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ACLrfE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Nosocomial Infections

Nosocomial infection is a general term that refers to an infection that

is acquired in the hospital setting. Many pathogens can cause a nosocomial infection, but the most commonly reported in the past years have been Escherichia coli, Staphylococcus allreus, Enterococcus

faecalis, Pseudomonas aeruginosa, and coagulase-negative staphyloc

COci.16 Patients who are at risk for developing nosocomial infections

are those who present with the following:

1.

Age; the very young or the very old

2.

Immunodeficiency; chronic diseases (cancer, chronic renal

disease, chronic obstructive pulmonary disease, diabetes, or

acquired immunodeficiency syndrome [AJDSJ)

3. Immunosuppression; chemotherapy, radiation therapy, or

corticosteroids

4.

Misuse of antibiotics; overprescription of antibiotics or

use of broad-spectrum antibiotics, leading to the elimination of a

patient's normal flora, which allows for the colonization of pathogens and development of drug-resistant organisms

5.

Use of invasive diagnostic and therapeutic procedures-

indwelling urinary catheters, monitoring devices, intravenous (i.v.)

catheters, and mechanical ventilation with intubation

6.

Surgery-incisions provide access to pathogens

7.

Burns-disrupt the first line of defense

8.

Length of hospitalization-increases the exposure to

pathogens and medical intervention

The mode of transmission for pathogens that cause nosocomial

infections can vary from contact to airborne. Pathogens can also

become opportunistic in patients who are immunocompromised or

immunosuppressed. Common sites for nosocomial infections are in

the urinary tract, surgical wounds, and the lower respiratory tract

(e.g., pneumonia). Clinical manifestations and management of nosocomial infections vary according to the type of pathogen and the organ system involved. However., the primary management strategy

for nosocomial infections is prevention by following standard and

specific precautions outlined in Table 10-4.'·16,17

INFF.CfIOUS DISEASES

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Table 10-4. Summary of Precautions to Prevent Infection

Precaution

Description

Standard

Treat all patient situations as potentially infectious.

Wash hands before and after each patient contact.

\Vear a different set of gloves wirh each patient.

If splashing of body fluids is likely, wear a mask, or face shield,

or borh, and a gown.

Airborne'"

A m<1sk is required in situations when conragious pathogens can

be transmmed by airborne droplet nuclei, as in the case of

measles, varicella (chickenpox), or tuberculosis.

Droplet'"

A mask or face shield, or both, are necessary when large·

particle droplet transmission (usually 3 ft or less) is likely.

Droplet transmission involves conract of the conjunctivae or the

mucous membranes of the nose or mouth with large·parricle

droplets (larger than 5 J-lm in size) generated from coughing,

l:ineezing, talking, and certain procedures, such as suctioning

and bronchoscopy.

Examples of pathogens requiring droplet precautions are Haemo·

philus m{luenzae, Neisseria menmgllidis, mycoplasmal pneu·

mOnla, streptococcal pneumonia, mumps, and rubella.

Contact'"

Gown and gloves are necessary when pathogens are transmitted

by direct person·ro·pcrson COntact or person·to·object COntact.

Examples of these pathogens include Clostridium dif(icile,

EscherIchia coli, herpes simplex virus, herpes lOSter, methicil·

Iin·resistant Staphylococcus aureus, and vancomycin·resis·

tant Enterococcus.

·These prec.!Utions arC' in addition to practicing standard precautions.

Sources: Data from D Rice. EC Eckstein. Inflammation :lnd Infection. In WJ Phipps, JK