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38. Nosocomial infections (definition (infection acquired in medical…
38. Nosocomial infections
definition
infection acquired in medical setting during medical treatment course
not found on admission
temporarily associated with admission or procedure at health-care facility
was incubating at admission but related to previous procedure or admission at another facility
localised or systemic
results from adverse reaction to infectious agent and its toxins
usually becomes evident within 48h post admission
in usa and europe, 5-10% of hospitalised patients develop an infection during their stay
higher incidence rates in dev countries
site of infection
urinary tract 40%
surgical wound 25%
resp tract 20%
bacteremia 3%
other 12%
etiology
contaminated hospital environment
instruments
fluid
food
air
medications
invasive devices
catheters
endotracheal tubes
wounds
endoscopes
medical personnel
colonised
infected
transient
carriers
patient flora
cutaneous
GI
genitourinary
respiratory
hyperalimentation
immunosuppression
type of infection
surgical wound
S. aureus
E. Coli
Strep. faecalis
pneumonia
K. pneumoniae
S. aureus
enterobacter spp.
E. Coli
IV catheter
staphylococcus epidermis
S. aureus
s. faecalis
Candida spp.
urinary catheter
E coli
S. faecalis
transmission
colonize GI tract
breech of skin barrier
ingestion
inhalation
direct contact
nosocomial pneumonia
gram -ve
colonize airway
risk factors
intubation
coma
thoracoabdominal surgery
renal failure
age 70>
prevention
ventilation
ET tube management
nosocomial bacteremia
primary or secondary
primary- no focus apparent usually due to IV catheter
IV catheter
66% extraluminal
20% intraluminal
related to catheter type and placement
prevention- removal, site maintenance