relating about the infections that occur in hospital and their survival rates

1. Hospital Acquired Infections and Their Survival Rate
Hospital Acquired Infections:
Hospital acquired infection is an infection that is acquired in a hospital or other health care
facility. It is also called nosocomial infection.
General causes of nosocomial infection:
 Bacteria
 Fungi
 Viruses
 Excessive and improper use of antibiotics.
 Unhygienic condition
 Use of contaminated syringes
 Use of contaminated surgical instrument [1]
Types of hospital acquired infection
Following are the types of hospital acquired infection (HAI):
 Blood stream infections
 Ventilated associated pneumonia
 Surgical site infection
 Urinary tract infection
1. Blood Stream Infections:
Septicemia:
Septicemia is a serious bloodstream infection. It's also known as blood
poisoning. Septicemia occurs when a bacterial infection elsewhere in the body,
such as the lungs or skin, enters the bloodstream. This is dangerous because the
bacteria and their toxins can be carried through the bloodstream to your entire
body.
It is also known as blood poisoning.
Causes:
Figure 1( Blood stream)

2. The most common infections lead to the blood stream infections:
 Kidney infections
 Lung infections
 Infections in the abdominal area
Bacteria from this area enter into the blood stream and cause the infection. People are also at a
high risk of infection if they if:
 They are already in hospital for anything else like surgery.
 Have severe wounds and burns.
 Very young or very old.
 Are on mechanical ventilation.
Symptoms:
 Chills
 Fever
 Breathing very fast
 Rapid heart rate
More severe symptoms if it is untreated are:
 Confusion or inability to think
 Nausea and Vomiting
 Red dots that appears on skin
 Reduced urine volume
 Inadequate blood flow
 Shock
Treatment:
This infection starts to affecting person’s organs and tissues is a medical emergency. It must
be treated in hospital.
Treatment depends on following factors:
 Age
 Overall health
 Extend of your condition

3.  Tolerance for certain medication
Antibiotics are used to treat the bacterial infection causing septicemia.
There is not enough time to figure out the type of bacteria so initially broad-spectrum
antibiotics. A more focused antibiotic may be used if the bacteria type is identified.
You may get other fluids and intravenously medications to maintain your blood pressure or to
prevent from blood clotting. [2]
Survival trends:
 The first report of epidemiology of sepsis in the US was performed by the Center for
Disease Control and Prevention in 1990, before the consensus definition, estimating
and increase of septicemia codes from 76 to 176 per 100,000 people from 1979 through
1987.
 Several studies estimated the incidence and mortality in sepsis reported and incidence
of severe sepsis of 300 per 100,000 population in seven states in 1995
 Another study showed an 11% and a 49% increase in infection codes and sepsis codes,
respectively, from 2003 and 2009.
 Sepsis mortality changes according to organ dysfunction. In patients without organ
dysfunction mortality is less than 20%. In patients with severe sepsis varies between
20% and 50% and in patients with septic shock is frequently over 50%. Variations in
the definitions of severe sepsis can explain differences in mortality rates.[3]
2. Ventilated associated pneumonia:
Pneumonia:
Pneumonia is defined as "new lung infiltrates plus clinical evidence that the
infiltrate is of an infectious origin, which include the new onset of fever, purulent
sputum, leukocytosis, and decline in oxygenation. Hospital-acquired
pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection
that was not incubating at the time of hospital admission and that presents
clinically 2 or more days after hospitalization.
Causes:
It is caused by:
Figure 2(Lung infiltrates)

4.  Bacteria especially aerobic gram-negative bacilli such as
 Pseudomonas aeruginosa
 Escherichia coli
 Klebsiella pneumoniae
 Acinetobacter species [4]
Symptoms:
 A cough with greenish or pus-like phlegm (sputum)
 Fever and chills.
 General discomfort, uneasiness, or ill feeling (malaise)
 Loss of appetite.
 Nausea and vomiting.
 Sharp chest pain that gets worse with deep breathing or coughing.
 Shortness of breath.
 Decreased blood pressure and fast heart rate.
Treatment:
Antimicrobial therapy:
Clinical strategy emphasizes prompt and appropriate empiric antimicrobial therapy for patients
with suspected HAP. There is consistent evidence that a delay in the initiation of appropriate
antibiotic therapy for patients with HAP is associated with increased mortality. The selection
of initial antibiotic therapy is based on risk factors for specific pathogens, modified by
knowledge of local patterns of antibiotic resistance and organism prevalence. Therapy is then
modified on the basis of clinical response on days 2 and 3 of an empiric antibiotic regimen and
the findings of cultures of lower respiratory tract secretions. [5]
Survival trends:
 Up to 10- 12% of patient older than 65 years required a higher level of assistance for
activities of daily living after hospitalization for acute respiratory illness.
 Patient above 65 years have greater risk of death from viral pneumonia.
 US census for 2000-2001listed pneumonia as the seventh leading cause of death despite
a 7.2% decrease in the mortality rate of pneumonia during this period. [6]

5. 3. Surgical site infection:
Surgical site infections is defined as the infection occur after 30 days of
surgery and affecting either the incision or deep tissues at the operation site.
The incidence of SSIs may be as high as 20% depending on the surgical
procedure, the surveillance criteria and the quality of the data collection.
In many SSIs the responsible pathogens originate from the patient’s
endogenous flora.
Causative agents:
The causative pathogens depend on the type of surgery; the most commonly isolated
organisms are:
 Staphylococcus aureus
 Coagulase-negative staphylococci
 Enterococcus spp.
 Escherichia coli.
Symptoms:
 Pus or drainage.
 Bad smell coming from the wound.
 Fever, chills.
 Hot to touch.
 Redness.
Treatment:
Essential treatment of the surgical wound’s infection is open the area and drain the pus. Certain
antibiotics are used in the treatment of surgical wound infection are:
 Amoxicillin-clavulanate
 Cephalexin
 Doxycycline
 Dicloxacillin.
 Trimethoprim-sulfamethoxazole
Figure 3(Surgical site)

6.  Clindamycin [7]
Survival Trends:
The overall incidence of SSI was 2.98%.
The majority of the positive cultures were gram-negative bacteria (45%) and 49% of all
reported organisms were drug resistant.
 Length of hospitalization increased substantially from 13 days to 24 days.
 Patients with SSI had more than three times higher mortality rate (7% compared with
1.9%). [8]
4. Urinary tract infection:
Catheter associated urinary tract infection (CAUI):
A catheter-associated UTI is a UTI in which the positive culture was taken when
an indwelling urinary catheter had been in place for more than 2 days. Patients
with indwelling bladder catheters are predisposed to bacteriuria and UTI.
Bacteria can enter the bladder during insertion of the catheter, through the catheter
lumen, or from around the outside of the catheter.
A biofilm develops around the outside of the catheter and on the uroepithelium. Bacteria enter
this biofilm, which protects them from the mechanical flow of urine, host defenses, and
antibiotics, making bacterial elimination difficult. Even with thoroughly aseptic catheter
insertion and care, the chance of developing significant bacteriuria is 3 to 10% every day the
catheter is indwelling. Of patients who develop bacteriuria, 10 to 25% develop symptoms of
UTI. Fewer develop sepsis.
Causes:
 Long term use of indwelling bladder catheters
 Bacteria
Symptoms:
Figure 4(Catheter)

7.  Malaise
 Fever
 Flank pain
 anorexia
 Altered mental status
 Signs of sepsis.
Treatment:
 Asymptomatic low-risk patients are not treated.
 Symptomatic and high-risk patients are treated using antibiotics and supportive
measures
 Choice of empiric antibiotic is as for acute pyelonephritis. Sometimes vancomycin is
added to the regimen. Subsequently, antibiotics with the narrowest spectrum of activity,
based on culture and sensitivity testing, should be used.[9]
Survival Trends:
 Catheter-associated urinary tract infections have become a major public health concern
in the United States. This study provides national estimates of CAUTI incidence,
mortality, and associated hospital length of stay over a 10-year period.
 70.4 million catheterized patients, 3.8 million of whom developed a CAUTI.
 The incidence of CAUTI decreased from 9.4 cases/100 catheterizations in 2001 to 5.3
cases/100 catheterizations in 2010.
 Mortality in patients with a CAUTI declined from 5.4% in 2001 to 3.7% in 2010.
Median (interquartile range) hospital LOS also declined, from 9 days in 2001 to 7 days
in 2010. [10]