By EssayAbd Alla Ibrahim Ahmed ShadyResident in Clinical Pathology DepartmentFaculty of Medicine-Mansoura University

SupervisorsProf.Dr.Lotfy Abdel-Naby Mahmoud

Prof. of Clinical PathologyFaculty of Medicine-Mansoura University

Dr.Wafaa Mohamed Mohamed ElemshatyAssociate Professor of Clinical Pathology

Faculty of Medicine -Mansoura University

Summary & Conclusion

Page 112

HAIs

Nosocomial infection (NI) or hospital acquired infection (HAI) can

be defined as an infection acquired in hospital by a patient who was

admitted for a reason other than that infection . This includes infections

acquired in the hospital but appearing after discharge, and also

occupational infections among staff of the facility .

Among the more industrialized and developed nations, the World

Health Organization found 8.7 % of all hospitalized patients to have

nosocomial infections. While HAI are an important health care concern

worldwide , they are especially troublesome in developing nations.

Nosocomial infection rates range from 1% in Northern Europe, especially

the Netherlands, which introduced extremely aggressive infection control

measures, to 40% in some parts of Asia, South America, and sub-Saharan

Africa .

Nosocomial infections (NI) contribute significantly to morbidity and

mortality, as well as to excess costs for hospitalized patients. According

to the available evidence, the impact of Health care associated infection

(HCAI) implies prolonged hospital stay, long-term disability, increased

resistance of microorganisms to antimicrobials, massive additional

financial burden for health systems, high costs for patients and their

family, and unnecessary deaths .The increased length of stay for infected

patients is the greatest contributor to cost .

Direct transmission from another host (healthy or ill) or from an

environmental reservoir or surface by direct contact or direct large-

droplet spread of infectious secretions is the simplest route of agent

spread. Examples of direct-contact transmission routes include kissing

(infectious mononucleosis), shaking hands [common cold (rhinovirus)],

or other skin contact (e.g., contamination of a wound with Staphylococci

HAIs

or Enterococcus spp. during trauma, surgical procedures or dressing

changes) .

Potentially pathogenic micro-organisms can colonize environmental

surfaces in the hospital environment and so act as a source for outbreaks

of nosocomial infection. Studies have presented evidence that the

majority of Gram-positive bacteria, including Staphylococcus aureus and

Enterococcus spp., are able to survive for months on dry surfaces. Gram-

negative bacteria, such as Klebsiella spp., Escherichia coli, and

Acinetobacter spp. can also survive for a relatively long time on

inanimate surfaces, while common fungi such as Candida spp. have

similar properties. Environmental conditions such as low temperature or

humidity appear to be crucial for the persistence of these organisms on

inanimate surfaces .

The highest prevalence of HAI occurred in ICUs and acute care

surgical and orthopedic settings. Old age, multiple morbidities or disease

severity, and decreased immunity increase patient susceptibility. Poor

infection control measures are an overall risk factor as are certain

invasive procedures including central venous or urinary catheter

placements. Antimicrobial misuse is associated with drug-resistant HAI .

Urinary tract, respiratory tract, surgical site, skin and bloodstream

infections are currently recognized as the major nosocomial infections.

However, it is becoming increasingly clear that gastroenteritis outbreaks

are also a major burden on the health services of industrialized nations .

Analysis of nosocomial pathogens has relied on a comparison of

phenotypic characteristics such as biotypes, serotypes, bacteriophage or

bacteriocin types, and antimicrobial susceptibility profiles. This approach

has begun to change over the past 2 decades, with the development and

implementation of new technologies based on DNA, or molecular

analysis. These DNA-based molecular methodologies, include pulsed-

HAIs

field gel electrophoresis (PFGE) and other restriction-based methods,

plasmid analysis, and PCR-based typing methods.

There are a number important attributes for successful typing

schemes: the methodologies should be standardized, sensitive, specific,

objective, and subject to critical appraisal. All typing systems can be

characterized in terms of typeability, reproducibility, discriminatory

power, ease of performance and interpretation, and cost (in terms of time

and money) . The use of strain typing in infection control decisions is

based on several assumptions: (i) isolates associated with the outbreak are

recent progeny of a single (common) precursor or clone, (ii) such isolates

will have the same genotype, and (iii) epidemiologically unrelated

isolates will have different genotypes .

Molecular techniques can be very effective in tracing the spread of

nososcomial infections due to genetically related pathogens, which would

allow infection control personnel to more rationally identify potential

sources of pathogens and aid infectious disease physicians in the

development of treatment regimens to manage patients affected by related

organisms. Therefore, the use of molecular tests is essential in many

circumstances for establishing disease epidemiology, which leads to

improved patient health and economic benefits through the reduction of

nosocomial infections .

Infection control (IC) activities are still developing in many health

institutions in Egypt. The national infection control program was started

in 2003 by the Ministry of Health and Population. The national IC

strategic plan entailed instituting IC programs in all hospitals in Egypt by

2010 .

The components of an infection control program are drawn from

regulatory requirements, current nursing home practices, and

HAIs

extrapolations from hospital programs. The limited resources affect the

type and extent of programs developed . The infection control program

should include some form of surveillance for infections, an epidemic

control program, education of employees in infection control methods,

policy and procedure formation and review, an employee health program,

a resident health program, and monitoring of resident care practices. The

program also may be involved in quality improvement, patient safety,

environmental review, antibiotic monitoring, product review and

evaluation, resident safety, prepareness planning, and reporting of

diseases to public health authorities .

HAIs

Conclusion

There are issues of concern about the emergence of nosocomial

infections, and the increase in morbidity, mortality, and costs

associated with these infections will drive the need for refinement

of molecular approaches to aid in the diagnosis and epidemiologic

analysis of nosocomial infections.

The evaluation of hospital-associated infections will continue to

rely on clinical infection surveillance as the first step to

understanding disease epidemiology and management of

infections.

Molecular testing will continue to be an essential tool, for tracing

of the source of infection .

Outbreak Control—A system for detection, investigation, and

control of epidemic infectious diseases is an important component

of infection control program.

Isolation—An isolation and precautions system to reduce the risk

of transmission of infectious agents

Continuing education in infection prevention and control ,Resident

health program , Employee health program , Disease reporting to

public health authorities , Facility management, including

environmental control, waste management, product evaluation and

disinfection, sterilization and asepsis are integrated component of

infection control program.

HAIs

Recommendations

Many non-pharmacological interventions have been shown to

significantly reduce rates of HAIs, but are often overlooked in clinical

practice so this article recommend ;

Proper hand washing

Better nutrition

Housing patients in separate rooms

Sufficient numbers of nursing staff

Coated urinary and CVCs

Lower overall antibiotic use which will reduce risk of antibiotic-

resistant organisms and improve efficacy of antibiotics given to

patients who acquire nosocomial infections.

Molecular technique can be very effective in tracing the spread of

nosocomial infection .