nosocomial infection; nursing home acquired infection

Introduction

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
  • 11% decrease catheter-associated urinary tract infections

Pathology

major nosocomial pathogens (89% monomicrobial):

• multidrug resistant gram-negative rods (59%)*
  • Klebsiella pneumonia
  • Enterobacter species
  • Pseudomonas aeruginosa
  • Bacteroides fragilis
  • Acinetobacter
  • Escherichia coli
• gram-positive cocci (31%)
  • vancomycin resistant enterococcus (VRE)
  • methicillin-resistant Staphylococcus aureus (MRSA)
  • coagulase-negative Staphylococcus
• fungi (8%)

* gram-negative carbapenem-resistance 38%

Complications

• nosocomial infections in critically ill ICU patients are associated with poor outcomes

Management

• hand hygiene is the single most important measure to prevent nosocomial infection
• chlorhexidine baths do not reduce nosocomial infection in critically ill ICU patients
• nasal decolonization with 10% povidone-iodine* and chlorhexidine* baths in nursing homes prevents some infection-related hospitalizations
• 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

More general terms

• healthcare-associated infection
• hospital-associated condition

More specific terms

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

Additional terms

• infection control