Introduction
Hospital acquired infection, is occasionally termed nosocomial infection, it is an infection that has been acquired in hospital by a patient who was admitted by a purpose other than that particular infection (Ducel et al., 2002). This involves infections that were acquired in the hospital, not only become visible after being discharged, but also occupational infections among staff of the facility (WHO, 2002). Hospital acquired infection frequently advance in 48 hours after hospital admission (Hensley, 2015). Furthermore, in current years, it has been progressively noticed that most of HAIs are preventable (Umscheid, 2011). In the view of mortality and morbidity, prolonged of stay and its costs, vigorous efforts must be made to the hospital as safe as necessary by preventing such infections (Wenzel, 1995). HAIs is a major problem in all levels of health care systems. World Health Organization (WHO) has appraised that it attacks multitude of people globally, at the same time, it is the main universal problem for patient safety (WHO, 2009). The widespread presence of HAIs in two teaching hospitals in Ethiopia was 14.9% (Yallew, 2016).
Danger of HAIs increased with invasive devices utilized (Deptula, 2015), for instance, for treatment and monitoring of patients in the Intensive Care Units (ICU) (Madani, 2009). Occurrence of device-associated infections (DAIs) as outlined by the International Nosocomial Infection Control Consortium (INICC) is higher than the one appraised by the US National Healthcare Safety Network (NHSN) (Dudeck 2015 & Rosenthal, 2016). Researches in developing countries revealed that the DAIs in the intensive care unit were outrageous (Jahani-Sherafat, 2015 & Rasslan, 2012) and incurred additional price for patients (Rosenthal, 2016; Higuera, 2007 & Rosenthal, 2003).
HAIs cause people to be hospitalized for extra 4 to 5 days. In Finland, in 2000, the rate of patients were evaluated at 8.5% (Lyytikainen, 2005), in Italy, since 2000 the rate of the infection was estimated at 6.7% which obviously caused between 4,500 and 7,000 loss of lives. A study in Lombardy was estimated at 4.9% in the year 2000 (Liziolia, 2003). Furthermore, in Switzerland, it was estimated between 2 and 14 %. In 2004, the national study was estimated at 7.2% (Sax, 2005). Again, in 2012, the Health Protection Agency outlined the prevalence rate of nosocomial infections in England was evaluated at 6.4% in 2011, against a rate of 8.2% in 2006 (Health Protection Agency, 2011). Finally, in US, CDC evaluated approximately 1.7 million of nosocomial infections from all kinds of bacteria combined contribute to 99,000 losses of lives annually (Klevens, 2007).
IMMENSITY OF THE PROBLEM
Hospital acquired infections are frequently produced by breaches of infection control practices as well as strategies, dirty and non-sterile environmental surfaces. With increasing infections, there is a growth of prolonged hospitalization, long-term disorder, growth of antimicrobial resistance, growth in economic disturbance and growth in mortality level. Unwanted stuff from the hospital can play a role as a potential reservoir for patients who require appropriate handling. Other technological advances that are being used to rescue our lives can also increase the probability that we will acquire the infections. The CDC estimates that roughly 2 million individuals in the US are affected by HAIs yearly, resulting in 20,000 deaths (Ricks, 2007).
A study of HAIs showed that at any time above 1.4 million individuals throughout the world are experiencing hardship from hospital acquired infections in treatment centres with an approximately 80, 000 losses of lives yearly. The real rates differ from 5 to 10% of entire patients that are hospitalized to present-time healthcare centres in the industrialized globe to up to 25% in developing countries. The danger of hospital acquired infections in developing countries is higher than in developed countries (WHO, 2002).
EFFECTS OF NOSOCOMIAL INFECTIONS
Socio – economic burden (WHO, 2002), due to direct and indirect medical costs connected to dwindled quality of life, prolonged hospitalization, and of course supplementary morbidity and mortality due to nosocomial infections. Hospital acquired infection can contribute to a functional disability and the emotional stress of the patient leading to an enfeebling condition that minimises the general well-being of the patient. In 2009, the CDC published a report evaluating the general annual direct medical costs of HAIs that ranged from $28-45 billion (CDC, 2008). The cost of HAIs appears to increase continuously. In the United Stated, it is estimated that nosocomial infection adds $2400 to the patient’s bill (Hospital Statistics, 1974; Dixon, 1972, Haley et al., 1980; Bennet, 1978), whereas In Canada, it is evaluated that a wound infection adds $2000 to patient’s bill for hospitalization alone (Cruse et al., 1980). Nosocomial infections are an extra burden on individual hospitals and healthcare systems (Saleh, 2010). The increased usage of drugs, the requirement of isolation as well as the usage of extra laboratory and further diagnostic studies lead to the costs (Plowman, 2001).
ROUTES OF TRANSMISSION
Microorganisms are transferred to hospital by several means, therefore they can be transmitted in five different routes (CDC, 2002). Contact transmission route involves two steps of contacts, either direct or indirect contact.
Direct contact- This is the most important form of transmission whereby an organism is being transferred between an infected patient and a health care worker through kissing, touching, sexual contact, or droplet spray. Indirect contact- happens when there is no person-to-person contact. If healthy individuals inbreathe infectious droplet, or if the contaminated droplets lands straight to their nose, mouth, eye.
Airborne spread route – Airborne transmission takes place by circulation airborne droplet nuclei or dust particles carrying infectious agents (Nosocomial Infection, 2007). The CDC has outlined an approach to minimize transmission of microorganisms via airborne spread in its Guideline for Isolation Precautions in Hospitals (Garner, 1996).
Respiratory droplets route- Droplet-size body fluids carrying microorganisms can be produced throughout coughing, sneezing, talking, suctioning, and bronchoscopy. They can cause an infection by being settled straight to a susceptible person’s mucosal surface.
Common vehicle transmission route- Common vehicle transmission relates to when several individuals are exposed and begin to be sick from a common inanimate vehicle of contaminated food, water, medications, solutions, devices, or equipment. Bacteria can increase exponentially in a common vehicle, however, viral replication cannot transpire. Common vehicle transmission is probably connected with a special outbreak setting. WHO evaluated that polluted drinking water is responsible for more than 500, 000 losses of lives annually (WHO, 2005).
Vector borne transmission route- it takes place when vector such as mosquitos, rats and other vermin transfer microorganisms (WHO, 2002; Weistein, 1995 & Bonten, 1996).
TYPES OF NOSOCOMIAL INFECTIONS
Central line associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections and also ventilator-associated pneumonia are the four main categories of infections (Klevens, 2007).
AETIOLOGY
Viral, bacterial and fungal pathogens cause HAIs. Gram-positive organisms, including Coagulase Negative Staphylococcus, Staphylococcus auerus and Enterococci cause Nosocomial bloodstream infections. A published study, review and the outcomes of the SENTRY Antimicrobial Surveillance Program in the United States (Nair, 2013) concluded that Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella species, Escherichia coli, Acinetobacter species, and Enterobacter species are the most common pathogens that cause hospital acquired pneumonia. The widespread usage of broad spectrum antibiotics has contributed to HAIs with drug resistant microbes (Nosocomial Infection, 2009). Examples involve Methicillin Resistant Staphylococcus aureus (MRSA), penicillin resistant precumococci, Vancomycin Resistant Enterococci, (VRE) and Multi Drug Resistant Tuberculosis (MDR-TB) (Maheiu, 2001).
HIGH-RISK SITUATIONS FOR ACQUIRING HOSPITAL-ACQUIRED INFECTIONS
There are a lot of risk elements which predispose to a host to come to have nosocomial infections involving low body resistance as in people who are in their dotage stage and in infancy, important underlying illnesses and vital surgeries (Dunn, 2001), immune deficiency conditions (WHO, 2002) and prolonged hospitalization (McNicholas, 2011). There are sections in the hospital environment that carry a higher risk of patients acquiring nosocomial infections (Mayon-White, 1988 & Britt, 199976). Patients who are in health care setting are as well on a greater risk of acquiring hospital infections from subjection of organisms that are conveyed between patients and health care workers. The sections that are mainly common for acquiring hospital infections involves ICUs, organ transplant unit, operation theatres and post-operative wards.
GAPS IN DIMINISHING HOSPITAL ACQUIRED INFECTIONS
Lack policies or guidelines
Absence of infection control committee organised in hospitals
Quality of treatment is below standard in hygiene, improper usage of antibiotics
Shortage of information and skills among health professionals
Deficiency of trained health professionals.
Insufficient hospital infrastructure with shortage of maintenance in hospital surrounding
PREVENTION OF HAIS
According to the CDC, the single most important thing a person can do to keep from getting sick and spreading illness to others, protect patient safety, and reduce infection, is to keep hands clean by thorough hand washing. Furthermore, “Improved Hand Hygiene to Prevent Health Care Associated Infections” is among the Patient Safety Solutions for 2007 promoted by the Joint Commission, Joint Commission International, and WHO as important global healthcare safety challenges. The following crucial elements are required:
To control the environmental danger of infection
To secure patients with suitable usage prophylactic antimicrobials, food and vaccination
To restrict the danger of endogenous infections by reducing invasive procedures and improve optimal antimicrobial usage
Surveillance of infections, to recognize and control the outbreaks
To prevent the infection among staff members
To increase the staff patient care practices.
To restrict the conveyance of organisms between patients and health care workers via sufficient hand washing, usage of gloves, suitable aseptic practice, isolation techniques, sterilization and disinfection practices, and laundry
HOSPITAL INFECTION CONTROL PROGRAMME
“The first requirement of a hospital is that it should do the sick no harm” was Florence Nightingale’s dictum. The main goal of having the infection control programme is to lessen the danger of infection during the prolonged hospitalization. These hospital’s programme can prevent 33% of nosocomial infections (Horan, 2004). Infection control programme was originally carried out by hospitals in the United States in the 1960s, nonetheless, it was not up until the report of the study review on the Efficacy of Nosocomial Infection Control (SENIC) in the year 1985 that the finest proof of their efficacy in minimizing nosocomial infections became available (Nosocomial Infection, 2009). This study revealed that all hospitals that have an infection control programme that involved surveillance and control components were capable of minimizing nosocomial infections compared to those hospitals whose never had such programme (SENIC, 1980). Health care settings are locations whereby sick individuals gather, building innumerable chances for microorganisms to proliferate between the patients, visitors and healthcare workers. Many of the infections, up to 70% are preventable. The programme is a master plan which is designated to recognize infections that transpire in patients and health care workers that have the potential for disease transference, recognizes the chances for reduction of danger for disease transference, recommend danger depletion practices by combining first principles of infection control management in patient care.
OBJECTIVES OF THE INFECTION CONTROL PROGRAMME
To observe hospital-associated infections, by the development of surveillance system. The surveillance system will initiate a database, which will then give the endemic rate of hospital acquired infections. The SENIC inspectors, found that surveillance was the essential element of infection prevention and control program required to minimize the rates of nosocomial infections
Observe and guidance on the safe usage of antibiotics
Observation of staff health to prevent health care worker to patient spread infection or vice versa
To train health care staff to prevent and control nosocomial infections
Inspection of outbreaks, 5% of nosocomial infection transpire epidemics or outbreaks (Wenzel, 1983). Inspections of outbreak provide hypercritical data about the epidemiology of serious pathogens.
INFECTION CONTROL ORGANIZATIONS IN A HOSPITAL
Infection control organizations are important characteristic of an infection control programme. The organizations are as follows:
Infection Control Committee (ICC)
The American Medical Association (AMA), initially proposed in 1958 that all hospitals should establish infection control committees. Although, that is not broadly accepted, with the alteration of the actual policy in 1976, it is at the present moment widely accepted phenomenon that the ICC is the policymaking body for infection control in all hospitals (Wiblin, 1976). The members are pharmacy, microbiology department, administration, nursing, etc. The committee draws up the policies for the prevention and control of infection (National Nosocomial Infections, 1996). One member is chosen to be the chairperson, and has an ingress to the head of hospital administration. The committee arranges a meeting regularly.
Infection Control Team (ICT)
Members of the Infection control team take up the day-to-day measures for the infection control. The ICT is in charge of establishing the policies of infection control and procedure as well, supplying advice and guidance with regard to the issues of infection control, audits and surveillance, recognition, inspections of outbreaks, knowledge and education of staff (Russell, 19990).
Infection Control Officer (ICO)
The Infection Control Officer is a medical microbiologist with the curiosity in hospital associated infections. The functions of ICO are as follows:
1. Is the responsibility of the ICC secretary to take note of the minutes and re-arrangement of the meetings
2. To recognize and give the detailed report of pathogens and their antibiotic sensitivity
3. Consistent analysis and distribution of antibiotic resistance information, transpiring pathogens and uncommon laboratory findings
4. Starting hospital infections surveillance and the recognition of outbreaks
5. Inspection of outbreaks
6. To educate the practices and techniques of infection control
Infection Control Nurse (ICN )
The senior nursing must be assigned full-time for this placement. The functions of ICN are as follows:
1. To increase the consciousness between patients and visitors regarding the infection control
2. To train and educate under the supervision of the Infection Control Officer
3. To gather the specimens and preliminary processing
4. To cooperate with the Infection Control Officer on surveillance of infection and recognition of the outbreaks
Infection Control Manual (ICM)
It is suggested that every hospital to come up with its infection control manual
PART OF THE MICROBIOLOGY LABORATORY
The microbiology laboratory possesses a vital part in the control of hospital acquired infections. The clinical microbiology laboratory is a crucial element of a fruitful infection control program. The microbiology laboratory must be included on all sides of the infection control program. Distinctly important are its part in the hospital's infection surveillance system, also in helping the infection control program to successfully and productively use laboratory services for epidemiologic purposes (Emori, 1993). The clinical microbiology laboratory plays a crucial part in patient care supplying data on a diversity of microorganisms with clinical importance and is an important element of a successful infection control program (Kalenic, 2009).
THE ROLE OF THE DEPARTMENT IN THE NOSOCOMIAL INFECTIONS CONTROL PROGRAMME
Identification of pathogens- the laboratory must be able to identify ordinary bacteria to the level of species
Supplying of advice on antimicrobial therapy and collection of specimen as well as the transport
Supplying of data on antimicrobial susceptibility of common pathogens (Koolmos, 1999).
The periodic reporting of such date is a vital service supplied by the department of microbiology. The frequency of this must be as determined by the ICC (Michael, 1997).
Recognition of sources and route of transmission of infection- Culture of carriers, environment for recognizing the source of the organism producing infection (Wilson, 1999).
Supplying facilities for microbiological testing of hospital materials if it is necessary (Emori, 1993). These may involve: infant feeds sampling, observation of blood products and dialysis fluids, sampling of quality control of disinfected equipment
Supplying training for personnel included in the control of infection (Reller, 2001). This makes up a significant part of the Infection Control Programme. Every hospital must develop an employee training programme. The goal of the training programme is to carefully orient the personnel of the hospital to the nature of nosocomial infection and to methods of prevention and treatment.
THE TRAINING PROGRAMME SHOULD INCLUDE THE FOLLOWING:
Fundamental concepts of infection
Hazards connected with their specific work classification
Techniques to prevent the conveyance of infection within the hospital
Secure work practice
Approval of their personal control and role in hospital infection control
COMMUNICATION AMONG THE PHYSICIAN AND THE MICROBIOLOGY LABORATORY
Constructive communication is the best aspect of a microbiology laboratory. To be successful, the chance for conversation betwixt a health care providers and laboratory personnel should be reachable, if not at once available. Provision should be sufficient for bidirectional interaction, because the data supplied is at all times qualitative and interpretive (Peterson, 2001). Lastly, microbiologists and the service of microbiology form a central component whereby all the tasks needed for treatment, diagnosis and the infection control performed by several hospital services converge (Bouza, 2003).