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nosocomial infection; nursing home acquired infection

Infection acquired in a hospital, skilled nursing facility or nursing home, especially in an intensive care unit (ICU) setting. The infection is not present or incubating at the time of admission. Onset is more than 48 hours after admission. Epidemiology: - 5% of hospitalized patients - most common complication of hospitalized patients in U.S. - 2008 to 2014 - 50% drop in central line-associated sepsis - 17% decrease in surgical site infections [6] - 11% decrease catheter-associated urinary tract infections Pathology: major nosocomial pathogens (89% monomicrobial) [9]: 1) multidrug resistant gram-negative rods (59%) [9]* a) Klebsiella pneumonia b) Enterobacter species c) Pseudomonas aeruginosa d) Bacteroides fragilis e) Acinetobacter f) Escherichia coli 2) gram-positive cocci (31%) [9] a) vancomycin resistant enterococcus (VRE) b) methicillin-resistant Staphylococcus aureus (MRSA) c) coagulase-negative Staphylococcus 3) fungi (8%) [9] * gram-negative carbapenem-resistance 38% [9] Complications: - nosocomial infections in critically ill ICU patients are associated with poor outcomes [9] Management: - hand hygiene is the single most important measure to prevent nosocomial infection [1] - chlorhexidine baths do not reduce nosocomial infection in critically ill ICU patients [5] - nasal decolonization with 10% povidone-iodine* and chlorhexidine* baths in nursing homes prevents some infection-related hospitalizations [10] - see healthcare-associated infection * 10% povidone-iodine twice daily for 5 days after admission & twice daily for 5 days every other week thereafter * chlorhexidine use with all routine bathing & showering

Related

infection control

Specific

nosocomial pneumonia; hospital-acquired pneumonia; health care-associated pneumonia

General

healthcare-associated infection hospital-associated condition

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. 18. American College of Physicians, Philadelphia 1998, 2012, 2018.
  2. ARUP Consult: Health Care-Associated Infections - Nosocomial Infections deprecated reference
  3. Lin MY, Hota B, Khan YM, Woeltje KF et al Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA. 2010 Nov 10;304(18):2035-41 PMID: 21063013
  4. Yokoe DS, Mermel LA, Anderson DJ et al A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S12-21 PMID: 18840084
  5. Noto MJ et al Chlorhexidine Bathing and Health Care-Associated Infections. A Randomized Clinical Trial; JAMA. Published online January 20, 2015 PMID: 25602496 http://jama.jamanetwork.com/article.aspx?articleid=2091544 - Pittet D, Angus DC Daily Chlorhexidine Bathing for Critically Ill Patients. A Note of Caution. JAMA. Published online January 20, 2015. PMID: 25603492 http://jama.jamanetwork.com/article.aspx?articleid=2091541
  6. Weiner LM, Fridkin SK, Aponte-Torres Z et al Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals - United States, 2014 MMWR Early Release / March 3, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6509e1er.htm
  7. Yokoe DS, Anderson DJ, Berenholtz SM et al A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol. 2014 Aug;35(8):967-77. PMID: 25026611 Free PMC Article
  8. Tunkel AR, Hasbun R, Bhimraj A et al 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017 Feb 14. PMID: 28203777 Free PMC Article
  9. Tabah A et al. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: The EUROBACT-2 international cohort study. Intensive Care Med 2023 Feb; 49:178. PMID: 36764959 PMCID: PMC9916499 Free PMC article https://link.springer.com/article/10.1007/s00134-022-06944-2
  10. Miller LG et al. Decolonization in nursing homes to prevent infection and hospitalization. N Engl J Med 2023 Oct 10; PMID: 37815935 https://www.nejm.org/doi/10.1056/NEJMoa2215254