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Hospital Acquired Infections

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A hospital-acquired infection (HAI) or nosocomial infection is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff.
In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year. In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital.
HAI is sometimes expanded as healthcare-associated infection to emphasize that infections can be correlated with health care in various settings (not just hospitals). Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some medical procedures bypass the body's natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as vectors.
Transmission
The drug-resistant Gram-negative bacteria, for the most part, threaten only hospitalized patients whose immune systems are weak. They can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters, and ventilators.
Hospital infections add more than $30 billion annually to the nation's health tab in hospital costs alone. The tab will increase rapidly, as more infections become drug-resistant.

Cost

A new study based on all the hospital infections reported in Pennsylvania in 2005 dramatizes this enormous economic burden. The average charge for patients who developed an infection ($173,206) was nearly four times as high as for patients admitted with the same diagnosis and severity of illness who did not contract an infection ($44,367). The 11,688 infections reported added over two billion dollars in hospital charges that year. That's in one state alone!

Other studies on the cost of infections found that: * Post surgical wound infections more than double a patient's hospital costs. When a patient develops an infection after surgery, the cost of care increases 119percent, on average, at a teaching hospital, and 101 percent at a community hospital. * Urinary tract infections increase a patient's hospital costs by 47 percent at a teaching hospital and 35 percent at a community hospital. * The average ventilator-associated pneumonia infection (a type of infection contracted when a patient is on a respirator) adds $40,000 to a patient's hospital costs. * Staphylococcus aureus infections are especially costly. According to a recent nationwide study, patients with Staph infections incur hospital costs that amount to more than triple the average hospital costs of other patients.
2,000,000 Estimated infections per year X $15,275
(Average additional hospital costs when a patient contracts an infection) = $30.5 Billion

Prevention
HHS Action Plan to Prevent Healthcare-associated Infections
The prevention and reduction of healthcare-associated infections is a top priority for the U.S. Department of Health and Human Services (HHS). The HHS Steering Committee for the Prevention of Healthcare-Associated Infections was established in July 2008, the Steering Committee, along with scientists and program officials across HHS, developed the HHS Action Plan to Prevent Healthcare-Associated Infections, providing a roadmap for HAI prevention in acute care hospitals. The U.S. Department of Health and Human Services (HHS) has identified the reduction of HAIs as an Agency Priority Goal for the Department. By September 30, 2013, HHS is committed to reducing the national rate of HAIs by demonstrating significant, quantitative, and measurable reductions in hospital-acquired central line-associated bloodstream infections and catheter-associated urinary tract infections.
Handwashing
Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient. Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions. The spread of nosocomial infections, among immunocompromised patients is connected with health care workers' hand contamination in almost 40% of cases, and is a challenging problem in the modern hospitals. The best way for workers to overcome this problem is conducting correct hand-hygiene procedures; this is why the WHO launched in 2005 the GLOBAL Patient Safety Challenge. Two categories of micro-organisms can be present on health care workers' hands: transient flora and resident flora. The first is represented by the micro-organisms taken by workers from the environment, and the bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group is represented by the permanent micro-organisms living on the skin surface (on the stratum corneum or immediately under it). They are capable of surviving on the human skin and to grow freely on it. They have low pathogenicity and infection rate, and they create a kind of protection from the colonization from other more pathogenic bacteria. The microbes comprising the resident flora are: Staphylococcus epidermidis, S. hominis, and Microccocus, Propionibacterium, Corynebacterium, Dermobacterium, and Pitosporum spp., while in the transitional could be found S. aureus, and Klebsiella pneumoniae, and Acinetobacter, Enterobacter and Candida spp. The goal of hand hygiene is to eliminate the transient flora with a careful and proper performance of hand washing, using different kinds of soap, (normal and antiseptic), and alcohol-based gels. The main problems found in the practice of hand hygiene is connected with the lack of available sinks and time-consuming performance of hand washing. An easy way to resolve this problem could be the use of alcohol-based hand rubs, because of faster application compared to correct hand washing.
All visitors must follow the same procedures as hospital staff to adequately control the spread of infections. Visitors and healthcare personnel are equally to blame in transmitting infections. Moreover, multidrug-resistant infections can leave the hospital and become part of the community flora if steps are not taken to stop this transmission.
Gloves
In addition to handwashing, gloves play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, they are worn to provide a protective barrier and to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin. In the USA, the Occupational Safety and Health Administration has mandated wearing gloves to reduce the risk of bloodborne pathogen infections. Second, gloves are worn to reduce the likelihood microorganisms present on the hands of personnel will be transmitted to patients during invasive or other patient-care procedures that involve touching a patient's mucous membranes and nonintact skin. Third, they are worn to reduce the likelihood the hands of personnel contaminated with micro-organisms from a patient or a fomite can be transmitted to another patient. In this situation, gloves must be changed between patient contacts, and hands should be washed after gloves are removed.
Wearing gloves does not replace the need for handwashing, because gloves may have small, inapparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Failure to change gloves between patient contacts is an infection control hazard.
Surface sanitation
Sanitizing surfaces is an often overlooked, yet crucial, component of breaking the cycle of infection in health care environments. Modern sanitizing methods such as NAV-CO2have been effective against gastroenteritis, MRSA, and influenza agents. Use of hydrogen peroxide vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria, such as Clostridium difficile, where alcohol has been shown to be ineffective. Ultraviolet cleaning devices may also be used to disinfect the rooms of patients infected with Clostridium difficile after discharge.
Antimicrobial surfaces
Micro-organisms are known to survive on inanimate ‘touch’ surfaces for extended periods of time. This can be especially troublesome in hospital environments where patients with immunodeficiencies are at enhanced risk for contracting nosocomial infections.
Touch surfaces commonly found in hospital rooms, such as bed rails, call buttons, touch plates, chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper towel, soap), dressing trolleys, and counter and table tops are known to be contaminated with Staphylococcus, MRSA (one of the most virulent strains of antibiotic-resistant bacteria) and vancomycin-resistant Enterococcus (VRE). Objects in closest proximity to patients have the highest levels of MRSA and VRE. This is why touch surfaces in hospital rooms can serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to patients.
A number of compounds can decrease the risk of bacteria growing on surfaces including: copper, silver, and germicides

Questions

1. WHAT IS THE EASIEST WAY TO PREVENT NOSOCOMIAL INFECTIONS?
a. Taking a bath
b. Hand-washing
c. Eating right
d. Using a tissue when sneezing

2. What are three common predisposing factors that make a person more susceptible to disease?
a. Age, stress, and ethnicity
b. Stress, ethnicity, and physical features
c. Age, stress, and heredity
d. Heredity, physical features, and place of birth

3. The number of cases of a disease occuring at a specific time in a certain population is its:
a. Prognosis
b. Prevalence
c. Pathogenesis
d. Promotion

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