Nosocomial infection
Encyclopedia
A nosocomial infection also known as a hospital-acquired infection or HAI, is an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. Such infections include fungal and bacterial infections and are aggravated by the reduced resistance of individual patients.
In the United States
, the Centers for Disease Control and Prevention
estimate that roughly 1.7 million hospital-associated infections, from all types of microorganism
s, 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.
s 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.
, which is Gram-negative. While there are antibiotic drugs that can treat diseases caused by Gram-positive MRSA, there are currently few effective drugs for Acinetobacter. However, Acinetobacter germs are evolving and becoming immune to existing antibiotics. "In many respects it’s far worse than MRSA," said a specialist at Case Western Reserve University
.
Another growing disease, especially prevalent in New York City
hospitals, is the drug-resistant Gram-negative germ, Klebsiella pneumoniae
. An estimated more than 20 percent of the Klebsiella infections in Brooklyn
hospitals "are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide."
The bacteria, classified as Gram-negative because of their reaction to the Gram stain test, can cause severe pneumonia
and infections of the urinary tract, bloodstream, and other parts of the body. Their cell structures make them more difficult to attack with antibiotics than Gram-positive organisms like MRSA. In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. "For Gram-positives we need better drugs; for Gram-negatives we need any drugs," said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-UCLA Medical Center
, and the author of Rising Plague, a book about drug-resistant pathogens.
One-third of nosocomial infections are considered preventable. The CDC estimates 2 million people in the United States are infected annually by hospital-acquired infections, resulting in 20,000 deaths. The most common nosocomial infections are of the urinary tract, surgical site and various pneumonia
s.
United States: The Centers for Disease Control and Prevention
(CDC) estimates that roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. Other estimates indicate that 10%, or 2 million, patients a year become infected, with the annual cost ranging from $4.5 billion to $11 billion. In the USA the most frequent type of infection hospitalwide is urinary tract infection (36%), followed by surgical site infection (20%), bloodstream infection (BSI), and pneumonia (both 11%).
France: estimates ranged from 6.7% in 1990 to 7.4% (patients may have several infections). At national level, prevalence among patients in health care facilities was 6.7% in 1996, 5.9% in 2001 and 5.0% in 2006. The rates for nosocomial infections were 7.6% in 1996, 6.4% in 2001 and 5.4% in 2006.
In 2006, the most common infection sites were urinary tract infection
s (30,3 %), pneumopathy (14,7 %), infections of surgery site (14,2 %). infections of the skin
and mucous membrane
(10,2 %), other respiratory infections (6,8%) and bacterial infections / blood poisoning (6,4 %). The rates among adult patients in intensive care were 13,5% in 2004, 14,6% in 2005, 14,1% in 2006 and 14.4% in 2007.
It has also been estimated that nosocomial infections make patients stay in the hospital 4-5 additional days. Around 2004-2005, about 9,000 people died each year with a nosocomial infection, of which about 4,200 would have survived without this infection.
Italy: since 2000, estimates show that about 6.7 % infection rate, i.e. between and patients, which caused between and deaths. A survey in Lombardy gave a rate of 4.9% of patients in 2000.
United Kingdom: estimates of 10% infection rate, with 8.2% estimated in 2006.
Switzerland: estimates range between 2 and 14%. A national survey gave a rate of 7.2% in 2004.
Finland: estimated at 8.5% of patients in 2005
Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact transmission.
, equipment sterilization
, washing, and other preventative measures. Thorough hand washing
and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections. More careful use of antimicrobial
agents, such as antibiotic
s, is also considered vital.
Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotic
s and other antimicrobial
drugs to help treat illness; this may increase the selection pressure
for the emergence of resistant strains.
s 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, secretion
s, excretion
s, 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 it is a real challenging problem in the modern hospitals. The best way for Health Care Workers to overcome this problem is acting right 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 one is represented by the micro organisms taken by Health Care Workers from the environment, and the bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group on the other hand, is represented by the permanent micro organisms that lived 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 skin of Health Care Workers is colonized by 3.9 x 104 – 4.6 x 106 cfu / cm2. The micro organisms creating the resident flora are: Staphylococcus epidermidis, Staphylococcus hominis, Microccoci, Propionibacterium, Corynebacterium, Dermobacterium, Pitosporum, while in the transitional could be found Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter spp, Enterobacter spp and Candida spp. The goal of hand hygiene is to eliminate the transient flora with a careful and proper performance of hand wash, using different kind of soap, from the normal one to the
antiseptic, and alcohol based gel. 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 rub, because of its faster application compared to a correct hand washing.
Although handwashing may seem like a simple process, it is often performed incorrectly. Healthcare settings must continuously remind practitioners and visitors on the proper procedure in washing their hands to comply with responsible handwashing. Simple programs such as Henry the Hand, and the use of handwashing signals can assist healthcare facilities in the prevention of nosocomial infections.
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.
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, gloves 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 infection. Second, gloves are worn to reduce the likelihood that 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, gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or a fomite
can transmit these microorganisms 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, non-apparent 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.
have been effective against gastroenteritis, MRSA, and influenza. 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.
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
, Methicillin-resistant Staphylococcus aureus
(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 staphylococcus, 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.
Copper alloy surfaces have intrinsic properties to destroy a wide range of microorganisms. In the interest of protecting public health, especially in heathcare environments with their susceptible patient populations, an abundance of peer-reviewed antimicrobial efficacy studies have been and continue to be conducted around the world regarding copper’s efficacy to destroy E. coli
O157:H7, methicillin
-resistant Staphylococcus aureus
(MRSA), Staphylococcus
, Clostridium difficile
, influenza A virus, adenovirus
, and fungi
.
Much of this antimicrobial efficacy work has been or is currently being conducted at the University of Southampton
and Northumbria University
(United Kingdom
), University of Stellenbosch (South Africa
), Panjab University (India
), University of Chile (Chile
), Kitasato University
(Japan
), the Instituto do Mar and University of Coimbra (Portugal
), and the University of Nebraska and Arizona State University
(U.S.A.). A summary of the antimicrobial copper touch surfaces clinical trials to date is available
In 2007, U.S. Department of Defense’s Telemedicine and Advanced Technologies Research Center (TATRC) began to study the antimicrobial properties of copper alloys in a multi-site clinical hospital trial conducted at the Memorial Sloan-Kettering Cancer Center
(New York City), the Medical University of South Carolina
, and the Ralph H. Johnson VA Medical Center (South Carolina). Commonly-touched items, such as bed rails, over-the-bed tray tables, chair arms, nurse's call buttons, IV poles, etc. were retrofitted with antimicrobial copper alloys in certain patient rooms (i.e., the “coppered” rooms) in the Intensive Care Unit
(ICU). Early results disclosed in 2011 indicate that the coppered rooms demonstrated a 97% reduction in surface pathogens versus the non-coppered rooms. This reduction is the same level achieved by “terminal” cleaning regimens conducted after patients vacate their rooms. Furthermore, of critical importance to health care professionals, the preliminary results indicated that patients in the coppered ICU rooms had a 40.4% lower risk of contracting a hospital acquired infection versus patients in non-coppered ICU rooms. The U.S. Department of Defense investigation contract, which is ongoing, will also evaluate the effectiveness of copper alloy touch surfaces to prevent the transfer of microbes to patients and the transfer of microbes from patients to touch surfaces, as well as the potential efficacy of copper-alloy based components to improve indoor air quality
.
In the U.S., the Environmental Protection Agency regulates the registration of antimicrobial products. After extensive antimicrobial testing according to the Agency’s stringent test protocols, 355 copper alloys
, including many brasses, were found to kill more than 99.9% of methicillin
-resistant Staphylococcus aureus
(MRSA), E. coli
O157:H7, Pseudomonas aeruginosa
, Staphylococcus aureus
, Enterobacter aerogenes
, and vancomycin-resistant Enterococci (VRE) within two hours of contact. Normal tarnishing was found to not impair antimicrobial effectiveness.
On February 29, 2008, the United States Environmental Protection Agency
(EPA) granted its first registrations of five different groups of copper
alloys as “antimicrobial
materials” with public health benefits. The registrations granted antimicrobial copper as "a supplement to and not a substitute for standard infection control practices." Subsequent registration approvals of additional copper alloys have been granted. The results of the EPA-supervised antimicrobial studies, demonstrating copper's strong antimicrobial efficacies across a wide range of alloys, have been published. These copper alloys are the only solid surface materials to be granted “antimicrobial public health claims” status by EPA.
The EPA registrations state that laboratory testing has shown that when cleaned regularly:
The registrations state that “antimicrobial copper alloys may be used in hospitals, other healthcare facilities, and various public, commercial and residential buildings.”
A list of antimicrobial copper products approved by the EPA is available.
/QC
measures to the health care
sectors and evidence-based management can be a feasible approach. For those VAP/HAP diseases (ventilator-associated pneumonia, hospital-acquired pneumonia
), controlling and monitoring hospital indoor air quality
needs to be on agenda in management whereas for nosocomial rotavirus
infection, a hand hygiene
protocol has to be enforced. Other areas that the management needs to be covered include ambulance
transport.
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
estimate that roughly 1.7 million hospital-associated infections, from all types of microorganism
Microorganism
A microorganism or microbe is a microscopic organism that comprises either a single cell , cell clusters, or no cell at all...
s, including bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
, combined, cause or contribute to 99,000 deaths each year. In Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
, where hospital surveys have been conducted, the category of Gram-negative
Gram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...
infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
and infections of the urinary tract
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance
Antibiotic resistance
Antibiotic resistance is a type of drug resistance where a microorganism is able to survive exposure to an antibiotic. While a spontaneous or induced genetic mutation in bacteria may confer resistance to antimicrobial drugs, genes that confer resistance can be transferred between bacteria in a...
is spreading to Gram-negative
Gram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...
bacteria that can infect people outside the hospital.
Known nosocomial infections
- Ventilator associated pneumonia (VAP)
- Staphylococcus aureusStaphylococcus aureusStaphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
- Methicillin resistant Staphylococcus aureus (MRSA)
- Candida AlbicansCandida albicansCandida albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Systemic fungal infections including those by C...
- Pseudomonas aeruginosaPseudomonas aeruginosaPseudomonas aeruginosa is a common bacterium that can cause disease in animals, including humans. It is found in soil, water, skin flora, and most man-made environments throughout the world. It thrives not only in normal atmospheres, but also in hypoxic atmospheres, and has, thus, colonized many...
- Acinetobacter baumanniiAcinetobacter baumanniiAcinetobacter baumannii is a species of pathogenic bacteria, referred to as an aerobic gram-negative bacterium, that is resistant to most antibiotics. As a result of its resistance to drug treatment, some estimates state the disease is killing tens of thousands of U.S...
- Stenotrophomonas maltophiliaStenotrophomonas maltophiliaStenotrophomonas maltophilia is an aerobic, nonfermentative, Gram-negative bacterium. It is an uncommon bacterium and human infection is difficult to treat. Initially classified as Pseudomonas maltophilia, S. maltophilia was also grouped in the genus Xanthomonas before eventually becoming the type...
- Clostridium difficileClostridium difficileClostridium difficile , also known as "CDF/cdf", or "C...
- TuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
- Urinary tract infectionUrinary tract infectionA urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
- Hospital-acquired pneumoniaHospital-acquired pneumoniaHospital-acquired pneumonia or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted. It is usually caused by a bacterial infection, rather than a virus....
(HAP) - GastroenteritisGastroenteritisGastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...
- Vancomycin-resistant EnterococcusVancomycin-Resistant EnterococcusVancomycin-resistant Enterococcus, or vancomycin-resistant enterococci , are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin. To become VRE, vancomycin-sensitive enterococci typically obtain new DNA in the form of plasmids or transposons which encode...
(VRE) - Legionnaires' disease
Epidemiology
Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment means that people who are hospitalized are more ill and have more weakened immune systems than may have been true in the past. Moreover, some medical procedureMedical procedure
A medical procedure is a course of action intended to achieve a result in the care of persons with health problems.A medical procedure with the intention of determining, measuring or diagnosing a patient condition or parameter is also called a medical test...
s 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.
Categories and treatment
Among the categories of bacteria most known to infect patients are the category MRSA, Gram-positive bacteria and HelicobacterHelicobacter
Helicobacter is a genus of Gram-negative bacteria possessing a characteristic helix shape. They were initially considered to be members of the Campylobacter genus, but since 1989 they have been grouped in their own genus...
, which is Gram-negative. While there are antibiotic drugs that can treat diseases caused by Gram-positive MRSA, there are currently few effective drugs for Acinetobacter. However, Acinetobacter germs are evolving and becoming immune to existing antibiotics. "In many respects it’s far worse than MRSA," said a specialist at Case Western Reserve University
Case Western Reserve University
Case Western Reserve University is a private research university located in Cleveland, Ohio, USA...
.
Another growing disease, especially prevalent in New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...
hospitals, is the drug-resistant Gram-negative germ, Klebsiella pneumoniae
Klebsiella pneumoniae
Klebsiella pneumoniae is a Gram-negative, non-motile, encapsulated, lactose fermenting, facultative anaerobic, rod shaped bacterium found in the normal flora of the mouth, skin, and intestines....
. An estimated more than 20 percent of the Klebsiella infections in Brooklyn
Brooklyn
Brooklyn is the most populous of New York City's five boroughs, with nearly 2.6 million residents, and the second-largest in area. Since 1896, Brooklyn has had the same boundaries as Kings County, which is now the most populous county in New York State and the second-most densely populated...
hospitals "are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide."
The bacteria, classified as Gram-negative because of their reaction to the Gram stain test, can cause severe pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
and infections of the urinary tract, bloodstream, and other parts of the body. Their cell structures make them more difficult to attack with antibiotics than Gram-positive organisms like MRSA. In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. "For Gram-positives we need better drugs; for Gram-negatives we need any drugs," said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-UCLA Medical Center
Harbor-UCLA Medical Center
Harbor–UCLA Medical Center is a 570-bed public teaching hospital located at 1000 West Carson Street within the unincorporated Los Angeles County area of West Carson, California...
, and the author of Rising Plague, a book about drug-resistant pathogens.
One-third of nosocomial infections are considered preventable. The CDC estimates 2 million people in the United States are infected annually by hospital-acquired infections, resulting in 20,000 deaths. The most common nosocomial infections are of the urinary tract, surgical site and various pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
s.
Country estimates
The methods used differ from country to country (definitions used, type of nosocomial infections covered, health units surveyed, inclusion or exclusion of imported infections, etc.), so that international comparisons of nosocomial infection rates should be made with the utmost care.United States: The Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
(CDC) estimates that roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. Other estimates indicate that 10%, or 2 million, patients a year become infected, with the annual cost ranging from $4.5 billion to $11 billion. In the USA the most frequent type of infection hospitalwide is urinary tract infection (36%), followed by surgical site infection (20%), bloodstream infection (BSI), and pneumonia (both 11%).
France: estimates ranged from 6.7% in 1990 to 7.4% (patients may have several infections). At national level, prevalence among patients in health care facilities was 6.7% in 1996, 5.9% in 2001 and 5.0% in 2006. The rates for nosocomial infections were 7.6% in 1996, 6.4% in 2001 and 5.4% in 2006.
In 2006, the most common infection sites were urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
s (30,3 %), pneumopathy (14,7 %), infections of surgery site (14,2 %). infections of the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
and mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
(10,2 %), other respiratory infections (6,8%) and bacterial infections / blood poisoning (6,4 %). The rates among adult patients in intensive care were 13,5% in 2004, 14,6% in 2005, 14,1% in 2006 and 14.4% in 2007.
It has also been estimated that nosocomial infections make patients stay in the hospital 4-5 additional days. Around 2004-2005, about 9,000 people died each year with a nosocomial infection, of which about 4,200 would have survived without this infection.
Italy: since 2000, estimates show that about 6.7 % infection rate, i.e. between and patients, which caused between and deaths. A survey in Lombardy gave a rate of 4.9% of patients in 2000.
United Kingdom: estimates of 10% infection rate, with 8.2% estimated in 2006.
Switzerland: estimates range between 2 and 14%. A national survey gave a rate of 7.2% in 2004.
Finland: estimated at 8.5% of patients in 2005
Transmission
The drug-resistant Gram-negative germs for the most part threaten only hospitalized patients whose immune systems are weak. The germs can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters, and ventilators.| Route | Description |
|---|---|
| Contact transmission | the most important and frequent mode of transmission of nosocomial infections. |
| Droplet transmission | occurs when droplets are generated from the source person mainly during coughing, sneezing, and talking, and during the performance of certain procedures such as bronchoscopy. Transmission occurs when droplets containing germs from the infected person are propelled a short distance through the air and deposited on the host's body. |
| Airborne transmission | occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 µm Micrometre A micrometer , is by definition 1×10-6 of a meter .In plain English, it means one-millionth of a meter . Its unit symbol in the International System of Units is μm... or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air handling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include Legionella Legionella Legionella is a pathogenic Gram negative bacterium, including species that cause legionellosis or Legionnaires' disease, most notably L. pneumophila. It may be readily visualized with a silver stain.... , Mycobacterium tuberculosis Mycobacterium tuberculosis Mycobacterium tuberculosis is a pathogenic bacterial species in the genus Mycobacterium and the causative agent of most cases of tuberculosis . First discovered in 1882 by Robert Koch, M... and the rubeola and varicella viruses. |
| Common vehicle transmission | applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment. |
| Vector borne transmission | occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms. |
Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact transmission.
| Route | Description |
|---|---|
| Direct-contact transmission | involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care Health care Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers... activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host. |
| Indirect-contact transmission | involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needle Hypodermic needle A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it... s, or dressings, or contaminated gloves that are not changed between patients. In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes. |
Risk factors
Factors predisposing a patient to infection can broadly be divided into three areas:- People in hospitals are usually already in a poor state of health, impairing their defense against bacteria – advanced age or premature birthPremature birthIn humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...
along with immunodeficiencyImmunodeficiencyImmunodeficiency is a state in which the immune system's ability to fight infectious disease is compromised or entirely absent. Immunodeficiency may also decrease cancer immunosurveillance. Most cases of immunodeficiency are acquired but some people are born with defects in their immune system,...
(due to drugs, illness, or irradiation) present a general risk, while other diseases can present specific risks - for instance, chronic obstructive pulmonary diseaseChronic obstructive pulmonary diseaseChronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...
can increase chances of respiratory tract infection. - Invasive devices, for instance intubationIntubationTracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
tubes, catheters, surgical drains, and tracheostomy tubes all bypass the body’s natural lines of defence against pathogens and provide an easy route for infection. Patients already colonised on admission are instantly put at greater risk when they undergo an invasive procedure. - A patient’s treatment itself can leave them vulnerable to infection – immunosuppressionImmunosuppressionImmunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...
and antacidAntacidAn antacid is a substance which neutralizes stomach acidity.-Mechanism of action:Antacids perform a neutralization reaction, increasing the pH to reduce acidity in the stomach. When gastric hydrochloric acid reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous...
treatment undermine the body’s defences, while antimicrobialAntimicrobialAn anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes or prevent the growth of microbes...
therapy (removing competitive floraFloraFlora is the plant life occurring in a particular region or time, generally the naturally occurring or indigenous—native plant life. The corresponding term for animals is fauna.-Etymology:...
and only leaving resistant organisms) and recurrent bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
transfusions have also been identified as risk factors.
Prevention
Hospitals have sanitation protocols regarding uniformsScrubs (clothing)
Scrubs are the shirts and trousers or gowns worn by nurses , surgeons, and other operating room personnel when "scrubbing in" for surgery. In the United Kingdom, they are sometimes known as Theatre Blues. They are designed to be simple with minimal places for dirt to hide, easy to launder, and...
, equipment sterilization
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...
, washing, and other preventative measures. Thorough hand washing
Hand washing
Hand washing for hand hygiene is the act of cleaning the hands with or without the use of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms....
and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections. More careful use of antimicrobial
Antimicrobial
An anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes or prevent the growth of microbes...
agents, such as antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s, is also considered vital.
Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s and other antimicrobial
Antimicrobial
An anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes or prevent the growth of microbes...
drugs to help treat illness; this may increase the selection pressure
Natural selection
Natural selection is the nonrandom process by which biologic traits become either more or less common in a population as a function of differential reproduction of their bearers. It is a key mechanism of evolution....
for the emergence of resistant strains.
Sterilization
Sterilization goes further than just sanitizing. Sterilizing kills all microorganisms on equipment and surfaces through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure.Isolation
Isolation precautions are designed to prevent transmission of microorganisms by common routes in hospitals. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission.Handwashing and gloving
Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganismSkin flora
The skin flora are the microorganisms which reside on the skin. Most research has been upon those that reside upon the 2 square metres of human skin. Many of them are bacteria of which there are around 1000 species upon human skin from 19 phyla. The total number of bacteria on an average human has...
s 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
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, body fluids, secretion
Secretion
Secretion is the process of elaborating, releasing, and oozing chemicals, or a secreted chemical substance from a cell or gland. In contrast to excretion, the substance may have a certain function, rather than being a waste product...
s, excretion
Excretion
Excretion is the process by which waste products of metabolism and other non-useful materials are eliminated from an organism. This is primarily carried out by the lungs, kidneys and skin. This is in contrast with secretion, where the substance may have specific tasks after leaving the cell...
s, 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 it is a real challenging problem in the modern hospitals. The best way for Health Care Workers to overcome this problem is acting right 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 one is represented by the micro organisms taken by Health Care Workers from the environment, and the bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group on the other hand, is represented by the permanent micro organisms that lived 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 skin of Health Care Workers is colonized by 3.9 x 104 – 4.6 x 106 cfu / cm2. The micro organisms creating the resident flora are: Staphylococcus epidermidis, Staphylococcus hominis, Microccoci, Propionibacterium, Corynebacterium, Dermobacterium, Pitosporum, while in the transitional could be found Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter spp, Enterobacter spp and Candida spp. The goal of hand hygiene is to eliminate the transient flora with a careful and proper performance of hand wash, using different kind of soap, from the normal one to the
antiseptic, and alcohol based gel. 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 rub, because of its faster application compared to a correct hand washing.
Although handwashing may seem like a simple process, it is often performed incorrectly. Healthcare settings must continuously remind practitioners and visitors on the proper procedure in washing their hands to comply with responsible handwashing. Simple programs such as Henry the Hand, and the use of handwashing signals can assist healthcare facilities in the prevention of nosocomial infections.
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
Flora (microbiology)
In microbiology, flora refers to the collective bacteria and other microorganisms in an ecosystem . While the term microflora is widely used, it is technically a misnomer since the word root flora pertains to the kingdom plantae...
if steps are not taken to stop this transmission.
In addition to handwashing, gloves
Medical gloves
Medical gloves are disposable gloves used during medical examinations and procedures that help prevent contamination between caregivers and patients. Medical gloves are made of different polymers including latex, nitrile rubber, vinyl and neoprene; they come unpowdered, or powdered with cornstarch...
play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, gloves 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
Occupational Safety and Health Administration
The United States Occupational Safety and Health Administration is an agency of the United States Department of Labor. It was created by Congress of the United States under the Occupational Safety and Health Act, signed by President Richard M. Nixon, on December 29, 1970...
has mandated wearing gloves to reduce the risk of bloodborne pathogen infection. Second, gloves are worn to reduce the likelihood that 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, gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or a fomite
Fomite
A fomite is any inanimate object or substance capable of carrying infectious organisms and hence transferring them from one individual to another. A fomite can be anything...
can transmit these microorganisms 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, non-apparent 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-CO2NAV-CO2
Non-flammable Alcohol Vapor in Carbon Dioxide systems were developed in Japan in the 1990s to sanitize hospitals and ambulances. These systems were developed in response to a need for a safe, effective, and environmentally sound way of sanitizing without the use of toxic or corrosive chemicals...
have been effective against gastroenteritis, MRSA, and influenza. Use of hydrogen peroxide
Hydrogen peroxide
Hydrogen peroxide is the simplest peroxide and an oxidizer. Hydrogen peroxide is a clear liquid, slightly more viscous than water. In dilute solution, it appears colorless. With its oxidizing properties, hydrogen peroxide is often used as a bleach or cleaning agent...
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.
Antimicrobial surfaces
Microorganisms 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
Staphylococcus
Staphylococcus is a genus of Gram-positive bacteria. Under the microscope they appear round , and form in grape-like clusters....
, Methicillin-resistant Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus is a bacterium responsible for several difficult-to-treat infections in humans. It is also called multidrug-resistant Staphylococcus aureus and oxacillin-resistant Staphylococcus aureus...
(MRSA), one of the most virulent strains of antibiotic-resistant bacteria and Vancomycin-resistant Enterococcus
Vancomycin-Resistant Enterococcus
Vancomycin-resistant Enterococcus, or vancomycin-resistant enterococci , are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin. To become VRE, vancomycin-sensitive enterococci typically obtain new DNA in the form of plasmids or transposons which encode...
(VRE). Objects in closest proximity to patients have the highest levels of staphylococcus, 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.
Copper alloy surfaces have intrinsic properties to destroy a wide range of microorganisms. In the interest of protecting public health, especially in heathcare environments with their susceptible patient populations, an abundance of peer-reviewed antimicrobial efficacy studies have been and continue to be conducted around the world regarding copper’s efficacy to destroy E. coli
Escherichia coli
Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls...
O157:H7, methicillin
Methicillin
Meticillin or methicillin is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It should not be confused with the antibiotic metacycline.-History:Methicillin was developed by Beecham in 1959...
-resistant Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
(MRSA), Staphylococcus
Staphylococcus
Staphylococcus is a genus of Gram-positive bacteria. Under the microscope they appear round , and form in grape-like clusters....
, Clostridium difficile
Clostridium difficile
Clostridium difficile , also known as "CDF/cdf", or "C...
, influenza A virus, adenovirus
Adenoviridae
Adenoviruses are medium-sized , nonenveloped icosahedral viruses composed of a nucleocapsid and a double-stranded linear DNA genome...
, and fungi
Fungus
A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...
.
Much of this antimicrobial efficacy work has been or is currently being conducted at the University of Southampton
University of Southampton
The University of Southampton is a British public university located in the city of Southampton, England, a member of the Russell Group. The origins of the university can be dated back to the founding of the Hartley Institution in 1862 by Henry Robertson Hartley. In 1902, the Institution developed...
and Northumbria University
Northumbria University
Northumbria University is an academic institution located in Newcastle upon Tyne in the North East of England. It is a member of the University Alliance.- History :...
(United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
), University of Stellenbosch (South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
), Panjab University (India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
), University of Chile (Chile
Chile
Chile ,officially the Republic of Chile , is a country in South America occupying a long, narrow coastal strip between the Andes mountains to the east and the Pacific Ocean to the west. It borders Peru to the north, Bolivia to the northeast, Argentina to the east, and the Drake Passage in the far...
), Kitasato University
Kitasato University
is one of the famous private university in Minato, Tokyo, Japan.The head of the university is located in the Shirokane Campus, neighboring the Kitasato Institute. Its major educational facilities are located in the Sagamihara Campus, located 60 kilometers west of central Tokyo...
(Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
), the Instituto do Mar and University of Coimbra (Portugal
Portugal
Portugal , officially the Portuguese Republic is a country situated in southwestern Europe on the Iberian Peninsula. Portugal is the westernmost country of Europe, and is bordered by the Atlantic Ocean to the West and South and by Spain to the North and East. The Atlantic archipelagos of the...
), and the University of Nebraska and Arizona State University
Arizona State University
Arizona State University is a public research university located in the Phoenix Metropolitan Area of the State of Arizona...
(U.S.A.). A summary of the antimicrobial copper touch surfaces clinical trials to date is available
In 2007, U.S. Department of Defense’s Telemedicine and Advanced Technologies Research Center (TATRC) began to study the antimicrobial properties of copper alloys in a multi-site clinical hospital trial conducted at the Memorial Sloan-Kettering Cancer Center
Memorial Sloan-Kettering Cancer Center
Memorial Sloan–Kettering Cancer Center is a cancer treatment and research institution founded in 1884 as the New York Cancer Hospital...
(New York City), the Medical University of South Carolina
Medical University of South Carolina
The Medical University of South Carolina opened in Charleston, South Carolina in 1824 as a small private college for the training of physicians. It is one of the oldest continually operating school of medicine in the United States and the oldest in the Deep South...
, and the Ralph H. Johnson VA Medical Center (South Carolina). Commonly-touched items, such as bed rails, over-the-bed tray tables, chair arms, nurse's call buttons, IV poles, etc. were retrofitted with antimicrobial copper alloys in certain patient rooms (i.e., the “coppered” rooms) in the Intensive Care Unit
Intensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...
(ICU). Early results disclosed in 2011 indicate that the coppered rooms demonstrated a 97% reduction in surface pathogens versus the non-coppered rooms. This reduction is the same level achieved by “terminal” cleaning regimens conducted after patients vacate their rooms. Furthermore, of critical importance to health care professionals, the preliminary results indicated that patients in the coppered ICU rooms had a 40.4% lower risk of contracting a hospital acquired infection versus patients in non-coppered ICU rooms. The U.S. Department of Defense investigation contract, which is ongoing, will also evaluate the effectiveness of copper alloy touch surfaces to prevent the transfer of microbes to patients and the transfer of microbes from patients to touch surfaces, as well as the potential efficacy of copper-alloy based components to improve indoor air quality
Indoor air quality
Indoor air quality is a term referring to the air quality within and around buildings and structures, especially as it relates to the health and comfort of building occupants....
.
In the U.S., the Environmental Protection Agency regulates the registration of antimicrobial products. After extensive antimicrobial testing according to the Agency’s stringent test protocols, 355 copper alloys
Copper alloys
Copper alloys are metal alloys that have copper as their principal component. They have high resistance against corrosion. The best known traditional types are bronze, where tin is a significant addition, and brass, using zinc instead...
, including many brasses, were found to kill more than 99.9% of methicillin
Methicillin
Meticillin or methicillin is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It should not be confused with the antibiotic metacycline.-History:Methicillin was developed by Beecham in 1959...
-resistant Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
(MRSA), E. coli
Escherichia coli
Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls...
O157:H7, Pseudomonas aeruginosa
Pseudomonas aeruginosa
Pseudomonas aeruginosa is a common bacterium that can cause disease in animals, including humans. It is found in soil, water, skin flora, and most man-made environments throughout the world. It thrives not only in normal atmospheres, but also in hypoxic atmospheres, and has, thus, colonized many...
, Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
, Enterobacter aerogenes
Enterobacter aerogenes
Enterobacter aerogenes is a Gram-negative, oxidase negative, catalase positive, citrate positive, indole negative, rod-shaped bacterium....
, and vancomycin-resistant Enterococci (VRE) within two hours of contact. Normal tarnishing was found to not impair antimicrobial effectiveness.
On February 29, 2008, the United States Environmental Protection Agency
United States Environmental Protection Agency
The U.S. Environmental Protection Agency is an agency of the federal government of the United States charged with protecting human health and the environment, by writing and enforcing regulations based on laws passed by Congress...
(EPA) granted its first registrations of five different groups of copper
Copper
Copper is a chemical element with the symbol Cu and atomic number 29. It is a ductile metal with very high thermal and electrical conductivity. Pure copper is soft and malleable; an exposed surface has a reddish-orange tarnish...
alloys as “antimicrobial
Antimicrobial
An anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes or prevent the growth of microbes...
materials” with public health benefits. The registrations granted antimicrobial copper as "a supplement to and not a substitute for standard infection control practices." Subsequent registration approvals of additional copper alloys have been granted. The results of the EPA-supervised antimicrobial studies, demonstrating copper's strong antimicrobial efficacies across a wide range of alloys, have been published. These copper alloys are the only solid surface materials to be granted “antimicrobial public health claims” status by EPA.
The EPA registrations state that laboratory testing has shown that when cleaned regularly:
- Antimicrobial Copper Alloys continuously reduce bacterial contamination, achieving 99.9% reduction within two hours of exposure.
- Antimicrobial Copper Alloy surfaces kill greater than 99.9% of Gram-negative and Gram-positive bacteria within two hours of exposure.
- Antimicrobial Copper Alloy surfaces deliver continuous and ongoing antibacterial action, remaining effective in killing greater than 99% of bacteria within two hours.
- Antimicrobial Copper Alloys surfaces kill greater than 99.9% of bacteria within two hours, and continue to kill 99% of bacteria even after repeated contamination.
- Antimicrobial Copper Alloys surfaces help inhibit the buildup and growth of bacteria within two hours of exposure between routine cleaning and sanitizing steps.
- Testing demonstrates effective antibacterial activity against Staphylococcus aureus, Enterobacter aerogenes, Methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli O157:H7, and Pseudomonas aeruginosa
The registrations state that “antimicrobial copper alloys may be used in hospitals, other healthcare facilities, and various public, commercial and residential buildings.”
A list of antimicrobial copper products approved by the EPA is available.
Aprons
Wearing an apron during patient care reduces the risk of infection. The apron should either be disposable or be used only when caring for a specific patient.Mitigation
The most effective technique of controlling nosocomial infection is to strategically implement QAQuality Assurance
Quality assurance, or QA for short, is the systematic monitoring and evaluation of the various aspects of a project, service or facility to maximize the probability that minimum standards of quality are being attained by the production process...
/QC
Quality control
Quality control, or QC for short, is a process by which entities review the quality of all factors involved in production. This approach places an emphasis on three aspects:...
measures to the health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
sectors and evidence-based management can be a feasible approach. For those VAP/HAP diseases (ventilator-associated pneumonia, hospital-acquired pneumonia
Hospital-acquired pneumonia
Hospital-acquired pneumonia or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted. It is usually caused by a bacterial infection, rather than a virus....
), controlling and monitoring hospital indoor air quality
Indoor air quality
Indoor air quality is a term referring to the air quality within and around buildings and structures, especially as it relates to the health and comfort of building occupants....
needs to be on agenda in management whereas for nosocomial rotavirus
Rotavirus
Rotavirus is the most common cause of severe diarrhoea among infants and young children, and is one of several viruses that cause infections often called stomach flu, despite having no relation to influenza. It is a genus of double-stranded RNA virus in the family Reoviridae. By the age of five,...
infection, a hand hygiene
Hand washing
Hand washing for hand hygiene is the act of cleaning the hands with or without the use of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms....
protocol has to be enforced. Other areas that the management needs to be covered include ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
transport.
See also
- Cubicle curtainCubicle curtainA cubicle curtain or hospital curtain is a dividing cloth used in a medical treatment facility that provides a private enclosure for one or more patients...
- Fluorescent lighting
- Infection controlInfection controlInfection control is the discipline concerned with preventing nosocomial or healthcare-associated infection, a practical sub-discipline of epidemiology. It is an essential, though often under-recognized and under-supported, part of the infrastructure of health care...
- PatientPakPatientpakSanitas Healthcare plc is a consumer hygiene pack manufacturer and retailer. The original product, PatientPak, was designed for use by patients to protect themselves from healthcare-associated infections , and especially from antibiotic resistant pathogens known as ‘superbugs’, when they go into...
- Phototherapy
- Sanitation Standard Operating ProceduresSanitation Standard Operating ProceduresSanitation Standard Operating Procedures is the common name give to the sanitation procedures in food production plants which are required by the Food Safety and Inspection Service of the USDA and regulated by 9 CFR part 416 in conjunction with 21 CFR part 178.1010...