Specifics of Nosocomial Infections and Anti-Infective Therapy - Essay Example

Discuss Nosocomial Infections Name Course Instructor Date Abstract Nosocomial infections are hospital acquired and present a significant health and cost burden to individuals and the community, despite being preventable. The purpose of this paper is to discuss nosocomial infections in terms of their definition, significance, major microbes involved and the surveillance measures in health care settings and control of outbreaks. The method involved in researching the discussion content was literature review performed through a database search of health journals. The keywords or phrases entered in the search box included ‘nosocomial infections’, definition of nosocomial infections’, ‘significance of nosocomial infection to patient well-being/cost to the community’, ‘microbes involved in NIs’ and surveillance measures within the health care settings and between hospitals’ and ‘control of NI outbreaks’. The inclusion criterion for the articles was having been published in credible health databases such as PubMed, Medline, and BioMed Central. In total 13 papers met the inclusion criteria. The main research themes considered were addressed by the key words and phrases. The result describes the meaning of nosocomial infections, their occurrence in health care settings, surveillance measures and what can be done to prevent their outbreak, in order to reduce their health burden to the patients and cost burdens to the community. Introduction Understanding nosocomial infections (NIs) is important because the knowledge can be shared with both patients and health care workers, which forms a basis to implicate suggestions to improve the situation. Many patients are impacted by the morbidity and mortality of NIs yet this can be preventable with more research in the subject. Based on research from peer-reviewed journals, this paper focuses on the definition of NIs, significance on patient well being and costs to the community, major microbes involved, surveillance measures within and across health setting, and control measures to prevent outbreaks. General Content a. A referenced definition of NIs NIs are infections acquired in the hospital or are missed at the time of patient admission hence the patient is in a carrier status (Kouchak & Askarian 2012). They can occur 48 hours after admission into a health facility, 3 days after discharge or 30 days in surgical sites after an operation (Revelas 2012). In the case of implants or prosthesis, it may take one year for the NI to manifest (Kouchak & Askarian 2012). NIs are also identified as infections in the healthcare facility if the patient was admitted for reasons other than the occurring infection (Balarabe et al. 2015). Although NI’s can occur in patients in any hospital wards, the Intensive Care Unit (ICU) is a significant source of NIs due to invasive procedures including mechanical ventilation and catheter insertion (Guggenbichler et al. 2011) b. Significance in terms of Impact on patient well-being Nosocomial infections are associated with a great deal of mortality and morbidity for hospitalized patients (Balarabe et al. 2015). NIs are frequent in patients requiring intensive care and mechanical ventilation and contribute to poor health outcomes for patients requiring prolonged use of invasive treatment methods (Zurek & Fedora 2012). The patient will require treatment for the disease that led to the admission as well as the nosocomial infection which leads to prolonged hospital stay, increased costs for further laboratory investigation, drugs, surgical intervention and supportive needs. Cost to the community Nosocomial infections have substantial economic burden in the health care systems of communities (Guggenbichler et al. 2011). NIs are increasing in low, middle, and high income societies (Kleef et al. 2013). According to the Centers for Disease Control and Prevention (CDC), at least 2 million patients are infected with nosocomial infections every year, and at least 100,000 die from them (Reed & Kemmerly 2009). Hence, hospital acquired infections result in up to US 4.5 billion dollars in additional healthcare expenses per year (Reed & Kemmerly 2009). The increases of these infections put a strain on resources in terms of funds dedicated to staff, educational programs, and prevention or treatment measures against nosocomial infections (Balarabe et al. 2015). b. Major microbes involved The NIs usually manifest as a systemic or localized condition resulting from an infectious microbe or toxin (Peleg & Hooper 2010). Staphylococci, Pseudomonas, and Escherichia coli have historically been associated with NIs. Common species include Gram positive cocci including Streptococci and Staphylococcus aureus, Gram negative bacilli such as Pseudomonas aeruginosa and Enterobacteraceae (Peleg & Hooper 2010). In the early and mid 90s the common pathogens responsible for nosocomial infections included S. aureus, coagulase negative staphylococci, enterococci, E. coli, P. aeruginosa, Enterobacter and Klebsiella pneumonia (Kleef et al. 2013). The microbes cause a variety of infections including surgical site infections, ventilator-associated pneumonia, catheter-associated urinary infections, vascular access-related bacteremia, and mediastinitis after coronary artery bypass graft surgery (Bryan 2013; Guggenbichler et al. 2011). Candida spp are the main cause for nosocomial urinary infections in ICUs. As the patients already have compromised immune systems, their bodies are less able to fight off the infections (Zurek & Fedora 2012). Antibiotic resistance also worsens the nature of these infections with microbes such as methicillin-resistant S-aureus (MRSA) and vancomycin-resistant enterococci (VRE) being the main ones involved (Ahoyo et al 2014; Donker, Wallinga & Grundmann 2010). c. Surveillance measures in healthcare settings Within a hospital or healthcare setting Early detection of a new variant of nosocomial agents should be a public health priority. Many countries have a statewide surveillance programs such as the US National Nosocomial Infections Surveillance (NNIS). The programs are responsible for monitoring surveillance related with surgical site infections and bloodstream infections (Mehta et al. 2014). Within the hospital, the various surveillance systems that exist include ICU surveillance, hospital-wide BSI surveillance, surgical antibiotic prophylaxis, staff health immunization surveillance and other small hospital programs including ventilator-associated pneumonia (VAP) surveillance (Mehta et al. 2014). All the units involved are expected to undertake regular reporting especially in the surgical antibiotic prophylaxis where the data can be followed by improvement in the choice of antibiotics for some procedures (Mehta et al. 2014). Between hospitals/healthcare setting (especially patient transfers) The NI pathogens can be spread in the network of hospitals connected by the movement of patients between them (Ciccolini et al. 2014). Nevertheless, it is possible to design an effective surveillance system based on the number of the network patients. Local and national surveillance can be done through provision of resources in terms of money, personnel and facilities to sustain the surveillance systems (Donker, Wallinga & Grundmann 2010). The surveillance system may involve hospitals or laboratories in the network voluntarily or mandatorily reporting the identified bacteraemias (Ciccolini et al. 2014). e. Control of NI outbreaks According to the World Health Organization (WHO) the increasing rate of nosocomial infections results from crowded hospital conditions, increasing number of people with compromised immune systems, new pathogens and increasing microbial resistance (Balarabe et al. 2015). Other causes include prolonged hospital stay, use of indwelling catheters, and failure of healthcare workers to sanitize between handling of patients or conduction medical procedures. Therefore, NI outbreaks are preventable through principal strategies such as, establishment of surveillance systems monitoring device-related infection, raising awareness for infection associated with implanted medical devices, and teaching and training skills to staff (Ahoyo et al. 2014; Guggenbichler et al. 2011). The intelligent use of appropriate antiseptics in combination with medical devices may in the long-term reduce and prevent nosocomial infections. Establishment of policies addressing the prevention and control of the NIs can also help (Reed & Kemmerly 2009). These include hand hygiene, universal precaution practices, healthy environment policies and regular training of hospital staff on nosocomial infection and its prevention (Reed & Kemmerly 2009). Strict aseptic technique while attending to surgical patients, proper quarantine and barrier nursing of infectious diseases such as proper wearing of face mask and gloves while attending infectious cases proper handling and disposal of sharp instruments after use are some of the best practices to prevent NI outbreaks (Mehta et al. 2014). Conclusion In summary, NIs are hospital acquired and manifest 48 hours of hospital admission, 3 days after discharge, 30 days after a surgical procedure, or one year after a prosthetic implant. NIs outbreaks are common in the ICU because of invasive procedures including catheter insertion and the generally compromised immune system of the patient receiving intensive treatment. Although preventable, nosocomial infections contribute to the high mortality and morbidity rates of hospitalized patients. Patients have to stay longer in hospital risking further infections and death, while costs of investigations, and treatment increases. The health burden of the community also increases in terms of health insurance and loss of community members through deaths. The major microbes involved are Gram positive and Gram negative bacteria although fungi and viruses are also common NI agents. Surveillance measures within the health facility and between hospitals during patient transfers can help to monitor and treat the infections in a timely manner. NI outbreaks can be prevented through strict aseptic practices and policies targeting regular training health of workers, and proper use or disposal of devices. Future research should emphasize on the cautious use of antibiotics and antibiotic-use surveillance to prevent resistance in patients being treated for NI. References: Ahoyo, T, Bankole, H, Adeoti, F, Gbhoun, A, Assavedo, S… 2014, ‘Prevalence of nosocomial infections and anti-infective therapy in Benin: Results of the first nationwide survey in 2012’, Antimicrobial Resistance & Infection Control, vol. 3, no. 17. Doi: 10.1186/2047-2994-3-17 Balarabe, SA, Istifanus, AJ, Danjuma, A, Dauda, M, Oluwafemi, O…2015, ‘Knowledge of healthcare workers on nosocomial infection in selected secondary health institutions in Zaria, Nigeria’, World Journal of Preventive Medicine, vol. 3, no. 1, pp. 1-6. Bryan, C 2013, ‘Preventing deep wound infection after coronary artery bypass grafting: A review’, Texas Heart Institute Journal, vol. 40, no. 2, pp. 125-139. Ciccolini, M, Donker, T, Grundmann, H, Bonten, M & Woolhouse, M 2014, ‘Efficient surveillance for healthcare-associated infections spreading between hospitals’, Proceedings of the National Academy Sciences of the USA, vol. 111, no. 6, pp. 2271-2276. Donker, T, Wallinga, J, & Grundmann, H 2010, ‘Patient referral patterns and the spread of hospital-acquired infections through national health care networks. 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