In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections from all types of micro-organisms, including bacteria, combined, cause or contribute to 99,000 deaths each year.
In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. In India an estimated 10 to 30 per cent of patients admitted to hospitals and nursing homes acquire a nosocomial infection. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital.
Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment means people who are hospitalized are more ill and have more weakened immune systems Among the categories of bacteria most known to infect patients are the category are Methicillin-resistant Staphylococcus aureus ( MRSA) .
Among the categories of bacteria most known to infect patients are the category member of Gram-positive bacteria and Acinetobacter. Acinetobacter bacteria are evolving and becoming immune to existing beta-lactam antibiotics which include the penicillins (methicillin, dicloxacillin, nafcillin, oxacillin, etc.) and the cephalosporins. MRSA may progress substantially within 24–48 hours of initial topical symptoms. After 72 hours, MRSA can take hold in human tissues and eventually become resistant to treatment. The initial presentation of MRSA is small red bumps that resemble pimples, spider bites, or boils; they may be accompanied by fever and, occasionally, rashes. Within a few days, the bumps become larger and more painful; they eventually open into deep, pus-filled boils.
Other categary are the drug-resistant, Gram-negative Klebsiella pneumoniae. An estimated more than 20 per cent of the Klebsiella infections in Brooklyn hospitals "are now resistant to virtually all modern antibiotics, and those super germs are now spreading worldwide. They cause destructive changes to human lungs inflammation and haemorrhage with cell death (necrosis) that sometimes produces a thick, bloody, mucoid sputum (currant jelly sputum), they also cause Patients with Klebsiella pneumonia tend to cough up a characteristic sputum that is said to resemble "red-currant jelly".
Induces Bronchitis which is inflammation of the mucous membranes of the bronchi, the airways that carry airflow from the trachea into the lungs. Induces Acute bronchitis is characterized by the development of a cough, with or without the production of sputum, mucus that is expectorated (coughed up) from the respiratory tract. Acute bronchitis often occurs during the course of an acute viral illness such as the common cold or influenza. Viruses cause about 90 per cent of cases of acute bronchitis, Chronic bronchitis, a type of chronic obstructive pulmonary disease, is characterized by the presence of a productive cough that lasts for three months or more per year for at least two years.
Chronic bronchitis most often develops due to recurrent injury to the airways caused by inhaled irritants. Cigarette smoking is the most common cause, followed by air pollution and occupational exposure to irritants. For Gram-positives we need better drugs; for Gram-negatives we need any drugs which means Gram-negetive bacteria have different cell structures make them more difficult to attack with antibiotics than Gram-positive organisms. In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. The most common nosocomial infections are of the urinary tract, surgical site and various pneumonias.
Types of nosocomial simplified criteria infection
Surgical site infection: Any purulent discharge, abscess, or spreading cellulitis at the surgical site during the month after the operation Urinary infection: Positive urine culture (1 or 2 species) with at least 105 bacteria/ml, with or without clinical symptoms
Respiratory infection: Respiratory symptoms with at least two of the following signs appearing during hospitalization:
n cough
n purulent sputum
n new infiltrate on chest radiograph consistent with infection
Vascular catheter Inflammation : lymphangitis or infection purulent discharge at the insertion site of the catheter Septicaemia Fever or rigours and at least.
The infections sites been represented based on the number of hospital cases found and Urinary infections gets number of hits.
Root causes:
a) Contact transmission: The most important and frequent mode of transmission of nosocomial infections is by direct contact.
b) Droplet transmission: Transmission occurs when droplets containing microbes from the infected person are propelled a short distance through the air and deposited on the host's body; droplets are generated from the source person mainly by coughing, sneezing, and talking, and during the performance of certain procedures, such as bronchoscopy.
c) Airborne transmission: Dissemination can be either airborne droplet nuclei (small-particle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Micro-organisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air-handling and ventilation are required to prevent airborne transmission. Micro-organisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.
d) Common vehicle transmission: This applies to micro-organisms transmitted to the host by contaminated items, such as food, water, medications, devices, and equipment.
e) Vector borne transmission : This occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit micro-organisms.
Prevention:
Washing the hands with antibacterial solutions and promptly usage of gloves will help in the preventions of the micro-organism transmission. Still micro-organisms are known to survive on inanimate ‘touch’ surfaces for extended periods of time.
This can be especially troublesome in hospital environments where patients with immuno deficiencies are at enhanced risk for contracting nosocomial infections. Touch surfaces commonly found in hospital rooms, such as bed rails, call buttons, touch plates, chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper towel, soap), dressing trolleys, and counter and table tops are known to be contaminated with Staphylococcus, MRSA (one of the most virulent strains of antibiotic-resistant bacteria) and vancomycin-resistant Enterococcus (VRE) .
Objects in closest proximity to patients have the highest levels of MRSA and VRE. This is why touch surfaces in hospital rooms can serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to patients. Antibacterial surfaces: Antimicrobial copper alloy touch surfaces (ACA) are surfaces that are made from alloys of the metal copper, such as brass and bronze. copper and copper alloys have a natural ability to kill harmful microbs relatively rapidly - often within two hours or less. Antimicrobial copper alloy surfaces (ACAs) continuously reduce bacterial contamination, achieving 99.9 per cent reduction within two hours of exposure (In India, old peoples still practice this, by taking food in copper bowls and drink’s water stored in bronze vessels) .
ACAs kill greater than 99.9 per cent of Gram-negative and Gram-positive bacteria within two hours of exposure.
ACAs deliver continuous and ongoing antibacterial action, remaining effective in killing greater than 99 per cent of bacteria within two hours, and continue even after repeated contamination.
ACAs help inhibit the build-up and growth of bacteria within two hours of exposure between routine cleaning and sanitizing steps.
Over the decay after human revolutions centuries are passed away. The population of the world already crossed multi billions and India’s population itself crossed seven billions. Similar to these along with human race micro-organism, pathogens, bacteria and virus already mutated and multiplied to such extent the existing medicines may not be enough to inhibit their growth. As human population also induces a lot of pollution into earth which served them as food for growth.
Currently people should look for ways to prevent infections by cleaning pollutions of the earth.
(The author is Research Scientist -1, AstraZeneca India Pvt Ltd, Bangalore)