Nosocomial infections are infections that occur in a hospital environment. Someone said experience nosocomial infection if the infection get when you are or undergoing treatment in the hospital.
Nosocomial infections can occur in patients, nurses, doctors, and hospital workers or visitors. Some examples of diseases that can occur due to nosocomial infections are bloodstream infections, pneumonia, urinary tract infection (UTI), and surgical site infection (ILO).
Causes of Nosocomial Infection
Nosocomial infections are most often caused by bacteria. This bacterial infection is more dangerous because it is generally caused by bacteria that are resistant to antibiotics, such as MRSA or ESBL-producing bacteria. Nosocomial infections caused by these bacteria can occur in patients who are receiving treatment in a hospital or patients with a weak immune system or immune system.
In addition to bacteria, nosocomial infections can also be caused by viruses, fungi, and parasites. Transmission of nosocomial infections can occur through air, water, or direct contact with patients in the hospital.
Nosocomial infection risk factors
There are a number of factors that can increase a person's risk in a hospital setting for nosocomial infections, including:
- Have a weak immune system, for example due to HIV/AIDS or taking immunosuppressant drugs
- Suffering from a coma, serious injury, burns, or shock
- Having access or frequent contact with patients who are suffering from infectious diseases, without using personal protective equipment according to operational standards (SOP)
- Getting more than 3 days or long-term care in the ICU
- Over 70 years old or still a baby
- Have a history of taking antibiotics in the long term
- Using a breathing apparatus, such as a ventilator
- Using an IV, urinary catheter, and endotracheal tube (ETT)
- Having surgery, such as heart surgery, bone surgery, surgery to implant medical equipment (such as a pacemaker or implant), or organ transplant surgery
In addition to the above factors, the crowded hospital environment, the activity of transferring patients from one unit to another, and the placement of patients with weak immune systems with patients suffering from infectious diseases in the same room, can also increase the risk of nosocomial infections.
Symptoms of Nosocomial Infection
Symptoms suffered by patients with nosocomial infections can vary, depending on the infectious disease that occurs. Symptoms that can appear include:
- Fever
- Rash on the skin
- Hard to breathe
- Fast pulse
- Body feels weak
- Headache
- Nausea or vomiting
In addition to the general symptoms mentioned above, symptoms can also arise according to the type of nosocomial infection that occurs, such as:
- Blood stream infection, with symptoms such as fever, chills, decreased blood pressure, or redness and pain at the infusion site if infection occurs through an intravenous infusion
- Pneumonia, with symptoms such as fever, shortness of breath, and cough with phlegm
- Surgical wound infection, with symptoms in the form of fever, redness, pain, and discharge of pus in the wound
- Urinary tract infection, with symptoms such as fever, pain when urinating, difficulty urinating, lower abdominal or back pain, and blood in the urine
When to go to the doctor
You need to check yourself or consult a doctor if you feel the symptoms of a nosocomial infection as mentioned above, especially if these symptoms appear after you get treatment in the hospital.
Symptoms of nosocomial infection can appear in the following timescales:
- From the beginning of hospital admission to 48 hours after
- Since leaving the hospital until 3 days after
- From the time of surgery to 90 days after
Nosocomial Infection Diagnosis
The doctor will ask about the complaints and symptoms experienced by the patient, then perform a physical examination to determine the patient's condition and whether there are signs of local infection on the skin.
To confirm the diagnosis, the doctor will perform the following investigations:
- Blood tests, to detect signs of infection from the levels of blood cells
- Urine test, to find out whether there is an infection in the urinary tract, including to see the type of bacteria that infects
- Sputum test, to determine the type of bacteria that infects the respiratory tract
- Cultures of blood, sputum, or surgical wound fluid, to determine the presence and type of bacteria, fungi, or parasites causing the infection
- CT scan, MRI, ultrasound, or X-ray, to detect damage and signs of infection in certain organs
Nosocomial Infection Treatment
If it is suspected that the cause of the infection is bacteria, the doctor will give antibiotics empirically. Empirical antibiotic therapy is the initial administration of antibiotics, before the type of bacteria causing the infection is known with certainty.
The hope is that the antibiotics can control or kill the bacteria causing the infection while waiting for the culture results to come out. After the culture results come out, the administration of antibiotics and other drugs will be adjusted to the type of bacteria or germs that cause nosocomial infections.
If the nosocomial infection is caused by a surgical wound infection or pressure ulcer, surgery will be performed debridement. This procedure is useful for removing infected and damaged tissue so that the infection does not spread.
Supportive therapy, such as giving fluids, oxygen, or medication to treat symptoms, will be given according to the patient's condition and needs. Supportive therapy is carried out to ensure that the patient's condition remains stable.
Whenever possible, all devices that increase the risk of infection are removed or replaced.
Complications of Nosocomial Infection
Nosocomial infections that are not treated immediately can cause various complications such as:
- Endocarditis
- Osteomyelitis
- Peritonitis
- Meningitis
- Sepsis
- Lung abscess
- Organ failure
- Gangrene
- Permanent damage to the kidneys
Nosocomial Infection Prevention
Nosocomial infection prevention measures are the responsibility of all people in the hospital, including health workers, such as doctors and nurses, patients, and visiting people. Some steps that can be taken to prevent the spread of this infection are:
1. Wash your hands
It is important for everyone who is in hospital to wash their hands properly according to WHO recommendations. There are 5 mandatory times to wash your hands while in the hospital, namely:
- Before handling the patient
- Before performing procedures and actions on patients
- After exposure to body fluids (e.g. blood, urine, or feces)
- After touching the patient
- After touching objects around the patient
2. Keep your home environment cleansick
The hospital environment needs to be cleaned with a cleaning fluid or disinfectant. Hospital floors need to be cleaned 2-3 times per day, while the walls need to be cleaned every 2 weeks.
3. Use the tool according to the procedure
Medical procedures and the use of devices or tubes that are attached to the body, such as infusions, breathing apparatus, or urinary catheters, must be used and installed according to standard operating procedures (SOPs) that apply in each hospital and health facility.
4. Place patients at risk in isolation rooms
Placement of patients must be in accordance with the conditions and illnesses suffered. For example, patients with low immunity or patients who have the potential to transmit the disease to other patients will be placed in isolation rooms.
5. Use PPE (personal protective equipment) according to the SOP
Staff and everyone involved in hospital services need to use personal protective equipment according to SOPs, such as gloves and masks, when serving patients.