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Int. J. Life. Sci. Scienti. Res.eISSN: 2455-1716Taiyaba et al., 2018DOI:10.21276/ijlssr.2018.4.4.2Review ArticleHospital Acquired Infections, Sources, Route of Transmission,Epidemiology, Prevention and Control1*2Taiyaba , Anurag Rai , Farhat Tahira31Department of Microbiology, G.C.R.G Institute of Medical Sciences and Hospital Lucknow, India2Department of Microbiology, Prasad Institute of Medical Sciences and Hospital Lucknow, India3Department of Microbiology, Saraswati Medical College Unnao, India*Address for Correspondence: Ms. Taiyaba, Tutor, Department of Microbiology, G.C.R.G Institute of Medical Sciencesand Hospital Lucknow, IndiaReceived: 27 Feb 2018/ Revised: 01 April 2018/ Accepted: 28 June 2018ABSTRACTNosocomial infections are infections acquired in hospital or healthcare service unit that first appear 48 hours or more afterhospital admission or within 30 days after discharge following in-patient care. The main routes of transmission of nosocomialinfections are contact, airborne, common vehicle and vector borne. Common infections are urinary tract infections (UTI), surgicaland soft tissue infections, gastroenteritis, meningitis and respiratory infections. The agents that are usually involved in hospitalacquired infections are Streptococcus sp., Acinetobacter sp., Enterococci, Pseudomonas aeruginosa, Coagulase negativeStaphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteriaceae family members including Proteusmirablis, Klebsiella pneumonia, Escherichia coli, Serratia marcescens. Out of these Enterococci, P. aeruginosa, S. aureus and E. colihave a major role. Various infection control programmes and organizations help to lower the risk of an infection during and afterthe period of hospitalization.Key-words: Urinary tract infections, Hospital Acquired Infections, Route of Transmission, Epidemiology, Prevention and ControlINTRODUCTIONAccording to the World Health Organization a Hospitalacquired infection is an infection acquired in hospital bya patient who was admitted for a reason other than thatinfection [1]. In other words nosocomial infections arethose infections which are acquired in hospital orhealthcare service unit that first appear 48 hours ormore after hospital admission or within 30 days afterdischarge following in-patient care [2].‘Nosocomial’ or‘healthcare associated infections’ (HCAI) can occurduring healthcare delivery for other diseases and evenafter the discharge of the patients.How to cite this articleTaiyaba, Rai A, Tahira K. Hospital Acquired Infections, Sources,Route of Transmission, Epidemiology, Prevention and Control. Int.J. Life. Sci. Scienti. Res., 2018; 4(4): 1858-1862.Access this article onlinewww.ijlssr.comThey also comprise of occupational infections among themedical staff [3].The situations in which infections are not believed asnosocomial are: The infections that were present at the time ofadmission and become complicated, neverthelesspathogens or symptoms change resulting to a newinfection; The infections that are acquired trans-placentallydue to some diseases like toxoplasmosis, rubella,syphilis or cytomegalovirus and appear 48 h afterbirth [4].Increasing nosocomial infections have led to anincreased antimicrobial resistance, increase in socioeconomic disturbance, and increased mortality rate [5].The various aspects of nosocomial infections are theroute of transmission, site of infections, commonnosocomial bacterial agents, selected antibiotic-resistantpathogens along with their modes of transmission andcontrol measures.Copyright 2015 - 2018 IJLSSR by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 04 Issue 04 Page 1858
Int. J. Life. Sci. Scienti. Res.eISSN: 2455-1716Taiyaba et al., 2018DOI:10.21276/ijlssr.2018.4.4.2Routes of Transmission- The main routes of transmissioninclude contact, airborne, common vehicle and vectorborne [6].Contact routeDirect Contact- It requires physical contact between theinfectious individual or contaminated object and thesusceptible host.Indirect contact- This requires mechanical transfer ofpathogens between patients through a health careworker or a medical kit.Air borne route- Airborne transmission occurs bydissemination of airborne droplet nuclei (small particle)[7]. Microorganisms inhaled by a susceptible host withinthe same room or over a long distance from the sourcepatient depending on environmental factors. Examplesinclude Mycobacterium tuberculosis, Legionella, and theRubella and Varicella viruses.Droplet route- Droplet particles, produced by coughing,sneezing and even talking, can settle either onsurrounding surfaces or on the body mucosa which canbe transferred to others. Examples include meningitisand pneumonia.Common vehicle transmission- It applies to microorganisms transmitted to the host by contaminateditems such as food, water, medications, devices andequipments.Vector borne transmission- Vector-borne diseases areinfections transmitted by the bite of infected arthropodspecies, such as mosquitoes, ticks, triatomine bugs,sandflies, and blackflies.Types of Nosocomial Infections- National HealthcareSafety Network with Center for Disease Control (CDC) forsurveillance has classified nosocomial infection sites into13 types, with 50 infection sites, which are specific onthe basis of biological and clinical criteria. The siteswhich are common include urinary tract infections (UTI),surgical and soft tissue infections, gastroenteritis,meningitis and respiratory infections [8].Agents of Nosocomial infections- Bacteria areresponsible for about ninety percent infections.Protozoans, fungi, viruses and mycobacteria are lesscontributing compared to bacterial infection [9]. Theagents that are usually involved in hospital acquiredinfections include Streptococcus sp., Acinetobacter sp.,Enterococci, Pseudomonas aeruginosa, CoagulaseNegative Staphylococci, Staphylococcus aureus, Bacilluscereus, Legionella and Enterobacteriaceae familymembers including Proteus mirablis, Klebsiellapneumonia, Escherichia coli, Serratia marcescens. Out ofthese Enterococci, P. aeruginosa, S. aureus and E. coliplay a major role [10]. UTIs are usually caused by E. coli,while it is uncommon in other infection sites. Contrarily,S. aureus is frequent at other body sites and rarelycauses UTI. Coagulase-Negative S. aureus is the maincausative agent in blood borne infections. Surgical-siteinfections contain Enterococcus sp. which is lessprevalent in respiratory tract. One tenth of all infectionsare caused by P. aeruginosa, which is evenly distributedto the entire body sites [11]. Nosocomial infections arebeing elevated by excessive and improper use of broadspectrum antibiotics especially in healthcare settings.Penicillin-resistant pneumococci, multi-drug-resistanttuberculosis, methicillin-resistant S. aureus (MRSA),vancomycin-resistant S. aureus (VRSA) are commonexamples of drug-resistant bacteria. The distribution ofbacteria in nosocomial infections is changing overperiods of time. For example, Proteus sp., Klebsiella sp.and Escherichia sp. were responsible for nosocomialinfections in the 1960s, but from 1975 to 1980s,Acinetobacter sp. with P. aeruginosa created clinicaldifficulties [12]. Lately, streptococci along with estaphylococci reemerged and incidence level of K.pneumonia and E. coli declined from 7% to 5% and 23%to 16%, respectively [13].S. aureus, out of many species of Staphylococcus genusisis considered one of the most important pathogens,responsible for nosocomial infections [14].E. coli is an emerging nosocomial pathogen causingproblems in health care settings. E. coli is responsible fora number of diseases including UTI, septicemia,pneumonia, neonatal meningitis, peritonitis andgastroenteritis [15,16]. The second leading cause ofhospital acquired infections worldwide is Enterococci [17].Three to seven percent of hospital-acquired bacterialinfections are related to K. pneumonia, which is theeighth significant pathogen in healthcare settings. It getsinvolved in diseases such as neonatal septicaemia,Copyright 2015 - 2018 IJLSSR by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 04 Issue 04 Page 1859
Int. J. Life. Sci. Scienti. Res.eISSN: 2455-1716Taiyaba et al., 2018DOI:10.21276/ijlssr.2018.4.4.2[18]pneumonia, wound infections and septicemiaP.aeruginosa contributes to 11% of all nosocomialinfections, which result in high mortality and morbidityrates. It is a cause of surgical and wound infections, UTI,pneumonia, cystic fibrosis and bacteremia [19]. C. difficileis an important nosocomial pathogen which mainlycauses diarrhea [20].High-risk stuations for acquiring hospital-acquiredinfectionsNumerous risk factors are there which predispose a hostto acquire HAIs which include low body resistance as ininfancy and old age, serious underlying illnesses, majorsurgeries [21], immune deficiency states [22] and prolongedhospital stay [23].Various areas are there in the hospitalwhich carry a greater risk of patients acquiring HAI’s[24,25]. These include intensive care unit, dialysis unit,organ transplant unit, burns unit, operation theatres,delivery rooms, post-operative wards.Prevention of Nosocomial Infections- Various measuresthat should be taken for prevention of Nosocomialinfections are: Limiting transmission of organisms between patientsin direct patient care through adequate handwashingand glove use, and appropriate aseptic practice,isolation strategies, sterilization and disinfectionpractices, and laundry. Controlling environmental risks leading to infection. Protecting patients with appropriate use ions. Limiting the risk of endogenous infections byminimizing invasive procedures and promotingoptimal antimicrobial use. Surveillance of infections, identifying and controllingoutbreaks. Prevention of infection in staff members. Enhancing staff patient care practices, andcontinuing staff education.Routine cleaning and precautionary measures in mosthospitals, effective environmental decontaminationmethods are still in demand. Disinfectants are commonlyused to minimize the risk of Methicillin-resistantStaphylococcus aureus (MRSA) [26]. Resistance toMethicillin is documentedStaphylococcus isolates [27].in8(50%)of16Hospital Infection Control Programme- In the 1960sinfection prevention and control programmes wereinitially implemented in hospitals in the US. The mainaim of the infection control programme is to lower therisk of an infection during the period of hospitalization[28].Infection Control OrganizationsInfection Control Committee (ICC)- Representatives ofmedical, nursing,, pharmacy, CSSD and Microbiologydepartments are the members of the ICC. Thecommittee formulates the policies for the preventionand control of infection [29]. The role of the InfectionControl Committee is very multi-faceted. It should beinvolved in planning, monitoring, evaluating, updatingand educating.Infection Control Team (ICT)- Infection Control Team isresponsible for establishing infection control policies andprocedures, providing advice and guidance regardinginfection control matters, regular audits and surveillance,identification and investigation of outbreaks, awarenessand education of staff.Infection Control Officer (ICO)- Secretary of InfectionControl Committee are responsible for recordingminutes and arranging meetings. When notified of anexposure incident, the infection control officer shouldensure that notification, verification, treatment andmedical follow-up occur.Infection Control Nurse (ICN)- To cooperate betweenmicrobiology department and clinical departments fordetection and control of HAI. ICN works in closeassistance with the ICO on surveillance of infection anddetection of outbreaks of infection. ICN also increasesthe awareness among patients and visitors aboutinfection control and various measures that needs to betaken.CONCLUSIONSIncreasing nosocomial infections have led to anincreased antimicrobial resistance, increase in socioeconomic disturbance, and increased mortality rateNosocomial infections are uncontrollable even in this ageCopyright 2015 - 2018 IJLSSR by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 04 Issue 04 Page 1860
Int. J. Life. Sci. Scienti. Res.eISSN: 2455-1716Taiyaba et al., 2018DOI:10.21276/ijlssr.2018.4.4.2of advanced antibiotics. Measures must be taken at theHospitals to come up with an in-house awarenessprogramme where staff members, patients and theirrelatives can be educated and well equiped onmaintaining hygiene.ACKNOWLEDGMENTSAuthors thank to the G.C.R.G. Institute of MedicalSciences and Hospital, Lucknow for their assistancewhere this study took place.CONTRIBUTION OF AUTHORSAll authors are equally contributed.REFERENCES[1] Prevention of hospital-acquired infections. WorldHealth Organization Department of CommunicableDisease, Surveillance and Response, 2002.[2] a.org/wiki/Wiki nosocomial infection. Accessed on June 2009.[3] WHO. The burden of health care-associated infectionworldwide, 2016.[4] Festary A, Kouri V, Correa CB, Verdasquera D, Roig T,Couret MP. Cytomegalovirus and herpes simplexinfections in mothers and newborns in a Havanamaternity hospital. MEDICC Rev, 2015; 17: 29-34.[5] Allegranzi B. Report on the burden of endemic healthcare associated infection worldwide. Geneva: WHO;2011.[6] Prevention of hospital-acquired infections. Apractical guide 2nd edition. World HealthOrganization Department of Communicable Disease,Surveillance and Response, 2002.[7] Nosocomial infections and infection control inhospital, 2007.[8] Raka L, Zoutman D, Mulliqi G, Krasniqi S, Dedushaj I,Raka N, et al. Prevalence of nosocomial infections inhigh-risk units in the university clinical center ofKosova. Infect Control Hosp Epidemiol, 2006; 27:421-3.[9] Gatermann S, Fünfstück R, Handrick W, Leitritz L,Naber KG, Podbielski A. Urinary Tract Infections:Quality standards for microbiological infections.München: Urban & Fischer, 2005; pp. 8-21.[10]Horan TC, Andrus M, Dudeck MA. CDC/NHSNsurveillance definition of health care-associatedinfection and criteria for specific types of infectionsin the acute care setting. Am J Infect Control, 2008;36: 309-32.[11]Murray PR, Rosenthal KS, Pfaller MA. Medicalmicrobiology. Mosby Inc., 2005.[12]Gordon RJ, Lowy FD. Pathogenesis of methicillinresistant Staphylococcus aureus infection. Clin InfectDis., 2008; 4: 350-9.[13]Shinagawa N, Taniguchi M, Hirata K, Furuhata T,Fukuhara K, Mizugucwi T. Bacteria isolated fromsurgical infections and its susceptibilities toantimicrobial agents-special references to bacteriaisolated between April 2010 and March 2011. Jpn. J.Antibiot., 2014; (5): 293-334.[14]Vandenesch F, Lina G, Henry T. Staphylococcusaureus hemolysins, bi-component leukocidins, andcytolytic peptides: a redundant arsenal ofmembrane-damaging virulence factors? Front CellInfect Microbiol, 2012; 2: 12.[15]Lausch KR, Fuursted K, Larsen CS, Storgaard M.Colonisation with multi-resistant Enterobacteriaceaein hospitalised Danish patients with a history ofrecent travel: a cross-sectional study. Travel MedInfect Dis, 2013; 11: 320-3.[16]Zhao W, Yang S, Huang Q, Cai P. Bacterial cell surfaceproperties: role of loosely bound extracellularpolymeric substances (LB-EPS). Colloids Surf BBiointerfaces, 2015; 128: 600-7.[17]Karki S, Leder K, Cheng AC. Should we continue ci in hospitals? Med J Aust, 2015; 202:234-6.[18]Lin YT, Wang YP, Wang FD, Fung CP. Communityonset Klebsiella pneumoniae pneumonia in Taiwan:clinical features of the disease and associatedmicrobiological characteristics of isolates frompneumonia and nasopharynx. Front Microbiol, 2015;9: 122.[19]Balasoiu M, Balasoiu AT, Manescu R, Avramescu C,Ionete O. Pseudomonas aeruginosa resistancephenotypes and phenotypic highlighting methods.Curr Health Sci J., 2014; 40: 85-92.[20]Kim J, Kang JO, Kim H, Seo MR, Choi TY, Pai H, et al.Epidemiology of Clostridium difficile infections in atertiary-care hospital in Korea. Clin Microbiol Infect.,2013; 19: 521-7.Copyright 2015 - 2018 IJLSSR by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 04 Issue 04 Page 1861
Int. J. Life. Sci. Scienti. Res.eISSN: 2455-1716Taiyaba et al., 2018DOI:10.21276/ijlssr.2018.4.4.2[21]Dunn DL. Hazardous crossing: immunosuppressionand nosocomial infections in solid organ transplantrecipients. Surg Infect, 2001; 2: 103–10.[22]Practical guidelines for infection control in healthcare facilities, 2002.[23]McNicholas, S., Andrews, C., Boland, K., Shields, M.,Doherty, G.A., Murray, F.E., Smith, E.G., Humphreys,H., & Fitzpatrick, F. Delayed acute hospital dischargeand healthcare-associated infections: the forgottenrisk factors. J. Hosp. Infect., 2011; 78: 157-8.[24]Mayon-White RT, Dual G, Kereselidze T, TikhomirovE. An international survey of the prevalence ofhospital acquired infection. J. Hosp. Infect., 198;8:11: S43-8.[25]Britt MR, Burk JP, Nordguist AG et al. Infectioncontrol in small hospital: prevalence surveys in 18institutions. JAMA, 1976; 236:1700-3.[26]Ahmed I. Khattab, Humodi A. Saeed. Prevalence ofMethicillin-Resistant Staphylococcus aureus and theRole of Disinfectants in Infection control Int. J. Life.Sci. Scienti. Res., 2016, 2(2): 59-67.[27]Nazreen Khan, Mohd. Shahid khan, Prevalence ofAntimicrobial Resistance in Bacterial Isolates CausingUrinary Tract Infection in Patients attending atIIMS&R Hospital, Lucknow nt. J. Life. Sci. Scienti. Res.,2016: 2: 1-8.[28]Horan T.C, Gaynes R.P. Surveillance of nosocomialinfections. In: Mayhall C.G eds. Williams and WilkinsHospital epidemiology and infection control 3rd ed.Philadelphia: Lippincortt; 2004: 1659-1702.[29]National Nosocomial Infections Surveillance (NNIS)System, Centers of Disease Control and Prevention.National Nosocomial Infections (NNIS) report. Am JInfect Control, 1996; 24: 380-8.Open Access Policy:Authors/Contributors are responsible for originality, contents, correct references, and ethical issues. IJLSSR publishes all articles under CreativeCommons Attribution- Non-Commercial 4.0 International License (CC BY-NC). alcodeCopyright 2015 - 2018 IJLSSR by Society for Scientific Research under a CC BY-NC 4.0 International License Volume 04 Issue 04 Page 1862
Various infection control programmes and organizations help to lower the risk of an infection during and after the period of hospitalization. Key-words: Urinary tract infections, Hospital Acquired Infections, Ro
SUSPECTED PEDIATRIC BONE AND JOINT INFECTIONS UNIVERSITY OF MICHIGAN CLINICAL PRACTICE GUIDELINE I. OVERVIEW: Bone and joint infections are relatively common invasive bacterial infections in children and adolescents. These infections can develop via hematogenous spread, via direct spread from adjacent soft tissue infection, or as a result
Infections in LTC Facilities This handbook lists the frequently encountered infections in long-term care (LTC) facilities, their common causative agents, and the suggested levels of precaution. In addition to these common infections, there have been several serious infections and outbreaks reported in long-term care facilities. CDC's Serious
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1.0/100 procedures 1.7/100 procedures 0.6/100 procedures Catheter-associated urinary tract infections (CAUTIs) in intensive care unitsC 1,703 2.6/1,000 catheter days Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections among inpatientsC Hospital-onset Community-onset 858 2,324 0.66/10,000 patient days 1.0/1000 admissions
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