Strategies to Reduce Hospital Acquired Infections

Strategies to Reduce infirmary Acquired transmittancesREVIEW OF LITERATUREWhen we think about infirmary, integrity thing comes to our mind is Hospital is the place for cure. This revolutionary base of treating the patient roles under the same roof was considered to ease the job of healing. But out-of-pocket to lack of knowledge of sterilization and antisepsis, it turned wrong in Pre- Listerian metre lead to gangrene and death of patients which were suffering from wounds. Due to this reason a new discipline was emerged called as senics which was principally dealing with the Hospital Acquired Infection (Nosocomial Infection). Semmelwis in 1861 with the help of medical officer and students observed the association of puerperal sepsis in patients. Thus by the introduction of hand washing with chlorinated lime, he was successful to bring dramatic reduction in transmittance rate. Hospital exactd transmittance (HAI) be transmittings acquired during hospitalization, which b e not present at eh time of admission (Atata et al, 2006).According to Baveja in 2002, the term hospital acquired transmittance, hospital- associated transmission system, hospital transmittal or nosocomial transmission system(nosocomion,meaning hospital) is defined as infection developing in patients by and byward admission to the hospital ,which was neither present nor in the pensiveness period at the time of hospitalization . Such infections may snuff it evident during their checkout in the hospital or sometimes after their deplete. Due to its increased mortality and morbidity in the hospital patients these HAIs ar of signifi stinkert cause. HAIs be alike caused repayable to prolonged hospital stay which are inconvenient for the patient and constitute economic burden on health negociate (Malhotra S, et al 2014).Dancer in 1999, depicts that microorganisms which are associated with hospital acquired infection displays two essential characteristics, firstly those are the pathogens of well-established medical impressiveness and secondly they in like manner can withstand the hospital surroundings which benefits them international temperature. Thus providing an appropriate environment niche for their survival until they transfer hold to patients. Some pathogens originate from patients own flora especially those who are immunocompromised whereas early(a)s can drop dead in human tissues and thus rely upon person to person spread in order to disseminate.The patients who are immunocompromised due to underlying diseases, medical or surgical treatment, age are typically affected by nosocomial infections. In pediatric ICU, the hospital acquired infections are approximately three times higher than elsewhere in hospitals (Weistein 2006). Pathogen transferee occurs roughly unwashedly by presence of bacterial or kingdom Fungi in inanimate surfaces and equipment or between the hands of health professionals and patients (Kayabas et al., 2008). The contagious disease of microorganisms from hands of health care workers, medical equipment and surfaces which has become contaminated with a wide variety of pathogenic and nonpathogenic organisms has become a significant remainder of hospital environment infection which ultimately egresss in crosscontamination (Sehulster et al., 2003). When compared to separate hospital patients, the patients who are hospitalized in ICUs are 5-10 times more likely to acquire nosocomial infection. The run a risk of infection and the frequency of infection vary by infection site. The increasing incidence of infection is caused mainly by antibiotic-resistant pathogens leading to seriousness of hospital acquired infection (Weber 2006). Some of the parking lot human pathogens like, s bumphylococcus aureus, Acinetobacter spp, Enterococcus spp and Escherichia coli can survive for longer periods of time on the hospital surfaces or formites that can potentially transmit infectious organisms (Kramer e t al., 2006).The primary quotations of interior demeanor contamination are the microorganisms. When compared to outside air environment, the indoor air environment can potentially place patients a greater risk because enclosed spaces can confine aerosols and allow them to build up to infectious level. The relative humidity and/ or the moisture content of the materials determine that to what effect varied micro-organisms are able to grow on indoor or outdoor materials (Dhanasekaran et al., 2009). Adebolu and Vhriterhire in 2002 reported that magnitude of hospital acquired infection is hooked upon the number and type of visitors, mechanical movement within the enclosed space, character of hospital systems and level of hygienic conditions in hospital environment.Sites where infections acquired in hospitals and other healthcare facilities. To be classified as a nosocomial infection, the patient must have been admitted for reasons other than the infection. He or she must also have shown no signs of active or incubating infection. Depending on the hospital involved, 1 to 10 percent of the patients affected die as a result of the nosocomial infection (George Krucik 2014). Most of these infections can be prevented while others are unavoidable. In hospitals the contaminated surfaces are increasing the cross transmission which is shown in figure-2.Figure-2 Showing the contaminated surfaces in hospitals (source Wikipedia).These infections occurUp to 48 hours after hospital admissionUp to 3 geezerhood after dischargeUp to 30 days after an operationIn a healthcare facility when a patient was admitted for reasons other than the infection.In the unite States, it has been estimated that 9.2 out of every 100 patients acquire a nosocomial infectionPathogens Causing InfectionAccording to the CDC, the most common pathogens that cause nosocomial infections are staphylococcus aureus, genus Pseudomonas aeroginosa, and E. coli (C.Glen May hall 2004).Based in biological and clinical criteria, the national Healthcare Safety network (NHSN) has categorise into 50 infection sites under 13 major types for the control direct (W. Bereket et al., 2012). When choosing the test organisms that are clinically relevant to human pathogens, six assorted organisms are considered to be major threats. These pathogens cannot cause the most devastating illnesses precisely majority of them go out compromise with antibiotic resistant infections that are seen in most healthcare settings. These are commonly called as ESKAPE pathogens namely Enterococcus faecium, staphylococcus aureus Klebsiella pneumonia, Actinobacter baumanni, Paeudomonas aeruginosa and several species of Enterobacter. These (ESKAPE Pathogens) pose a biggest threat that physician face today. To rouse with them we definitely subscribe some new drugs and need some cooperation among patience and government to setup RD (research and development) infrastructure to fill the needs of new drugs that will t ackle tomorrows infectious diseases threats.Escherichia ColiIt is oxidase negative, Gram negative, and facultative anaerobic. It is iodine of the common organisms that are involved in Gram negative sepsis and endotoxin-induced shock. It is atomic number 53 if the leading cause of kind stream infections among all other Gram-negative pathogens. It is the fifth leading pathogen for causing seam stream infection in United States (Maazuddin t al., 2014). According to Bijay Kumar Chandra 2012, a study was concluded that Escherichia coli were most common agent found in nosocomial diarrhea. Some of the common infection caused by this organism let ins wound infection, urinary infection, meningitis in neonates, pneumonia in immunocompromised hospitalized patients and E. coli associated diarrheal disease or gastroenteritis. It also possess handsome range of virulence factors which are responsible for disease such as UTIs and gastroenteritis (Brooks GF et al., 2007).Enterococcus sppThese are gram-positive cocci typically ordered in short chains and pairs. These grow optimally at 350C on a complex media which requires carbon such as glucose, nucleic acid base and vitamin B. when enriched with sheep blood agar, it supports the growth with large and white colonies. Enterococcus species are facultative anaerobic and are considered as a part of normal flora in GU tract and gastrointestinal tract of humans. Enterococcus species have emerged as a oneness of the most important pathogen of hospital environment. The major enterococcal infections of humans are caused by two species namely Enterococcus faecalis and Enterococcus faecium.Enterococci are one of the most important hospital acquired pathogens. Isolates of Enterococcus faecium and Enterococcus faecalis are the third most prevalent pathogens worldwide. The most common infection produced by this organisms are intra-abdominal infection, urinary tract infection, pelvic infection, surgiclal wound infection, endocarditis , bacteremia, neonatal sepsis and rarely meningitis. Enterococcus faecalis is the most common cause of infection (80-90%) followed by Enterococcus faecium (10-15%) (Marothi YA et al., 2005).staphylococci aureusStaphylococcus aureus is by far the most important pathogen in the hospital environment in all the genus staphylococcus. It is non-spore forming, non-motile, gram positive, catalase positive facultative anaerobe arranged in clusters (Wahington CW et al., 2006). The indicence of nosocomial blood stream infection is more know to be caused by S. aureus (Rodrigo et al., 2012). S. aureus is rarely isolated from urinary tract infection (T.Grace et al., 1993). This S. aureus is both pathogen and commensal. Approximately 30% individuals are intermittently colonized with S. aureus whereas 20% are persistently colonized. It is one of the leading cause of hospital acquired infections. Methicillin opponent staphylococcus aureus (MRSA) are the one which causes most of the infection and it s isolation is forever increasing (S Khono et la., 2007). Infections may occur during hospital stay by streptococcus and staphylococcus species when compared to other Gram-negative bacteria.Coagulase Negative StaphylococciThe coagulase-negative staphylococci (CNS) species are widely know to cause NTs specifically bacteraemia in patients with prosthetic implants and catheter and also in patients who are immunocompromised. Staphylococcus epiermidis and Staphylococcus haemolyticus are the teo well know species and occur most common in CNS species (C.Geary et al., 1997). Coagulase negative staphylococci, Staphylococcus aureus and Enterococcus are the three most widely isolated pathogens which tends to cause blood stream infections. After hospitalization of the patient, the CNS usually takes 19 days to cause bacteraemia. The mortality rate of CNS is less when compared to some other pathogens (Aldof et al., 200). For the colonization of CNS, the main reason is its antimicrobial resistan ce. This CNS isolates is resistant to Oxacillin or nafcillin and methicillin (T Grace et al., 1993).Pseudomonas aeruginosaIt is a Gram-negative with mucoid polysaccharide capsule typically arranged in pairs. It is a well known cause of pneumonia, endophthalmitis, conjunctivitis, sepsis and also associated with high mortality rates. Potential reservoirs include humidifiers, equipment, incubators, sinks, tap water and hands of health care workers. The identification of this genus Pseudomonas aeruginosa is mainly based on simple biochemical test and colony characteristics. It colonizes the respiratory and gastrointestinal tracts of the hospitalized patients. When normal defense mechanism is impaired, the pathogenesis by this organism is initiated. Pseudomonas aeruginosa attaches and colonizes the mucous or skin and invades locally to produce systemic disease. This form is mediated by different virulent factors like enzymes (proteases, elastases, phospholipase C), Pili and toxins (end otoxin A). P. aeruginosa produces infection such as blue-green pus, urinary tract infection, meningitis, and necrotizing pneumonia (Contreras GA et al., 2008). Many modern studies showed that, the antibiotic resistance among the gram-negative bacteria is increasing especially of pseudomonas aeruginosa. The rate of resistance towards ceftazidime and imipenem by Pseudomonas aeruginosa was increasing dramatically. barroom of InfectionThere are number of simple care practices that can reduce the probability of developing a Hospital acquired infection. Some of them include sterilization of resuscitation bags and masks, elimination of overcrowding, decreasing number of heal sticks, use of unfertilized suctioning technique, careful preparation and storage of infants formulas, using single dose memorial tablet of medications and avoiding drugs associated with increased risk of nosocomial infection.Infection Control CommitteeThe infection control citizens committee is a board which deals with the preventionof hospital acquired infections. It involves multidisciplinary personals like p disparageacists, physicians, clinical microbiologists and others. This committee works on co-operation, information sharing principles and inputs. It has many different tasks to perform for the eradication and prevention of hospital acquired infection. It has to review and approve the surveillance data when needed. It has to examine and encourage the infection control practices and provide fit cater training in infection control safety. It also need to assess the new devices used in the hoapital for their risk in violating infection control stratergies and slso to communicate and co-operate with the hospital control committees for information. According to infection committee statistics, the infection rate were increased from 13.8- 22.1 per 1000 catheter days (Jeffery et al., 2005). Therefore infection control committee plays a key role in preventing the nosocomial infection.Hand Hy gieneHand hygiene has been considered to be the most important tool in nosocomial infections control. One of the significant contributors to the outbreaks of this hospital environment infection is failure to perform appropriate hand hygiene. Resident and passing(a) microorganisms are known to be the natural microflora of the skin of hands. The resident physician microorganisms survive and multiply on skin and does not cause any harm to human flora whereas transient microorganisms represent recent contamination of hands which is acquired from colonized or infected patients/clients or contaminated environment or equipment. These transient microorganisms are not isolated consistently from most of the persons. When compared to resident microorganisms, the transient microorganisms which are found on the hands of health care personnel will become as a primary source of infections. Gram negative coliforms and Staphylococcus aureus has been known to be the most common transient microorgan isms (Sarmad et al., 2009). Appropriate hand washing results in reduced incidence of both nosocomial and community infection (Kampf et al., 2004).An estimated 40 percent of nosocomial infections are caused by poor hand hygiene (WHO). Hospital staff can significantly reduce the number of cases with regular hand washing (Figure-8). They should also wear protective garments and gloves when working with patients (James Chin 2000).