REVIEW OF LITERATURE
MATERIALS AND METHODS
RESULTS AND DISCUSSION
Hospital acquired infection are also known as nosocomial infection are infections acquired from healthcare services (hospitals) during treatment, which are secondary to the patients original condition. The source and spread of organisms inside the hospital are important issues, human related organisms or the body flora, also found in clothing are spread through shedding during human activities(Ekhaise et al., 2010). Although many such infections occur in patients, infections acquired at work by staff members also are considered nosocomial infections. Many factors can contribute to the acquisition of nosocomial infections, and no single factor or condition to explain why they occur. The most significant factor for determining the outcome of infection is the immunological state of the host. The nosocomial infections are often related to therapeutic and diagnostic procedures that are routinely employed in health care.
For more than a century, this issue has been recognized as a critical problem which affects the quality of healthcare and a principal source of adverse outcomes. The patients who are immunocompromised are often hospitalized and undergo invasive examination and treatments thus hospital environment may facilitate the transmission of microorganisms among patients. The intense use of antibiotic promotes antibiotic resistance for the pathogenic microorganisms whereas changes in the medical practices continually present new opportunities for the development of infection (Dilip Kumar et al., 2013).
According to Baveja in 2002, the term hospital acquired infection, hospital- associated infection, hospital infection or nosocomial infection(nosocomion,meaning hospital) is defined as infection developing in patients after admission to the hospital ,which was neither present nor in the incubation period at the time of hospitalization . Such infections may become evident during their stay in the hospital or sometimes after their discharge. According to Gupte in 2006, sources of hospital acquired infection are infecting microorganisms from fellow patients which may be multidrug resistant, infecting organisms from hospital staff, infecting organisms from instrument, blood products, intravenous fluid, from patient’s normal flora, etc, insects are also source multidrug infection, organism may be present in air, dust, water, antiseptic solution, food, surfaces contaminated by patient’s secretions, blood fluid, etc.
In all over the world weather it is a developing or developed countries, this hospital acquired infection have assumed worrisome proportions in all healthcare scenarios (Col Shivinder Singh, et al 2015). As much as 80% of the estimated hospital deaths are related either directly or indirectly from Hospital Acquired Infection (Hughes et al, 2005). Patients are likely to get sick in hospital due to wide variety of microorganisms which are responsible for many different kinds of hospital infection. Thus during the stay of patients in the hospital it has become increasingly unsafe place. Thus infection has become a significant health hazard and requires great expense for final outcome of treatment. Infection safety (IC) is a quality standard which is essential for safety of patients, staff and visitors. It involves issues like clinical governance, risk management, quality of health and safety which affects most departments of the hospital (Dhayana Sharon Ross et al., 2014).
Hospitals have the potential for pathogen spread because they have contact with instruments, medical furniture, medical staff, skin, air, physical facilities and drainage. Contaminated environment are the main cause for such pathogens thus strict safety biosecurity procedures is to be applied (Mazzali M et al., 2003). The common nosocomial infections are mainly include urinary tract infections, surgical site infections, respiratory tract infections, blood stream infections, skin infections, gastrointestinal tract infections and central nervous system infections. These are mainly caused by Staphylococci, Pseudomonas, E.coli etc. And the common antibiotic resistant nosocomial infections include the Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Staphylococcus aureus (VRSA) and Vancomycin resistant Enterococci (VRE).
Many different environmental factors may either help or prevent the transmission of microorganisms. Hospital environment are the one where both infected person and persons who is at increased risk of infection assemble (Mayon et al., 1988)
Today HAIs affects more than 2million patients annually, at a cost of 4.5 billion (Apostolopoulou and Veldekis 2005).
The present study aimed to investigate the prevalence of microorganisms in hospital wards of National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore. Many different wards such as female neurology ward, male neurology ward, male neurosurgery ward, female neurosurgery ward, male pshyciatry ward, female pshyciatry ward, paediatric neurology ward, paediatric neurosurgery ward, de- addiction ward, short stay ward, head injury ward and step down ward was chosen for the study due to its high patronage by patients from all over India. Labs such as clinical microbiology lab, fluorescent microscope room, NABL room, bactec room and neuromicrobiology lab was also taken into consideration in order to ascertain the nature of microorganisms present.
REVIEW OF LITERATURE
When we think about hospital, one thing comes to our mind is “Hospital is the place for cure”. This revolutionary idea of treating the patients under the same roof was considered to ease the job of healing. But due to lack of knowledge of sterilization and antisepsis, it turned wrong in Pre- Listerian era leading to gangrene and death of patients which were suffering from wounds. Due to this reason a new discipline was emerged called as senics which was mainly dealing with the Hospital Acquired Infection (Nosocomial Infection). Semmelwis in 1861 with the help of medical officer and students observed the association of Puerperal sepsis in patients. Thus by the introduction of hand washing with chlorinated lime, he was successful to bring dramatic reduction in infection rate. Hospital acquired infection (HAI) are infections acquired during hospitalization, which are not present at eh time of admission (Atata et al, 2006). Due to its increased mortality and morbidity in the hospital patients these HAIs are of significant cause. HAIs are also caused due to prolonged hospital stay which are inconvenient for the patient and constitute economic burden on health care (Malhotra S, et al 2014).
Dancer in 1999,depicts that microorganisms which are associated with hospital acquired infection displays two important characteristics, firstly those are the pathogens of well-established medical importance and secondly they also can withstand the hospital environment which benefits them outside temperature. Thus providing an appropriate environment niche for their survival until they transfer back to patients. Some pathogens originate from patients own flora especially those who are immunocompromised whereas others can survive in human tissues and thus rely upon person to person spread in order to disseminate. The patients who are immunocompromised due to underlying diseases, medical or surgical treatment, age are typically affected by nosocomial infections. In pediatric ICU, the hospital acquired infections are approximately three times higher than elsewhere in hospitals (Weistein 2006).
Pathogen transference occurs most commonly by presence of bacterial or fungi in inanimate surfaces and equipment or between the hands of health professionals and patients (Kayabas et al., 2008). The transmission of microorganisms from hands of health care workers, medical equipment and surfaces which has become contaminated with a wide variety of pathogenic and nonpathogenic organisms has become a significant proportion of hospital environment infection which ultimately results in crosscontamination (Sehulster et al., 2003). When compared to other hospital patients, the patients who are hospitalized in ICUs are 5-10 times more likely to acquire nosocomial infection. The risk of infection and the frequency of infection vary by infection site. The increasing incidence of infection is caused mainly by antibiotic-resistant pathogens leading to seriousness of hospital acquired infection (Weber 2006). Some of the common human pathogens like, Staphylococcus aureus, Acinetobacter spp, Enterococcus spp and Escherichia coli can survive for longer periods of time on the hospital surfaces or formites that can potentially transmit infectious organisms(Kramer et al., 2006).
The primary sources of indoor air contamination are the microorganisms. When compared to outside air environment, the indoor air environment can potentially place patients a greater risk because enclosed spaces can confine aerosols and allow them to build up to infectious level. The relative humidity and/ or the moisture content of the materials determine that to what extent different micro-organisms are able to grow on indoor or outdoor materials (Dhanasekaran et al., 2009). Adebolu and Vhriterhire in 2002 reported that magnitude of hospital acquired infection is dependent upon the number and type of visitors, mechanical movement within the enclosed space, quality of hospital systems and level of hygienic conditions in hospital environment.
Hand hygiene has been considered to be the most important tool in nosocomial infections control. One of the significant contributors to the outbreaks of this hospital environment infection is failure to perform appropriate hand hygiene. Resident and transient microorganisms are known to be the natural microflora of the skin of hands. The resident microorganisms survive and multiply on skin and does not cause any harm to human flora whereas transient microorganisms represent recent contamination of hands which is acquired from colonized or infected patients/clients or contaminated environment or equipment. These transient microorganisms are not isolated consistently from most of the persons. When compared to resident microorganisms, the transient microorganisms which are found on the hands of health care personnel will become as a primary source of infections. Gram negative coliforms and Staphylococcus aureus has been known to be the most common transient microorganisms (Sarmad et al., 2009). Appropriate hand washing results in reduced incidence of both nosocomial and community infection (Kampf et al., 2004).
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