UNIT 7

• Nosocomial infections


  Infections acquired within hospitals or other health care facilities
• Community-acquired infections


  Infections acquired outside of health care facilities, present or incubating at the time of hospital admission
• Pathogens most often involved in nosocomial infections

  • Gram-positive cocci (Staphylococcus aureus, Enterococcus spp.)
  • Gram-negative bacilli (Escherichia coli, Pseudomonas aeroginosa, Klebsiella spp.)
• Most common types of nosocomial infections


  • Urinary tract infections (UTI)
  • Surgical wound infections (postsurgical wound infection)
  • Lower respiratory tract infections (primarily pneumonia)
  • Bloodstream infections (septicemia)
• Major factors contributing to nosocomial infections


  • Increasing number of drug-resistant pathogens
  • Failure of health care personnel to follow infection control guidelines
  • Increased number of immunocompromised patients
• Most critical areas for disease transmission


  • Emergency room
  • Operating room
  • Delivery room
  • Nursery
  • Central supply area
• Most vulnerable patients in the hospital

  • Premature infants and newborns
  • Women in labor and delivery
  • Surgical and burn patients
  • Diabetic and cancer patients
  • Those receiving treatment with steroids, anticancer drugs, and radiation
  • Those with a deficient immune response
  • Patients who are paralyzed or undergoing renal dialysis or catheterization
  • Elderly patients
• Prevention of airborne contamination

  1. Cover mouth and nose when coughing or sneezing

  2. Limit the number of persons in a room

  3. Remove dirt and dust from the floor and furniture by dusting with a damp cloth

  4. Open the room to fresh air and sunlight whenever possible

  5. Roll linens together carefully to prevent dispersal of microbes in the air

  6. Remove bacteria from the air with a filtered air-conditioning system
• Handling food and eating utensils

  1. Use high quality fresh food

  2. Properly refrigerate and store food

  3. Properly wash, prepare, and cook food

  4. Thoroughly wash hands and fingernails

  5. Properly dispose of nasal and oral secretions in tissues

  6. Cover hair and wear clean clothes and aprons

  7. Provide periodic health examinations for kitchen workers

  8. Keep all kitchen equipment scrupulously clean
• Handling of fomites


  1. Use disposable equipment and supplies whenever possible

  2. Disinfect or sterilize equipment as soon as possible after used

  3. Use individual equipment for each patient

  4. Use an individual thermometer for each patient and store each thermometer in a disinfectant solution

  5. Empty bedpans and urinals, wash them in hot water, and store them in a clean cabinet between uses

  6. Place bed linen and soiled clothing in bags to be sent to the laundry
• Hand-washing


  1. Use gloves or tongs to handle contaminated materials

  2. Wash hands with disinfectant soap before and after contact with every patient

  3. Rinse hands under running water

  4. Dry hands and apply antiseptic lotion to prevent chapping
• Medical asepsis


  Includes all precautionary measures necessary to prevent direct transfer of pathogens from person to person and indirect transfer of pathogens through the air or fomites. Goal is to exclude pathogens.
• Surgical asepsis


  Includes practices used to render and keep objects and areas sterile (free of microorganisms). Goal is to exclude all microorganisms.
• Types of isolation system

  • Strict
  • Contact
  • Respiratory
  • Tuberculosis
  • Enteric precautions
  • Drainage-secretion precautions
  • Blood-body fluid precautions
  • Reverse isolation
• Universal precautions


  • Wash hands before and after contact with patients
  • Wash hands even before and after gloves are used
  • Wash hands immediately if they come into contact with blood, body fluids, human tissue
  • Wear gloves if blood splattering is likely
  • Wear mask and protective goggles
  • Minimize the need for mouth-to-mouth resuscitation
  • Clean up blood spills promptly with a disinfectant solution
  • Consider all patients' blood specimens as biohazardous
• Infection control


  Numerous measures taken to prevent infections from occurring in health care settings, including actions to eliminate or contain reservoirs of infection, interrupt the transmission of pathogens, and protect patients, employees and visitors from becoming infected
• Medical waste disposal


  1. Use receptacles that do not leak

  2. Remove all sweepings, solid or liquid wastes and garbage to avoid creating a menace to health

  3. Address the handling and disposal of potentially contaminated items in the infection control program
• Sharp instruments and disposables

  1. Do not recap, purposely bend or break needles by hand or remove from disposable syringes

  2. Place disposable syringes, scalpel blades, and other sharp items in puncture-resistant containers for disposal of sharps after use

  3. Ensure the containers are easily accessible, will not spill if knocked over, and will not cause injuries
• Laboratory specimens


  1. Place all specimens of body fluids in a well-constructed container with a secure lid to prevent leaking

  2. Decontaminate contaminated materials used in laboratory tests before processing

  3. Dispose of in accordance with institutional policies for disposal of infectious waste