9.

Nosocomial
Infections
Tiana Milanda
Nosocomial infections are…
 Infections that are
acquired in hospital (48
hours or more after
admission)
 Approx 9% of patients will
suffer from an infection
whilst in hospital – risk
increases with length of
stay
 Significant financial
burden
Impact of nosocomial infections

 100,000 infections per year in UK

 5,000 deaths with nosocomial infections playing
a role in 15,000 others
 Costs the NHS £1 billion
 Cannot eradicate but it’s thought they could be
reduced by up to 30% (saving £300,000,000!)
Why are we more likely to get an
infection in hospital?
Consider 4 important factors…
1. The host
2. The microbes
3. The environment
4. Treatment
 The host
 People in hospital are already sick!
 They may have poor general resistance to
infection
 Lack of immunity
 Extremesof age
 Immunocompromised (eg HIV+, cancer
chemotherapy)
 The host
 Reduced immunity
 Diabetes, severe burns
 Poor local resistance
 Poor blood supply to tissues
 Surgery
 Wounds, sutures
 Medical devices
 Catheters, prostheses, tubing etc
 The microbes
 Nosocomial infections are often caused by
opportunistic pathogens i.e. those which
do not normally cause infection in healthy
people
 May be a reflection of reduced defences of
host or access to sites not normally
colonized by organisms
 May be from normal flora or environment
 Antibiotic resistance is a problem
 Opportunistic pathogens
 Pseudomonas aeruginosa
 Staphylococci
 E. coli and other coliforms
 Streptococci and Enterococci
 Bacteroides fragilis
 Candida albicans
 Herpes simplex virus
 Cytomegalovirus
 The Environment
 There are many different sources of
pathogens when in hospital
 Own normal flora (endogenous)
 Infected patients
 Traffic of staff and visitors
 Environment e.g. fungi, Legionella
 Blood products
 Instruments
 Biofilms
 Biofilms are microbial
communities (cities) living
attached to a solid
support, eg catheters/
other medical devices
 Biofilms are involved in
up to 60% of nosocomial
infections
 Antibiotics are less
effective at killing bacteria
when part of a biofilm
 Treatment
 There is continuous usage of antibiotics in hospitals,
especially in ICU
 As a result there will be a natural selection for strains
that are antibiotic resistant – infections are getting harder
to treat
 This has led to problems with multi-resistant bacteria,
e.g. MRSA (Methicillin Resistant S. aureus), VRE
(Vancomycin Resistant E.coli), ESBLs (Extended
Spectrum Beta Lactamases)
 Antibiotic treatment can also lead to alterations in normal
flora and allow pathogens cause infection, eg
Clostridium difficile
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 substantial
antimicrobial resistance - Reported with
increasing frequency
 Urinary Tract Infections
 Gram-negative enterics, 50%
 Fungi,25%
 Enterococci, 10%
 Surgical site infections
 S. aureus, 20%
 Pseudomonads, 16%
 Coagulase-negative staphylococci, 15%
 Enterococci, fungi, Enterobacter species,
and Escherichia coli, less than 10% each
 Causes of death
1. Primary bloodstream infection
2. Pneumonia
3. Infection of surgical site
 Infection Control
 Infections may derive
from endogenous
(auto-infection) or
exogenous sources
(cross-infection)

 We need to consider
the chain of infection
and the transmission
of an infectious agent
 Role of infection control teams

 Education and training

 Development and dissemination of
infection control policy
 Monitoring and audit of hygiene
 Clinical audit
Isolation & barrier precautions

Decontamination of equipment

Prudent use of antibiotics

Hand washing

Decontamination of environment
 Surveillance
 Continuous
monitoring of the
frequency and
distribution of
infectious diseases
 Determines the most
important causes of
infectious diseases
and identifies at risk
groups
 Conclusion

Hospital Pathogen Unhappy Unhappy

patients director

Hospital Surveillance Happy Happy

Patients director