
•Optimal antibiotic prophylaxis
•Aseptic practice in operating room
•Surgical wound surveillance

23. Measures for Prevention of common
nosocomial infections
•Pneumonia Ventilator-associated (VAP)
•Aseptic intubation and suctioning
•Limit duration
•Non-invasive ventilation
•Others Influenza vaccination for staff
•Isolation policy
•Sterile water for oxygen and aerosol therapy
•Prevention of Legionella and Aspergillus during renovations
•Vascular device infections
•All catheters Closed system
•Limit duration
•Local skin preparation
•Aseptic technique at insertion
•Removal if infection suspected
•Central lines
•Surgical asepsis for insertion
•Limitation of frequency of dressing change
•Antibiotic-coated catheter for short term

24. •Organization measures
•Hygienic measures
•Antiepidemic measures
•Disinfection and sterilization
•increasing the body's resistance
•introduction of new medical technologies.
Measures of the prevention of nosocomial
infections

25. Organization measures of the prevention
of nosocomial infections
•Hospitals must have an infection control and prevention program to
identify and reduce the risks of acquiring and transmitting infections
among patients, healthcare personnel, and visitors.
•The hospital should have an infection control manual which includes
infection prevention and control program.
•The infection control and prevention program should have procedures
that meet international infection control and prevention guidelines
•The infection control program shall support safe practice and ensure a
safe environment for patients, healthcare workers (HCWs) and hospital
visitors.
•The hospital has a designated and qualified infection control
professional(s)/committee to oversee the infection and prevention control
program.

26. Infection Control Team
•Investigating & controlling out breaks
•Formulating appropriate admissions guidelines
•Nursing & treatment of infectious patients
•Sterilization & disinfection practices
•Surveillance Determining antibiotic policy &
immunization schedules
•Educating patients & hospital personnel's on
infection control
•Soap water & common sense

27. •Control of endemic antibiotic resistance
•Ensure appropriate use of antibiotics (optimal choice,
dosage and duration of antimicrobial therapy and
chemoprophylaxis based on defined hospital antibiotic
policy, monitoring and antibiotic resistance, and up-to-date
antimicrobial guidelines).
•Institute protocol (guidelines) for intensive infection control
procedures and provide adequate facilities and resources,
especially for handwashing, barrier precautions (isolation),
and environmental control measures.
•Improve antimicrobial prescribing practices through
educational and administrative methodsLimit use of topical
antibiotics.

28. •Preventing infections of staff
•Health care workers (HCW)are at risk of acquiring
infection through occupational exposure can also
transmit infections to patients and other employees
HCW’s health should be reviewed at recruitment
•Immunizations recommended for staff include: hepatitis
A and B, yearly influenza, measles, mumps, rubella,
tetanus, diphtheria
•Specific post exposure policies must be developed, and
compliance ensured for: HIV, HAV, HBV, HCV, N.
meningitidis, M. tuberculosis, VZV, HEV, C. diphtheriae,
B.pertussis, and rabies

29. •When appropriate the infection control professional(s)/committee consults
with someone who has expertise in infection prevention and control in order
to make informed decisions.
•The hospital should conduct regular pre-induction training sessions on
prevention and control of infections for appropriate categories of new staff.
•The hospital should conduct regular “in-service” and educational training
sessions on the prevention and control of infections for all concerned
categories of staff at least once in a year.
•The hospital should have a process for the education of patients and families
on infection prevention and control
•The hospital should monitor and report and share the information with the
staff and service providers on trends of infections and track infection rates
including healthcare associated (nosocomial) infections.
•The infection prevention and control program should focus on adherence to
standard precautions at all times and include equipment cleaning and
sterilization practices, laundry and linen management, kitchen sanitation and
food handling issues.

30. In recent years, increasing attention has been paid to the
protection of the personnel, in particular against the
transmission of bloodborne infections, e.g. AIDS and
viral hepatitis B and C. Preventive measures are
known as universal or standard precautions.
It is impossible to avoid all contact with infected tissue
or potentially contaminated body fluids, excreta, and
secretions. Even when they are not touched with the
bare hands, they may come in contact with instruments,
containers, linen, etc.
All objects that come in contact with patients
should be considered as potentially
contaminated!

31. Hygienic measures in the prevention of nosocomial
infections
•architectural and planningmeasures (a set of premises,
areas, process streams)
•technicalmeasures (ventilation)
•general sanitarymeasures (sanitary maintenance of
rooms, personal hygiene of staff and patients).

32. GENERAL
SANITARY
MEASURES

33. General sanitary measures in prevention of
nosocomial infections
(Sanitary maintenance of the premises, laundry
mode, personal hygiene of patients and staff)

34. Sanitary
maintenance of
premises
All the facilities, equipment,
interior ward premises must
be kept clean. Wet cleaning
(mopping, wiping furniture,
equipment, window sills,
doors) must be carried out at
least 2 times per day, more
often if necessary, with the
use of detergents and
disinfectants.
General cleaning of chambers
(processing of walls, floors,
equipment, interior, lamps)
should be carried out at least 1
time per month.

35. General cleaning of the operating unit, dressing rooms, procedural,
sterilization, delivery rooms, manipulation rooms should be carried
out once a week, outside the plan -in case of unsatisfactory results
of microbial contamination of the external environment and
according to epidemiological indications. Window panes should be
washed as needed, but at least 2 times per year.

36. All cleaning equipment shall be clearly marked with the premises
and the types of harvesting, used for its intended purpose and
stored separately.

37. During the general cleaning disinfectant solution is applied to the
wall by spraying or wiping a height of at least two meters (in the
operating theater -to the entire height of the walls), windows,
window sills, doors, furniture and equipment. At the end of time
disinfecting all surfaces are washed clean cloth moistened with
tap water and then disinfecting the indoor air. Staff should hold
shift overalls.

38. Removing the current defects finishes (elimination of damp,
mold, sealing cracks, cracks, defects flooring) must be carried out
immediately.

39. Once a year, if necessary, often must be conducted refreshing
redecorating the premises. Major repairs must be carried out
according to the sanitary condition of the building and premises.
During the current operation, or overhaul of the premises should
be discontinued. Instruction of personnel involved in cleaning for
sanitary cleaning mode and technology, should be held at least 1
time per year.

40. Linen mode
•Linen patients should be carried out to the extent of pollution,
but at least 1 time per 7 days. Linen contaminated secretions of
patients must be replaced immediately.
•Bed linen postpartum women should be performed 1 time in 3
days, underwear and towels -every day. It should be used sterile
linen.

41. Dismantling of dirty linen in the compartments is prohibited.
The collection is carried out in a special container (plastic bags).
Temporary storage (no more than 12 hours) of dirty linen in
departments should be carried out in sanitary rooms.
Washing should be carried out centrally in dedicated laundries at
hospitals.
Clean linen should be stored in dedicated areas.
Dirty and clean linen must be transported in containers marked "clean"
and "dirty" linen.
Transportation of clean and dirty linen in the same container is not
allowed.

42. Hygienic care for seriously ill patients (washing, rinsing cavity
and others.) Is carried out after meals and when contaminated
body. Periodically should be organized wash and shave
patients. Each patient must be provided with an individual
with a towel and soap. The patient is given an individual care
products: bedpan, drinking bowl; he is given the right to take
to the House of personal hygiene items.

43. Before returning the patient to the ward after the operation a
mandatory linen. Linen patients after surgery should be carried out
systematically before the termination of discharge from the wound.
After discharge, the patient's death, as well as pollution of mattresses,
pillows, blankets should be subjected to disinfection treatment
chamber.

44. Personal hygiene
of medical staff
Medical personnel should be
provided with a set of replacement
workers (health) dress -robes,
slippers, indoor shoes. Storage
needs to be carried out in special
lockers.
Change work clothes in the surgical
departments should be carried out
on a daily basis and the extent of
pollution, at the offices of
therapeutic profile -1 time in 3
days. The reserve is to be an extra
set of clothes for the emergency
replacement.
Laundry sanitary clothing must be
carried out centrally and separately
from the laundry patients.

45. Prevention of HAI by Standard
Hygiene Practices
•Handwashing:Hands are the most common modes of transmission of
pathogenic microorganisms. And handwashing is the single-most effective
method to prevent this from happening. If the hands are visibly soiled or
blood-stained, they should be washed with soap and water. Alternatively, if
the hands are not visibly soiled, they should be rubbed with a solution
containing 0.5% chlorhexidine and 70% ethanol.
•Gloves: These should be worn after hand hygiene procedure, particularly if a
mucus membrane or broken skin needs to be touched or if some aseptic
technique needs to be carried out, such as the insertion of a catheter.
•Mask/Eye Protection: These should be worn to protect the mucus membrane
of the eyes and respiratory tract from aerosols of blood or other bodily fluids,
while carrying out procedures or attending a patient. Moreover, patients and
their relatives should be made to wear masks if they present with respiratory
symptoms.

46. Doctors,nursesandmidwivesshouldalwayswashtheirhandsby2-
foldsoapingeachpatientbeforetheinspection,implementation
procedures,andafterthe"dirty"procedures(cleaning,changeof
underwearafterthesick,goingtothetoilet,etc.).

47. Login operating personnel involved in the operation should be
carried out by bathing and delousing establishment (3 adjacent
spaces). The 1st place -the staff removes the clothing in which he
worked in the department, takes a shower and produces hygienic
processing of hands. In the 2nd -wear clean surgical suits, special
shoes, shoe covers, and goes into the corridor operating unit
further in the preoperative. After the operation, the staff in the 3rd
room removes the used clothes (gowns, costumes, masks, hats,
boots and runs in the 1st room where taking a shower, put on
protective clothing for work in the office. Login operating unit
personnel not involved in the operation is prohibited.

48. Thank you for attention!