Health Care Associated Infections - Nosocomial Infections

Health Care Associated Infections - Nosocomial Infections

 

Health care associated (nosocomial) infections may cause infectious outbreaks in hospitals, extended-care facilities and communities at large and can be associated with substantial morbidity and mortality. 

Epidemiology

  • Prevalence – 5-10% of patients admitted to a U.S. hospital will develop HCAI
  • Transmission – acquisition of healthcare associated infections may occur from poor hand hygiene, prosthetic-related devices, inadequate decontamination (e.g., doorknobs, handrails, etc.)

Microorganisms

  • Staphylococcus aureus
    • >50% are methicillin resistant (MRSA)
  • Enterococcus
    • >30% are vancomycin resistant
  • Enterobacteriaceae
    • >30% are resistant to beta lactams
  • Clostridium difficile
  • Acinetobacter sp

Risk Factors

  • Presence of an indwelling catheter
    • Majority are associated with a central venous catheter
  • Prolonged hospitalization
  • Prior exposure to antibiotics
  • Prolonged ventilation

Anatomic Distribution

  • Urinary tract – 35%
  • Surgical site – 10%
  • Lung – 10%
  • Blood stream – 10%
  • Other – 10%

Clinical Presentation

  • Nonspecific – worsening clinical condition without obvious symptoms
  • Fever
  • New infiltrate on chest X-ray

Diagnosis

  • Laboratory testing
    • Specific site cultures to identify pathogen and antimicrobial resistance
    • Bacterial strain characterization – assists in infection control for the investigation of outbreaks

Prevention

  • Hand washing
  • Appropriate catheter insertion and maintenance
  • Avoidance of non-necessary antibiotics

See Also