COMMON SOURCES OF NOSOCOMIAL (Hospital caused) INFECTIONS
Norwalk and Noroviruses
Description:
Noroviruses are a group of viruses that cause vomiting and diarrhea, typically in the winter and in Institutional settings (Hospitals & clinics, child-care centers or communal settings (schools, cruise ships, etc).
Result of infection:
Vomiting and diarrhea, often associated with headache, malaise and slight fever lasting for 12 to 48 hours. Symptoms appear 24 to 48 hours after infection.
Transmission:
These viruses affect only humans and are transmitted via a fecal/oral route, either directly by contact with vomit/feces of an infected person or indirectly by contamination by an infected person of food, furniture, clothing, etc that then come in contact with an uninfected person.
Populations at risk:
All, but may be more severe for young children and the elderly.
Prevention:
Avoid contact with infected persons and/or items and frequent hand washing to prevent ingestion of the virus.
In institutional settings careful sanitation is required to kill and remove the virus. Particular care must be given to washrooms, bedding and equipment in an infected persons room, common area surfaces such as door knobs, counters and other areas where the virus can be transferred (the virus can survive for long periods on hard and soft surfaces!). To sanitize alcohol based sanitizers and detergents are not considered effective, bleach based solutions or heat above 140F will kill the virus.
Clostridium difficile (C difficile or C diff)
Description
An anaerobic spore forming bacteria that has developed a resistance to common antibiotics. The bacteria is common in the digestive track and in small numbers is not harmful. MRSA presents a risk when other competing bacteria are eliminated, typically by antibiotic use, allowing the C diff bacteria population to grow unchecked and release toxins that affect the patient. The spore form is quite hardy and can survive quite well in the environment where it is resistant to heat and many sanitizers/disinfectants.
Results of infection
Bloating, diarrhea, cramping and also constipation. In severe cases diarrhea can lead to severe dehydration, colitis and in the very infirm, death.
Transmission
Transmission is via the fecal/oral route and involves the C Diff spore (the bacteria itself doesn’t survive well in an oxygen environment). The spores pass through the stomach to the colon where they activate and multiply.
Populations at risk
Long stay hospital patients, particularly those on antibiotics, and Nursing home patiets.
Prevention
Hand washing is key to prevent ingestion of the spore and certainly avoiding contact with contaminated surfaces is important. Good sanitation practices in general are important as well as deep cleaning to remove the spores is important. Some common disinfectants used in hospitals actually result in spore formation. Recommended are bleach solutions and/or high heat to kill the spores.
Methicillin resistant staphylococcus aureus (MRSA)
Description
A staph bacteria that is common on the skin or in the nasal passages of up to a 1/3 of the population that has developed a resistance to antibiotics. The bacteria is typically harmless unless it enters the body through a cut or wound. Those individuals who are healthy and carry the bacteria can pass the germ onto others.
Results of infection
Common staph infections which are limited to the skin surface can manifest as small pus filled bumps, blisters or boils. More severe infections can cause cellulitis and if the bacteria has entered the blood stream much more serious results include: pneumonia, endocarditis, blood poisoning, toxic shock syndrome, organ failure and death.
Population at risk
Surgical patients, older individuals and those with weakened immune systems. Patients in hospitals or long term care facilities are typically older and/or with weakened immune systems but since the bacteria is fairly common infections can be acquired anywhere and have affected those considered healthy.
Prevention
Avoid contact with persons who may be colonized with MRSA and objects that may have been touched by these people. Some patients with MRSA caused pneumonia can spread the bacteria by airborne droplets so quarantine should be considered and use of masks for vistors/caregivers.
Proper sanitation is required to remove MRSA from all surfaces that could come in contact with open sores or skin breaks and in rooms where persons who could be susceptible are.
Vancomycin-resistant enterococcus (VRE)
Description:
A bacteria commonly found in the intestines or urinary tracts of humans and animals that has developed a resistance to antibiotics. VRE have the ability to pass resistant genes to other bacteria.
Results of infection:
Infections occur when the bacteria enter the body through a break or wound. Typical symptoms include fever, wound infection, swelling/redness. Urinary tract infections are possible and in serious cases pneumonia.
Transmission
The bacteria is transmitted from contact (direct or indirect) with bodily fluids, particularly feces. The bacteria grows well on skin so direct contact by an infected person or a caregiver is a common method of transmission. The bacteria can also survive for weeks on inanimate objects such as toilet seats, door handles, furniture, stethoscopes etc.
Population at risk
Immunocompromized individuals.
Prevention
Hand washing, particularly by caregivers between patients, and proper sanitation of all surfaces. |
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