Disease Information for Nosocomial infection

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Clinical Manifestations
Signs & Symptoms
Constitutional symptoms
Disease Progression
Course/Acute
Course/Acute only
Demographics & Risk Factors
Established Disease Population
Patient/Hospital patient/on IV fluids
Patient/Mechanical Ventilation/Intubated
Occupational Factors
Occupation/Health care worker
Occupation/Nurse
Associated Diseases & Rule outs
Associated Disease & Complications
Iatrogenic disorder/complication/effects
Nosocomial infection
Disease Mechanism & Classification
Process
PROCESS/Infected organ/abscess (category)
Definition

pertaining to or originating in the hospital; an infection not present or incubating prior to admittance to the hospital; usually used to refer to patients, but hospital personnel may also acquire nosocomial infection;------------------------------Nosocomial infections are defined as those not present or incubating at the time of hospital admission and developing 48-72 hours after admission; Hospital setting ; 25% of patients will have fever of noninfectious origin; Causes include drug fever, nonspecific postoperative fevers (atelectasis, tissue damage or necrosis), hematoma, pancreatitis, pulmonary embolus, myocardial infarction, and ischemic bowel disease; The most common infections are urinary tract infections, usually associated with Foley catheters or urologic procedures; bloodstream infections, most commonly from indwelling catheters but also from secondary sites such as surgical wounds, abscesses, pneumonia, the genitourinary tract, and the gastrointestinal tract; pneumonia in intubated patients or those with altered levels of consciousness; surgical wound infections; and C difficile colitis; Nosocomial infections are often caused by organisms that are multidrug-resistant and are different from those encountered in community-acquired infections; Examples are S aureus and S epidermidis (a frequent cause of prosthetic device infection) that may be resistant; often necessary to institute therapy with vancomycin, a carbapenem, an aminoglycoside, or a fluoroquinolone until a specific agent is isolated and sensitivities are known; preventing the development of multidrug-resistant organisms is antibiotic cycling [hospital policy] ; By changing the class of antibiotic primarily used every 6-12 months (eg, a cephalosporin, then fluoroquinolones, then carbapenems), selection pressure is decreased and less resistance emerges; Single Blood culture represents a true bacteremia is 10-20%; Unless two separate venipuncture cultures are obtained-not through catheters-interpretation of results is impossible and unnecessary therapy is given; use of gloves is intended to prevent contamination of the hands of health care workers with infected secretions and subsequent spread of infection to other patients by direct contact; Hand washing is the easiest and most effective means of preventing nosocomial infections and should be done routinely even when gloves are worn; Application of a rapid drying, alcohol-based is rapidly becoming the method of choice for hand disinfection; peripheral intravenous lines should be replaced every 3 days and arterial lines every 4 days; Lines in the central venous circulation (including those placed peripherally) can be left in indefinitely and are changed or removed when they are clinically suspected of being infected; Silver alloy-impregnated Foley catheters reduce the incidence of catheter-associated bacteriuria, and antibiotic-impregnated venous catheters reduce line infections and bacteremia; [CM DXRX2005]

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Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
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