Nosocomial Infections
Nosocomial infections, also known as Hospital-acquired infection, occur when a patient acquires an infection while in a healthcare facility during treatment for other conditions. Such infections include bacterial and fungal infections and become severe in immune-compromised patients. Methicillin-resistant Staphylococcus aureus, Clostridium difficile and Enterobacteriaceae (carbapenem-resistance), are some of the bacteria that cause nosocomial infection. The Centers for Disease Control and Prevention estimates roughly 1.7 million hospital-acquired infections in the United States that lead to 99,000 deaths annually (Bennett, J. V., Jarvis, W. R., & Brachman, P. S., 2007).
In Texas, some of the activities carried out by the state to prevent healthcare-associated infections include antimicrobial stewardship activities. These look into roles of microbial mutations in the development of emerging nosocomial infections. Another activity the state has implemented is SSI (Surgical Site Infection) and CLABSI (Catheter-associated bloodstream infection) collaborative. This prevents infections occurring at surgery sites and also to prevent urinary tract infections caused by devices such as catheters used in medical procedures. The state health department and the hospital association became involved in a CUSP initiative aimed at preventing CLABSI and CAUTI (Central line-associated bloodstream infection). Together, they have achieved some goals which include; improved safety culture and reduced rates of CLABSI by forty percent. In the year 2009-2011, the state provided funding for infrastructure, monitoring and prevention projects. In addition, the affordable care act funding in 2011 included activities like HAI prevention infrastructure, antimicrobial use surveillance and public health partnership (Bennett et al., 2007)
As a nurse, the personal plans to prevent transmitting nosocomial infections during work involve areas pertaining to the hospital environment, medical equipment, management of multidrug resistant micro-organisms and ways of reducing transmission. In preventing infection related to the hospital environment, operation room doors should be closed except for the passage of equipment, personnel and patients. This would help limit levels of contamination within the operation rooms. Regular cleaning of surfaces and removal of dust and soil should also be done. This helps prevent persistence of gram negative cocci and gram negative bacilli which prefer dry conditions and moist environments respectively. Surfaces should also be disinfected using dilute solutions of hypochlorite in rooms of patients with Clostridium difficile infections. Use of disinfectants in some environments is beneficial in preventing the development of resistant microbes. Another recommendation is that medical equipment surfaces be disinfected with intermediate level disinfectants.
Medical devices such as surgical instruments, implanted medical devices, and biopsy forceps should be sterilized by steam in relation to their resistance to heat. This is due to the large margin of safety that steam sterilization has considered consistency, reliability and lethality in eliminating microbial contamination. Medical devices are critical items since they come into contact with sterile body fluids or tissues (Wenzel, R. P., 2003). To prevent antimicrobial resistance, appropriate clinical practices should be incorporated in all routine patient care. Some of these practices include accurate diagnosis of infectious etiologies, optimal management of urinary and vascular catheters, prevention of lower respiratory tract infection in cannulated patients and judicious utilization and antimicrobial selection.
Precautions that should be followed to reduce development and spread of nosocomial infections include prevention of person to person transmission of bacteria. This can be done by maintaining proper hand hygiene, gloving and gowning. Staff should also be educated and involved in preventing infections. Another precaution is on sterilization and maintenance of equipment and devices.
Reference
Bennett, J. V., Jarvis, W. R., & Brachman, P. S. (2007). Bennett & Brachman's hospital infections. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Wenzel, R. P. (2003). Prevention and control of nosocomial infections. Philadelphia [ etc.: Lippincott Williams & Wilkins.
