HEALTH : Nosocomial Infections

Nosocomial or hospital acquired infections are the infections acquired in the hospital. The criterion is that the infection should not have been present in the person before and should have been acquired within 72 hours of hospitalization. Hospitals as one knows very well are a place full of germs. People with wide variety of infectious diseases are there for treatment. Now these people pass out germs regularly through breathing, coughing, in the urine, stool, e.t.c. Somebody susceptible to it can catch the germs through various means and become sick with it. Those hospitalized are more vulnerable to catch these infections as their resistance is already down due to sickness. Urinary and intravenous catheters, injections, surgical interventions are potential sources of infections in a hospitalized person. Sepsis, hepatitis B and C, HIV are infections which can be transmitted through interventions in the patient. He or she is also prone to acquire cross infection from germs being brought out by other patients. Common examples are pneumonia and T.B., influenza, e.t.c. Use of common toilets or bed pans lead to urinary tract infections, use of unclean drinking water in the hospital is source of diarrhoeas, dysentery. Fungus present in the wards due to dampness or renovation work, can lead to systemic fungal infections. A health care worker, i.e. a doctor or nurse is also at risk of getting infected by a patient due to exposure to the infectious germs the patient has. A patient is also likely to be infected by a doctor or nurse by microbes present in the hands of the doctor or expelled from his breath. Skin diseases like boils or scabies can also be transmitted from one person to another in the hospital wards due to interaction between patients and between doctors and patients. In all these situations, development of the disease after exposure depends on amount of the infectious agent and resistance of the individual. Usually a sick patient is more prone to acquire new illness. Particularly vulnerable are the elderly people who are bed ridden. Smoking and alcohol also reduce the resistance of a person. Diseases like HIV/AIDS, diabetes, kidney failure, cancers make a person weak and susceptible to infections. The matter of concern in nosocomial infections is that mostly the micro organisms causing the infection are highly virulent and resistant to treatment like pseudomonas, proteus mirabilis, e.t.c. At times the germs normally present in one’s own intestines or throat become virulent and cause sickness when the patient is already sick. Therefore one should be aware of the fact that while being in the hospital for cure of some illness, the original illness may be cured but is likely to get sick with other illness. I remember vividly a young girl hospitalized with hysteria that developed pneumonia after 3 days which she caught from a patient in the adjacent bed. It is not that care givers in hospitals are careless or hygienic procedures are not observed. It is simply a matter of one’s reduced resistance and presence of virulent germs in high concentration in the hospital. In resource poor settings it becomes difficult to identify these germs as facilities for identifying all germs may not be present or patient may not be capable of paying for advance tests. In case of instrumentation like urinary catheters, in spite of best aseptic precautions a person can develop infection. Microbes being passed in the urine from one’s own body can infect the catheter. Germs present in the environment can also enter the body with the prick while one is receiving a injection or with any other intervention. Therefore one has to be vigilant regarding hospitalization and invasive treatment. Many people have the belief that receiving injections and perfusions is panacea for all cures. Many times people demand injections. Little do they realize that they are potentially exposing themselves to more sickness. Unless absolutely necessary one should not be hospitalized. After treatment, they should return home as early as possible. Injections should be avoided and taken only when absolutely necessary. Thus with these measures only, nosocomial infections can be avoided. The author is a specialist in Internal Medicine E-mail –rachna212002@yahoo.co.uk