nosocomial infections
Summary
Nosocomial infections are those acquired during healthcare delivery, arising more than forty-eight hours after admission. Urinary catheters, central lines, ventilators, and surgical wounds account for most of them, and prevention centres on device stewardship and hand hygiene.
Detail
Device-associated infection is the dominant category, and the single most effective preventive measure for each is removing the device as soon as it is no longer needed. Urinary catheters should be placed for defined indications only and removed promptly; central lines require full barrier precautions at insertion, chlorhexidine skin preparation, and daily review of necessity; ventilated patients benefit from head-of-bed elevation, daily sedation interruption with spontaneous breathing trials, and oral care. Antimicrobial resistance is concentrated in this setting: MRSA, vancomycin-resistant enterococci, extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae, and multidrug-resistant Pseudomonas and Acinetobacter. Clostridioides difficile deserves separate mention because its spores are not killed by alcohol-based hand rub, requiring soap and water and contact precautions with a sporicidal agent; risk follows broad-spectrum antibiotics, especially clindamycin, fluoroquinolones, and cephalosporins, and treatment of a first episode is oral vancomycin or fidaxomicin, with faecal microbiota transplantation for recurrent disease. Hand hygiene remains the highest-yield single intervention.
Sources
- Harrison's Principles of Internal Medicine
- Levinson Medical Microbiology and Immunology
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