Nosocomial Infection

Nosocomial Infection

Nosocomial infections are infections that occur in the hospital environment. Someone is said to have a nosocomial infection if the infection  occurs while being or undergoing treatment in a hospital.

Nosocomial infections can occur in patients, nurses, doctors, and hospital workers or visitors. Some examples of diseases that can occur as a result of nosocomial infections are bloodstream infections,  pneumonia , urinary tract infections (UTIs), and surgical wound infections  (ILO).

Causes of Nosocomial Infections

Nosocomial infections are most often caused by bacteria, such as Staphylococcus aureus , E. coli , Enterococci , and Pseudomonas aeruginosa . This bacterial infection is more dangerous because it is generally caused by bacteria that are already resistant ( resistant ) to antibiotics, for example MRSA or  ESBL-producing bacteria .

Nosocomial infections caused by bacteria can attack patients who are being treated in hospitals or patients with weak immune systems.

Apart from bacteria, nosocomial infections can also be caused by viruses, fungi and parasites. Nosocomial infection transmission can occur through air, water, or direct contact with patients in the hospital.

Risk factors for nosocomial infection

Someone who is in the hospital is more at risk of developing nosocomial infections if they have the following factors:

  • Older or still a baby
  • Have a history of taking antibiotics in the long term
  • Using IVs,  urinary catheters , and  endotracheal tubes  (ETT)
  • Suffering  from a coma , serious injury, burns, or  shock
  • Having a weak immune system, for example due to HIV/AIDS or using  immunosuppressant drugs
  • Frequent contact with patients with infectious diseases without using personal protective equipment according to operational standards (SOP)
  • Use breathing apparatus, such as  a ventilator
  • Get long-term care in the ICU
  • Undergoing surgical procedures, such as  heart surgery, bone surgery, organ transplant surgery, and medical device implant surgery, such as pacemakers

In addition to the factors above, the crowded hospital environment, the transfer of patients from one unit to another, and the combination of infectious disease patients and patients with weak immune systems in the same room also increase the risk of nosocomial infections.

Symptoms of Nosocomial Infection

Symptoms that appear in patients with nosocomial infections may vary, depending on the infectious disease that occurs. Symptoms that can appear include:

  • Fever
  • Cough
  • Hard to breathe
  • Rashes on the skin
  • Rapid pulse
  • The body feels weak
  • Headache
  • Muscle ache
  • Nausea or vomiting
  • Diarrhea

In addition to the general symptoms mentioned above, sufferers may also experience specific symptoms according to the type of nosocomial infection they are experiencing, such as:

  • Blood stream infection , with symptoms such as fever, chills, shortness of breath, decreased blood pressure, or redness and pain at the infusion site if the infection occurs through an infusion
  • Pneumonia, with symptoms such as fever, shortness of breath, cough with phlegm, and sharp pain in the chest that is felt when breathing or coughing
  • Surgical wound infection, which is characterized by fever, redness, pain, and pus discharge from the wound
  • Urinary tract infection , with symptoms such as fever, difficulty or pain when urinating, pain in the lower abdomen or back, and blood in the urine (hematuria)

When to see a doctor

You need to check yourself or consult a doctor if you experience symptoms of a nosocomial infection as mentioned above, especially if these symptoms appear in the following timeframes:

  • After 48 hours in the hospital
  • After 3 days out of the hospital
  • After 30 days postoperatively
  • During treatment at the hospital because of a non-infectious disease

Diagnosis of Nosocomial Infections

The doctor will ask about the patient's complaints, then carry out a physical examination to determine the patient's condition and whether or not there are signs of local infection on the skin.

To confirm the diagnosis, the doctor will carry out the following supporting examinations:

  • Blood test , to detect signs of infection
  • Urine test , to determine whether there is an infection in the urinary tract, including to see the type of infecting bacteria
  • Sputum culture , to determine the type of bacteria that infect the respiratory tract
  • Cultures of blood , sputum, or surgical wound fluid, to confirm the presence and type of bacteria, fungi, or parasites causing the infection
  • Scanning with CT scans , MRI, ultrasound, or X-rays, to detect whether there is damage and signs of infection in certain organs

Treatment of Nosocomial Infections

If the infection is suspected to be caused by bacteria, the doctor will give antibiotics empirically. Empirical antibiotic therapy is the initial administration of antibiotics before the type of bacteria causing the infection is known with certainty.

The aim of the therapy is to inhibit the development or kill the bacteria causing the infection while waiting for the culture results to come out. After the culture results come out, the antibiotics and other drugs given will be adjusted to the type of bacteria or germs that cause nosocomial infections.

If the nosocomial infection is caused by a surgical wound infection or decubitus ulcer , the doctor will perform a  debridement operation . This procedure is useful for removing infected and damaged tissue so that the infection does not spread.

Supportive therapy, such as giving fluids, oxygen , or drugs to treat symptoms, will be given according to the patient's condition and needs. Supportive therapy aims to ensure that the patient's condition remains stable. Whenever possible, any devices that increase the risk of infection will be removed or replaced.

Complications of Nosocomial Infections

Nosocomial infections that are not treated immediately can cause various complications, such as:

  • Heart infection ( endocarditis )
  • Bone infection ( osteomyelitis )
  • Infection of the lining covering the digestive organs ( peritonitis )
  • Infection of the lining of the brain ( meningitis )
  • Sepsis
  • Collection of pus in the lung ( lung abscess )
  • Organ damage
  • organ rot ( gangrene )
  • Respiratory failure
  • Slower wound healing
  • Kidney failure

Prevention of Nosocomial Infections

Prevention of nosocomial infections is the responsibility of everyone in the hospital, including patients, visitors, and health workers, such as doctors and nurses. Efforts that can be taken to prevent the spread of this infection are:

1. Wash hands

It is important for everyone in the hospital to wash their hands properly according to WHO recommendations. There are five mandatory conditions for washing hands while in the hospital, namely:

  • before handling the patient
  • Before carrying out procedures and actions on patients
  • After exposure to bodily fluids (e.g. blood, urine or faeces)
  • After touching the patient
  • After touching objects around the patient

2. Keep the hospital environment clean

The hospital environment needs to be cleaned with cleaning fluids or disinfectants. Hospital floors need to be cleaned 2–3 times per day, while walls need to be cleaned every 2 weeks.

3. Use the tool according to the procedure

Medical procedures and the use of devices or tubes attached to the body, such as infusions, respirators, or urinary catheters, must be used and installed according to standard operating procedures (SOPs) that apply in each hospital or health facility.

4. Place the at-risk patient in the isolation room

Placement of the patient must be in accordance with the condition and disease suffered. For example, patients with weak immune systems or patients who are at risk of transmitting the disease to other patients will be placed in an isolation room.

5. Use personal protective equipment (PPE) according to the SOP

Staff and everyone involved in hospital services need to use personal protective equipment according to the SOP, such as gloves and masks, when serving patients.

In addition to the several prevention efforts above, it is recommended for infants, children and the elderly not to visit hospitals in order to reduce the risk of getting nosocomial infections

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