Nosocomial Infection: A Refresher Crash Course
Nosocomial Infection: A Refresher Crash Course
Nosocomial infections are those that are acquired within a hospital. There are mutliple modes of transimission and several diseases of extreme concern for the elderly, disabled and immunodeficient individuals. At highest risk, are our patients receiving palliative or hospice care as these patients are often at a point of critical illness. This is where our hospice and home care actions tend to make a huge difference in the overall quality of life and care for the patient. Keeping patients away from the hospital by providing skilled care elsewhere is absolutely the most ideal situation, but still not completelt foolproof in avoiding the transmission of nosocomial infection. Enclosed is some basic information on the common nosocomial infections that are persistently problematic in today's healthcare settings.
Oftentimes healthcare workers are dedicated to that one particular area, or even singular physical location. This means that they typically aren't spending a large amount of time traveling in and out of different areas of a hospital, where they could unwittingly become a vector for disease.
Oftentimes the caregiver's clothing becomes a fomite-culprit, as it comes in contact with all the environs the worker is in contact with. While the liklihood of encountering these diseases is slimmer with the comparmentalization of our medical care here in the United States, it is wise to stay on top of hand hygeine and judicious use of gloves and all available PPE. Compunds that are specifically made to be virucidal, bactericidal and fungicidal like Zenatize ® are highly useful, but the fumes can be quite noxious to some individuals, so use them away from patients with respiratory issues as often as possible.
Here's a quick review of some of the top nastiest nosocomial infections.
Etiologic Agents
There are an endless multitude of infectious diseases that run rampant in hospitals despite our best efforts to utilize PPE and isolation procedures. As healthcare workers are increasingly aware, all pathogens are opportunistic. Given the right environment and opportunity they will take hold. Viruses, bacteria and fungi are all around us and living within us.
1) Influenza Viruses
Every year, the CDC projects its expectations for severity, spread and most likely variants of the influenza virus to gain the greatest hold on the populace. As a disease spread by close human contact and respiratory droplets, with an approximate two-week incubation period, it's one that spreads like wildfire. Hence why healthcare workers, the elderly and very young are always the most encouraged, if not outright requiredto get vaccinated. It is believed that a vaccinated individual is far less likely to act as a vector to infect another person that is unvaccinated. Also, high risk individuals may receive antiviral drugs as a prophylactic measure.
2) Clostridium difficile
This little nasty bug is difficult to eradicate, if not impossible. C. difficile, often referred to as C. diff is a normal gut flora, but when antibiotics are used, it can flourish and cause intractable diarrhea linked to over 14,000 American deaths each year, painful cramping, and even potentially necrosis of skin that it's come in contact with. Clostridium is an infamous genus containing some of the most powerful toxin-producing baceria discovered thus far, such as Clostridium perfringrens, which can cause a dry gangrene and Clostridium tetani, which causes lockjaw and eventual death, to Clostridium botulinum now known for its refined toxin A which is used in a plethora of cosmetic and medicinal applications.
CDC Clostridium difficile Information
3) Pseudomonas aeruginosa
While less talked-up than the Influenze viruses, Pseudomonas aeruginosa has a wider range for infecting body systems. It can cause systemic illness, pneumonia, skin infections and rashes, septicemia from entry via IV catheters and central lines as well as potentially breaking through the integumentary layer in immunocompromised individuals.
CDC Pseudomonas aeruginosa Information4) Vancomycin resistant Enterococcus spp
The Enterococcus genus is a broad one, and also what would be considered a normal intestinal dweller. It can often go unnoticed, colonizing the urinary tract, wounds and catheter sites. This is yet another true opportunist that waits for the immune system to go down and make its move. VRE is spread through contact from the hands of healthcare workers, fomites and poor hygeine in the sense of not washing thoroughly between patient contact. Just because a patient appears to be healthy is no reason to forsake the gloves and hand-washing between patients.
5) MRSA
Methicillin Resistant Staphylococcuss Aureus aka MRSA has gained much notoreity in recent years. It seems every skin infection gets pre-emptively labeled as MRSA and while it's good to be cautious, it's easy to forget that this bacteria often lives in the nasal passages of healthcare workers and on the skin of normal immunocompetent individuals quite frequently. MRSA also can present as pneumonia or in septic forms as well.
6) Candida albicans
Out of the twenty-some Candida species that can cause disease in humans, Candida albicans is the most common. Often seen in asthmatics, COPD or other patients with repiratory disease, Candida often takes hold as a secondary fungal infection in the form of thrush. Also, this can be a potential fungal culprit for urinary tract infections.
CDC Candida albicans Information
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