9. Infeksi Nosokomial

8/8/2019 9. Infeksi Nosokomial

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9. NosocomialInfections

Tiana Milanda
http://www.hpa.org.uk/


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Nosocomial infections are

Infections that areacquired in hospital (48hours or more afteradmission)Approx 9% of patients willsuffer from an infectionwhilst in hospital riskincreases with length ofstaySignificant financialburden


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Impact of nosocomial infections

100,000 infections per year in UK5,000 deaths with nosocomial infections playing

a role in 15,000 othersCosts the NHS 1 billionCannot eradicate but its thought they could be

reduced by up to 30% (saving 300,000,000!)


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Why are we more likely to get an

infection in hospital?Consider 4 important factors1. The host2. The microbes3. The environment

4. Treatment


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The host

People in hospital are already sick!They may have poor general resistance toinfectionLack of immunity

Extremes of ageImmunocompromised (eg HIV+, cancerchemotherapy)


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The host

Reduced immunityDiabetes, severe burns

Poor local resistancePoor blood supply to tissues

SurgeryWounds, sutures

Medical devicesCatheters, prostheses, tubing etc


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The microbes

Nosocomial infections are often caused byopportunistic pathogens i.e. those which

do not normally cause infection in healthypeopleMay be a reflection of reduced defences ofhost or access to sites not normallycolonized by organismsMay be from normal flora or environmentAntibiotic resistance is a problem


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Opportunistic pathogens

Pseudomonas aeruginosa StaphylococciE. coli and other coliformsStreptococci and EnterococciBacteroides fragilis Candida albicans Herpes simplex virusCytomegalovirus


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The Environment

There are many different sources ofpathogens when in hospital

Own normal flora (endogenous)Infected patientsTraffic of staff and visitors

Environment e.g. fungi, Legionella Blood productsInstruments


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Biofilms

Biofilms are microbialcommunities (cities) livingattached to a solidsupport, eg catheters/ other medical devicesBiofilms are involved inup to 60% of nosocomialinfectionsAntibiotics are lesseffective at killing bacteriawhen part of a biofilm


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Treatment

There is continuous usage of antibiotics in hospitals,especially in ICUAs a result there will be a natural selection for strainsthat are antibiotic resistant infections are getting harderto treatThis has led to problems with multi-resistant bacteria,e.g. MRSA (Methicillin Resistant S. aureus ), VRE(Vancomycin Resistant E.coli ), ESBLs (ExtendedSpectrum Beta Lactamases)Antibiotic treatment can also lead to alterations in normalflora and allow pathogens cause infection, egClostridium difficile


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Bloodstream nosocomial infections

Coagulase-negative staphylococci, 40%Enterococci, 11.2%

Fungi, 9.65%Staphylococcus aureus, 9.3%Enterobacter species, 6.2%

Pseudomonads, 4.9%Acinetobacter baumannii with substantialantimicrobial resistance - Reported withincreasing frequency


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Urinary Tract Infections

Gram-negative enterics, 50%Fungi, 25%

Enterococci, 10%


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Surgical site infections

S. aureus, 20%Pseudomonads, 16%Coagulase-negative staphylococci, 15%Enterococci, fungi, Enterobacter species,and Escherichia coli, less than 10% each


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Causes of death

1. Primary bloodstream infection2. Pneumonia3. Infection of surgical site


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Infection Control

Infections may derivefrom endogenous(auto-infection) orexogenous sources(cross-infection)

We need to considerthe chain of infectionand the transmissionof an infectious agent


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Role of infection control teams

Education and trainingDevelopment and dissemination ofinfection control policyMonitoring and audit of hygieneClinical audit


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Isolation & barrier precautions

Decontamination of equipment

Prudent use of antibiotics

Hand washing

Decontamination of environment


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Surveillance

Continuousmonitoring of the

frequency anddistribution ofinfectious diseasesDetermines the mostimportant causes ofinfectious diseasesand identifies at riskgroups
http://www.hpa.org.uk/


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Conclusion

Hospital Pathogen Unhappypatients

Unhappydirector

Hospital Surveillance Happy

Patients

Happy

director

9. Infeksi Nosokomial

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