Saturday, September 17, 2011

Important health care acquired infections in chest hospitals

1. Air borne infections
Close proximity of persons together with handling of human secretions (e.g.: respiratory secretions) make health care workers particularly vulnerable to transmission of droplet-transmitted respiratory infections. This was tragically highlighted during the international outbreak of severe acute respiratory syndrome (SARS) in 2003 with attack rates of more than 50% in health care workers (HCW) before infection control measures were instituted (Pieris et al, 2003)
a. Hospital acquired Tuberculosis
Tuberculosis (TB) is one of the major death-threatening contagious diseases in the world. Although TB is curable, it kills 5000 people every day (World Health Organization, 2006a).
Transmission of M. tuberculosis is a recognized risk to patients and health-care workers (HCWs) in health-care facilities. Transmission is most likely to occur from patients who have unrecognized pulmonary or laryngeal TB, are not on effective anti-tuberculosis therapy, and have not been placed in isolation (Sharon et al., 2009).
Several recent TB outbreaks in health-care facilities, including outbreaks of multidrug-resistant TB (MDR-TB), have heightened concern about nosocomial transmission. Patients who have MDR-TB can remain infectious for prolonged periods, which increase the risk for transmission (Kilinc et al., 2002).
Examples of such healthcare acquired transmission of TB have been reported both locally and internationally. During the late 1980's and early 1990's in the United States, for instance, a healthcare acquired cluster of TB transmission occurred which affected both patients and healthcare workers. Between 2002 and 2003 in Taiwan, there were 19 suspected clusters of healthcare acquired TB infection that occurred in hospitals and nursing institutions (Kilinc et al., 2002).
The healthcare acquired TB clusters mainly resulted from inadequate implementation of infection control measures, delay in diagnosing and confirming TB cases, lack of healthy practices, healthcare workers' poor immunity due to mandatory periodic night shifts and subsequent work fatigue. Also, careless contacts among nursing staff might be one of the reasons that contributed to the nosocomial infection (Margarita et al., 2006).
b. Health care-associated pneumonia HCAP
HAP is defined as pneumonia that occurs 48 hours or more after admission, and that was not incubating at the time of admission. VAP refers to pneumonia that occurs more than 48 hours after endotracheal intubation. HCAP includes the following patients with pneumonia: hospitalized in an acute care hospital for more than 2 days within 90 days of the pneumonia; resided in a long-term care facility (e.g., nursing home); received recent parenteral antimicrobial therapy, chemotherapy, or wound care within 30 days of pneumonia; or received treatment in a hospital or hemodialysis clinic. For practical purposes, most principles for HCAP, VAP, and HAP will overlap. (Chinsky, 2002).
Hospital-acquired pneumonia (HAP) is considered the second most-frequent cause of healthcare acquired infection, accounting for 15 to 20% of these infections. It usually occurs in patients with underlying diseases associated with significant morbidity and mortality and increased costs of treatment. HAP is associated with crude mortality rates of up to 70% and attributable mortality rates as high as 33% to 50%. Many of these deaths may be caused by ventilator-associated pneumonia (VAP), which is believed to be the most frequent infection in patients admitted to the intensive care unit (ICU) (Marcos et al. 2004).
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