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Adrienne-Rae Velasquez
Microbiology
Citation


1. Abedon, Stephen. "Nosocomial Infections." Nosocomial Infections. 05/September/1998. 9 Dec 2008 .

2. "Nosocomial Infections." Nosocomial Infections. 2005. Envirotech Solutions. 9 Dec 2008 .

3. "Airborne nosocomial infection: a contemporary perspective." nosocomial infection. 15/November/1994. Pub Med. 9 Dec 2008 .

4. Weinstein, Robert. "Nosocomial Infection Update." Emerging Infectious Disease Vomule 4, Number 311/1998 9 Dec 2008 .

5. Graves, Nicholas. "Nosocomial Infection, the Deficit Reduction Act, and Incentives for Hospitals." nosocomial infection 300 1/October/2008 9 Dec 2008 .

6. "Statistics By Country for Nosocomial Infections." wrong diagnosis. 10/October/2008. Wrong Diagnosis. 9 Dec 2008 .





Adrienne Velasquez, 1
Microbiology E.C.
12/01/2008

Nosocomial Infection

According to medicaldictionary.com, nosocomial is defined as originating or taking place in a hospital, acquired in a hospital. Therefore, basing off this definition, a nosocomial infection is any infection that takes place in the hospital. Hospital patients usually acquire a nosocomial infection, usually acquired within 72 hours of admitting into the hospital.
The first research done on nosocomial infections date back to the 1840’s when doctor Ignaz Semmelweis noticed women dying from the same puerperal fever after delivering their child.1 Because of the multiple occurrences, this lead him to perform an experiment which included a ward ran by medical students and a ward ran by midwives who did not explore any part of the hospital but the labor room. After further observation, it was shown that the women that were held in the ward ran by college students had a higher death rate than the ward ran by midwives. To be completely exact, the rate was about 10% in the ward containing medical students, while it was a small 3% in the ward containing entirely midwives. He came to the conclusion that the medical students carried cadaveric material from the dissecting rooms they had previously been in.2 Due to the discovery, they tested to see if the medical students washed their hands with chlorine water. It seemed that their hypothesis was right, and the percentage of death due to
nosocomial infections/pueperal fevers had declined dramatically.
While Ignaz Semmelweis questioned the puerperal fever, Joseph Lister has also taken a look at nosocomial infections around the same time. Joseph Lister was able to realize that a sterile environment was essential for surgical operations, therefore he used phenolic solutions over surgical wounds to decrease the chances of microorganism residents in the hospital patients.3 In his hospital he enforced that surgeons wear rubber gloves and newly washed operating gowns because the chances of spreading the microorganism from surgeon to patient were very high. From then, hospitals require the most sterile environments to decreases the chances of acquiring a nosocomial infection.4

Exactly how did these pathogens grab hold of the human’s sacred immune system? Actually, there are many ways in which pathogens may enter while one resides in the hospital. First, one may acquire the microorganism by contact transmission. Contact transmission is defined by the spread of microorganisms
through some form of touch or immediate contact between two different people. The next type of transmission is direct-contact transmission. Direct-contact transmission requires contact between two immediate people. If not those two, then one may acquire a nosocomial infection through indirect contact, usually accompanied by fomites. Fomites are defined as any object or substance that may hold a disease. (sitation here). Air borne transmission occurs in the hospital due to the bacteria on the outside released from vents. Lastly, one may acquire a nosocomial infection through droplet transmission. Droplet transmission usually occurs when some form of liquid is transferred (i.e. during a sneeze), for the particle can travel for about a meter.4 However, out of these five different types of transmissions, direct transmission is shown to be the most prevalent modes of transmission. It is shown that in most people carry a pathogen on their hand and unintentionally contaminate equipment in the hospital. People are very susceptible to nosocomial infections in the hospital for their immune system is very weakened.


There are 7 main sites where nosocomial infection occurs. They occur in: 1.) urinary tract 2.) surgical wounds 3.) respiratory tract 4.) skin (especially burns 5.) blood 6.) gastrointestinal tract and 7.) central nervous system.3 It has been shown that in recent years, the rate of urinary tract infections as a secondary infection have risen to 10% each time a patient has a catheter placed inside of them. This has been shown because the catheter allows easy access from the outside environment into the urinary tract. The most common bacteria that cause nosocomial infections are shown to be gram-negative and gram-positive bacteria. These include Escherichia coli and Proteus mirabilis and the rest of the “Enterobacteriacaea” members that reside in the intestinal tract.5 Their mode of contamination is through fecal contamination of people as well as instruments or other surface. The main gram-positive bacteria is known to be Staphylococcus aureus, found on the surface of the skin.3
Main reasons why nosocomial infections happen to frequently in the hospital is because the patient’s immune system is incompetent to recognize nor combat infections, along with the common knowledge that patients are exposed to more potentially disease-causing microorganisms. The inability of one’s immune system to detect infections, they are then more vulnerable that normal. Another reason why nosocomial infections are so persistent is because many bacteria develop resistance to the number of antibiotics commonly used in hospitals.6 Also, due to the abundant amount of guests that visit the hospital, it makes it difficult to decrease the amount of foreign pathogens. Lastly, because pathogens are exposed to all the various antibiotics, they then gain antibiotic resistance. Antibiotic resistance is when the pathogens are exposed to antibiotics that they can then alter their genes to become resistant. Many antibiotics are encountered and used in hospitals that bacteria are able to develop some sort of resistance toward the antibiotics.1
Further extending this research, America actually has the most patients that encounter nosocomial infections. Their number well exceeds the 2 million mark. America has the leading number of nosocomial infections, and according to wrongdiagnosis.com, they encounter approximately 2,159,230 incidences, while the other countries only reach a little past 1,000,000. Unfortunately, statistics show that 1 approximately 1 out of every 156 Americans acquire an infection every day.5
With all this said, health care professionals have come up with ways to further prevent nosocomial infections. To eliminate the spread of microorganisms from one’s normal flora to an open wound, or exposed flesh, health care professionals are required to wash their hands, before, after, and in between attending to different patients. One must avoid hand contact to eyes or any oral areas, and lastly, the mere education of nosocomial infections and how they may kill a patient leads health care professionals to a more precautious mind. Aside from what a health care professional can do, there are ways to change the patient’s environment. These alterations include: isolation of patient, education of visitors to wash their hands or avoid any type of physical contact, such as touching, and lastly, to discourage the visitation by sick visitors.7 Similar to preventing all other types of diseases, vaccinations for patients are available to boost up their immune system. One may also change the hospital environment. Ways one can do this, is to sterilize each equipment before and after each time it has been used. This decreases the chances of infecting a patient by killing any microbes present on the equipment. The last and final precaution one can take is to install air filtration systems to decrease the amount of microbes in the air. It has been shown that patients may be infected through airborne transmission, therefore with this knowledge, air ventilation systems have been inputted throughout hospitals for the sake of preventing nosocomial infections.7
Though many precautions are taken prior to any surgical procedure, nosocomial infections still occur. Actually, a whopping 2 million american hospital patients acquire a nosocomial disease every year. Out of that 2 million, 20,000 patients result in death per year. Why do they still occur if the hospital is supposed to be sterile? According to Ohio State University, there are three resulting factors contributing to nosocomial infections. These three are “1.) the high prevalence of pathogens, 2.) high prevalence of compromised hosts, and lastly 3.) efficient mechanisms of transmission from patient to patient.”5
Concluding this research, patients acquire nosocomial infections due to the fact that the pathogens have gained antibiotic resistance. Antibiotic resistance is defined as any pathogen that has gained resistance to antibiotics due to over exposure. United States is the nation with the leading number of nosocomial infections. Lastly, even with all the solutions and preventions that healthcare professionals have come up, it is near to impossible to completely eradicate nosocomial infections due to the fact that there are so many factors to take into consideration.