EPIDEMIOLOGY OF NOSOCOMIAL INFECTIONS (NCIs) PART-1. Dr. A.K.AVASARALA MBBS, M.D. PROFESSOR & HEAD DEPT OF COMMUNITY MEDICINE & EPIDEMIOLOGY PRATHIMA INSTITUTE OF MEDICAL SCIENCES, KARIMNAGAR, A.P.. INDIA: +91505417 [email protected] DEFINITION.
Dr. A.K.AVASARALA MBBS, M.D.
PROFESSOR & HEAD
DEPT OF COMMUNITY MEDICINE & EPIDEMIOLOGY
PRATHIMA INSTITUTE OF MEDICAL SCIENCES, KARIMNAGAR, A.P..
LEARNER SHOULD LEARN
LEARNER SHOULD BE ABLE TO
1. Estimate the extent and nature of nosocomial infections in his hospital
2. Identify the changes in the incidence of nosocomial infections and the pathogens that cause them.
3. Provide his hospital with comparative data on nosocomial infection rates.
4. Develop efficient and effective data collection, management and analysis methods for his hospital.
5. Conduct collaborative research studies on nosocomial infections in his hospital.
Caused by the organisms that are present as part of normal flora of the patient
2. Exogenous: caused by organisms acquiring by exposure to hospital personnel, medical devices or hospital environment
Intrinsic host susceptibilityAge, Poor nutritional status, Co morbidity, severity of underlying disease
Environmental factorshospital location, diagn procedures, immunosuppressive, chemotherapy, antibiotics, med & surgical devices, exposure to infected patients or health workers, asymptomatic carriers
Agent factorsvarieties of organisms
Institutional and human
Reservoirs & their virulence
1) complex mix of the patients
2) aggressive treatment
3) local practices
Dr F D Dastur, Director, Medical education, P D Hinduja, Hospital:
“nosocomial control programme is at a nascent stage in Indian hospitals, with some yet to establish a central sterilization and supply department (CSSD) and appoint an infection control nurse”
Dr Vijay D Silva, director, critical care, Asian Heart Institute (AHI):
“Suggestions to strengthen the infection control programme is turned down by the management of most hospitals as spending on infection control does not generate revenue.”
Ranks in infants
Ranks in children
Ranks in adults
1. Prolongation of hospital stay:
Varies by site, greatest with pneumonias and wound infections
2. Additional morbidity
3. Mortality increases - in order - LRI, BSI, UTI
4. Long-term physical &neurological consequences
5. Direct patient costs increased-
Escalation of the cost of care
“ While MRSA is the troublemaker in most cases, at Vellore nosocomial infection due to MRSA is only five per cent because of genotyping.”
patient care personnel
2) Indirect - contaminated inanimate objects
in environment (Endoscopes etc)
3) Droplet infections by large aerosols
Long term catheter use (retention, obstruction, incontinence) increases BU by 90%
Incidence varies from 1.5 to 13 per 100 operations.
MOSTLY SEEN IN ICU
BSI ARE INCREASING PRIMARILY DUE TO INCREASE IN INFECTIONS WITH GM+VE BACTERIA & FUNGI
MOST COMMON IN NEONATES IN HIGH RISK NURSERIES
MORTALITY RATE FOR NOSOCOMIAL BACTEREMIA IS HIGHER THAN FOR COMMUNITY ACQUIRED BACTEREMIA