MICROBIOLOGY

Peter Akosah Gyamfi

E-mail: pakosahgyamfi@gmail.com
0209130643
Nosocomial Infections
A nosocomial infection — also called “hospital acquired infection” can be defined as:

An infection acquired in hospital by a patient who was admitted for a reason other than
that infection . An infection occurring in a patient in a hospital or other health care facility
in whom the infection was not present or incubating at the time of admission. This
includes infections acquired in the hospital but appearing after discharge, and also
occupational infections among staff of the facility.
Nosocomial Infections cont’d…
Nosocomial infections may also be considered either endemic or epidemic.

Endemic infections are most common and are usually localized to individual clinics and
hospitals.

Epidemic infections occur during outbreaks, defined as an unusual increase above the
baseline of a specific infection or infecting organism.

Infections occurring more than 48 hours after admission are usually considered
nosocomial.
Risk factors associated with
nosocomial infections
Age > 70 years

Lengthy hospital stays → high risk of infection

Via medical staff (e.g., insufficient disinfection of hands, clothing) and contact surfaces (e.
g., equipment, furniture)

Via indoor air (may be contaminated by droplets from infected patients, staff, or
procedures like bronchoscopy)

Metabolic diseases (especially diabetes mellitus) and immunosuppression

Risk factors associated with
nosocomial infections cont’d…
Invasive instruments and foreign bodies: catheters, intravenous catheters,

endotracheal tubes

Conditions which require a high amount of interventional procedures (e.g., shock, major

trauma, acute renal failure, coma)

Mechanical ventilation
Reservoirs of transmission
The permanent or transient flora of the patient(endogenous infection):

Bacteria present in the normal flora cause infection because of transmission to sites
outside the natural habitat (urinary tract), damage to tissue (wound) or inappropriate
antibiotic therapy that allows overgrowth
Reservoirs of transmission cont’d…
Flora from another patient or member of staff (exogenous cross-infection):

Bacteria are transmitted between patients or staff: (a) through direct contact between
patients (hands, saliva droplets or other body fluids), (b) in the air (droplets or dust
contaminated by a patient’s bacteria), (c) via staff contaminated through patient care
(hands, clothes, nose and throat) who become transient or permanent carriers,
subsequently transmitting bacteria to other patients by direct contact during care, (d)
via objects contaminated by the patient (including equipment), the staff’s hands, visitors
or other environmental sources (e.g. water, other fluids, food).
Reservoirs of transmission cont’d…
Flora from the health care environment (endemic or epidemic exogenous environmental infections)
:

Several types of microorganisms survive well in the hospital environment:

In water, damp areas, and occasionally in sterile products or disinfectants (Pseudomonas,
Acinetobacter, Mycobacterium)

in items such as linen, equipment and supplies used in care

 in food

 in fine dust and droplet nuclei generated by coughing or speaking (bacteria smaller than 10 μm in
diameter remain in the air for several hours and can be inhaled in the same way as fine dust).
Central Line-associated
Bloodstream Infection (CLABSI)
A central line (also known as a central venous catheter) is a catheter (tube) that
doctors often place in a large vein in the neck, chest, or groin to give medication or fluids
or to collect blood for medical tests.

Central lines are different from IVs because central lines access a major vein that is
close to the heart and can remain in place for weeks or months and be much more likely
to cause serious infection. Central lines are commonly used in intensive care units.
Symptoms of CLABSIs
•Fever

•Red skin and soreness around the central line

•Inflammation

• lymphangitis or infection purulent discharge at the insertion site of the

catheter
Portals of entry for microorganisms in IV systems
Prevention of CLABSIs
Perform hand hygiene

Apply appropriate skin antiseptic

Ensure that the skin prep agent has completely dried before inserting the central line

Use all five maximal sterile barrier precautions:

◦Sterile gloves
◦Sterile gown
◦Cap
◦Mask
◦Large sterile drape
Surgical Site Infections (SSI)
A surgical site infection is an infection that occurs after surgery in the part of the body
where the surgery took place. Surgical site infections can sometimes be superficial
infections involving the skin only. Other surgical site infections are more serious and can
involve tissues under the skin, organs, or implanted material.

Most SSIs can be treated with antibiotics. The type of antibiotic given depends on the
bacteria (germs) causing the infection.
Symptoms of SSIs
Redness and pain around the area where you had surgery

purulent discharge

 abscess

 spreading cellulitis at the surgical site during the month after the
operation

Fever
Prevention of SSIs
Clean hands and arms up to their elbows with an antiseptic agent just before the surgery.

Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.

If indicated, remove some of your hair immediately before your surgery using electric clippers if the hair is in
the same area where the procedure will occur.

Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.

When indicated, give you antibiotics before your surgery starts. In most cases, you should get antibiotics
within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery.

Clean the skin at the site of your surgery with a special soap that kills germs.
Catheter-associated Urinary Tract
Infections (CAUTI)
A urinary tract infection (UTI) is an infection involving any part of the
urinary system, including urethra, bladder, ureters, and kidney.
UTIs are the most common type of healthcare-associated infection (HAI)
and are most often caused by the placement or presence of a catheter in
the urinary tract.
The most important risk factor for developing a catheter-associated UTI
(CAUTI) is prolonged use of the urinary catheter
Symptoms of CAUTIs
•burning or pain in the lower abdomen

•an increase in the frequency of urination

•positive urine culture (1 or 2 species) with at least 105 bacteria/ml, with

or without clinical symptoms

•fever
Prevention of CAUTIs
Minimize urinary catheter use and duration of use in all patients, particularly those at
higher risk for CAUTI or mortality from catheterization such as the elderly, and patients with
impaired immunity

Perform hand hygiene immediately before and after insertion or any manipulation of the
catheter device or site

Ensure that only properly trained persons (e.g. hospital personnel, family members, or
patients themselves) who know the correct technique of aseptic catheter insertion and
maintenance are given this responsibility.
Ventilator-associated pneumonia
(VAP)
Ventilator-associated pneumonia (VAP) is a lung infection that develops in a person
who is on a ventilator.

A ventilator is a machine that is used to help a patient breathe by giving oxygen

through a tube placed in a patient’s mouth or nose, or through a hole in the front of the
neck.

An infection may occur if micro-organisms enter through the tube and get into the
patient’s lungs.
Symptoms of VAP
 Respiratory symptoms with at least two of the following signs
appearing during hospitalization:
 cough
 purulent sputum
 new infiltrate on chest
 radiograph consistent with infection
Prevention of VAP
To prevent ventilator-associated pneumonia, doctors, nurses, and other healthcare providers can do
the following things:

Keep the head of the patient’s bed raised between 30 and 45 degrees unless other medical
conditions do not allow this to occur.

Check the patient’s ability to breathe on his or her own every day so that the patient can be taken
off of the ventilator as soon as possible.

Clean their hands with soap and water or an alcohol-based hand rub before and after touching the
patient or the ventilator.

Clean the inside of the patient’s mouth on a regular basis.

Prevention of VAP cont’d…
 Use steam sterilization (by autoclaving) or high-level disinfection by wet heat
pasteurization at >158 F (>70°C) for 30 minutes for equipment or devices that are not
sensitive to heat and moisture

Use sterile water for rinsing reusable respiratory equipment and devices when rinsing is
needed after they have been chemically disinfected

When changing a tracheostomy tube, wear a gown, use aseptic technique, and replace the
tube with one that has undergone sterilization or high-level disinfection

Clean or replace equipment between use on different patients

Type of nosocomial Infection Simplified criteria

Surgical site infection Any purulent discharge, abscess, or spreading cellulitis at

the surgical site during the month after the operation

Urinary infection Positive urine culture (1 or 2 species) with at least 105

bacteria/ml, with or without clinical symptoms

Respiratory infection Respiratory symptoms with at least two of the following

signs
appearing during hospitalization:
— cough
— purulent sputum
— new infiltrate on chest
radiograph consistent with
infection
Vascular catheter Inflammation, lymphangitis or infection purulent discharge
at the insertion site of the catheter
Staphylococcus aureus
Staphylococcus aureus (staph), is a type of bacteria that about 30% of people carry in their noses. Most of
the time, staph does not cause any harm; however, sometimes staph causes infections.

In healthcare settings, these staph infections can be serious or fatal, including:

Bacteremia or sepsis when bacteria spread to the bloodstream.

Pneumonia, which most often affects people with underlying lung disease including those on mechanical
ventilators.

Endocarditis (infection of the heart valves), which can lead to heart failure or stroke.

Osteomyelitis (bone infection), which can be caused by staph bacteria traveling in the bloodstream or put
there by direct contact such as following trauma (puncture wound of foot or intravenous (IV) drug abuse).
Types of Staph Infections
Staph infections are caused by several different types of staph germs, including:

methicillin-resistant Staphylococcus aureus (MRSA)

methicillin-susceptible Staphylococcus aureus (MSSA)

vancomycin-intermediate Staphylococcus aureus (VISA)

vancomycin-resistant Staphylococcus aureus (VRSA)

Although MRSA is often better known, any staph infection can be dangerous even if it is not
resistant to antibiotics.
Methicillin-resistant Staphylococcus
aureus
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is
resistant to certain antibiotics called beta-lactams.

Resistance mechanism is developed by forming a modified penicillin-binding protein (PBP)

that inhibits binding to beta-lactam antibiotics, thereby decreasing their bactericidal effect

These antibiotics include methicillin and other more common antibiotics such as oxacillin,
penicillin, and amoxicillin.

 MRSA infections are skin infections that often appear as a bump, a boil, or area that is red,
tender and swollen, and is sometimes confused with a spider bite.
Measures to curb MRSA
Hygiene measures: hand disinfection, protective clothing (gown, mask) , disinfection of

patient rooms

•Patient isolation, if necessary cohort isolation

•Use of Mupirocin nasal ointment, antiseptic solution for skin/hair contamination (e.g.,

chlorhexidine
Enterobacteriaceae
Enterobacteriaceae are a large family of different types of bacteria. Examples of bacteria in
the Enterobacteriaceae family include Escherichia coli (E. coli) and Klebsiella pneumoniae.

Bacteria in this family have developed a resistance mechanism by being able to produce
beta-lactamases that have a broad spectrum and are thus able to cleave penicillins,
cephalosporins, and, in isolated cases, carbapenems.

Associated with nosocomial urinary tract infections and healthcare-associated pneumonia

Pathogen Resistance
First-line therapy Alternative therapy

MRSA  Vancomycin
 All beta-lactam antibiotics (penicillins, cephalosporins, and Linezolid

carbapenems)
 Further potential resistance to  Quinupristin/dalfopristin
o Aminoglycosides  Daptomycin
o Macrolides  Tigecycline
o Lincosamides

o Quinolones

Vancomycin-
resistant  Vancomycin (possibly also teicoplanin)
enterococci
(VRE)  Numerous further resistances to

o Macrolides  Quinupristin/dalfopristin

o Most penicillins  Linezolid  Tigecycline

o Quinolones Daptomycin

o Aminoglycosides

o Tetracyclines