nosocomial infection


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infection

 [in-fek´shun]
invasion and multiplication of microorganisms in body tissues, as in an infectious disease. The infectious process is similar to a circular chain with each link representing one of the factors involved in the process. An infectious disease occurs only if each link is present and in proper sequence. These links are (1) the causative agent, which must be of sufficient number and virulence to destroy normal tissue; (2) reservoirs in which the organism can thrive and reproduce; for example, body tissues and the wastes of humans, animals, and insects, and contaminated food and water; (3) a portal through which the pathogen can leave the host, such as the respiratory tract or intestinal tract; (4) a mode of transfer, such as the hands, air currents, vectors, fomites, or other means by which the pathogens can be moved from one place or person to another; and (5) a portal of entry through which the pathogens can enter the body of (6) a susceptible host. Open wounds and the respiratory, intestinal, and reproductive tracts are examples of portals of entry. The host must be susceptible to the disease, not having any immunity to it, or lacking adequate resistance to overcome the invasion by the pathogens. The body responds to the invasion of causative organisms by the formation of antibodies and by a series of physiologic changes known as inflammation.

The spectrum of infectious agents changes with the passage of time and the introduction of drugs and chemicals designed to destroy them. The advent of antibiotics and the resultant development of resistant strains of bacteria have introduced new types of pathogens little known or not previously thought to be significantly dangerous to man. A few decades ago, gram-positive organisms were the most common infectious agents. Today the gram-negative microorganisms, and Proteus, Pseudomonas, and Serratia are particularly troublesome, especially in the development of hospital-acquired infections. It is predicted that in future decades other lesser known pathogens and new strains of bacteria and viruses will emerge as common causes of infections.

The development of resistant strains of pathogens can be limited by the judicious use of antibiotics. This requires culturing and sensitivity testing for a specific antibiotic to which the identified causative organism has been found to be sensitive. If the patient has been receiving a broad-spectrum antibiotic prior to culture and sensitivity testing, this should be discontinued as soon as the specific antibiotic for the organism has been found. It would be helpful, too, if the general public understood that antibiotics are not cure-alls and that there is danger in using them indiscriminately. In some instances an antibiotic can upset the normal flora of the body, thus compromising the body's natural resistance and making it more susceptible to a second infection (superinfection) by a microorganism resistant to the antibiotic.

Although antibacterials have greatly reduced mortality and morbidity rates for many infectious diseases, the ultimate outcome of an infectious process depends on the effectiveness of the host's immune responses. The antibacterial drugs provide a holding action, keeping the growth and reproduction of the infectious agent in check until the interaction between the organism and the immune bodies of the host can subdue the invaders.

Intracellular infectious agents include viruses, mycobacteria, Brucella, Salmonella, and many others. Infections of this type are overcome primarily by T lymphocytes and their products, which are the components of cell-mediated immunity. Extracellular infectious agents live outside the cell; these include species of Streptococcus and Haemophilus. These microorganisms have a carbohydrate capsule that acts as an antigen to stimulate the production of antibody, an essential component of humoral immunity.

Infection may be transmitted by direct contact, indirect contact, or vectors. Direct contact may be with body excreta such as urine, feces, or mucus, or with drainage from an open sore, ulcer, or wound. Indirect contact refers to transmission via inanimate objects such as bed linens, bedpans, drinking glasses, or eating utensils. Vectors are flies, mosquitoes, or other insects capable of harboring and spreading the infectious agent.
Patient Care. Major goals in the care of patients with threatening, suspected, or diagnosed infectious disease include the following: (1) prevent the spread of infection, (2) provide physiologic support to enhance the patient's natural curative powers and resources for warding off or recovering from an infection, (3) provide psychologic support, and (4) prepare the patient for self-care if this is feasible.

Special precautions for prevention of the spread of infection can vary from strict isolation of the patient and such measures as wearing gloves, mask, or gown to simply using care when handling infective material. No matter what the diagnosis or status of the patient, handwashing before and after each contact is imperative.

Unrecognized or subclinical infections pose a threat because many infectious agents can be transmitted when symptoms are either mild or totally absent.

In the care of patients for whom special precautions have not been assigned, gloves are indicated whenever there is direct contact with blood, wound or lesion drainage, urine, stool, or oral secretions. Gowns are worn over the clothing whenever there is copious drainage and the possibility that one's clothes could become soiled with infective material.

When a definitive diagnosis of an infectious disease has been made and special precautions are ordered, it is imperative that everyone having contact with the patient adhere to the rules. Family members and visitors will need instruction in the proper techniques and the reason they are necessary.

Physiologic support entails bolstering the patient's external and internal defense mechanisms. Integrity of the skin is preserved. Daily bathing is avoided if it dries the skin and predisposes it to irritation and cracking. Gentle washing and thorough drying are necessary in areas where two skin surfaces touch, for example, in the groin and genital area, under heavy breasts, and in the axillae. Lotions and emollients are used not only to keep the skin soft but also to stimulate circulation. Measures are taken to prevent pressure ulcers from prolonged pressure and ischemia. Mouth care is given on a systematic basis to assure a healthy oral mucosa.

The total fluid intake should not be less than 2000 ml every 24 hours. Cellular dehydration can work against adequate transport of nutrients and elimination of wastes. Maintenance of an acid urine is important when urinary tract infections are likely as when the patient is immobilized or has an indwelling urinary catheter. This can be accomplished by administering vitamin C daily. Nutritional needs are met by whatever means necessary, and may require supplemental oral feedings or total parenteral nutrition. The patient will also need adequate rest and freedom from discomfort. This may necessitate teaching her or him relaxation techniques, planning for periods of uninterrupted rest, and proper use of noninvasive comfort measures, as well as judicious use of analgesic drugs.

Having an infectious disease can alter patients' self-image, making them feel self-conscious about the stigma of being infectious or “dirty,” or making them feel guilty about the danger they could pose to others. Social isolation and loneliness are also potential problems for the patient with an infectious disease.

Patients also can become discouraged because some infections tend to recur or to involve other parts of the body if they are not effectively eradicated. It is important that they know about the nature of their illness, the purposes and results of diagnostic tests, and the expected effect of medications and treatments.

Patient education should also include information about the ways in which a particular infection can be transmitted, proper handwashing techniques, approved disinfectants to use at home, methods for handling and disposing of contaminated articles, and any other special precautions that are indicated. If patients are to continue taking antibacterials at home, they are cautioned not to stop taking any prescribed medication even if symptoms abate and they feel better.
Chain of infection.
Stages of infection. Each period varies with different pathogens and different diseases.
airborne infection infection by inhalation of organisms suspended in air on water droplets or dust particles.
infection control
1. in the nursing interventions classification, a nursing intervention defined as minimizing the acquisition and transmission of infectious agents.
2. the use of surveillance, investigation, and compilation of statistical data in order to reduce the spread of infection, particularly nosocomial infections.

Practitioners in infection control are often nurses employed by hospitals. They have titles such as Infection Control Officer and Infection Control Nurse, and they function as liaisons between staff nurses, physicians, department heads, the infection control committee, and the local health department. Such practitioners also assume some responsibility for teaching patients and their families, as well as employees of the hospital.

The centers for disease control and prevention is an excellent source of information related to infection control; their web site is http://www.cdc.gov. Another source of help and support for infection control practitioners is the Association for Practitioners in Infection Control and Epidemiology, 1275 K St., NW, Suite 100, Washington, DC 20005-4006.
cross infection infection transmitted between patients infected with different pathogenic microorganisms.
droplet infection infection due to inhalation of respiratory pathogens suspended on liquid particles exhaled by someone already infected.
dustborne infection infection by inhalation of pathogens that have become affixed to particles of dust.
endogenous infection that due to reactivation of organisms present in a dormant focus, as occurs, for example, in tuberculosis.
exogenous infection that caused by organisms not normally present in the body but which have gained entrance from the environment.
mixed infection infection with more than one kind of organism at the same time.
nosocomial infection see nosocomial infection.
opportunistic infection infection by an organism that does not ordinarily cause disease but becomes pathogenic under certain circumstances, as when the patient is immunocompromised.
pyogenic infection infection by pus-producing organisms, most commonly species of Staphylococcus or Streptococcus.
risk for infection a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which an individual is at increased risk for being invaded by pathogenic organisms.
secondary infection infection by a pathogen following an infection by a pathogen of another kind.
subclinical infection infection associated with no detectable symptoms but caused by microorganisms capable of producing easily recognizable diseases, such as poliomyelitis or mumps; this may occur in an early stage of the infection, with signs and symptoms appearing later during the course of the infection, or the symptoms and signs may never appear. It is detected by the production of antibody, or by delayed hypersensitivity exhibited in a skin test reaction to such antigens as tuberculoprotein.
terminal infection an acute infection occurring near the end of a disease and often causing death.
urinary tract infection see urinary tract infection.
vector-borne infection infection caused by microorganisms transmitted from one host to another by a carrier, such as a mosquito, louse, fly, or tick.
waterborne infection infection by microorganisms transmitted in water.

nosocomial

 [nos″o-ko´me-al]
pertaining to or originating in a hospital.
nosocomial infection an infection acquired during hospitalization. More than one third of all such infections are easily preventable without sophisticated and expensive equipment or procedures. In most cases washing the hands after each patient contact is the most effective way to prevent the spread of infections. Other measures include basic cleanliness and sanitation in handling and storing of equipment, and particularly careful handling of urinary catheters and drainage bags. In addition to the urinary tract, other common sites of infection are the respiratory tract and surgical wounds. The Joint Commission on the Accreditation of Health Care Organizations sets specific standards for in-house control of infection. See also infection control.

nosocomial infection

an infection acquired at least 72 hours after hospitalization, often caused by Candida albicans, Escherichia coli, hepatitis viruses, herpes zoster virus, Pseudomonas, or Staphylococcus. Also called hospital-acquired infection.

healthcare-associated infection

Any infection by any pathogen acquired as a consequence of a healthcare intervention or which is acquired by a healthcare worker in the course of his or her duties.

The Health Protection Agency (UK) assists infection control and control of antimicrobial resistance in healthcare settings by monitoring infections with mandatory and voluntary surveillance schemes for methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile infection (C diff/CDI), glycopeptide-resistant enterococci (GRE), bacteraemia, and surgical site infections (of which some orthopaedic categories are mandatory) via the surgical site infection surveillance scheme (SSISS). Other healthcare-associated infections, including antimicrobial (antibiotic) resistant micro-organisms, are also monitored via a voluntary microbiology laboratory reporting system.

nosocomial infection

Cross infection Epidemiology An infection that begins ≥ 3 days after admission to a hospital or other healthcare facility; the microorganisms that cause nosocomial infection are a function of
1. The underlying disease: burns are associated with Pseudomonas aeruginosa, leukemia with enterobacteriaceae due to indwelling vascular accesses, DM with anaerobes, GNRs, and post-operative wounds with S aureus and.
2. The organ system involved, often facilitated by an indwelling catheter, tracheostomy or other device; NIs affect 2-4 million Pts/yr–US at a cost of ± $4.5 x 109 Sites Urinary 39%, lower respiratory 18%, surgical wound 17%, blood 7.5%, other 19%.

nosocomial infection

an infection acquired during the course of a stay in hospital and not present when the patient was admitted.

Nosocomial infection

An infection that can be acquired in a hospital. ABPA is a nosocomial infection.

infection

1. invasion and multiplication of microorganisms in body tissues, especially that causing local cellular injury due to competitive metabolism, toxins, intracellular replication or antigen-antibody response.
2. an infectious disease.

acute infection
short duration, of the order of several days.
airborne infection
infection by inhalation of organisms suspended in air on water droplets or dust particles.
arrested infection
restrained in its development by a capsule or adhesion but still containing infective material.
chronic infection
long duration, of the order of weeks or months.
infection control
the utilization of procedures and techniques in the surveillance, investigation and compilation of statistical data in order to reduce the spread of infection, particularly nosocomial infections.
cross infection
infection transmitted between patients infected with different pathogenic microorganisms.
droplet infection
infection due to inhalation of respiratory pathogens suspended on liquid particles exhaled by an animal that is already infected.
dustborne infection
infection by inhalation of pathogens that have become affixed to particles of dust.
endogenous infection
that due to reactivation of organisms present in a dormant focus, as occurs in tuberculosis, etc.
exogenous infection
that caused by organisms not normally present in the body but which have gained entrance from the environment.
general infection
see systemic infection (below).
latent infection
the animal is infected but there are no clinical signs nor infectious agent detectable in discharges.
local infection
has a common syndrome of varying degree, depending on the site and acuteness of the lesion and the type of microorganisms present, including fever, toxemia and leukocytosis with a left shift. The specific individual signs relate to the location of the lesion and the pressure it exerts on nearby organs. See also abscess, cellulitis, phlegmon, osteomyelitis, omphalophlebitis, empyema, adenitis, metritis, mastitis, periphlebitis.
masked infection
an infection is known to occur but the infectious agent cannot be demonstrated, e.g. the sheep-associated malignant catarrhal fever virus.
mixed infection
infection with more than one kind of organism at the same time.
nosocomial infection
pertaining to or acquired in hospital.
opportunistic infection
infection with organisms which are normally harmless but become pathogenic when the body's defense mechanisms are compromised.
patent infection
one in which the infectious agent can be demonstrated in discharges of the patient.
persistent infection
a characteristic of some viruses, particularly herpesviruses and lentiviruses, in which there may be long-lasting or life-long latent infections, with asymptomatic periods and recurring acute episodes of clinical disease (herpesviruses) or onset of severe clinical disease (lentiviruses).
pyogenic infection
infection by pus-producing organisms.
secondary infection
infection by a pathogen following an infection by a pathogen of another kind.
infection stones
see struvite urolith.
subclinical infection
infection associated with no detectable signs but caused by microorganisms capable of producing easily recognizable diseases, such as mastitis or brucellosis; often detected by the production of antibody, or by delayed hypersensitivity exhibited in a skin test reaction to such antigens as tuberculoprotein.
super infection
a second infection occurs in an animal which is already experiencing an infection with another agent.
systemic infection
the infection is widespread throughout the body and must be assumed to be in all organs.
terminal infection
an acute infection occurring near the end of a disease and often causing death.
transmissible infection
an infection capable of being transmitted from one animal to another. Called also contagious.
waterborne infection
infection by microorganisms transmitted in water.
References in periodicals archive ?
The incidence density rate of nosocomial infections was calculated by dividing the total number of nosocomial infections by the total patient-days (x1000) during the defined period of time.
Results: Nosocomial infections were defined according to the CDC criteria.
National Nosocomial Infections Surveillance (NNIS) system report: data summary from January 1990-May 1999, issued June 1999.
Other studies also showed that nosocomial infection caused by P.
Isolates were collected from a tertiary care medical center in Beirut, Lebanon, during a 1-year period from patients suffering from otitis externa (community acquired) and nosocomial infections.
On the Cher hand, the increase in the years 2001 and 2002 can be attributed to the resignation of experienced staff, especially the nurses in order to work in state hospitals, and employing new, inexperienced staff, who were later on educated about hospital hygiene and nosocomial infections.
In Japan, the extended costs of hospital infections associated with post-surgical and nosocomial infection in a hospital with about 1,000 beds were reviewed by Kimura (20).
Total nosocomial infections 45 Total patient days or discharges for report period 2,152 Nosocomial infection rate (%) for this report period 2.
In the three most recent years--1999-2001--an average of 10 patients per 100 admissions developed nosocomial infections, costing the hospitals an estimated $29 million.
Fore Pharma's latest report 'Global Nosocomial Infection Drug Pipeline Capsule - 2012 Update' provides most up-to-date information on key Research and Development activities (R&D) in the global Nosocomial Infection market.