presentation8 nosocom

7/28/2019 Presentation8 Nosocom

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Nosocomial Infections

Dr. A. A. Wegdan


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Nosocomial Infections

I have unwillingly, and almost tremblinglyproceeded to operate in the hospital Icame to the conclusion that pyemia, if it doesnot find its birthplace, it does find its naturalhome in hospitals, and although the hospitalmay not be the mother of pyemia it is itsnurse.

Norwich surgeon, 1874


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Why? People seeking health care services may be more

susceptible to infections. People seeking treatment may have infections that

can be transmitted to others. Patients undergoing invasive procedures may be at

increased risk of infection if basic infection control(IC) practices are not observed.

Health care providers may transmit infectious agentsdirectly or indirectly to clients and to themselvesunless basic IC practices are observed.


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Why? Other general factors that contribute to potential

cross-transmission include:- Overcrowding during periods of high admissions

with limited physical space for carrying outappropriate IC practices.

- Staff shortages.

- Poor infrastructure to support infection control(IC) practices.


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Definitions Infection :

The organisms had entered a site, hadcolonized and caused pathological andimmunological reactions with or without clinicalsigns.

Carrier : A healthy individual living chronically withorganism(s).


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Definitions Latin origin: Nosocomium means hospital or related to

hospital/health care facility. Greek: Nosos means disease and komeion means to take care. English: Nosocomial infection or hospital acquired infection.

Recently: Emphasis on health care associated infections i.e.iatrogenic events. So, nosocommial infections could be identified as: Nosocomial infection: An infectious disease acquired in a health

care facility and was not present or incubating at the time of admission.

General Definition of Nosocomial infection: Infection thatoccurred after 48 hours of admission or more than the incubationperiod for a specific disease.


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Definitions Colonization :

Survival of organisms without primary or secondary immunologic defense.

Contamination :Normal flora and organisms present withoutdirect consequences.


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Types of Infection Community-acquired infection:

The entry and multiplication of an infectiousagent derived from the community in the tissuesof the host.

Hospital acquired infection (Nosocomialinfection): An infectious disease acquired in a health carefacility and was not present or incubating at thetime of admission.


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Sources of Microorganisms Endogenous from patient.

Exogenous from health care workers(Hospital to Patient) .

Environmental (Hospital to Patient).


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Population at Risk Patient .

Health care works .

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Risk Factors Individual patient risk determinants:

1. Intrinsic risk factors (Endogenous).- Malnutrition and hypoalbumenuria- Extremes of age.- Immunocompromized or cancer patients.- Diabetes Obesity.

- Loss of skin or mucosal integrity.- Co- existent illnesses/trauma.- Long pre-operative stay.


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Risk Factors American Society for Anesthesiologists (ASA)

scores.1963 the ASA adopted a five category physical status

classification system for assessing a patient before surgery. A sixth category was later added. These are:1. A normal healthy patient.2. A patient with mild systemic disease.3. A patient with severe systemic disease.

4. A patient with severe systemic disease that is a constant threat to life.5. A moribund patient who is not expected to survive with or without the

operation.6. A declared brain dead patient whose organs are being removed for

donor purposes.


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Risk Factors If the surgery is an emergency, the physical status score is

followed by E (for emergency) for example 3E. Category 5 is usually an emergency and is therefore usually

"5E". The category "6E" does not exist and is simply recorded as

category "6", as all organ retrieval in brain-dead patients aredone urgently.

The original definition of emergency was "a surgicalprocedure which, in the surgeon's opinion, should beperformed without delay."

An emergency is now defined as existing when delay intreatment would significantly increase the threat to thepatient's life or body part.


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Risk Factors

2. Extrinsic Risk factors (Exogenous).- High-risk medical devices.- Shaving surgical site.

- Operative procedures:- Length of surgery.- Surgical technique.- Foreign body.- Wound class and aseptic techniques.- Environment maintenance.


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Risk Factors Determinants of an Employees Risk:

1. The probability of occupational exposureto the potentially infected material.2. The prevalence of the target infection in

the patient population served.


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Types of nosocomial infections

1. Surgical site infections.2. Urinary tract infections.

3. Respiratory tract infection.4. Intravascular catheter related

infections.5. Gastrointestinal infection.6. Systemic infections.


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presentation8 nosocom

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