Healthcare acquired infections also known as nosocomial infections are defined as an infection obtained by a patient 48 hours or later after admission into a healthcare service. Any infections thought to be obtained prior to 48 hours are considered to be obtained within the community (Gould et al, 2000). This standard of the 48 hour inoculation period is however arbitrary as it has remained the standard for many years despite the variable rate of incubation in different bacteria (Ami et al, 2003). It also includes infections acquired by patients after discharge and occupational infections among staff. It is a major issue in health care services as it increases mortality rate, In 2007 alone, 9,000 deaths were recorded as a result of MRSA and Clostridium difficile (NICE, 2012). The cost incurred by the NHS as a result of HAIs is approximately 1 billion each year (NICE, 2012).
Acinetobacter species, Anaerobic Gram negative bacillus, Candida albicans, Clostridium difficile (C.difficile), Coagulase negative staphylococci, Comamonas acidovorans, Enterobacter species, Enterococcus species, Escherichia coli (E.coli), Extended Spectrum beta-lactamase producing Gram-negative organisms, Glycopeptide resistant enterococci, Group A Streptococcus (Streptococcus pyogenes), Group B Streptococcus, Group G Streptococcus, Glycopeptide resistant enterococci, Klebsiella species, Methicillin Resistant Staphylococcus aureus (MRSA), Methicillin Sensitive Staphylococcus aureus (MSSA), Norovirus, Pantoea agglomerans, Proteus species, Pseudomonas aeruginosa, Respiratory Tract Infections, Serratia species, Stenotrophomonas maltophilia, Streptococcus pneumoniae (Pneumococcus), Streptococcus species (alpha- haemolytic), Surgical Site Infections and Urinary Tract Infections, these are all varieties of infections associated with HAI’s (Gould et al, 2000. NICE, 2012. Taylor et al, 2001. NHS, 2009. Haslam, 2006. Hywel Dda Health Board, 2014). The chart below shows which type of infection is most predominantly acquired in a healthcare setting.
(Hwyel Dda Health Board, 2014)
Pathogens enter the patient’s body via portals of entry such as respiratory tract, gastrointestinal tract, urogenital tract or breaks in the surface of the skin, from small abrasions to surgical wounds. Due to the increase of invasive procedures used in today’s medicine, such as IV lines catheters etc., pathogens can gain direct entry into the bloodstream and tissue (Gould et al, 2000). Once they have entered the body and intended target site it thrives by obtaining all its nutrients from the host and multiply rapidly and colonise (NHS, 2009). If the host is susceptible to disease then these pathogens will cause illness. Patients in hospitals or other health care environment tend to be more vulnerable to infection due to their already weak immune system less able to fight infection (Hywel DDa Health Board, 2014). The virulence of pathogens is dependent on several factors, such as the size of the inoculating dose, the ability to invade the hosts tissue, Enzyme and toxin production in defence against the host’s immune system (Gould et al, 2000). The wide spread over use of antibiotics is also a major issue as it can lead to micro-organisms becoming resistant to treatment of antibiotics. Antibiotics need to be avoided where possible; if an antibiotic is needed then a suitable one at the lowest dose should be prescribed. It is also alarming the amount of antibiotic found in human food, due to the treatment of animals, e.g. antibiotics administered to cows in their feed in the treatment of mastitis (Taylor et al, 2001). Due to the amount of contact we have with antibiotics, pathogens can mutate by either preventing the antibiotic from reaching its target by a change in its cell wall making it resilient against the antibiotic, by a change in its antigen camouflaging itself and imitating another cell, it can also avoid antibiotics by hiding in the body’s cells. Another...
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