Table of Contents
Nosocomial infections are infections that are a result of treatment in a hospital or a healthcare unit. These infections are commonly seen two or three days after admission. Therefore those that are not clinically apparent but incubate at admission are excluded. It may also be within 30 days after discharge. There have been changes in health care delivery and due to these changes, nosocomial infections may also include health care associated infections (Weinstein, 1991).These infections are also called hospital-acquired infection. Studies in the passed have reported that nosocomial infections account for at least five percent of patients hospitalized. In the United States over 1.5 million infections contributed to more than 90,000 deaths each year. In Europe the deaths estimated are 20000 each year. However, the case is more seen in the category of Gram-negative infections, which accounts for an estimated two thirds of the total cases reported.
Nosocomial infections are commonly transmitted as a result of negligence of hygiene by some hospital personnel. Medical officials move from one patient to another. Thus in a situation where they do not maintain high hygiene standards, the officials themselves serve as means for spreading dangerous pathogens. Moreover, body’s natural protective barriers of the patients are bypassed by some medical procedures such as surgeries and injections. Hence with such hygienic negligence in our hospitals and other healthcare units, nosocomial infections become the order of the day and my cause severe cases of infections of the urinary tract, pneumonia and bloodstream or other parts of the body.
Causes of nosocomial infections
Nosocomial infections are caused by various factors. Some of the common ones include improper hygiene. Patients can get infections of diseases such methicillin resistant staphylococcus aureus (MRSA), respiratory illnesses and pneumonia from hospital staff and their visitors (Webster, 1998). Also doctors and nurses who do not practice basic hygienic measures such as washing hands before attending to patients may spread MRSA among them. Other infections are due to injections. There are cases where some hospital staffs do not give injections properly. Infections like HIV and hepatitis B can be as a result of contaminated blood due to sharing syringes and needles between patients when injecting medication into their intravenous lines. Nosocomial infections may also be as a result of torn or improperly bandaged incisions during surgeries. These incisions get contaminated with bacteria from the skin or the surrounding environment. Similarly, bacteria can be introduced into the patient’s body by contaminated surgical equipment. Also breathing machines such as ventilators can spread infections like pneumonia among patients using them. Staffs that do not use the proper infection control measures tend to contaminate these machines with germs. There are also cases where people on breathing machines are unable to cough and expel germs from their lungs. This can be another cause. In addition, urinary track infections can be due to faulty removal of urine from patients who are not able to use the toilet. In most cases catheters are the common cause for such cases. These catheters cause these infections when they become contaminated with bacteria by medical staff during insertion or are not properly maintained while in use (Webster, 1998). Another cause of nosocomial infections is the organ transplant. Illnesses such hepatitis B, hepatitis C, HIV and syphilis can be spread through bone and tissue grafts that may result from blood transfusions, skin and organ transplants. However such cases have become less common today due to factors such as improved technology. Many protective measures have been put in place to cut on these risks.
Prevention of nosocomial infections
Several measures can be put in place to prevent the spread of nosocomial infections. However the most important measure to reduce these risks of transmitting skin microorganisms between patients is hand washing. Medical staffs are advised to thoroughly and promptly wash hands after attending to one patient where they may have come into contact with excretions, blood or other body fluids, or equipment with these fluids. This is a very important measure of nosocomial infection control. Even though it appears as a simple process, it is mostly overlooked or done incorrectly (Hiramatsu, Aritaka, Hanaki, Kawasaki, Hosoda & Hori, 1997). As a result practitioners and visitors should be continuously reminded on the advantages of proper washing of hands. This can be achieved through use of signals on responsible hand washing. In addition to hand washing, gloves are very important since they prevent gross contamination of the hands in cases where they come into contact with blood, other body fluids and mucous membranes. They offer a protective barrier, in cases of exposure to blood borne pathogens. Similarly there is emphasis on surface sanitation. In health care environments, this is a vital component of infection control cycle. In cases concerning influenza, gastro enteritis and MRSA modern methods such as NAV-CO2 have been effective. Alcohol has been shown to be ineffective in endospore-forming bacteria such as Clostridium difficile and thus hydrogen peroxide is appropriate in this case. In addition, use of hydrogen peroxide vapor reduces infection rates and risks of acquisition. Some causes of infections are agent and host factors that are hard to control. In such cases isolation precautions can be designed to prevent transmission in common routes in health centers. For example a patient suffering from an air borne disease can be put in a separate room so as to control the spread of the disease. Another prevention measure is putting on protective clothing. An apron reduces the risk of infection as it covers most parts of the body. However with all this said, strategically implementing QA/QC measures in health care sectors and evidence-based management are the most effective technique of controlling nosocomial infections. For example, in cases of diseases such as ventilator-associated pneumonia and hospital-acquired pneumonia, the management of the health center should pay more emphasis on the control and monitoring of the quality of the hospital’s indoor air (Hiramatsu, Aritaka, Hanaki, Kawasaki, Hosoda, & Hori, 1997).
A Review of the Literature
Robert A Weinstein (Cook County Hospital & Rush Medical College, Chicago, Illinois, USA)
In his research paper Robert Weinstein begins by a comparison of the cases of nosocomial infections now and in the past. Even though he agrees that there has been a reduction in number of cases, he goes a head to state that the numbers of death are still high. According to him, a study carried out in the United States estimated that in 1995, these infections cost more than $4 billion and contributed to more than 80,000 deaths. I concur with these findings. Poor hygiene standards in most health centers have contributed to these high figures. There have been cases of medical practitioners who overlook basic hygienic measures such as a proper hand washing when attending to patients. There are cases where some medical services like injections are not administered in a proper manner. This is due to unqualified medical expertise especially in small health care centers. I think the research’s large numbers of deaths from nosocomial infections is due to such factors. I also agree with Weinstein that there is an approximately one third reduction in rate of infections in hospitals with the four basic infection control components which include an infection control practitioner for every 250 beds/patient, an effective hospital epidemiologist, effective control efforts and an active surveillance mechanism. As a result I think these infections can be controlled to a higher percentage if all hospitals and health centers could employ these basic components.
Robert A Weinstein also states that there has been an increase in viral infections. Most nosocomial infections in Semmelweis's era were due to group A streptococci. In 1990 to 1996, 34% of nosocomial infections were due to the most common gram-positive pathogens. While the gram-negative pathogens such P. aeruginosa, Enterobacter spp., Klebsiella pneumoniae and Escherichia coli, accounted for 32%. With this trend I agree with Weinstein report. There has also been an increase in the blood transmitted infections hence increase in the cases of herpes viruses HIV-infections.
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On the other hand Weinstein’s reveals that there is a higher rate of infection among the intensive care unit (ICU) patients. This is evident in our hospitals today. I think the increasingly aggressive medical and therapeutic interventions, including modern medical advancements like organ transplantations and implanted foreign bodies have created a cohort of particularly vulnerable persons (Fridkin, Welbel & Weinstein, 1997). In most cases, patients affected by nosocomial infections are those immunocompromised by underlying diseases, age or medical/surgical treatments. More cases of bloodstream infections coagulase-negative staphylococci occur in the ICU because it is in these areas that patients with invasive vascular catheters and monitoring devices could come into contact with these bloodstream infections. Due to these factors, I concur with Weinstein’s estimation that infection rates in adult and pediatric ICUs are three times higher than elsewhere in hospitals.
In conclusion, Robert A Weinstein’s research paper portrays a comprehensive research. It addresses changes in the medical fraternity that have affected nosocomial infections in one way or another. It also shows the significant impact of advancement in technology in medical and health care in relation to nosocomial infections.
Jessica Lietz presents her research on nosocomial infections putting more emphasis on the causes and prevention measures of the infections. She introduces her research stating that there are higher rates of infections in public hospitals as compared to private health centers. I concur with her findings on the basis of the difference in management in the two setups. Private centers tend to be managed in a better manner than public centers. This is because private hospitals are business oriented and the management is always doing all it can to better the institution so as to cope with the high market competition. As a result of this emphasis on good management, medical staff tends to adhere to rules and regulations. Hence the hygiene standards of these institutions are always high. Similarly there is close supervision of staff, another factor that advantages private hospitals over public ones. For the public medical institutions, the case is not the same. In most centers hygiene is not to standard. This may be due to several reasons. There is no close supervision of staff and same take this advantage of lack of a questioning authority to bypass basic hygiene measures. Similarly, public setups are prone to the effects of political differences between the staffs. Cases of corruption tend to take root in such centers and as a result, unqualified medical personnel find themselves in these institutions.
In her take on the causes of nosocomial infections, she states lack of adequate public education on the infections as a key factor in their spread. I think the point holds water since there are same cases of transmission of these infections due to ignorance. For instance one may visit a patient suffering from an air borne disease and contact the disease without knowing. Similarly patients may share personal items such as towels, not knowing that they are subjecting themselves to harmful infections. I think enlightening the public in general on the dangers of these infections and the basic control measures like maintaining a high personal hygiene can go a greater mile in trying to control these infections. It is therefore important to create a society that empresses these basic measures. This can be achieved through airing nosocomial infection related articles in the media, organized open air lessons in villages and also be taught in learning institutions.
Jessica Lietz on the other hand, argues out that just as hand washing is important as a measure of control; more emphasis should also be put on wearing of gloves. She states that gloves can also be used in the same context as hand washing as long as one glove is used on only one patient. I seem to disagree with this since there are challenges that come with it. Even though gloves offer a protective barrier, there are cases where these gloves tear. Moreover in instances where the gloves are not properly worn both the expertise and the patient may be a risk of infections. I strongly believe that a high standard of hygiene is the most appropriate way of fighting infections. As such, a basic, prompt and thorough hand wash is always the better option due its advantages. However, this does not rule out the use of gloves as they are equally important.
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In conclusion, this research article gives a general view of nosocomial infections. It does not reflect a deep research into the subject. Jessica gives more emphasis on general arguments. There are some issues concerning these infections that have not been covered or have been covered shallowly. Jessica does not explain in length how nosocomial infections have been affected by technology. Advancement in technology has revolutionalized the medical fraternity and has come with its own advantages and disadvantage. Therefore one can not make a general decision from this article as it is shallow and needs further research.
National Center for Infectious Diseases
This is an article on the research carried out on the nosocomial infections by the National Center for Infectious Diseases in the United States. It points out young people, the old and those with compromised immune systems as people who are more prone to these infections. Long hospital stays, failure of healthcare workers to wash hands, use of indwelling catheters and overuse of antibiotics have also been highlighted to cause some cases of the infection (Fridkin, Welbel, & Weinstein, 1997). Moreover the research acknowledges the effects of the diversification of technology on the spread and control of the infections highlighting organ transplant, catheters, xenotransplantations among others, as examples.
Invasive procedures expose patient to the possibility of infection. The research highlights the percentages below.
Causes of Urinary Tract Infections in Hospital Patients:
Escherichia coli: 19%
'Other' Gram-negative bacteria: 25%
Coagulase-negative staphylococci: 3%
'Other' Gram-positive bacteria: 13%
Candida albicans: 7%
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Causes of Community-acquired Urinary Tract Infections
Escherichia coli: 73%
Coagulase-negative staphylococci: 7%
Proteus mirabilis 13%
'Other' Gram-negative bacteria: 9%
'Other' Gram-positive bacteria: 2%
This is a comprehensive research that has covered nosocomial infections at length. It discusses key components of the infections giving considerations to both past and today world. Moreover, it compares the rate of the infections both in the urban and rural setting. Hence it is an article that tries to solve nosocomial infection dilemma.
Toni Rizzo presents his research on the common types of infections in our hospital. He highlights respiratory procedures, intravenous (IV) procedures, surgery and wound and urinary bladder catheterization as the common types of infections. He states that most hospital-acquired UTIs happen after urinary catheterization. A healthy urinary bladder does not have bacteria or microorganisms (it is sterile). A catheter picks up bacteria that may be in or around the urethra and take them up into the bladder hence infecting it.
This is a standard research as it touches on almost key issues in the subject matter. I agree with the findings. Fungus infections from Candida are prone to affect patients who are taking antibiotics or that have a poorly functioning immune system. Hence bacteria from the intestinal track are the most types of UTIs. Similarly respiratory procedures done in our hospitals today are the common causes of bacteria getting into the throat. Pneumonia thus becomes another common type of hospital-acquired infections. It is easy for a patient to inhale the microorganisms into the lungs once the throat is colonized. Moreover, patients who can not cough or gag well inhale colonized bacteria and microorganisms into their lungs.
In general Toni Rizzo tries to address affects in medicine today. Infections due to modern advancements like organ transplant among others have been effectively discussed. Thus this is a comprehensive research.
Emmanuelle Girou and Francois Stephan
(Case-control Study of ICU Patients)
This is an article on a study done in the ICU patients. Generally ICU patients are at a high risk of acquiring nosocomial infections and in same cases some die from these infections. There is a need for therapy whether infections in the ICU occur or not. The objectives of the study were to try and solve various nosocomial infection dilemmas that are common in the ICU, with more attention on the interrelationships between patients’ diseases, their severity and therapeutic activities and their effects on the out come of the patient. The study was conducted in a 10-bed medical ICU. Initial severity of illness was matched, and monitored daily. The study ran for a period of one year with a close analysis of the findings.
Global incidence rate of 14.6 infections per 100 admissions was estimated. It was also found out that at least one case of nosocomial infection developed in forty one patients out of the 300 studied. Some of the cases that gave significant results included urinal-track infections, central-venous-catheter-related infections and pneumonia with each recording more than 30 cases out of the 300 studied. Similarly there were 29 cases of bacteremias infections. Surgical wounds and sinusitides infections reported the list numbers. However the cases reported in these cases were so severe. There was one incidence of an organic transplant infection.
This is a very detailed and comprehensive case study. It clearly explains why the rate of infection is high in the ICU. This high rate is attributed to various factors. The immune system of most patients in the ICU is always low. Similarly these patients are subjected to taking more antibiotics. Long hospital stays is also another factor. Also it is in the ICU that most medical procedures like organ transplant, catheter, xenotransplantations among others, take place. The research also accounts for the effects of technology and other factors that affect these infections. It accounts for the findings given reasons based on concrete facts. As result, it’s a dependable research that can be used to study nosocomial infections especially in the ICU.
In conclusion, all the articles above points out improved hygiene especially hand washing and immunization have resulted to the overall advances in control of infectious diseases. Negligence of hygiene is also portrayed as a major challenge to the efforts of control of nosocomial infections. I think for us to significantly control the infections, we must join forces and work together with medical personnel on implementation of existing infection control technologies. We should empress positive changes towards the control of nosocomial infection and observe high standards of hygiene so that we do not rely solely on technologic advances.