Microbiology and Immunology

Table of Contents



Significance of Nosocomial Infections.

Types of Nosocomial Infections.

1) Urinary Tract Infections.

2) Respiratory Infections.

3) Surgical Site Infections.

Control Measures For Nosocomial Infections.



Abstract on Microbiology and Immunology

Nosocomial infections are described as infections which are caused under different circumstances affecting people already under medical care. These infections are a common finding for both developing and well-developed countries accounting to 7% and 10% in developed and developing countries respectively. As predicted by the World Health Organization, almost 15% all patients under medical care are exposed to this kind of infection (Khan, Baig and Mehboob, 2017). Some of the ways in which a patient can be prone to a nosocomial infection are pneumonia through and infected ventilator, urinary infections through catheters and surgical site infections. This report aims at understanding the concept of nosocomial infections and the possible ways in which a patient can be prone to such an infection. This report also aims at understanding the prevalence and impact of nosocomial infections on the well-being of patients. The areas of nosocomial infections which this report discusses are urinary tract infections, respiratory infections and surgical site infections. The report also discusses the control procedures which can be used to control infectious outbreaks.

Introduction to Microbiology and Immunology

According to Shiel Jr. (n.d.), nosocomial is used to describe an infection which originates or takes place in a hospital. The term ‘nosocomial’ has been derived from a combination Greek words. ‘Nosus’ which is used to describe disease and ‘komeion’ which translates to ‘to take care’ together form nosocomial. Hence, nosocomial is used to describe a disease which is contracted by a patient under medical care. These infections have caused impacts on various factors such as cost to the community and patient well-being. Nosocomial infections and its types constitute to major causes of infection spreads and death rates in preterm new-born babies (Comas-Garcia et al., 2020). It is also one of leading causes of morbidity and mortality in cirrhosis. In a study conducted by Bajaj et al (2019), the results depicted that almost 15% of patients enrolled with cirrhosis had contracted the nosocomial infection. Hence, it becomes equally important to understand the causes, effects and mitigation techniques to curb such infections.

Significance of Nosocomial Infections

Nosocomial infections usually occur within two or 3 days after a person has been admitted to a hospital. Such infections form the base of the increased number in mortality, disability and extended hospitalization. This leads to an increased medical cost thus leading to socio-economic burden. These infections can also lead to multi-organ failure. A person admitted to a hospital is presumed to recover within a given timeframe, but patients who contract infections while in the hospital face the threats of complications and extended stays (Shalini et al., 2015). Exact estimation of the impacts on the socio-economic burden and patient health is difficult as the effects of nosocomial infections vary for different people with different medical history and difference in their response towards the infection. Such hospital acquired infections are one of the leading causes of death in some of the most advanced countries such as USA and Canada and cost the medical industry a surplus billion dollars (Shalini et al., 2015).

Types of Nosocomial Infections

1) Urinary Tract Infections

Patients who are admitted to hospitals due to severe health issues and who are bed ridden, depend in catheters to relieve incontinence. Also, patients with neurosurgical procedures are also dependent on catheters to measure urine output. These catheters often lead to infections, owing to 40% of total hospital acquired infections and 80% due to indwelling urinary catheter (Mohapatra et al., 2018). Gram-negative bacteria are one of the leading causes of catheter associated urinary tract infections. They are also caused due to endogenous native microflora of the patients. The catheter used by patients act as a route for bacteria to enter the body and improper disposal and mismanagement can lead to increased chances of infection spread. Such infections often lead to increased risks to orchitis and prostatitis amongst males and meningitis and cystitis (Khan, Baig and Mehboob, 2017).

2) Respiratory Infections

Patients dependent on respiratory support are assisted with ventilators to ease the process of respiration. Respiratory nosocomial infections amount to 23.6% of all nosocomial infections. Respiratory tract infections refer to a number of infectious diseases in the upper and lower respiratory tract (Trivic and Hojsak, 2018). These infections include influenza, parainfluenza, adenovirus disease and bacterial pneumonia. In a study conducted by Wang et al (2019) found out that 43 out of the 552 cases admitted in a respiratory ICU with community acquired pneumonia has developed nosocomial infections in a teaching hospital located in northwest China. As a whole, 102 out of the 1347 patients had contracted infections. A total of 177 pathogens were identified form the 102 patients which included 83 g-negative bacilli, 63 g-positive bacilli and 31 fungi. Also, out of the 1347 patients, 47 people had contracted ventilator associated pneumonia who were on ventilator support for total 4804 days with a ratio of device utilization of 0.42.

3) Surgical Site Infections

Surgical infections have been a common infection site due to various reason including mishandling of the surgery, contaminated tools used for the surgery etc. They can be defined as infections which arise 30 days post the surgery excluding implants or if in cases the surgery makes use of implants, the timeline increases to 1 year. These kinds of infections are the second most common nosocomial infection after urinary tract infections (Sattar et al., 2019). Most surgical site infections are caused due to endogenous microorganisms present on the skin of the patient. Other factors which lead to external microorganisms infecting the surgical site are surgical instruments, the quality of air and operating surfaces (Darouiche). In a study carried out by Mukagendaneza et al (2019), on 294 patients admitted to the University Teaching Hospital of Kigali, the occurrence of a surgical site infection was 10.9%.

Control Measures For Nosocomial Infections

Nosocomial infections can be mitigated and controlled using different methods and processes. One of the most useful and easy steps to decrease the probability of being contracted by a nosocomial disease is by being precautious. A study carried out by Goyal and Chaudhry (2019), showed the need for training programs required to train people to retain the infection by carrying out standard precautionary measures. Hospitals and clinics should conduct workshops and educational drives for both the staff and the public to raise awareness regarding the issue and ways to prevent it. Surveillance of various parameters which contribute to such infections can also prove as a vital step in infection prevention. Surveillance of such parameters include data collection over a variety of sources by professional data collectors which included key information such as patient’s medical history, test data, and others. (Khan, Baig and Mehboob, 2017).

The spread of infections is also affected by the medical care’s infrastructure and healthcare facilities. A study carried out by Stiller et al (2016), showed that hospitals in which each patient occupied a single room instead of twin or multi-shared room helped in reducing the rates of infection. Setting up infection control tools such as hand rub dispensers which can be easily accessed can also help in infection control. Patients often need to transferred to other healthcare units and test centres due to unavailability of required instrumentation and equipment to help treat the patient. Transferring patients from one point to another can lead to chances of nosocomial infections by exposure to contaminated air or surface used to transfer. Possibility of contracting nosocomial infections can be reduced by making different tool and equipment portable so as to reduce inter and intra hospital transfer of patients.

Conclusion on Microbiology and Immunology

Nosocomial infections have been a key drawback for the healthcare sector. One of the major challenges faced by them is the reduction of these infections. Nosocomial infections refer to the infections contracted by patients while in hospitals. Some of the most commonly found nosocomial infections are urinary tract infections, respiratory infections and surgical site infections. This report discusses some key issues related to such infections including their types, causes and counter measures. The discussed nosocomial infections can be caused by microorganisms and exposure to contaminated tools and equipment. These infections can be mitigated using various measure such as educating people about the infection and educate them about ways to curb it. Using portable tools and equipment can reduce patient transfers which can help in reduction of the infection. Infection rate can be further decreased by an efficient infrastructure and surveillance of parameters which contribute to the infection spread.

References for Microbiology and Immunology

Khan, H. A., Baig, F. K. and Mehboob, R. 2017. Nosocomial infections: Epidemiology, prevention, control and surveillance In Asian Pacific Journal of Tropical Biomedicine. 7(5). pp 478-482. [Online]. Available at: https://doi.org/10.1016/j.apjtb.2017.01.019

Shiel Jr., W. C., n.d., Medical Definition of Nosocomial. [Online]. Available at: https://www.medicinenet.com/script/main/art.asp?articlekey=4590

Comas-Garcia, A., Aguilera-Martinez, J. L., Escalante-Padron, F. J., Lima-ROgel, V., Gutierrez-Mendoza, L. M. and Noyola, D. E. 2020. Clinical impact and direct costs of nosocomial respiratory syncytial virus infections in the neonatal intensive care unit In American Journal of Infection Control. [Online]. Available at: https://doi.org/10.1016/j.ajic.2020.04.009

 Bajaj, J.S., O'Leary, J.G., Tandon, P., Wong, F., Garcia-Tsao, G., Kamath, P.S., Biggins, S.W., Lai, J.C., Vargas, H.E., Maliakkal, B. and Fallon, M.B. 2019. Nosocomial infections are frequent and negatively impact outcomes in hospitalized patients with cirrhosis In American Journal of Gastroenterology. 114(7). pp 1091-1100.

Mohapatra, S., Agarwal, R., Kokkayil, P., Rath, G.P., Kapil, A., Das, B.K., Dhawan, B. and Sood, S. 2018. Multidrug Resistant Bacteria Causing Nosocomial Urinary Tract Infection in Neurology/Neurosurgical Unit of a Tertiary Care Hospital In Eastern Journal of Medical Sciences. pp 2-5. [Online]. Available at: https://doi.org/10.32677/EJMS.2018.v03.i01.002

Trivic, I. and Hojsak, I. 2018. Use of probiotics in the prevention of nosocomial infections In Journal of clinical gastroenterology. 52. pp S62-S65. [Online]. Available at: 10.1097/MCG.0000000000001070

Wang, L., Zhou, K. H., Chen, W., Yu, Yan. and Feng, S. F. 2019. Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015 In BMC Infectious diseases. 19. [Online]. Available at: https://doi.org/10.1186/s12879-019-3772-2

 Darouiche, R. n.d. Surgical Site Infections. [Online]. Available at: https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/hospital-infection-control/surgical-site-infections/#:~:text=Surgical%20site%20infections%20may%20be,common%20causative%20skin%2Ddwelling%20microorganisms.

Mukagendaneza, M.J., Munyaneza, E., Muhawenayo, E. et al. 2019. Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study In Patient Saf Surg. 13. https://doi.org/10.1186/s13037-019-0190-8

Sattar, F., Sattar, Z., Zaman, M. and Akbar, S. 2019. Frequency of Post-operative Surgical Site Infections in a Tertiary Care Hospital in Abbottabad, Pakistan In Cureus. 11(3). [Online]. Available at: 10.7759/cureus.424

Goyal, M. and Chaudhry, D. 2019. Impact of Educational and Training Programs on Knowledge of Healthcare Students Regarding Nosocomial Infections, Standard Precautions and Hand Hygiene: A Study at Tertiary Care Hospital In Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 23(5). p 227. DoI: 10.5005/jp-journals-10071-23166

Stiller, A., Salm, F., Bischoff, P. and Gastmeier, P. 2016. Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis In Antimicrobial resistance and infection control. 5. [Online]. DoI: https://doi.org/10.1186/s13756-016-0152-1

Shalini, S., Vidyasree, M. D., Abiselvi, A. and Gopalakrishnan, S. 2015. Impact and Effect of nosocomial infections: a review In Research journal of pharmaceutical, biological and chemical sciences. 6(1). pp 947-951.

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