Case study: Nosocomial Infections

Nosocomial infections still remain the most frequent complications in hospitalized patients. They are the fourth most common cause of mortality in the United States after the cardiovascular system diseases, cancer and strokes. Discussing background of the necessity of this question observation Schaffer et al stated that “Nosocomial infections are widespread. 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 and treatments).

New microorganisms.

Increasing bacterial resistance to antibiotics.” (Schaffer et al, 1996).

Despite advances in infection control, the emergence and introduction into clinical practice of new antimicrobial drugs, improved diagnostic methods, improving the overall level of care, the issue of prevention and control of nosocomial infections is still valid. Thus, we are going to talk about nosocomial infections and their prevention with more details in the body of this paper.

First of all it is necessary to define the term a “nosocomial infection”, and analyzing medical literature it was found that the most commonly used definition was given by the World Health Organization. According to the World Health Organization “A nosocomial infection – also called ‘hospital-acquired infection’ can be defined as: ‘an infection acquired in hospital by a patient who was admitted for a reason other than that infection.’ An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility.” (Ducel, Fabry, and Nicolle, 2002) Analyzing a general timeline of infections, it is necessary to mention that infections occurring more than 48 or 72 hours after hospitalization are often considered nosocomial.

It is generally accepted position that there must be clinical signs of infection in the first place of diagnosing nosocomial infections, which are identified either by direct observations of the patient, or when analyzing the primary documentation about the patient (for example, diagram of body temperature).

In addition to the clinical signs of infection may be used the results of paraclinical methods of investigation (e.g., radiological examination for nosocomial pneumonia), as well as laboratory data (microbiological, serological, and rapid diagnostic methods).

In complex analysis of these data physicians should take into account the fact that some out-of-hospital infections have an incubation period of more than 48 hours, such as typhoid fever, and intrauterine infections, for example, the symptoms and signs of which appear shortly after birth. Thus, the above numerated infections did not relate to nosocomial infections according to their different nature.

Observing division of nosocomial infections we could mark out several classes: endemic and epidemic. Observing sources of infection appearance we see that the most important are still endogenous sources. First of all, it is obligatory flora of the patient (skin, gastrointestinal tract, etc.), and not only that flora which already existed in the patient’s admission to the hospital but also acquired in a second time in a hospital, and foci of chronic infection. Describing exogenous sources we see among them hands of medical personnel, medical equipment, tools, household articles, unsterile catheters, syringes, etc., aerogenic contamination, water and foodstuffs. It is frequently observed the combination of exogenous and endogenous factors in their interaction. In addition to previously stated information, Pinner et al added that “most are endemic, meaning that they are at the level of usual occurrence within the setting. Epidemic infections occur when there is an unusual increase in infection above baseline for a specific infection or organism.” (Pinner, 1982)

Research on the epidemiology of nosocomial infections provides essential information for making decisions in the event of outbreaks of communicable diseases in those or other departments, analyze the structure of pathogens, the level of phenotypes and their antimicrobial resistance, the prevalence of “rare” pathogens.

Structure of nosocomial infections depends on the profile of hospital, its policy in antibacterial drugs using, and patient contingent. Decisive for the choice of therapy in a particular health facility are the results of microbiological monitoring of antibiotic resistance in pathogens.

As it was stated in the beginning of this paper it is necessary to concern our attention not only on the nature of nosocomial infections, but also on preventive methods in the struggle against this kind of infections.

Wenzel troubled about the prevention of nosocomial infections and due to this described specific infection control measures in his work; and according to them we see that “Besides the committees and other leaders in infection control, much of infection control lies in the hands of the personnel in direct contact with the sick patient. These healthcare employees must understand specific guidelines in prevention of infection transmission through isolation and other good healthcare habits. Much of this information in disseminated through training and educational programs given by the infection control departments. An example of guidelines that are essential for the healthcare worker are specified as:

Hand washing;

Hygiene and uniform;

Barriers: caps, masks, gloves;

Injection practices;

Equipment safety;

Isolation.” (Wenzel, 1997).

Statistical data demonstrated that approximately 90% of all nosocomial infections caused by bacteria, a distinctive feature of which is resistance to many groups of antibacterial drugs (polyresistance) (Berntsen, 2004) In such a way exactly this its property causes problems in the treatment of nosocomial infections, predetermining a low efficiency and high cost of treatment. Resistant strains are formed in the hospitals under the influence of commonly used antibiotics out there. They can go to the hospital from an organism of patients-carriers. Health care personnel is involved in the transfer of bacteria from patient to patient in caring for the sick person, during the process of diagnostic procedures realization, etc. The problem connected with the treatment of nosocomial infections is widely discussed all over the world and medical facilities in conjunction with pharmaceutical companies are looking for ways to combat this kind of infection nowadays.

Lynch as one of the researchers who is interested in nosocomial infections prevention and treatment declared that “Most of these infections can be prevented with readily available, relatively inexpensive strategies by:

adhering to recommended infection prevention practices, especially hand hygiene and wearing gloves;

paying attention to well-established processes for decontamination and cleaning of soiled instruments and other items, followed by either sterilization or high-level disinfection; and

improving safety in operating rooms and other high-risk areas where the most serious and frequent injuries and exposures to infectious agents occur.” (Lynch, 1997).

Thus, summarizing the above presented information we could say that solutions of the problem of nosocomial infectious complications greatly depends on effective control and prevention measures, among which an important place occupies the use of modern aseptic and antiseptic remedies.

Microorganisms circulating in the hospital and attending the various environmental objects can interact with the patient in two ways. Under appropriate conditions, they are either the direct cause of infectious complications, causing the so-called exogenous infection or hospital strains replace patient’s microflora with impaired colonization resistance (mostly due to antibiotic therapy), forming part of its auto microscopic flora and become the cause of endogenous infection. In this case as it was previously explained patient nosocomial infection with strains of microorganisms and colonization of them can be prevented through the use of modern sterilization, disinfecting and antiseptic agents by disinfection and sterilization. These activities are not only important from a medical point of view but also considered economically viable steps in medical treatment.

We should remember that medical housekeeping of environment, sterilization of medical instruments, which are in contact with skin or mucous membranes of patient adherence to aseptic technique during any invasive manipulation, and currently remain the cornerstone in the prevention of nosocomial infections. The most important and maybe the most simple of these measures is to wash own hands before and after patient contact (even when wearing medical gloves). Discussing this side of the problem it becomes understandable that in terms of effectiveness of prevention of nosocomial infections is most advisable to use disposable instruments, gloves, catheters, equipment, factory-sterilized. However, this is not always possible. Thus, the question of decontamination of reuse medical devices consists of the following steps: disinfection, cleaning and sterilization. Under the pre-sterilized cleansing understand the mechanical removal of foreign, mainly organic material with disinfected surfaces. Disinfection – is a physical or chemical process, which destroyed virtually all microorganisms, except bacterial spores. Under the sterilization process physicians imply the complete destruction of all microorganisms including bacterial spores. And connecting disinfection with antibiotic treatment we should say that prophylactic use of antibiotics – is one of the methods of control of nosocomial infections, the theoretical basis of which is the need for surgical intervention during a certain concentration of antibiotic for the maintenance of microbial numbers in the field of surgical wound below the level at which infection may occur.

Thus, basing on the information presented in this paper we see that timely identification of infection sources, the detection mechanisms of microbial resistance are the key measure to combat nosocomial infections, which are required to take medical facilities. In such a way qualitative diagnosis, allowing in proper time to identify the carrier, plays a crucial role in preventing of nosocomial infections spread and favour the decrease of treatment costs.

In conclusion, nosocomial infections continue to be the great problem for the entire healthcare system throughout the whole world due to increased risks to patients and medical personnel. Nowadays there were developed a big quantity of effective infection control programs directed on the control and prevention of nosocomial infections. But for the best results it is necessary to continue educate medical personnel about the elementary hygiene rules and norms that are the first step of nosocomial infections prevention.