1. BY; Kashif Nadeem Khokhar
January, 30, 2013

2. Hospital acquired infection
•
 are generally
Hospital Acquired Infections
known as Nosocomial Infections or Health-care
Associated Infections (HAI).
• HAI do NOT originate from patient’s original
diagnosis.
• Infections that become clinically evident, 48
Hours after hospitalization are called HAI.
• If infections are acquired during hospitalization
but become evident after discharge, they are said
to have Nosocomial Origin.

3. PATHOPHYSIOLOGY

 Risk Factors for invasion of pathogens are categorized
into 3 Areas, Iatrogenic, Organizational, and patient
related.
 Iatrogenic RF include, Pathogens present on Medical
Personnel hands, Invasive Procedures (e.g.
intubation, urine catheterization) and Antibiotic use and
prophylaxis.
 Organizational RF include contaminated air-conditioning
and water system, and staffing and physical layout of the
facility. (e.g. Nurse-to-patient ratio, open bed distance).
 Patient RF include, severity of illness, underlying
immuno-compromised state, and Length of the stay.

4. CLINICAL CAUSES

 HAI are caused by Viral, Bacterial and Fungal pathogens.
 During Hospital Stay, many patients acquire Rotaviral
infections and Viral Respiratory infections in Winter, (e.g.
Influenza). And Enteroviral infections in Summer.
 Viruses are Responsible for up to 14% of HAI, with
Identifiable pathogens in Pediatric Patients.
 Bacterial and Fungal infections are less Common.
 Bacterial infections are mostly caused while placing
Intravascular lines and Urinary Catheters.
 Fungal infections mostly arise from Patient’s own Flora.

5. SIGNS AND SYMPTOMS

Fever, Tachycardia, Skin Rash, General Malaise
can be Physical signs and symptoms.
Instrumentation is a most common source of HAI,
Endotracheal Tube may be Associated with
Sinusitis, Tracheitis and Pneumonia.
Intravascular Catheter may be source of Phlebitis
or line infection.

7. MOST COMMON HOSPITAL
ACQUIRED INFECTIONS

 Candidiasis
 Colitis
 Endocarditis (Bacterial & Fungal)
 Enteroviral Infections
 Hepatitis C
 Influenza
 Legionella Infections
 Toxic Shock Syndrome
 Pseudomonas Infections
 Rhinovirus Infections
 Urinary Tract Infections ( UTI ).

8. DIAGNOSIS

 A detailed Physical Examination (PE) and Review of the
systems, Reveal the involved Organs & Systems.
 Study should be centered on Infections of Bloodstream
, UTI, and Pneumonia, unless, An Obvious Source (e.g.
Surgical-Site infection) is readily Identified.
 Blood cultures, Radiography, Sputum Culture, Gram
staining, Acid-Fast Staining, Fungal Cultures, and Viral
Cultures can be helpful for diagnosing HAI.
 Special Imaging Techniques (e.g. Sonography, CT, or MRI)
can be helpful in Evaluating Obscure Site Infections.

9. TREATMENT

Medical Care;
Symptomatic Treatment for Shock, Hypoventilation and other Complications is
provided, Along with the Administration of
Empiric Broad Spectrum
Antimicrobials, Antifungals and Antivirals.

10. HOSPITAL
ACQUIRED
INFECTIONS

11. BLOOD-STREAM INFECTIONS

Broad-Spectrum Antibiotics should be
Selected according to the Microbial
Susceptibility.
Antifungals (e.g. Fluconazole) can be added
to Empiric Antibiotics in Some Cases.
Antivirals (e.g. Acyclovir) can be used for
Viral Infections.

12. PNEUMONIA

Broad-Spectrum Antibiotics are used.
Macrolide Antibiotics are indicated in
Legionellosis.
Antivirals (e.g. Amantadine, and Rimantadine)
are used for Viral Pneumonia, ( for patients over
age 1 year ).
The most Cost-Effective Prevention measure is
Vaccination against Influenza A and B.

13. URINARY TRACT
INFECTIONS ( UTI )

Indwelling Catheters should be
Removed, if Feasible.
Empiric Antibiotic and Antifungal
Therapy, based on Results of Urinalysis
and Urine Gram Staining.

14. CONSULTATIONS

Many Nosocomial Infected patients
require Expert Care from an ICU Team.
Infectious Disease Specialists, BurnCare Specialists, And Surgical Teams,
Usually are involved in the care of
These Complicated Cases.

15. BACTERIAL AND VIRAL
AGENTS

16. Bacterial Agents

Multiple-Resistant Organisms, such as
 Vancomycin-Resistant S. aureus, and
 Inducible or Extended-Spectrum Betalactamase Gram-Negative Organisms
Are Constant Threat.

17. VIRAL AGENTS

The Rapid spread of Respiratory
Syncytial Virus ( RSV ) among Pediatric
Patients during an RSV Epidemic,
poses a Threat to Children, Who
Require Hospitalization during Winter
Months.

18. Facts & Figures

19. FREQUENCY

In United States, Hospital Acquired
Infections are Estimated to occur in 5%
of all Acute Hospitalizations.
The highest Rates of infection occurs in
The Burn ICU, Neonatal ICU, and
Pediatric ICU.
Mortality Rate is about 90,000 deaths
per Year in USA due to HAI.

20. SURVEY REPORT

 Among 6,290 Pediatric Patients Surveyed between
1992-1997, The Incidence of HAI were as Follows,
 Bloodstream Infections, 28%
 Ventilator Associated Pneumonia, 21%
 Urinary Tract Infections ( UTI ), 15%
 Lower Respiratory Infections, 12%
 GI, Skin, Soft Tissue and CV Infections, 10%
 Surgical Site Infections, 7%
 ENT Infections, 7%

21. LATEST SURVEY

 In Ireland, 3,992 in-patients across 16 acute and local Hospitals
were Surveyed in 2012.
 Overall only 4.2% Patients had HAI.
 Respiratory Infections, 27.9%
 Surgical Site Infections, 18.9%
 Urinary Tract Infections, 11.8%
 Patients taking more than 1 Antibiotic, 10.9%
 Overall Use of Antibiotics for HAI, 18.3%

22. THANK YOU SO
MUCH…!!!!!

Kashif Nadeem Khokhar