Nosocomial Infection: Causes, Symptoms and Preventive Methods

Introduction:

The hospital-acquired infections are known as nosocomial infections. It is an infection that occurs in an individual within 48 hours of hospital admission, three days of discharge, or within 30 days of any surgical procedure. Nosocomial infection is a global challenge, accounting for increased mortality and morbidity rates. Studies indicate that its prevalence is reasonably high in developing countries compared to developed countries. It leads to an extended hospital stay, financial burden, long-term disability, emotional and psychological anxiety among the family members, and even medical disputes.

Though doctors and paramedical staff are aware and well-trained in managing nosocomial infection, it is vital for them to understand that prevention is of utmost importance in nosocomial infection. Therefore, emphasis should be laid on preventive guidelines that would benefit the hospital staff and the patients. In addition, the logistics staff in the hospital should be trained and sensitized on this topic. Logistics staff are crucial members of the hospital as they play a key role in various hospital activities and are in close contact with the patient. Hence training them along with the doctors is mandatory to prevent nosocomial infections.

What Is Nosocomial Infection?

A nosocomial infection is a hospital-acquired infection or a healthcare-associated infection. It is an infection the patient contracts within 48 hours of admission and is not present at the time of admission. It is usually caused due to improper infection control, multidrug-resistant organisms, or via invasive procedures. The visitors or even health care professionals carry these organisms inside the hospital, and they spread them to others unknowingly. The patient's immune system would also be compromised, due to which they are at increased risk for contracting the infection. Nosocomial infections must be managed on an emergency basis as they could be fatal and lead to sepsis and death.

What Are the Types of Nosocomial Infections?

There are various types of nosocomial infections, such as:

• Bacterial Infections: Bacterial infections are not harmful, yet can cause serious illness. However, infections of antibiotic-resistant bacteria like MRSA (methicillin-resistant staphylococcus aureus) are grave and difficult to treat.

• Fungal Infection: Fungal infections can be potentially harmful and contagious.

• Viral Infections: The most common viral nosocomial infections are caused by influenza (flu) virus and respiratory syncytial virus.

What Are the Risk Factors Associated with Nosocomial Infection?

Certain factors that are associated with an increased risk of developing a nosocomial infection are:

• Increasing age.

• Duration of hospitalization.

• Improper and unwarranted use of antibiotics.

• Use of invasive devices such as urinary catheters, mechanical ventilation, central venous catheters, and surgical procedures.

• Individuals with comorbid diseases such as diabetes, chronic lung or renal disease, and cardiac diseases.

What Causes Nosocomial Infection?

The hospital environment has various factors that could result in developing nosocomial infections. A few of the most common factors are discussed below:

• Antibiotics: Prolonged and excessive use of antibiotics could eliminate the essential and healthy bacteria in the body. This increases the chance of developing a nosocomial infection.

• Urinary Catheters: An urinary catheter is a flexible tube inserted into the urinary bladder to collect urine. It is primarily used in patients who have undergone surgical procedures, are immobilized, or received general anesthesia. A contaminated urinary catheter could result in a urinary tract infection (UTI). UTI is the most commonly encountered nosocomial infection.

• Central Lines: Central lines are intravenous lines that connect to your bloodstream. It is primarily used to deliver intravenous fluids and medications. Microorganisms can enter the bloodstream through the external end of the tube, the skin, or from the gloves of the health care professional resulting in bloodstream infections. It is extremely critical as it may result in sepsis and even death.

• Surgical Procedures: Surgical site infections may occur after surgery. They are usually caused by organisms present on the skin or transferred by the working hospital staff.

• Mechanical Ventilation: Hospital-acquired pneumonia or ventilator-associated pneumonia is yet another common nosocomial infection associated with mechanical ventilation. Early-onset pneumonia is caused by community-acquired organisms and occurs within four days of hospitalization, whereas drug-resistant bacteria cause late-onset.

What Are the Symptoms of Nosocomial Infection?

The symptoms vary depending on the type of infection; however, a few common symptoms are:

• Fever.

• Difficulty in breathing.

• Cough.

• Difficulty in urinating.

• Burning sensation while urinating.

• Rashes or soreness in the skin around the wound or surgical site.

• Nausea.

• Fatigue.

• Excessive sweating.

How Can Nosocomial Infection Be Prevented?

Prevention of hospital-acquired infections begins by making all the medical and paramedical staff aware of all possible venues from where the patient can contract a superadded infection. In addition, implementing strict infection control protocols will be more beneficial. They are described in detail below:

General Guidelines for Infection Control:

1. Isolation: Evaluate and assess the needs for isolating a patient. Patients who have known communicable diseases, are immunocompromised, or have weakened immune systems are more prone to develop nosocomial infections. Isolating such patients will prevent the risk of potential transmission and also reduce the risk of opportunistic infections, particularly in immunocompromised patients.

2. Identifying High-risk Patients: Patients at increased risk for nosocomial infections, such as the elderly, those with assisted ventilation, implanted device, chronic renal and liver diseases, patients on steroids or chemotherapy, and those in shock or coma, are more prone to develop superadded infections. Therefore, enough care should be taken, and constant monitoring is required of these patients.

3. Practice Good Hand Hygiene: The easiest way to spread infection is through the hands; hence hand hygiene is of utmost importance to prevent nosocomial infection. World Health Organization (WHO) has laid down five moments for hand hygiene:

• Before touching a patient.

• Before carrying out any aseptic procedures.

• After exposure to any body fluids.

• After touching a patient.

• After touching the patient's surroundings.

This hand hygiene technique is to protect the patient as well as the hospital staff from acquiring and transmitting the infection. Hands should be washed using soap and water for 15 seconds. Then, all the areas should be appropriately scrubbed. An alcohol-based rub can be used if not visibly dirty with blood or other body fluids. Ensure to remove all jewellery before any surgical procedure. Nails should be trimmed, and avoid long sleeves. After the hand hygiene technique, sterile gloves should be worn while performing aseptic procedures. The gloves should be changed while performing different procedures on the same patient or examining different body parts. Also, ensure to change the gloves while moving on to the next patient. Practice hand hygiene once the gloves are removed.

4. Use of Personal Protective Equipment: A sterile gown can be worn during aseptic procedures, and ensured to dispose of a soiled gown immediately after the procedure to avoid any risk of contamination. Relatives of the patients should also be encouraged to use a mask while visiting. In addition, medical staff can use face shields and eye protection while performing procedures or other patient care activities.

Guidelines to Prevent Transmission-based Infections:

Contact transmission infection could be either due to direct contact or indirect contact. The most commonly encountered transmission infection is airborne and droplet-spread infections. Certain precautions should be taken in patients with known contact infections, such as

• Isolate the patients with negative-pressure ventilation.

• Medical staff should enter the isolation room wearing personal protective equipment.

• Disposable N-95 masks are mandatory for the hospital staff and visitors entering the patient's room.

• Patient transport should be restricted.

Guidelines to Prevent Endogenous Infections:

• Avoid excessive and improper use of antibiotics.

• Proper disinfection before and during surgery can reduce surgical site infections.

• Encourage non-invasive ventilation instead of intubation wherever possible. Prefer oral intubations if needed. Avoid reintubation. Ensure to drain and discard the condensate if any is collected in the mechanical ventilator. These steps can prevent or reduce the risk of hospital-acquired pneumonia (HAP).

• While inserting a urinary catheter, follow an aseptic procedure. Remove the catheter when it is no longer in use. Ensure the urinary bag is not touching the floor. Ensure there is unobstructed urine flow and a closed drainage system.

• Ensure sterile dressings are used.

Conclusion:

Nosocomial infections are potentially grave and may cause fatalities if not managed timely. The risk of developing a nosocomial infection primarily depends on the hospital's infection control protocols. Those with poor disinfection and sterilization protocols are identified with increasing cases of hospital-acquired infections. Also, patients with risk factors such as increasing age, comorbid conditions, and prolonged hospitalization are at risk of developing nosocomial infections. Stringent infection control guidelines and vigilant surveillance can prevent these infections, facilitating better patient recovery and alleviating the economic burden.