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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