Mikrobiol. Z. 2021; 83(4):98-105.
doi: https://doi.org/10.15407/microbiolj83.04.098

A Review of Nosocomial Infections: Source and Prevention

D.B. Phule, A.V. Manwar

Department of Microbiology
Dnyanopasak College of Arts, Commerce, Science, and Technology
Parbhani, India

Nosocomial infections are a severe public health concern around the world, particularly in developing nations where infection control is difficult owing to financial constraints. Despite the significant drop in infectious disease due to advances in medical technology and medicine, it is well acknowledged that nosocomial infection has been one of the key impediments to better health conditions. The spread of bacterial species associated with number of medical devices for example commonly used stethoscope is one of the sources of infection. The presence of coagulase negative Staphylococcus species, Enterococci species, Escherichia coli, Klebsiella species and Acinetobacter species found to be common on stethoscope. The indiscriminate use of antibiotics without any regulation and proper screening certainly making many antibiotics non-functional to control their targeted pathogens. The hospital acquired pathogens mainly showcase increased incidences of antibiotic resistance. The purpose of this study is to examine epidemiologic characteristics of nosocomial infection and to find out effectives measures for their preventing.

Keywords: nosocomial infections, microbial pathogens, prevention and transmission.

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  1. Fehr J, Hatz C, Soka I, Kibatala P, Urassa H, Smith T, Mshinda H, Frei R, Widmer A. Risk factors for surgical site infection in a Tanzanian district hospital: a challenge for the traditional national nosocomial infections surveillance system index. Infect Control Hosp Epidemiol. 2006; 27(12):1401–1404. https://doi.org/10.1086/509855
  2. Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine. 2017; 7(5):478–482. https://doi.org/10.1016/j.apjtb.2017.01.019
  3. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Reinhart K. International study of the prevalence and outcomes of infection in intensive care units. Jama. 2009; 302(21):2323–2329. https://doi.org/10.1001/jama.2009.1754
  4. Mawalla B, Mshana SE, Chalya PL, Imirzalioglu C, Mahalu W. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania. BMC Surg. 2011; 11:10–21. https://doi.org/10.1186/1471-2482-11-21
  5. Allegranzi B, Nejad SB, Castillejos GG, Kilpatrick C, Kelley E. Report on the Burden of Endemic Health Care–Associated Infection Worldwide. Geneva, Switzerland: World Health Organization. Lancet Infect Dis. 2011; 13:843–51. https://doi.org/10.1016/S1473-3099(13)70163-4
  6. Gupta A, Divya CV, Singh DK, Krutarth B, Maria N, Srinivas R. Prevalence of health care associated infections in a tertiary care hospital in Dakshina Kannada, Karnataka: a hospital based cross sectional study. International Journal of Medical Research and Health Sciences. 2015; 4(2):317–321. https://doi.org/10.5958/2319-5886.2015.00059.4
  7. Hughes Ronda G, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality (US), April, 2008.
  8. Revelas A. Healthcare–associated infections: A public health problem. Nigerian medical journal: journal of the Nigeria Medical Association. 2012; 53(2):59. https://doi.org/10.4103/0300-1652.103543
  9. Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infection and drug resistance. 2018; 11:2321. https://doi.org/10.2147/IDR.S177247
  10. Klevens RM, Edwards JR, Richards Jr CL, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Estimating health care-associated infections and deaths in US hospitals. 2002. Public health reports. 2007; 122(2):160–166. https://doi.org/10.1177/003335490712200205
  11. Centers for Disease Control and Prevention. Vital signs: central line–associated blood stream infections—United States, 2001, 2008, 2009. Annals of emergency medicine. 2011; 58(5):447–450. https://doi.org/10.1016/j.annemergmed.2011.07.035
  12. World Health Organization. Preventing bloodstream infections from central line venous catheters. 2012. http://www.who.int/patientsafety/implementation/bsi/en/index.html
  13. Haddadin Y, Annamaraju P, Regunath H. Central line associated blood stream infections (CLABSI). StatPearls; 2020.
  14. CDC Types of healthcare-associated infections. Healthcare-associated infections (HAIs). 2016. https://www.cdc.gov/HAI/infectionTypes.html
  15. World Health Organization. Preventing bloodstream infections from central line venous catheters. WHO World Health Organisation, Geneva, Switzerland; 2014.
  16. Lin KY, Cheng A, Chang YC, Hung MC, Wang JT, Sheng WH, Chang SC. Central lineassociated bloodstream infections among critically-ill patients in the era of bundle care. Journal of microbiology, immunology and infection. 2017; 50(3):339–348. https://doi.org/10.1016/j.jmii.2015.07.001
  17. Warren JW. Catheter-associated urinary tract infections. International journal of antimicrobial agents. 2001; 17(4):299–303. https://doi.org/10.1016/S0924-8579(00)00359-9
  18. CDC. Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection). Atlanta, Georgia: CDC; 2015.
  19. Anderson DJ. Surgical site infections. Infectious disease clinics of North America. 2011; 25(1):135–153. https://doi.org/10.1016/j.idc.2010.11.004
  20. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. Journal of hospital infection. 2008; 70:3–10. https://doi.org/10.1016/S0195-6701(08)60017-1
  21. Hunter JD. Ventilator associated pneumonia. BMJ. 2012; 344:3325. https://doi.org/10.1136/bmj.e3325
  22. Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev. 2006; 19(4):637–657. https://doi.org/10.1128/CMR.00051-05
  23. Joshi SG, Litake GM. Acinetobacter baumannii: An emerging pathogenic threat to public health. World Journal of Clinical Infectious Diseases.  2013; 3(3):25–36. https://doi.org/10.5495/wjcid.v3.i3.25
  24. Salamati P, Rahbarimanesh AA, Yunesian M, Naseri M. Neonatal nosocomial infections in Bahrami children hospital. The Indian Journal of Pediatrics. 2006; 73(3):197–200. https://doi.org/10.1007/BF02825479
  25. Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: a review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Canadian Journal of Infectious Diseases and Medical Microbiology. 2008; 19(2):173–184. https://doi.org/10.1155/2008/846453
  26. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. Critical care medicine. 1999; 27(5):887–892. https://doi.org/10.1097/00003246-199905000-00020
  27. Weinstein RA, Hota B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clinical infectious diseases. 2004; 39(8):1182–1189. https://doi.org/10.1086/424667
  28. Sengupta S, Sirkar A, Shivananda PG. Stethoscopes and nosocomial infection. The Indian Journal of Pediatrics. 2000; 67(3):197. https://doi.org/10.1007/BF02723663
  29. O’Brien KL, Beall B, Barrett NL, Cieslak PR, Reingold A, Farley MM, et al. Epidemiology of invasive group A streptococcus disease in the United States, 1995–1999. Clinical Infectious Diseases. 2002; 35(3):268–276. https://doi.org/10.1086/341409
  30. Rodvold KA, McConeghy KW. Methicillin-resistant Staphylococcus aureus therapy: past, present, and future. Clinical infectious diseases. 2014; 58(suppl 1):20–27. https://doi.org/10.1093/cid/cit614
  31. Castelblanco RL, Lee M, Hasbun R. Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study. The Lancet Infectious diseases. 2014; 14(9):813–819. https://doi.org/10.1016/S1473-3099(14)70805-9
  32. Pizza M, Rappuoli R. Neisseria meningitidis: pathogenesis and immunity. Current opinion in microbiology. 2015; 23:68–72. https://doi.org/10.1016/j.mib.2014.11.006
  33. Aintablian N, Walpita P, Sawyer MH. Detection of Bordetella pertussis and respiratory syncytial virus in air samples from hospital rooms. Infection Control and Hospital Epidemiology. 1998; 19(12):918–923. https://doi.org/10.2307/30142018
  34. Pearson ML, Jereb JA, Frieden TR, Crawford JT, Davis BJ, Dooley SW, Jarvis WR. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers. Annals of internal medicine. 1992; 117(3):191–196. https://doi.org/10.7326/0003-4819-117-3-191
  35. Micek ST, Wunderink RG, Kollef MH, Chen C, Rello J, Chastre J, Calbo E. An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistance. Critical Care. 2015; 19(1):219. https://doi.org/10.1186/s13054-015-0926-5
  36. Richards AM, Abu Kwaik Y, Lamont RJ. Code blue: Acinetobacter baumannii, a nosocomial pathogen with a role in the oral cavity. Molecular oral microbiology. 2015; 30(1):2–15. https://doi.org/10.1111/omi.12072
  37. Cunha BA, Burillo A, Bouza E. Legionnaires’ disease. The Lancet. 2016; 387(10016):376–385. https://doi.org/10.1016/S0140-6736(15)60078-2
  38. Goldstein EJ, Johnson S, Maziade PJ, McFarland LV, Trick W, Dresser L, Low DE. Pathway to prevention of nosocomial Clostridium difficile infection. Clinical Infectious Diseases. 2015; 60(suppl 2):148–158. https://doi.org/10.1093/cid/civ142
  39. Leffler DA, Lamont JT. Clostridium difficile infection. New England Journal of Medicine. 2015; 372(16):1539–1548. https://doi.org/10.1056/NEJMra1403772
  40. Bagaitkar J, Demuth DR, Scott DA. Tobacco use increases susceptibility to bacterial infection. Tobacco induced diseases. 2008; 4(1):12. https://doi.org/10.1186/1617-9625-4-12
  41. Aitken C, Jeffries DJ. Nosocomial spread of viral disease. Clinical microbiology reviews. 2001; 14(3):528–546. https://doi.org/10.1128/CMR.14.3.528-546.2001
  42. Ducel G, Fabry J, Nicolle L. Prevention of hospital acquired infections: a practical guide. Prevention of hospital acquired infections: a practical guide. 2002.
  43. Castro‐Rodriguez JA, Daszenies C, Garcia M, Meyer R, Gonzales R. Adenovirus pneumonia in infants and factors for developing bronchiolitis obliterans: a 5‐year follow‐up. Pediatric pulmonology. 2006; 41(10):947–953. https://doi.org/10.1002/ppul.20472
  44. Carducci A, Verani M, Lombardi R, Casini B, Privitera G. Environmental survey to assess viral contamination of air and surfaces in hospital settings. Journal of Hospital Infection. 2011; 77(3):242–247. https://doi.org/10.1016/j.jhin.2010.10.010
  45. Schaffner W. An outbreak of airborne nosocomial varicella. Pediatrics. 1982; 70:550–556.
  46. Hamdan HZ, Abdelbagi IE, Nasser NM, Adam I. Seroprevalence of cytomegalovirus and rubella among pregnant women in western Sudan. Virology Journal. 2011; 8(1):217. https://doi.org/10.1186/1743-422X-8-217
  47. Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clinical microbiology reviews. 2011; 24(1):141–173. https://doi.org/10.1128/CMR.00027-10
  48. Bouza E, Cercenado E. Klebsiella and Enterobacter: antibiotic resistance and treatment implications. In Seminars in respiratory infections. 2002; 17(3):215–230. https://doi.org/10.1053/srin.2002.34693
  49. Lee K, Yong D, Jeong SH, Chong Y. Multidrug-resistant Acinetobacter spp.: increasingly problematic nosocomial pathogens. Yonsei medical journal. 2011; 52(6):879–891. https://doi.org/10.3349/ymj.2011.52.6.879
  50. Kalsi J, Arya M, Wilson P, Mundy A. Hospital-acquired urinary tract infection. International journal of clinical practice. 2003; 57(5):388–391.
  51. Hollenbeck BL, Rice LB. Intrinsic and acquired resistance mechanisms in Enterococcus. Virulence. 2012; 3(5):421–569. https://doi.org/10.4161/viru.21282
  52. Pitout J. Extraintestinal pathogenic Escherichia coli: a combination of virulence with antibiotic resistance. Frontiers in microbiology. 2012; 3:9. https://doi.org/10.3389/fmicb.2012.00009
  53. Fridkin SK, Jarvis WR. Epidemiology of nosocomial fungal infections. Clinical microbiology reviews. 1996; 9(4):499–511. https://doi.org/10.1128/CMR.9.4.499
  54. Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine. 2017; 7(5):478–482. https://doi.org/10.1016/j.apjtb.2017.01.019