2. Hospital acquired infection
•
are generally
Hospital Acquired Infections
known as Nosocomial Infections or Health-care
Associated Infections (HAI).
• HAI do NOT originate from patient’s original
diagnosis.
• Infections that become clinically evident, 48
Hours after hospitalization are called HAI.
• If infections are acquired during hospitalization
but become evident after discharge, they are said
to have Nosocomial Origin.
3. PATHOPHYSIOLOGY
Risk Factors for invasion of pathogens are categorized
into 3 Areas, Iatrogenic, Organizational, and patient
related.
Iatrogenic RF include, Pathogens present on Medical
Personnel hands, Invasive Procedures (e.g.
intubation, urine catheterization) and Antibiotic use and
prophylaxis.
Organizational RF include contaminated air-conditioning
and water system, and staffing and physical layout of the
facility. (e.g. Nurse-to-patient ratio, open bed distance).
Patient RF include, severity of illness, underlying
immuno-compromised state, and Length of the stay.
4. CLINICAL CAUSES
HAI are caused by Viral, Bacterial and Fungal pathogens.
During Hospital Stay, many patients acquire Rotaviral
infections and Viral Respiratory infections in Winter, (e.g.
Influenza). And Enteroviral infections in Summer.
Viruses are Responsible for up to 14% of HAI, with
Identifiable pathogens in Pediatric Patients.
Bacterial and Fungal infections are less Common.
Bacterial infections are mostly caused while placing
Intravascular lines and Urinary Catheters.
Fungal infections mostly arise from Patient’s own Flora.
5. SIGNS AND SYMPTOMS
Fever, Tachycardia, Skin Rash, General Malaise
can be Physical signs and symptoms.
Instrumentation is a most common source of HAI,
Endotracheal Tube may be Associated with
Sinusitis, Tracheitis and Pneumonia.
Intravascular Catheter may be source of Phlebitis
or line infection.
8. DIAGNOSIS
A detailed Physical Examination (PE) and Review of the
systems, Reveal the involved Organs & Systems.
Study should be centered on Infections of Bloodstream
, UTI, and Pneumonia, unless, An Obvious Source (e.g.
Surgical-Site infection) is readily Identified.
Blood cultures, Radiography, Sputum Culture, Gram
staining, Acid-Fast Staining, Fungal Cultures, and Viral
Cultures can be helpful for diagnosing HAI.
Special Imaging Techniques (e.g. Sonography, CT, or MRI)
can be helpful in Evaluating Obscure Site Infections.
9. TREATMENT
Medical Care;
Symptomatic Treatment for Shock, Hypoventilation and other Complications is
provided, Along with the Administration of
Empiric Broad Spectrum
Antimicrobials, Antifungals and Antivirals.
11. BLOOD-STREAM INFECTIONS
Broad-Spectrum Antibiotics should be
Selected according to the Microbial
Susceptibility.
Antifungals (e.g. Fluconazole) can be added
to Empiric Antibiotics in Some Cases.
Antivirals (e.g. Acyclovir) can be used for
Viral Infections.
12. PNEUMONIA
Broad-Spectrum Antibiotics are used.
Macrolide Antibiotics are indicated in
Legionellosis.
Antivirals (e.g. Amantadine, and Rimantadine)
are used for Viral Pneumonia, ( for patients over
age 1 year ).
The most Cost-Effective Prevention measure is
Vaccination against Influenza A and B.
13. URINARY TRACT
INFECTIONS ( UTI )
Indwelling Catheters should be
Removed, if Feasible.
Empiric Antibiotic and Antifungal
Therapy, based on Results of Urinalysis
and Urine Gram Staining.
14. CONSULTATIONS
Many Nosocomial Infected patients
require Expert Care from an ICU Team.
Infectious Disease Specialists, BurnCare Specialists, And Surgical Teams,
Usually are involved in the care of
These Complicated Cases.
17. VIRAL AGENTS
The Rapid spread of Respiratory
Syncytial Virus ( RSV ) among Pediatric
Patients during an RSV Epidemic,
poses a Threat to Children, Who
Require Hospitalization during Winter
Months.
19. FREQUENCY
In United States, Hospital Acquired
Infections are Estimated to occur in 5%
of all Acute Hospitalizations.
The highest Rates of infection occurs in
The Burn ICU, Neonatal ICU, and
Pediatric ICU.
Mortality Rate is about 90,000 deaths
per Year in USA due to HAI.
20. SURVEY REPORT
Among 6,290 Pediatric Patients Surveyed between
1992-1997, The Incidence of HAI were as Follows,
Bloodstream Infections, 28%
Ventilator Associated Pneumonia, 21%
Urinary Tract Infections ( UTI ), 15%
Lower Respiratory Infections, 12%
GI, Skin, Soft Tissue and CV Infections, 10%
Surgical Site Infections, 7%
ENT Infections, 7%
21. LATEST SURVEY
In Ireland, 3,992 in-patients across 16 acute and local Hospitals
were Surveyed in 2012.
Overall only 4.2% Patients had HAI.
Respiratory Infections, 27.9%
Surgical Site Infections, 18.9%
Urinary Tract Infections, 11.8%
Patients taking more than 1 Antibiotic, 10.9%
Overall Use of Antibiotics for HAI, 18.3%
