Introduction To Nosocomial Infections

Introduction
Hospital-acquired or nosocomial infections result in substantial morbidity, prolong

hospital stay, increases in direct patient care costs and mortality. Although our
understanding of the epidemiology of nosocomial infections has increased
dramatically over the last two decades, the incidence of nosocomial infections
continues to affect about 5% of hospitalized patients. There is evidence, however as
reported by the Centers for Disease Control and Prevention (CDC) at the recent 4th
Decennial International Conference on Nosocomial and Healthcare-associated
Infections held at Atlanta in March that active hospital infection control programs lead
to reduced infections and safer patient care. At the meeting, CDC reported a 10-year
decline of over 30 percent in rates of hospital-acquired infections.
Definition
A nosocomial infection is defined as an infection that is not present or incubating
when a patient is admitted to a hospital or a healthcare facility. In determining if an
infection is nosocomial or community-acquired, the incubation period of the specific
infection must be taken into account. Generally, for bacterial infection, a 48-72 hours
after admission is used as a guide to discount the initial onset of the infection.
It is important to note that nosocomial infections may be either endogenous or

exogenous. Endogenous infections are caused by those organisms that are present
as part of the patient’s own flora; exogenous infections on the other hand are those
caused by organisms acquired by exposure to medical devices, hospital personnel,
or the hospital environment.
Incidence
It is estimated that approximately 5% of patients in acute care tertiary hospitals
develop nosocomial infection. A large proportion of these infections occur in patients
with severe illnesses/trauma and those with poor underlying conditions in the
intensive care units of hospitals. It is estimated that about a third of all nosocomial
infections could have been prevented while the other two-thirds may be inevitable
due the following reasons:
• Patient’s poor underlying condition/severe illness

• Impaired immunity
• Inherent risk of infection associated with sickness, medical and surgical
intervention
Epidemiology
Rates of nosocomial infection vary according to the type of hospital, type of patient
and the level of patient risk. Generally, the rate of nosocomial infection is higher in
surgical patients compared to those from the medical or obstetric and gynaecology
services.
Urinary tract infection, an infection often associated with the use of an indwelling
urinary catheter or instrumentation of the urinary tract is by far the most frequent type
of nosocomial infection reported. It accounts for between 30-40% of all nosocomial
infections reported. Lower respiratory and surgical wound infections are the next two
frequent nosocomial infections reported. Other less frequent nosocomial infections
include bacteremia, intravenous site infection, gastrointestinal tract and skin
infections.
Nosocomial infections can be caused by a wide variety of pathogens. These include
Klebsiella sp. Escherichia coli, enterococci, Pseudomonas aeruginosa and
Staphylococcus aureus. A significant proportion of these nosocomial pathogens has
been reported to be multi-resistant to antibiotics. Methicillin-resistant Staphylococcus
aureus or MRSA as it is commonly known, is one of the more problematic
nosocomial pathogens faced by hospitals world-wide because of the high cost
associated in treating these infections.
Cost of nosocomial infection
CDC has reported previously that nearly 2 million patients get an infection annually
while being treated for other illness or injury, and nearly 88,000 die as a direct or
indirect cause of these infections. The economic costs of these infections result
largely from the extended length of stay in the hospital and the additional use of
medical and therapeutic resources, including antibiotics to treat these infections.
The cost varies according to the type and severity of these infections. In general, the
number of extra days a patient has to spend in the hospital varies according to the
type of infection he or she gets; an estimated 1 to 4 days for a urinary tract infection,
7 – 8 days for a surgical site infection, 7 – 21 days for a blood stream infection, and 7
– 30 days for pneumonia.
The CDC has reported at the recent 4th Decennial International Conference on
Nosocomial and Healthcare-associated Infections held at Atlanta that nearly US$5
billion are added to U.S. health costs every year as a result of infections that patients
get while they are hospitalized for other health problems.

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Introduction To Nosocomial Infections

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Introduction

Hospital-acquired or nosocomial infections result in substantial morbidity, prolong

It is important to note that nosocomial infections may be either endogenous or

• Patient’s poor underlying condition/severe illness

Cost of nosocomial infection

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