Nosocomial Disease
Nosocomial Disease Definitions: Infection is the presence of an organism in tissue or body fluids with a clinical symptom of both local and systemic. Infections that arise during such a person admitted to the hospital and began to show a person's symptoms during or after completion cared cared so-called nosocomial infections. In general, patients who were admitted to hospital and showed signs of infection less than 72 hours showed that the incubation period of the disease had occurred before the patient entered the hospital, and new infections show symptoms after 72 hours of new patients are referred to hospital infection nosokomia
Nosocomial infections can be derived from the patient's body or outside the body. Endogenous infections are caused by microorganisms that originally there had been in the body and move to a new place that we call self-infection or auto-infection, while exogenous infection (cross infection) caused by microorganisms from the hospital and from one patient to another.
SakitRumah home hospital is a place where people are ill treated and placed in very close proximity. At this point the patient receives treatment and care to be cured. However, hospitals in addition to searching for a cure, also a depot for various diseases from patients and visitors with the status of a career. These germs can live and thrive in a hospital environment, such as; air, water, flooring, food and objects of medical and non medical. The occurrence of nosocomial infections will cause a lot of losses, among other things:
• long day care growing longer
• suffering increased
• increased costs
From the results of a descriptive study Suwarni, A in all hospitals in Yogyakarta in 1999 showed that the proportion of the incidence of nosocomial infections ranged from 0.0% to 12.06%, with an overall average of 4.26%. For the average treatment duration ranged from 4.3 to 11.2 days, with an overall average of 6.7 days. After further investigation it was found that the number of germs floor treatment room has a meaningful relationship with nosocomial infections.
During this back 10-20 years has been a lot of progress has been made to locate the main problem of the increasing incidence of nosocomial infections in many countries, and in some countries, it is very alarming condition. This situation actually increase the time to care and treatment changes with expensive drugs, and the use of services outside the hospital. That's why, in countries poorer, developing, prevention of nosocomial infections are preferred to be able to improve the quality of patient care in the hospital and other health facilities. In some parts, especially in parts of the internal medicine, there are many procedures and actions taken either to help diagnose or monitor the disease course and therapy can cause enough patients susceptible to nosocomial infections. Patients with old age, the old lie, or some action such as invasive diagnostic procedures, long infusion and urinary catheters are long, or patients with a certain disease is a disease that requires chemotherapy, with very severe disease, malignant disease, diabetes, anemia, diseases autoimmune and immuno suppressants or steroid use was found that the risk of infection larger.2., 3.5 Source of infection and mode of transmission is mainly through the hands and from health care workers and other health personnel, injection needles, IV catheters, urinary catheters, gauze dressings or bandages, and a wrong way to deal with injuries. Nosocomial infection is also not just about the patient, but also to the entire hospital personnel in direct contact with the patient or the patient's guardian and the visitors.
Epidemiology Many nosocomial infections occur throughout the world with the highest incidence in poor countries and developing countries due to infectious diseases are still a major cause. A study conducted by the WHO indicate that approximately 8.7% of the 55 hospitals from 14 countries from Europe, the Middle East, Southeast Asia and the Pacific remains indicate the presence of nosocomial infection in Southeast Asia as much as 10.0% .3 Although science and microbiology research increased rapidly in the last 3 decades, and little by little the risk of infection can be prevented, but the increase of patients with immunocompromised diseases, antibiotic resistant bacteria, viruses and fungal super infections, and invasive procedures, is still causing infections Nosocomial cause 88,000 deaths annually walaupun.4 case Moreover, if we compare the germs that exist in society, microorganisms that are in the hospital more dangerous and more resistant to the drug, because it required a more potent antibiotic or a combination of antibiotics. All of these conditions can increase the risk of infection to the pasien.2, 3.5
Development of Nosocomial Infection Causes
1 Infectious Agents The patient will be exposed to a wide variety of microorganisms during his hospitalization. Contact between the patient and a wide variety of microorganisms is not always cause clinical symptoms because of other factors which may cause the occurrence of nosocomial infections. The possibility of infection depends on: 3
• characteristics of microorganisms,
• resistance to antibiotic substances,
• the level of virulence,
• and the number of infectious material.
All of microorganisms including bacteria, viruses, fungi and parasites can cause nosocomial infections. These infections can be caused by microorganisms acquired from others (cross infection) or caused by the normal flora of the patient's own (endogenous infection). Most infections occur in hospitals is mainly due to external factors, namely the spread of disease through food and air and objects or materials that are not sterile. Diseases acquired from the hospital today most commonly caused by microorganisms that are always present in people who previously did not or rarely cause disease in normal people.
1. Bacterium
Bacteria can be found as normal flora in the human body healthy. The presence of bacteria here is very important in protecting the body from the coming pathogenic bacteria. But in some cases it can cause infection if the man has a low tolerance for microorganisms. For example, Escherichia coli is most often found as a cause of urinary tract infections. More harmful pathogenic bacteria and cause infection either sporadic or endemic. For example: • Anaerobic Gram-positive, which can lead to gangrene Clostridium • gram-positive bacteria: Staphylococcus aureus is a parasite on the skin and the nose can cause lung irritation, home, heart and blood vessels as well as infections are often resistant to antibiotics. • Gram-negative bacteria: Enterobacteriacae, for example, Escherichia coli, Proteus, Klebsiella, Enterobacter. Pseudomonas often found in water and water reservoirs that cause infection in the digestive tract and patients treated. This gram-negative bacteria responsible for about half of all infections in hospitals. Serratia marcescens •, can cause serious infections in wounds scar, lung, and peritoneum.
2. Virus Many possible nosocomial infection caused by a variety of viruses, including hepatitis B and C viruses in the media transmission of transfusion, dialysis, injections and endoscopy. Respiratory syncytial virus (RSV), rotavirus, and enteroviruses are transmitted from hand to mouth contact or through the faecal-oral route. Hepatitis and HIV is transmitted by sharing needles, and blood transfusions. Transmission route for the virus the same as other microorganisms. Gastrointestinal infections, respiratory tract infections, skin diseases and blood. Other viruses that often cause nosocomial infection is cytomegalovirus, Ebola, influenza virus, herpes simplex virus, and varicella-zoster virus, can also be transmitted.
3. Parasites and Fungi Some parasites such as Giardia lamblia can be transmitted easily to adults and children alike. Many fungi and parasites may arise during the administration of antibiotics and the bacterial immunosuppressant drugs, such as infections of Candida albicans, Aspergillus spp, Cryptococcus neoformans, Cryptosporidium.
II.1.2 response and tolerance of the patient's body The most important factor affecting the level of tolerance and response of the patient in this case is: 3.9 • Age • immune status of patients • illness • Obesity and malnutrition • People who use immunosuppressant drugs and steroids • Interventions were performed on the body to perform diagnostics and therapeutics.
Young age and old age is associated with decreased resistance to infection is much worse on the condition of patients suffering from chronic diseases such as tumors, anemia, leukemia, diabetes mellitus, renal failure, SLE and AIDS. These conditions will increase the body's tolerance to infection from bacteria that originally are opportunistic. Drugs that are immunosuppressives can lower the body's defense against infection. The number of investigations and therapeutic procedures such as biopsy, endoscopy, catheterization, intubation and surgery also increases the risk infeksi.3, 9 Type the patient's risk of infection Minimal is immunocompromised, are not exposed to a disease found Patients are being infected and with some risk factors Weight Patients with severely immunocompromised, (5 lm. Example bacterial meningitis, and diphtheria require the following; separate rooms for each patient. Masks for healthcare workers. Restricted areas for the patient, and the patient should wear a mask when leaving the room.
4 Infection by direct or indirect contact Infections that occur due to contact directly or indirectly with the cause of the infection. Transmission of this infection can be through the hands, skin and clothes, such as staphylococcus aureus group. Can also be given through intravenous fluids and syringes, hepatitis and HIV. Equipment and medical instruments. Food is not sterile, not cooked and were taken using a hand which causes the occurrence of cross infection.3, 9
2 Antibiotic Resistance Along with the discovery of penicillin and antibiotic use between the years 1950-1970, many serious and fatal diseases when it can be treated and cured. However, this success led to the overuse of antibiotics and pengunsalahan. Many microorganisms are now becoming more resistant. Increased bacterial resistance may increase the mortality rate of patients who are immunocompromised, especially. Resitensi of bacteria transmitted between patients and resistance factor transferred between bacteria. The use of antibiotics constantly multipikasi and actually increase the spread of resistant strains. The main cause for: • The use of antibiotics is not appropriate and is not controlled • The dose of antibiotics that are not optimal • Therapy and treatment using antibiotics that are too short • Error diagnosis
The number of patients who received antibiotics and alteration of genes that are resistant to antibiotics, resulting in the emergence of germ multiresistensi to these drugs. The use of antibiotics on a large scale for the treatment and prophylaxis of resistance is a major factor. Many strains of pneumococci, staphylococci, enterococci, and tuberculosis was resistant to many antibiotikaa, as well as Klebsiella and Pseudomonas aeruginosa also has to be multiresistant. This situation is very real occurred mainly in developing countries where second-line antibiotics does not exist or is not available. Nosocomial infections affect morbidity and mortality in the hospital, and is very important because: • Increasing the number of patients treated • Frequent body weakened immunity due to illness, treatment or age • new microorganisms (mutation) • Increased bacterial resistance to antibiotics
3 Factors tools From a clinical study, tertama nosocomial infections caused by infections from urinary catheters, infusion needle infections, respiratory tract infections, skin infections, surgical wound infections and septicemia from. The use of intravenous and urinary catheters are no longer interchangeable. Diruang medicine, an estimated 20-25% of patients require infusion therapy. Intravenous cannulation complications may include mechanical disruption, physical and chemical. These complications include: 3.5 Extravasation infiltrates: intravenous fluids enter the tissue around the cannula insertion Blockage: Infuse not function properly without the detectable presence of other disorders Phlebitis: There is swelling, redness and tenderness along the vein Thrombosis: There is a swelling along the vein that impede the flow of infusion Colonization cannula: When it can be cultured microorganisms from the cannula is in the vein Septicaemia: When the hematogenous spread of germs cannula Suppuration: If there has been a formation of pus around the cannula insertion
Some of the following factors play a role in increasing the complications of intravenous cannulae are: type of catheter, catheter size, mounting via venesection, a catheter is inserted more than 72 hours, a catheter is placed in the lower limbs, not heeding pronsip anti sepsis, intravenous fluids and blood transfusion hypertonic because it is a medium the growth of microorganisms, additional equipment in place for setting drip infusion drugs, manipulation too often on the cannula. Colonization of bacteria on the tip of the catheter is the initial infusion site infections and bacteremia.
Illnesses caused by nosocomial infections
1 Urinary tract infections This infection is the most common occurrence, approximately 40% of nosocomial infections, 80% of infection associated with the use of urinary catheters. Although it is not too dangerous, but can cause bacteremia and result in death. Biaa organisms that normally infects E. coli, Klebsiella, Proteus, Pseudomonas, or Enterococcus. Infections that occur earlier mainly due to endogenous microorganisms, whereas infection that occurs after a long time usually due to microorganisms eksogen.4, 9.11 It is very difficult to prevent the spread of microorganisms through the urethra which is attached to the surface of the catheter. Most patients will be infected after 1-2 weeks of catheter placement. Is the most significant cause of hand or glove contamination when the catheter, or the water used to raise the balloon catheter. It can also be due to a failed sterilization and septic techniques and aseptik.9
Nosocomial Pneumonia 2 Nosocomial pneumonia can occur, especially patients using ventilator, tracheostomy action, intubation, installation NGT, and inhalation therapy. The most common germs that cause these infections are from gram-negative as Klebsiella, and Pseudomonas. These organisms are often located in the mouth, nose, throat, and stomach. The existence of these organisms can cause infection due to aspiration by respiratory tract organisms bawah.3 section, 9 Of the group may be caused olehcytomegalovirus virus, influenza virus, adeno virus, the influenza virus, enteroviruses and corona virus. 11 Risk factor for this infection are: 9 • Type and type of respiratory • Heavy smokers • Not sterility of assistive devices • Obesity • Quality of care • Chronic heart disease • Chronic lung disease • Weighing the condition of the patient and organ failure • Level of use of antibiotics • The use of ventilators and intubation • Decreased awareness of patient
The disease commonly found include: respiratory syncytial virus and influenza. In patients with low immune systems, pneumonia caused by Legionella and Aspergillus. While the country with a high prevalence of tuberculosis, should be kept clean air.
3 Bakteremi Nosocomial These infections represent only about 5% of total nosocomial infections, but with a very high risk of death, mainly due to antibiotic-resistant bacteria such as Staphylococcus and Candida. Infection may occur in the entry of equipment such as syringes, catheters and infusion urine. The main factor of this infection is the length of the catheter, body temperature while performing invasive procedures, and treatment of catheter or infusion.
Other Nosocomial Infections 1. Tuberkulosis11 The main cause is the presence of strains of multi-resistant drugs. Control of this disease is important for the proper identification, isolation, and treatment as well as the negative pressure in the room. 2. diarrhea and gastroenteritis The most common microorganisms derived from E. coli, Salmonella, Vibrio cholerae and Clostridium. In addition, more than gologan virus caused by enterovirus group, adenovirus, rotavirus, and hepatitis A. Distinguish between diarrhea and gastroenteritis. Risk factors of nosocomial gastroenteritis can be divided into intrinsic and extrinsic factors. • Intrinsic factors: o abnormality of mucosal defenses, such as achlorhydria o lack of intestinal motility, and o changes in normal flora. • Extrinsic factors: Installation of a nasogastric tube and consuming drugs gastrointestinal tract. 3. Vascular infection These infections are intimately associated with the use of infusion, cardiac catheters and injections. The virus that can be transmitted from the way this is the hepatitis B virus, hepatitis C virus, and HIV. These infections are divided into two main categories: • Infection of primary veins, appear without any signs of infection before, and in contrast to organisms found another body section • Secondary infection, emerged as a result of infection from the same organism from the other side of the body. 4. Diphtheria, tetanus and pertussis • Corynebacterium diptheriae, gram-negative pleomorphic, produce endotoxins that cause disease, infections primarily through the respiratory system. • Bordetella pertussis, which causes whooping cough. Cycle every 3-5 years and emerging infections as much as 50 in 100% of individuals who are not immune. • Clostridium tetani, a gram-positive anaerobic causing trismus and muscle spasms.
Skin and soft tissue infections. Open wounds such as ulcers, burns, and operation scars and increase the likelihood of bacterial infection results in systemic infection. From herpes simplex virus that group, zooster varicella, and rubella. Infecting organism will be different in each population because of differences in health care provided, differences in facilities owned and inhabited country differences. These infections include:
• Infections of the bones and joints
Osteomyelitis, bone or joint infection and vertebral disc
• Cardiovascular system infections
Arterial or venous infection, endocarditis, myocarditis, pericarditis and mediastinitis
• Infection of the central nervous system
Meningitis or ventrikulitis, absess spinal and intracranial infection
• Infection of the eyes, ears, nose, and mouth
Konjunctivitis, eye infection, otitis externa, otitis media, otitis interna, mastoiditis, sinusitis, and upper respiratory tract infection.
• Infections of the digestive tract
Gastroenteritis, hepatitis, necrotizing enterocolitis, intra-abdominal infections
• lower respiratory tract infections
Bronchitis, trakeobronkhitis, tracheitis, and other infections
• Infection of the reproductive system
Endometriosis and episiotomy scar
Prevention of Nosocomial Infection
Prevention of nosocomial infections is required an integrated planning, monitoring and programs include:
• Limiting the transmission of organisms or between patients with hand washing and use of gloves, septic and aseptic measures, sterilization and disinfectant.
• Controlling the risk of transmission of the environment.
• Protect the patient with the use of antibiotics is adequate, adequate nutrition, and vaccination.
• Limiting the risk of endogenous infection by minimizing invasive procedures.
• Supervision of infection, disease identification and control its spread
1 Decontamination hand Transmission of disease through the hands can be minimized by keeping hiegene of hand. But in reality, it is difficult to do properly, because of reasons such as lack of equipment, hand washing product allergies, at least knowledge of the importance of this, and a long time to wash hands. In addition, the use of gloves is highly recommended when going to take action or examination in patients with infectious diseases. The thing to remember is: Wear gloves when it will take or touching blood, body fluids, or sweat, feces, urine, mucous membranes and material that we consider to have been contaminated, and immediately wash hands after removing gloves.
2 instruments are often used Hospital Simonsen et al (1999) concluded that more than 50% of injections were performed in developing countries is not safe (eg, needles, tubes or both are used repeatedly) and the number of injections that are not important (eg, injection of antibiotics) .7 In order to prevent the spread of disease through a syringe is needed: • Reduction of injection are less necessary • Use a sterile needle • The use of disposable syringes. Masks, as protection against air-borne diseases. Likewise with patients suffering from respiratory tract infections, they should wear a mask while the patient out of the room. Gloves should be used especially when touching blood, body fluids, faeces and urine. Gloves should always be changed for each patient. After bandaging the wound or exposed objects are dirty, sanrung hand should immediately diganti.11 Special clothing should also be worn to protect the skin and clothing as long as we take action to prevent splashing of blood, body fluids, urine and feces.
3 Preventing the spread of hospital environment Regular cleansing is vital to ensure that the hospital is very clean and completely clean of dust, grease and dirt. Keep in mind that about 90 percent of the visible dirt must contain germs. There should be a regular time to clean walls, floors, beds, doors, windows, blinds, bathroom, and medical devices that have been used many times. Good air setting is difficult in many health facilities. Try to use the presence of the air filter, especially for people with low immune status or for people who can spread the disease through the air. Room with good air arrangements will be more likely to decrease the risk of tuberculosis transmission. In addition, hospitals must establish a water filter facility and maintain the cleanliness of the filter for processing and mencegahan occurrence of bacterial growth. Water sterilization at hospitals with limited infrastructure can use heat matahari.11 Toilet hospitals should also be maintained, especially in the patient care units to prevent diarrhea infections among patients. Surface toilets should be kept clean and given disinfektan.11 Disinfectant to kill germs and prevent transmission between patients. Disinfection is used: • Have criteria kill germs • Has the effect of the detergent • Has the effect of many bacteria, may dissolve oils and protein. • It is not difficult to use • Do not volatile • No materials containing hazardous substances both for workers and patients • Effectively • odorless, or smells bad
4 Fix endurance In the human body, in addition to existing opportunistic pathogenic bacteria, some mutualistic bacteria which help in the physiological processes of the body, and help the body's resistance against invasion of pathogenic microorganisms and to maintain the balance between commensal microorganisms population in general, such as what which occurs in the human gastrointestinal tract. Knowledge of a healthy person's body resistance mechanisms that can control the opportunistic microorganisms need to be identified completely, so it can be used in maintaining the body's defenses in patients with severe disease. Thus the danger of infection by opportunistic bacteria in patients with severe disease can be resolved without having to use antibiotics.
5 Non-Isolation The spread of nosocomial infections can be prevented by making a separation of the patient. Isolation is needed, especially for diseases transmitted through the air, for example, tuberculosis, and SARS, which resulted in severe contamination. Involving the transmission of the virus, for example, DHF and HIV. Typically, patients who have a low resistance eperti leukemia and immunosuppressant drug users also need to be isolated to avoid infection. But the hand and food hygiene, health equipment in the isolation room is also very important. The isolation room should always be covered with air vents always heading out. Should the patient be in an isolation room, but when it is happening extraordinary events and people beyond capacity, some patients in one room is not anything for them to suffer illness sama.9
REFERENCES
1. Olmsted RN. APIC Infection Control and Applied Epidemiology: Principles and Practice. St. Louis, Mosby; 1996
2. anonymus. Infectious Disease Epidemiology Section. www.oph.dhh.louisiana.gov
3. Ducel, G. et al. Prevention of hospital-acquired infections, A practical guide. 2nd edition. World Health Organization. Department of Communicable Disease, Surveillance and Response; 2002
4. Light RW. Infectious disease, noscomial infection. Harrison's Principles of Internal Medicine 15 Edition.-CD Room; 2001
5. Soeparman, et al. Internal Medicine Volume II. Publisher FKUI Hall, Jakarta; 2001
6. Surono, A. Editorial Digest. agussur@hotmail.com
7. Anonymus. Preventing nosocomial Infection.Louisiana; 2002
8. Suwarni, A. Study of Environmental Sanitation Efforts Diskriptif Pattern Relation to Mean Old Day Care and Genesis Nosocomial Infection Case Study: Patients with Post-Surgical Inpatient Hospital Yogyakarta Provincial Government and Private 1999. Agency for Health Research and Development Department of Health and Social Welfare, Yogyakarta; 2001
9. Babb, JR. Liffe, AJ. Pocket Reference to Hospital Acquired infection. Science Press limited, Cleveland Street, London; 1995
10. Pohan, HT. Current Diagnosis and Treatment in Internal Medicine. Center for Information and Publishing Department of Medicine Faculty of medicine, Jakarta; 2004
11. Wenzel. Infection control in the hospital, in the International society for infectious diseases, second ed, Boston; 2002
Nosocomial Disease Definitions: Infection is the presence of an organism in tissue or body fluids with a clinical symptom of both local and systemic. Infections that arise during such a person admitted to the hospital and began to show a person's symptoms during or after completion cared cared so-called nosocomial infections. In general, patients who were admitted to hospital and showed signs of infection less than 72 hours showed that the incubation period of the disease had occurred before the patient entered the hospital, and new infections show symptoms after 72 hours of new patients are referred to hospital infection nosokomia
Nosocomial infections can be derived from the patient's body or outside the body. Endogenous infections are caused by microorganisms that originally there had been in the body and move to a new place that we call self-infection or auto-infection, while exogenous infection (cross infection) caused by microorganisms from the hospital and from one patient to another.
SakitRumah home hospital is a place where people are ill treated and placed in very close proximity. At this point the patient receives treatment and care to be cured. However, hospitals in addition to searching for a cure, also a depot for various diseases from patients and visitors with the status of a career. These germs can live and thrive in a hospital environment, such as; air, water, flooring, food and objects of medical and non medical. The occurrence of nosocomial infections will cause a lot of losses, among other things:
• long day care growing longer
• suffering increased
• increased costs
From the results of a descriptive study Suwarni, A in all hospitals in Yogyakarta in 1999 showed that the proportion of the incidence of nosocomial infections ranged from 0.0% to 12.06%, with an overall average of 4.26%. For the average treatment duration ranged from 4.3 to 11.2 days, with an overall average of 6.7 days. After further investigation it was found that the number of germs floor treatment room has a meaningful relationship with nosocomial infections.
During this back 10-20 years has been a lot of progress has been made to locate the main problem of the increasing incidence of nosocomial infections in many countries, and in some countries, it is very alarming condition. This situation actually increase the time to care and treatment changes with expensive drugs, and the use of services outside the hospital. That's why, in countries poorer, developing, prevention of nosocomial infections are preferred to be able to improve the quality of patient care in the hospital and other health facilities. In some parts, especially in parts of the internal medicine, there are many procedures and actions taken either to help diagnose or monitor the disease course and therapy can cause enough patients susceptible to nosocomial infections. Patients with old age, the old lie, or some action such as invasive diagnostic procedures, long infusion and urinary catheters are long, or patients with a certain disease is a disease that requires chemotherapy, with very severe disease, malignant disease, diabetes, anemia, diseases autoimmune and immuno suppressants or steroid use was found that the risk of infection larger.2., 3.5 Source of infection and mode of transmission is mainly through the hands and from health care workers and other health personnel, injection needles, IV catheters, urinary catheters, gauze dressings or bandages, and a wrong way to deal with injuries. Nosocomial infection is also not just about the patient, but also to the entire hospital personnel in direct contact with the patient or the patient's guardian and the visitors.
Epidemiology Many nosocomial infections occur throughout the world with the highest incidence in poor countries and developing countries due to infectious diseases are still a major cause. A study conducted by the WHO indicate that approximately 8.7% of the 55 hospitals from 14 countries from Europe, the Middle East, Southeast Asia and the Pacific remains indicate the presence of nosocomial infection in Southeast Asia as much as 10.0% .3 Although science and microbiology research increased rapidly in the last 3 decades, and little by little the risk of infection can be prevented, but the increase of patients with immunocompromised diseases, antibiotic resistant bacteria, viruses and fungal super infections, and invasive procedures, is still causing infections Nosocomial cause 88,000 deaths annually walaupun.4 case Moreover, if we compare the germs that exist in society, microorganisms that are in the hospital more dangerous and more resistant to the drug, because it required a more potent antibiotic or a combination of antibiotics. All of these conditions can increase the risk of infection to the pasien.2, 3.5
Development of Nosocomial Infection Causes
1 Infectious Agents The patient will be exposed to a wide variety of microorganisms during his hospitalization. Contact between the patient and a wide variety of microorganisms is not always cause clinical symptoms because of other factors which may cause the occurrence of nosocomial infections. The possibility of infection depends on: 3
• characteristics of microorganisms,
• resistance to antibiotic substances,
• the level of virulence,
• and the number of infectious material.
All of microorganisms including bacteria, viruses, fungi and parasites can cause nosocomial infections. These infections can be caused by microorganisms acquired from others (cross infection) or caused by the normal flora of the patient's own (endogenous infection). Most infections occur in hospitals is mainly due to external factors, namely the spread of disease through food and air and objects or materials that are not sterile. Diseases acquired from the hospital today most commonly caused by microorganisms that are always present in people who previously did not or rarely cause disease in normal people.
1. Bacterium
Bacteria can be found as normal flora in the human body healthy. The presence of bacteria here is very important in protecting the body from the coming pathogenic bacteria. But in some cases it can cause infection if the man has a low tolerance for microorganisms. For example, Escherichia coli is most often found as a cause of urinary tract infections. More harmful pathogenic bacteria and cause infection either sporadic or endemic. For example: • Anaerobic Gram-positive, which can lead to gangrene Clostridium • gram-positive bacteria: Staphylococcus aureus is a parasite on the skin and the nose can cause lung irritation, home, heart and blood vessels as well as infections are often resistant to antibiotics. • Gram-negative bacteria: Enterobacteriacae, for example, Escherichia coli, Proteus, Klebsiella, Enterobacter. Pseudomonas often found in water and water reservoirs that cause infection in the digestive tract and patients treated. This gram-negative bacteria responsible for about half of all infections in hospitals. Serratia marcescens •, can cause serious infections in wounds scar, lung, and peritoneum.
2. Virus Many possible nosocomial infection caused by a variety of viruses, including hepatitis B and C viruses in the media transmission of transfusion, dialysis, injections and endoscopy. Respiratory syncytial virus (RSV), rotavirus, and enteroviruses are transmitted from hand to mouth contact or through the faecal-oral route. Hepatitis and HIV is transmitted by sharing needles, and blood transfusions. Transmission route for the virus the same as other microorganisms. Gastrointestinal infections, respiratory tract infections, skin diseases and blood. Other viruses that often cause nosocomial infection is cytomegalovirus, Ebola, influenza virus, herpes simplex virus, and varicella-zoster virus, can also be transmitted.
3. Parasites and Fungi Some parasites such as Giardia lamblia can be transmitted easily to adults and children alike. Many fungi and parasites may arise during the administration of antibiotics and the bacterial immunosuppressant drugs, such as infections of Candida albicans, Aspergillus spp, Cryptococcus neoformans, Cryptosporidium.
II.1.2 response and tolerance of the patient's body The most important factor affecting the level of tolerance and response of the patient in this case is: 3.9 • Age • immune status of patients • illness • Obesity and malnutrition • People who use immunosuppressant drugs and steroids • Interventions were performed on the body to perform diagnostics and therapeutics.
Young age and old age is associated with decreased resistance to infection is much worse on the condition of patients suffering from chronic diseases such as tumors, anemia, leukemia, diabetes mellitus, renal failure, SLE and AIDS. These conditions will increase the body's tolerance to infection from bacteria that originally are opportunistic. Drugs that are immunosuppressives can lower the body's defense against infection. The number of investigations and therapeutic procedures such as biopsy, endoscopy, catheterization, intubation and surgery also increases the risk infeksi.3, 9 Type the patient's risk of infection Minimal is immunocompromised, are not exposed to a disease found Patients are being infected and with some risk factors Weight Patients with severely immunocompromised, (5 lm. Example bacterial meningitis, and diphtheria require the following; separate rooms for each patient. Masks for healthcare workers. Restricted areas for the patient, and the patient should wear a mask when leaving the room.
4 Infection by direct or indirect contact Infections that occur due to contact directly or indirectly with the cause of the infection. Transmission of this infection can be through the hands, skin and clothes, such as staphylococcus aureus group. Can also be given through intravenous fluids and syringes, hepatitis and HIV. Equipment and medical instruments. Food is not sterile, not cooked and were taken using a hand which causes the occurrence of cross infection.3, 9
2 Antibiotic Resistance Along with the discovery of penicillin and antibiotic use between the years 1950-1970, many serious and fatal diseases when it can be treated and cured. However, this success led to the overuse of antibiotics and pengunsalahan. Many microorganisms are now becoming more resistant. Increased bacterial resistance may increase the mortality rate of patients who are immunocompromised, especially. Resitensi of bacteria transmitted between patients and resistance factor transferred between bacteria. The use of antibiotics constantly multipikasi and actually increase the spread of resistant strains. The main cause for: • The use of antibiotics is not appropriate and is not controlled • The dose of antibiotics that are not optimal • Therapy and treatment using antibiotics that are too short • Error diagnosis
The number of patients who received antibiotics and alteration of genes that are resistant to antibiotics, resulting in the emergence of germ multiresistensi to these drugs. The use of antibiotics on a large scale for the treatment and prophylaxis of resistance is a major factor. Many strains of pneumococci, staphylococci, enterococci, and tuberculosis was resistant to many antibiotikaa, as well as Klebsiella and Pseudomonas aeruginosa also has to be multiresistant. This situation is very real occurred mainly in developing countries where second-line antibiotics does not exist or is not available. Nosocomial infections affect morbidity and mortality in the hospital, and is very important because: • Increasing the number of patients treated • Frequent body weakened immunity due to illness, treatment or age • new microorganisms (mutation) • Increased bacterial resistance to antibiotics
3 Factors tools From a clinical study, tertama nosocomial infections caused by infections from urinary catheters, infusion needle infections, respiratory tract infections, skin infections, surgical wound infections and septicemia from. The use of intravenous and urinary catheters are no longer interchangeable. Diruang medicine, an estimated 20-25% of patients require infusion therapy. Intravenous cannulation complications may include mechanical disruption, physical and chemical. These complications include: 3.5 Extravasation infiltrates: intravenous fluids enter the tissue around the cannula insertion Blockage: Infuse not function properly without the detectable presence of other disorders Phlebitis: There is swelling, redness and tenderness along the vein Thrombosis: There is a swelling along the vein that impede the flow of infusion Colonization cannula: When it can be cultured microorganisms from the cannula is in the vein Septicaemia: When the hematogenous spread of germs cannula Suppuration: If there has been a formation of pus around the cannula insertion
Some of the following factors play a role in increasing the complications of intravenous cannulae are: type of catheter, catheter size, mounting via venesection, a catheter is inserted more than 72 hours, a catheter is placed in the lower limbs, not heeding pronsip anti sepsis, intravenous fluids and blood transfusion hypertonic because it is a medium the growth of microorganisms, additional equipment in place for setting drip infusion drugs, manipulation too often on the cannula. Colonization of bacteria on the tip of the catheter is the initial infusion site infections and bacteremia.
Illnesses caused by nosocomial infections
1 Urinary tract infections This infection is the most common occurrence, approximately 40% of nosocomial infections, 80% of infection associated with the use of urinary catheters. Although it is not too dangerous, but can cause bacteremia and result in death. Biaa organisms that normally infects E. coli, Klebsiella, Proteus, Pseudomonas, or Enterococcus. Infections that occur earlier mainly due to endogenous microorganisms, whereas infection that occurs after a long time usually due to microorganisms eksogen.4, 9.11 It is very difficult to prevent the spread of microorganisms through the urethra which is attached to the surface of the catheter. Most patients will be infected after 1-2 weeks of catheter placement. Is the most significant cause of hand or glove contamination when the catheter, or the water used to raise the balloon catheter. It can also be due to a failed sterilization and septic techniques and aseptik.9
Nosocomial Pneumonia 2 Nosocomial pneumonia can occur, especially patients using ventilator, tracheostomy action, intubation, installation NGT, and inhalation therapy. The most common germs that cause these infections are from gram-negative as Klebsiella, and Pseudomonas. These organisms are often located in the mouth, nose, throat, and stomach. The existence of these organisms can cause infection due to aspiration by respiratory tract organisms bawah.3 section, 9 Of the group may be caused olehcytomegalovirus virus, influenza virus, adeno virus, the influenza virus, enteroviruses and corona virus. 11 Risk factor for this infection are: 9 • Type and type of respiratory • Heavy smokers • Not sterility of assistive devices • Obesity • Quality of care • Chronic heart disease • Chronic lung disease • Weighing the condition of the patient and organ failure • Level of use of antibiotics • The use of ventilators and intubation • Decreased awareness of patient
The disease commonly found include: respiratory syncytial virus and influenza. In patients with low immune systems, pneumonia caused by Legionella and Aspergillus. While the country with a high prevalence of tuberculosis, should be kept clean air.
3 Bakteremi Nosocomial These infections represent only about 5% of total nosocomial infections, but with a very high risk of death, mainly due to antibiotic-resistant bacteria such as Staphylococcus and Candida. Infection may occur in the entry of equipment such as syringes, catheters and infusion urine. The main factor of this infection is the length of the catheter, body temperature while performing invasive procedures, and treatment of catheter or infusion.
Other Nosocomial Infections 1. Tuberkulosis11 The main cause is the presence of strains of multi-resistant drugs. Control of this disease is important for the proper identification, isolation, and treatment as well as the negative pressure in the room. 2. diarrhea and gastroenteritis The most common microorganisms derived from E. coli, Salmonella, Vibrio cholerae and Clostridium. In addition, more than gologan virus caused by enterovirus group, adenovirus, rotavirus, and hepatitis A. Distinguish between diarrhea and gastroenteritis. Risk factors of nosocomial gastroenteritis can be divided into intrinsic and extrinsic factors. • Intrinsic factors: o abnormality of mucosal defenses, such as achlorhydria o lack of intestinal motility, and o changes in normal flora. • Extrinsic factors: Installation of a nasogastric tube and consuming drugs gastrointestinal tract. 3. Vascular infection These infections are intimately associated with the use of infusion, cardiac catheters and injections. The virus that can be transmitted from the way this is the hepatitis B virus, hepatitis C virus, and HIV. These infections are divided into two main categories: • Infection of primary veins, appear without any signs of infection before, and in contrast to organisms found another body section • Secondary infection, emerged as a result of infection from the same organism from the other side of the body. 4. Diphtheria, tetanus and pertussis • Corynebacterium diptheriae, gram-negative pleomorphic, produce endotoxins that cause disease, infections primarily through the respiratory system. • Bordetella pertussis, which causes whooping cough. Cycle every 3-5 years and emerging infections as much as 50 in 100% of individuals who are not immune. • Clostridium tetani, a gram-positive anaerobic causing trismus and muscle spasms.
Skin and soft tissue infections. Open wounds such as ulcers, burns, and operation scars and increase the likelihood of bacterial infection results in systemic infection. From herpes simplex virus that group, zooster varicella, and rubella. Infecting organism will be different in each population because of differences in health care provided, differences in facilities owned and inhabited country differences. These infections include:
• Infections of the bones and joints
Osteomyelitis, bone or joint infection and vertebral disc
• Cardiovascular system infections
Arterial or venous infection, endocarditis, myocarditis, pericarditis and mediastinitis
• Infection of the central nervous system
Meningitis or ventrikulitis, absess spinal and intracranial infection
• Infection of the eyes, ears, nose, and mouth
Konjunctivitis, eye infection, otitis externa, otitis media, otitis interna, mastoiditis, sinusitis, and upper respiratory tract infection.
• Infections of the digestive tract
Gastroenteritis, hepatitis, necrotizing enterocolitis, intra-abdominal infections
• lower respiratory tract infections
Bronchitis, trakeobronkhitis, tracheitis, and other infections
• Infection of the reproductive system
Endometriosis and episiotomy scar
Prevention of Nosocomial Infection
Prevention of nosocomial infections is required an integrated planning, monitoring and programs include:
• Limiting the transmission of organisms or between patients with hand washing and use of gloves, septic and aseptic measures, sterilization and disinfectant.
• Controlling the risk of transmission of the environment.
• Protect the patient with the use of antibiotics is adequate, adequate nutrition, and vaccination.
• Limiting the risk of endogenous infection by minimizing invasive procedures.
• Supervision of infection, disease identification and control its spread
1 Decontamination hand Transmission of disease through the hands can be minimized by keeping hiegene of hand. But in reality, it is difficult to do properly, because of reasons such as lack of equipment, hand washing product allergies, at least knowledge of the importance of this, and a long time to wash hands. In addition, the use of gloves is highly recommended when going to take action or examination in patients with infectious diseases. The thing to remember is: Wear gloves when it will take or touching blood, body fluids, or sweat, feces, urine, mucous membranes and material that we consider to have been contaminated, and immediately wash hands after removing gloves.
2 instruments are often used Hospital Simonsen et al (1999) concluded that more than 50% of injections were performed in developing countries is not safe (eg, needles, tubes or both are used repeatedly) and the number of injections that are not important (eg, injection of antibiotics) .7 In order to prevent the spread of disease through a syringe is needed: • Reduction of injection are less necessary • Use a sterile needle • The use of disposable syringes. Masks, as protection against air-borne diseases. Likewise with patients suffering from respiratory tract infections, they should wear a mask while the patient out of the room. Gloves should be used especially when touching blood, body fluids, faeces and urine. Gloves should always be changed for each patient. After bandaging the wound or exposed objects are dirty, sanrung hand should immediately diganti.11 Special clothing should also be worn to protect the skin and clothing as long as we take action to prevent splashing of blood, body fluids, urine and feces.
3 Preventing the spread of hospital environment Regular cleansing is vital to ensure that the hospital is very clean and completely clean of dust, grease and dirt. Keep in mind that about 90 percent of the visible dirt must contain germs. There should be a regular time to clean walls, floors, beds, doors, windows, blinds, bathroom, and medical devices that have been used many times. Good air setting is difficult in many health facilities. Try to use the presence of the air filter, especially for people with low immune status or for people who can spread the disease through the air. Room with good air arrangements will be more likely to decrease the risk of tuberculosis transmission. In addition, hospitals must establish a water filter facility and maintain the cleanliness of the filter for processing and mencegahan occurrence of bacterial growth. Water sterilization at hospitals with limited infrastructure can use heat matahari.11 Toilet hospitals should also be maintained, especially in the patient care units to prevent diarrhea infections among patients. Surface toilets should be kept clean and given disinfektan.11 Disinfectant to kill germs and prevent transmission between patients. Disinfection is used: • Have criteria kill germs • Has the effect of the detergent • Has the effect of many bacteria, may dissolve oils and protein. • It is not difficult to use • Do not volatile • No materials containing hazardous substances both for workers and patients • Effectively • odorless, or smells bad
4 Fix endurance In the human body, in addition to existing opportunistic pathogenic bacteria, some mutualistic bacteria which help in the physiological processes of the body, and help the body's resistance against invasion of pathogenic microorganisms and to maintain the balance between commensal microorganisms population in general, such as what which occurs in the human gastrointestinal tract. Knowledge of a healthy person's body resistance mechanisms that can control the opportunistic microorganisms need to be identified completely, so it can be used in maintaining the body's defenses in patients with severe disease. Thus the danger of infection by opportunistic bacteria in patients with severe disease can be resolved without having to use antibiotics.
5 Non-Isolation The spread of nosocomial infections can be prevented by making a separation of the patient. Isolation is needed, especially for diseases transmitted through the air, for example, tuberculosis, and SARS, which resulted in severe contamination. Involving the transmission of the virus, for example, DHF and HIV. Typically, patients who have a low resistance eperti leukemia and immunosuppressant drug users also need to be isolated to avoid infection. But the hand and food hygiene, health equipment in the isolation room is also very important. The isolation room should always be covered with air vents always heading out. Should the patient be in an isolation room, but when it is happening extraordinary events and people beyond capacity, some patients in one room is not anything for them to suffer illness sama.9
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4. Light RW. Infectious disease, noscomial infection. Harrison's Principles of Internal Medicine 15 Edition.-CD Room; 2001
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6. Surono, A. Editorial Digest. agussur@hotmail.com
7. Anonymus. Preventing nosocomial Infection.Louisiana; 2002
8. Suwarni, A. Study of Environmental Sanitation Efforts Diskriptif Pattern Relation to Mean Old Day Care and Genesis Nosocomial Infection Case Study: Patients with Post-Surgical Inpatient Hospital Yogyakarta Provincial Government and Private 1999. Agency for Health Research and Development Department of Health and Social Welfare, Yogyakarta; 2001
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