The Impact Of Nosocomial Infections Essay
Nosocomial Infections 4
Running Head: NOSOCOMIAL INFECTIONS
Nosocomial infections are those that result because of a treatment process normally carried out in a health care facility like a hospital. Typically these infections will appear two days after admission into the facility or hospital and up to one month after discharge from the hospital. Nosocomial infections are also known as health care associated infections or hospital acquired infections. These infections are not genetic in nature. They are typically caused by a pathogenic organism that may invade the body and cause that particular type of infection. The Centre for Disease Control and Prevention (CDC) in the US puts firth estimates on infections at about 2 million resulting into 100,000 deaths annually. In Europe nosocomial infections account for two thirds of the 25,000 deaths annually.
Typically nosocomial infections result in blood stream infections, urinary tract infections and severe pneumonia. Most of these resulting infections have been known to exhibit antibiotic treatment resistance. The bacteria strains behind these infections are quickly evolving into Gram negative bacteria which is typically infecting people outside the health care facility.
These health care associated infections being widely prevalent are now being considered as important contributors of mortality and morbidity. They are continuing to increasingly attract attention due to the fact that increasing populations resulting in crowding, increased bacterial resistance especially to antibiotics, new strains of microorganisms and impaired immunity due to age, treatments and illness. Nosocomial infections continue to attract concerted focus. For developing countries these infections have become a major cause of preventable disease and death.The Impact Of Nosocomial Infections Essay. The infections of concern and focus in this bracket include diarrhea, pneumonia and urinary tract infection, maternal and new born infections and those resulting from surgery and invasive medical procedures. Studies continue to indicate that the organisms that cause these hospital acquired infections usually come from a patient – endogenous flora. However they can also result from contaminated instruments and needles, environment – exogenous and contact with health care staff which are cases of cross contamination. Due to the fact that patients are mobile and admission periods have become shorter, a discharge is always initiated before the nosocomial infection becomes evident in the patient. This in turn has made it difficult to determine the causing organisms nature, whether it is exogenous or endogenous. When hospital attendants are complacent and ignore to practice correct hygiene regularly, nosocomial infections are likely to occur. As the hospital staff attends to one patient after another they themselves can be carriers of the pathogens The use of the out-patient treatment procedure means crowding as more people are hospitalized due to illnesses and a generally weakened immunity. It has also been noted that certain medical procedures which override the body’s natural immunity have resulted into a compromise of the defence system resulting into nosocomial infections. Health care facilities and hospitals continue to uphold sanitation protocols by the use of uniforms, washing and sterilization of equipment. It has been proven and has become acceptable standard procedure to wash hands using alcohol rubs before and after every patient contact. This is one of the ways available to combat nosocomial infection incidences. The controlled administration and prescription of anti- microbial agents such as antibiotics is also of great importance as far as nosocomial infections are concerned. The general view is that patients should have antibiotic prescription to treat illness but this sometimes may increase selection pressure resulting into resistant strains of the microorganism. The MRSA, Gram positive bacteria and Acinetobacter which is considered Gram negative are the cause agents of nosocomial infections. Currently drugs to effectively handle Acinetobacter germs are in short supply. Studies continue to show that Acinetobacter germs are evolving are becoming resistant to existing antibiotics. One typical case is that one of Klebsielle pneumoniae a strain prevalent in Brooklyn , New York city which is showing signs of resistance to all modern antibiotics. These germs are also fast spreading around the world. The Gram negative bacteria so classified because of its reaction to the Gram test has been known to cause infections of the bloodstream, urinary tract and severe pneumonia. These Gram negative micro organism has a unique cell structure that makes it difficult to attack unlike the Gram positive type.
Statistical data is now available in terms of country figures showing the annual infection rates. The CDC in the US puts forth 1.7 million infections annually with a mortality rate of 99,000 during the same period. The cost incurred ranges between 4.5 billion dollars to 11 billion dollars. The infections in France have been as indicated from 6.7% in 1990 to 7.4% Nationally the infection rate stood at 6.7% for 1995, 5.9% for 2001 and 5.01% for 2006. The Impact Of Nosocomial Infections Essay.
The United Kingdom has a 10% infection rate and an 8.2% estimate in 2006. Finland has estimated infection rates at 8% in 2006.
Typically the Gram negative germs affect most often the hospitalized patients due to their weakened immune system. The Gram negative germ survives for long periods of time on surfaces entering the body through wounds, catheter and ventilators.
The contact transmission route remains the most frequent and important mode of transmission for this type of infections. Contact transmission may either be direct in which case involving direct body surface to body surface contact and subsequent transference of the bacteria from the host. This will normally result from circumstances such as a person (medical staff) physically turning patient, giving the patient a bath or any other activity requiring direct personal contact. This can also transpire between two patients. The indirect contact transmission involves a host and a contaminated object. This object maybe needles or dressing, instruments or gloves. The improper use of bags, vials and saline flush syringes also fall under this category of transmission. Microorganisms can also be passed onto the host by contaminated food, water, contaminated equipment and medication all of which fall under common vehicles of transmission.
Droplet transmission also a mode of transmission for the Gram negative germs. Droplets generated from source through coughing , sneezing and talking or during bronchoscopy convey the germs from the person and deposited on the host. Airborne transmission mode would fall the droplet transmission. In this case residue particles present in evaporated droplets which is a medium for the microorganism are suspended in the air for long periods of time. The germs in this case are widely dispersed and often enter the host through inhalation.
Gram negative germs can also be transmitted through vectors such as flies, rats and mosquitoes.
Nosocomial infections have various impacts. They generally reduce the quality of life when they result in disabling conditions. They cause emotional stress and functional impairment. The Impact Of Nosocomial Infections Essay. The impact is much greater even among the countries poor in resource. Due to the little progress made to address the prevalence of nosocomial infections, their condition is deteriorating. The overall effect of this has been that the cost of health care has increased. This is as a result of increased periods in the duration of hospitalization, use of auxiliary medical care services such as lab tests, X- rays and transfusions. The treatment with expensive drugs may also be considered under this heading.
Nosocomial infections point to certain risk factors. This factors will pre-dispose a patient to infection. Treatments such as immunosuppresion and ant acid which form part of the patient’s treatment tend to undermine the body’s defence. Recurrent blood transfusions and anti microbial therapy are also considered as contributory risk factors.
The use of invasive devices such as catheters, surgical drains, tracheosomy tube, and intubations overrides the body’s natural lines of defence promoting pathogen invasion leading to an infection. Premature birth, immunodeficiency due to illness , irradiation and drugs which are some of the states of hospitalization impair their body’s defence against bacteria.
The prevention of nosocomial infections is directed towards isolation precautions. These precautions are aimed at preventing transmission. The interruption process is normally directed at transmission. Common practices such as washing hands and gloving helps to reduce the risk of skin microorganism transference between persons. Washing of hands promptly and repeatedly after every patient contact procedure has become an important part of controlling infection and also serves as an isolation precaution. Although a simple process, hand washing is nonetheless ineffective because it is often performed incorrectly. The Impact Of Nosocomial Infections Essay.Gloves must be changed between patients and hands must be washed after the gloves have been removed. Sanitizing surfaces is also another way of effectively breaking the cycle of infection. However this also has been overlooked. The use of sanitization methods such as NAV-CO2 has proven effective against MRSA gastroententis and influenza. Sometimes hydrogen peroxide has also been in use. Using disposable aprons is also a method that can be employed to combat the transmission of nosocomial infections.
One of the areas of concern among the general medical fraternity is the antimicrobial resistance phenomenon. The Gram negative bacteria that is a cause of the nosocomial infections is a drug resistant agent. Malaria, TB, gonorrhea and ear infections are difficult to treat because of the drug resisting pathogens. A school of thought has indicated that in the near future we are likely to witness increased incidences of untreatable bacterial infections. A study by National Academy of Science puts the annual treatment cost for antibiotic resistant infections at approximately 30 billion dollars. While looking at the advent and development of antimicrobial resistance, we must consider the ability of the organism to speedily adapt to altered or new environment. These organisms being unicellular will rapidly evolve via a single gene mutation. A general view of the scope of the antimicrobial resistance takes into account a number of factors. The emergence of resistant strains such as Staphylococcus aureus in hospitals and non hospital settings. Similarly Streptococcus pneumoniae leads to many cases of pneumonia and meningitis, and this strain is resistant to penicillin.
The appearance of multi drug resistant TB has also elicited a lot of concern over the recent times especially so for the treatment of people with HIV. Shigella dysenteriae, Vibrio cholerae,Salmonella and Eschenchia remain some of today’s highly drug resistant pathogenic bacteria that are currently responsible for diarrhea. The Impact Of Nosocomial Infections Essay.
Nosocomial infections are infections that are a result of treatment in a hospital or a healthcare unit. These infections are identified at least forty-eight to seventy-two hours following admission, so infections incubating, but not clinically apparent, at admission are excluded. It may also be within 30 days after discharge. With recent changes in health care delivery, the concept of nosocomial infections has sometimes been expanded to include other health care associated infections (Weinstein, 1991). These infections are also called hospital-acquired infection. Studies in the passed have reported that during hospitalization, at lest five percent of patients become infected. Similarly, a study carried out by the Centers for Disease Control and Prevention in the United States estimates that roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. In Europe the deaths estimated are 25000 each year. However, the case is more seen in the category of Gram-negative infections, which accounts for an estimated two thirds of the total cases reported.
Nosocomial infections are commonly transmitted as a result of negligence of hygiene by some hospital personnel. Medical officials move from one patient to another. Thus in a situation where they do not maintain high hygiene standards, the officials themselves serve as means for spreading dangerous pathogens. Moreover, body’s natural protective barriers of the patients are bypassed by some medical procedures such as surgeries and injections. Hence with such hygienic negligence in our hospitals and other healthcare units, nosocomial infections become the order of the day and my cause severe cases of pneumonia and infections of the urinary tract, bloodstream or other parts of the body.
Causes of nosocomial infections
Nosocomial infections are caused by various factors. Some of the common ones include improper hygiene. Patients can get infections of diseases such methicillin resistant staphylococcus aureus (MRSA), respiratory illnesses and pneumonia from hospital staff and their visitors (Webster, 1998). Also doctors and nurses who do not practice basic hygienic measures such as washing hands before attending to patients may spread MRSA among them. Other infections are due to injections. There are cases where some hospital staffs do not give injections properly. Infections like HIV and hepatitis B can be as a result of contaminated blood due to sharing syringes and needles between patients when injecting medication into their intravenous lines. The Impact Of Nosocomial Infections Essay. Nosocomial infections may also be as a result of torn or improperly bandaged incisions during surgeries. These incisions get contaminated with bacteria from the skin or the surrounding environment. Similarly, bacteria can be introduced into the patient’s body by contaminated surgical equipment. Also breathing machines such as ventilators can spread infections like pneumonia among patients using them. Staffs that do not use the proper infection control measures tend to contaminate these machines with germs. There are also cases where people on breathing machines are unable to cough and expel germs from their lungs. This can be another cause. In addition, urinary track infections can be due to faulty removal of urine from patients who are not able to use the toilet. In most cases catheters are the common cause for such cases. These catheters cause these infections when they become contaminated with bacteria by medical staff during insertion or are not properly maintained while in use (Webster, 1998). Another cause of nosocomial infections is the organ transplant. Illnesses such hepatitis B, hepatitis C, HIV and syphilis can be spread through bone and tissue grafts that may result from blood transfusions, skin and organ transplants. However such cases have become less common today due to factors such as improved technology. Many protective measures have been put in place to cut on these risks.
Prevention of nosocomial infections
Several measures can be put in place to prevent the spread of nosocomial infections. The most important measure to reduce the risk of transmitting skin microorganisms from one patient to another is hand washing. Medical staff washing hands as thoroughly and promptly as possible after attending to one patient where they may have come into contact with body fluids, excretions and blood, or equipment with these fluids, is a very important measure of nosocomial infection control. Even though it appears as a simple process, it is mostly overlooked or done incorrectly (Hiramatsu, Aritaka, Hanaki, Kawasaki, Hosoda & Hori, 1997). As a result practitioners and visitors should be continuously reminded on the advantages of proper washing of hands. The Impact Of Nosocomial Infections Essay. This can be achieved through use of signals on responsible hand washing. In addition to hand washing, gloves are very important since they prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, and mucous membranes. They offer a protective barrier, in cases of exposure to blood borne pathogens. Similarly there is emphasis on surface sanitation. In health care environments, this is a critical component of breaking the cycle of infections. In cases concerning influenza, gastro enteritis and MRSA modern methods such as NAV-CO2 have been effective. Alcohol has been shown to be ineffective in endospore-forming bacteria such as Clostridium difficile and thus hydrogen peroxide is appropriate in this case. In addition, use of hydrogen peroxide vapor reduces infection rates and risks of acquisition. Some causes of infections are agent and host factors that are hard to control. In such cases isolation precautions can be designed to prevent transmission in common routes in health centers. For example a patient suffering from an air borne disease can be put in a separate room so as to control the spread of the disease. Another prevention measure is putting on protective clothing. An apron reduces the risk of infection as it covers most parts of the body. However with all this said, strategically implementing QA/QC measures in health care sectors and evidence-based management are the most effective technique of controlling nosocomial infections. For example, in cases of diseases such as ventilator-associated pneumonia and hospital-acquired pneumonia, the management of the health center should pay more emphasis on the control and monitoring of the quality of the hospital’s indoor air (Hiramatsu, Aritaka, Hanaki, Kawasaki, Hosoda, & Hori, 1997). The Impact Of Nosocomial Infections Essay.
A Review of the Literature
Robert A Weinstein
(Cook County Hospital & Rush Medical College, Chicago, Illinois, USA)
In his research paper Robert Weinstein begins by a comparison of the cases of nosocomial infections now and in the past. Even though he agrees that there has been a reduction in number of cases, he goes a head to state that the numbers of death are still high. According to him, a study carried out in the United States estimated that in 1995, nosocomial infections cost $4.5 billion and contributed to more than 88,000 deaths (one death in every six minutes). I concur with these findings. Poor hygiene standards in most health centers have contributed to these high figures. There have been cases of medical practitioners who overlook basic hygienic measures such as a proper hand washing when attending to patients. There are cases where some medical services like injections are not administered in a proper manner. This is due to unqualified medical expertise especially in small health care centers. I think the research’s large numbers of deaths from nosocomial infections is due to such factors. I also agree with Weinstein that there is an approximately one third reduction in rate of infections in hospitals with the four basic infection control components (one infection control practitioner for every 250 beds, an effective hospital epidemiologist, ongoing control efforts and an active surveillance mechanism). As a result I think these infections can be controlled to a higher percentage if all hospitals and health centers could employ these basic components.
Robert A Weinstein also states that there has been an increase in viral infections. Most nosocomial infections in Semmelweis’s era were due to group A streptococci. In 1990 to 1996, 34% of nosocomial infections were due to the three most common gram-positive pathogens-S. aureus, enterococci and coagulase-negative staphylococci while the four most common gram-negative pathogens-Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiella pneumoniae, accounted for 32%. With this trend I agree with Weinstein report. There has also been an increase in the blood transmitted infections hence increase in the cases of herpes viruses HIV-infections.
On the other hand Weinstein’s reveals that there is a higher rate of infection among the intensive care unit (ICU) patients. The Impact Of Nosocomial Infections Essay. This is evident in our hospitals today. I think the increasingly aggressive medical and therapeutic interventions, including modern medical advancements like organ transplantations, implanted foreign bodies and xenotransplantations, have created a cohort of particularly vulnerable persons (Fridkin, Welbel & Weinstein, 1997). In most cases, patients affected by nosocomial infections are those immunocompromised by underlying diseases, age or medical/surgical treatments. More cases of bloodstream infections coagulase-negative staphylococci occur in the ICU because it is in these areas that patients with invasive vascular catheters and monitoring devices could come into contact with these bloodstream infections. Due to these factors, I concur with Weinstein’s research findings that infection rates in adult and pediatric ICUs are approximately three times higher than elsewhere in hospitals.
In conclusion, Robert A Weinstein’s research paper portrays a comprehensive research. It addresses changes in the medical fraternity that have affected nosocomial infections in one way or another. It also shows the significant impact of advancement in technology in medical and health care in relation to nosocomial infections.
Jessica Lietz presents her research on nosocomial infections putting more emphasis on the causes and prevention measures of the infections. She introduces her research stating that there are higher rates of infections in public hospitals as compared to private health centers. I concur with her findings on the basis of the difference in management in the two setups. Private centers tend to be managed in a better manner than public centers. This is because private hospitals are business oriented and the management is always doing all it can to better the institution so as to cope with the high market competition. As a result of this emphasis on good management, medical staff tends to adhere to rules and regulations. Hence the hygiene standards of these institutions are always high. Similarly there is close supervision of staff, another factor that advantages private hospitals over public ones.The Impact Of Nosocomial Infections Essay. For the public medical institutions, the case is not the same. In most centers hygiene is not to standard. This may be due to several reasons. There is no close supervision of staff and same take this advantage of lack of a questioning authority to bypass basic hygiene measures. Similarly, public setups are prone to the effects of political differences between the staffs. Cases of corruption tend to take root in such centers and as a result, unqualified medical personnel find themselves in these institutions.
In her take on the causes of nosocomial infections, she states lack of adequate public education on the infections as a key factor in their spread. I think the point holds water since there are same cases of transmission of these infections due to ignorance. For instance one may visit a patient suffering from an air borne disease and contact the disease without knowing. Similarly patients may share personal items such as towels, not knowing that they are subjecting themselves to harmful infections. I think enlightening the public in general on the dangers of these infections and the basic control measures like maintaining a high personal hygiene can go a greater mile in trying to control these infections. It is therefore important to create a society that empresses these basic measures. This can be achieved through airing nosocomial infection related articles in the media, organized open air lessons in villages and also be taught in learning institutions.
Jessica Lietz on the other hand, argues out that just as hand washing is important as a measure of control; more emphasis should also be put on wearing of gloves. She states that gloves can also be used in the same context as hand washing as long as one glove is used on only one patient. I seem to disagree with this since there are challenges that come with it. Even though gloves offer a protective barrier, there are cases where these gloves tear. Moreover in instances where the gloves are not properly worn both the expertise and the patient may be a risk of infections. I strongly believe that a high standard of hygiene is the most appropriate way of fighting infections. As such, a basic, prompt and thorough hand wash is always the better option due its advantages. However, this does not rule out the use of gloves as they are equally important. The Impact Of Nosocomial Infections Essay.
In conclusion, this research article gives a general view of nosocomial infections. It does not reflect a deep research into the subject. Jessica gives more emphasis on general arguments. There are some issues concerning these infections that have not been covered or have been covered shallowly. Jessica does not explain in length how nosocomial infections have been affected by technology. Advancement in technology has revolutionalized the medical fraternity and has come with its own advantages and disadvantage. Therefore one can not make a general decision from this article as it is shallow and needs further research.
National Center for Infectious Diseases
This is an article on the research carried out on the nosocomial infections by the National Center for Infectious Diseases in the United States. It points out young children, the elderly and persons with compromised immune systems as people who are more prone to these infections. Long hospital stays, failure of healthcare workers to wash hands, use of indwelling catheters and overuse of antibiotics have also been highlighted to cause some cases of the infection (Fridkin, Welbel, & Weinstein, 1997). Moreover the research acknowledges the effects of the diversification of technology on the spread and control of the infections highlighting organ transplant, catheters, xenotransplantations among others, as examples.
Invasive procedures expose patient to the possibility of infection. The research highlights the percentages below.
Causes of Urinary Tract Infections in Hospital Patients:
Escherichia coli: 40%
Proteus mirabilis: 11%
‘Other’ Gram-negative bacteria: 25%
Coagulase-negative staphylococci: 3%
‘Other’ Gram-positive bacteria: 16%
Candida albicans: 5%
Causes of Urinary Tract Infections that are Community-acquired:
Escherichia coli: 80%
Coagulase-negative staphylococci: 7%
Proteus mirabilis: 6%
‘Other’ Gram-negative bacteria: 4%
‘Other’ Gram-positive bacteria: 3%
This is a comprehensive research that has covered nosocomial infections at length.The Impact Of Nosocomial Infections Essay. It discusses key components of the infections giving considerations to both past and today world. Moreover, it compares the rate of the infections both in the urban and rural setting. Hence it is an article that tries to solve nosocomial infection dilemma.
Toni Rizzo presents his research on the common types of infections in our hospital. He highlights respiratory procedures, intravenous (IV) procedures, surgery and wound and urinary bladder catheterization as the common types of infections. He states that most hospital-acquired UTIs happen after urinary catheterization. A healthy urinary bladder does not have bacteria or microorganisms (it is sterile). A catheter picks up bacteria that may be in or around the urethra and take them up into the bladder hence infecting it.
This is a standard research as it touches on almost key issues in the subject matter. I agree with the findings. Fungus infections from Candida are prone to affect patients who are taking antibiotics or that have a poorly functioning immune system. Hence bacteria from the intestinal track are the most types of UTIs. Similarly respiratory procedures done in our hospitals today are the common causes of bacteria getting into the throat. Pneumonia thus becomes another common type of hospital-acquired infections. Once the throat is colonized, it is easy for a patient to inhale the microorganisms into the lungs. Moreover, patients who are unable to cough or gag very well are most likely to inhale colonized bacteria and microorganisms into their lungs.
In general Toni Rizzo tries to address affects in medicine today. Infections due to modern advancements like organ transplant among others have been effectively discussed. Thus this is a comprehensive research.
Emmanuelle Girou and Francois Stephan
(Case-control Study of ICU Patients)
This is an article on a study done in the ICU patients. Generally ICU patients are at a high risk of acquiring nosocomial infections and in same cases some die from these infections. There is a need for therapy whether infections in the ICU occur or not. The objectives of the study was to define the interrelationships between underlying disease, severity of illness, therapeutic activity and nosocomial infections in ICU patients, and their influence on these patients’ out come. The study was conducted in a 10-bed medical ICU. The Impact Of Nosocomial Infections Essay. Initial severity of illness was matched, with daily monitoring of severity of illness and therapeutic activity scores, and with analysis of the contribution of nosocomial infections to patients’ outcomes. The study ran for one year and data carefully taken.
Global incidence rate of 14.6 infections per 100 admissions was estimated as forty one out of the 281 studied patients developed at least one nosocomial infection. During their ICU stay, the 41 case-patients developed 98 nosocomial infections (2.4 episodes per patient): 15 pneumonias, 35 bacteremias, 33 urinary-tract infections, 12 central-venous-catheter-related infections, two sinusitides, and one surgical wound infection. Of the 35 episodes of bacteremia, only four were primary; the other 31 complicated the following nosocomial infections: 14 urinary tract infections, eight catheter-related infections, eight instances of pneumonia, and one surgical-site infected. The characteristics of patients in both groups were compared through use of the Mann-Whitney nonparametric test for continuous variables and the chi-square test for categorical variables. Wilcoxon’s test was used to compare two continuous variables within one group. To identify risk factors independently associated with nosocomial infection, variables found to be significantly different between cases and controls in the univariate analysis were entered into a forward stepwise logistic-regression model (Statistica 4.5; Statsoft, Inc., Tulsa, OK). When patients developed multiple nosocomial infections during their hospitalization, only the first episode was used in the risk factor analysis. A value of p < 0.05 constituted a significant difference.
This is a very detailed and comprehensive case study. It clearly explains why the rate of infection is high in the ICU. This high rate is attributed to various factors. The immune system of most patients in the ICU is always low. Similarly these patients are subjected to taking more antibiotics. Long hospital stays is also another factor. Also it is in the ICU that most medical procedures like organ transplant, catheter, xenotransplantations among others, take place. The research also accounts for the effects of technology and other factors that affect these infections. It accounts for the findings given reasons based on concrete facts. As result, it’s a dependable research that can be used to study nosocomial infections especially in the ICU. The Impact Of Nosocomial Infections Essay.
In conclusion, all the articles above points out improved hygiene especially hand washing and immunization have resulted to the overall advances in control of infectious diseases. Negligence of hygiene is also portrayed as a major challenge to the efforts of control of nosocomial infections. I think for us to significantly control the infections, we must join forces and work together with medical personnel on implementation of existing infection control technologies. We should empress positive changes towards the control of nosocomial infection and observe high standards of hygiene so that we do not rely solely on technologic advances. The Impact Of Nosocomial Infections Essay.