NOSOCOMIAL INFECTIONS HOSPITALIZED PATIENT

An infection is suspected any time a hospitalized patient develops a fever that cannot be explained by the underlying illness. Some patients, especially the elderly, may not develop a fever. In these patients, the first signs of infection may be rapid breathing or mental confusion.Diagnosis of a hospital-acquired infection is determined by:
• evaluation of symptoms and signs of infection
• examination of wounds and catheter entry sites for redness, swelling, or the presence of pus or an abscess
• a complete physical examination and review of underlying illness
• laboratory tests, including complete blood count (CBC) especially to look for an increase in infectionfighting white cells; urinalysis, looking for white cells or evidence of blood in the urinary tract; cultures of the infected area, blood, sputum, urine, or other body fluids or tissue to find the causative organism
• chest x ray may be done when pneumonia is suspected to look for the presence of white blood cells and other inflammatory substances in lung tissue
• review of all procedures performed that might have led to infection Treatment
Cultures of blood, urine, sputum, other body fluids, or tissue are especially important in order to identify the bacteria, fungi, virus, or other microorganism causing the infection. Once the organism has been identified, it will be tested again for sensitivity to a range of antibiotics so that the patient can be treated quickly and effectively with an appropriate medicine to which the causative organism will respond. While waiting for these test results, treatment may begin with common broadspectrum antibiotics such as penicillin, cephalosporins, tetracyclines, or erythromycin. More and more often, some types of bacteria are becoming resistant to these standard antibiotic treatments, especially when patients with chronic illnesses are frequently given antibiotic therapy for long periods of time. When this happens, a different, more powerful, and more specific antibiotic must be used to which the specific organism has been shown to respond.

Two strong antibiotics that have been effective against resistant bacteria are vancomycin and imipenem, although some bacteria are developing resistance to these antibiotics as well. The prolonged use of antibiotics is also known to reduce the effectiveness of the patients own immune system, sometimes becoming a factor in the development of infection. Fungal infections are treated with antifungal medications. Examples of these are amphotericin B, nystatin, ketoconazole, itraconazole, and fluconazole. Viruses do not respond to antibiotics. A number of antiviral drugs have been developed that slow the growth or reproduction of viruses, such as acyclovir, ganciclovir, foscarnet, and amantadine.

Prevention
Hospitals take a variety of steps to prevent nosocomial infections, including:
• Adopt an infection control program such as the one sponsored by the U.S. Centers for Disease Control (CDC), which includes quality control of procedures known to lead to infection, and a monitoring program to track infection rates to see if they go up or down.
• Employ an infection control practitioner for every 200 beds.
• Identify high-risk procedures and other possible sources of infection.
• Strict adherence to hand-washing rules by health care workers and visitors to avoid passing infectious microorganisms to or between hospitalized patients.
• Strict attention to aseptic (sterile) technique in the performance of procedures, including use of sterile gowns, gloves, masks, and barriers.
• Sterilization of all reusable equipment such as ventilators, humidifiers, and any devices that come in contact with the respiratory tract.
• Frequent changing of dressings for wounds and use of antibacterial ointments under dressings.
• Remove nasogastric (nose to stomach) and endotracheal (mouth to stomach) tubes as soon as possible.
• Use of an antibacterial-coated venous catheter that destroys bacteria before they can get into the blood stream.
• Prevent contact between respiratory secretions and health care providers by using barriers and masks as needed.
• Use of silver alloy-coated urinary catheters that destroy bacteria before they can migrate up into the bladder.
• Limitations on the use and duration of high-risk procedures such as urinary catheterization.
• Isolation of patients with known infections.
• Sterilization of medical instruments and equipment to prevent contamination.
• Reductions in the general use of antibiotics to encourage better immune response in patients and reduce the cultivation of resistant bacteria.