NURSING ESSAY NOTES
10. a. Define infection
b. Explain how you will prevent occurrence of nosocomial infection in
your ward
Nosocomial Infection
Nosocomial infections can be defined as those occurring within 48
hours of hospital admission, 3 days of discharge or 30 days of an
operation. They affect 1 in 10 patients admitted to hospital.
Causes for Nosocomial Infection
Intravascular device related infections and infections acquired
through the respiratory tract are among the most common
nosocomial infections in critically ill patients. Among the numerous
risk factors for acquiring a nosocomial infection, the length of
hospital stay is the most important. Aetiological agents vary and
include antibiotic resistant bacteria, particularlyStaphylococcus
aureus, Gram negative bacilli and enterococci, viruses (which
account for up to 20% of cases), and fungi.
Risk factors for nosocomial infection
Duration of hospital stay
Indwelling catheters
Mechanical ventilation
Use of total parenteral nutrition
Antibiotic usage
Use of histamine (H2) receptor blockers (owing to relative bacterial
overgrowth)
, Age-more common in neonates, infants, and the elderly
Immune deficiency
Hand washing
The hands of staff are the commonest vehicles by which
microorganisms are transmitted between patients. Hand washing is
accepted as the single most important measure in infection control.
Not surprisingly, hospital staff believe that they wash their hands
more often than they actually do, and they also overestimate the
duration of hand washing. In a study of nurses' practices, hands were
only cleaned after 30% of patient contacts and after 50% of activities
likely to result in heavy contamination. Poorer hand washing
performance was related to increasing nursing workload and the
reduced availability of hand decontaminating agents. At many
hospitals and clinics, particularly in developing countries, handwash
basins are poorly accessible and the unavailability of soap, sprays,
and hand towels is a regular, annoying occurrence.
Alcoholic hand disinfection is generally used in Europe, while hand
washing with medicated soap is more commonly practised in the
United States. 10 The superiority of one method over the other is a
moot point. Voss and Widmer argue that alcoholic hand disinfection,
with its rapid activity, superior efficacy, and minimal time
commitment, allows easy and complete compliance without
interfering with the quality of patient care. They estimated that given
100% compliance, soap hand washing would consume 16 hours of
nursing time for a 24 hour shift, whereas alcoholic hand disinfection
from a bedside dispenser requires only three hours. Hand washing
using a spray can be accomplished in 20 seconds, compared with 40-
80 seconds for soap.
Theatre staff are sometimes reluctant to remove their wedding rings
when scrubbing up. Higher microbial counts after washing are found
in health workers who prefer not to remove rings, and may put the
10. a. Define infection
b. Explain how you will prevent occurrence of nosocomial infection in
your ward
Nosocomial Infection
Nosocomial infections can be defined as those occurring within 48
hours of hospital admission, 3 days of discharge or 30 days of an
operation. They affect 1 in 10 patients admitted to hospital.
Causes for Nosocomial Infection
Intravascular device related infections and infections acquired
through the respiratory tract are among the most common
nosocomial infections in critically ill patients. Among the numerous
risk factors for acquiring a nosocomial infection, the length of
hospital stay is the most important. Aetiological agents vary and
include antibiotic resistant bacteria, particularlyStaphylococcus
aureus, Gram negative bacilli and enterococci, viruses (which
account for up to 20% of cases), and fungi.
Risk factors for nosocomial infection
Duration of hospital stay
Indwelling catheters
Mechanical ventilation
Use of total parenteral nutrition
Antibiotic usage
Use of histamine (H2) receptor blockers (owing to relative bacterial
overgrowth)
, Age-more common in neonates, infants, and the elderly
Immune deficiency
Hand washing
The hands of staff are the commonest vehicles by which
microorganisms are transmitted between patients. Hand washing is
accepted as the single most important measure in infection control.
Not surprisingly, hospital staff believe that they wash their hands
more often than they actually do, and they also overestimate the
duration of hand washing. In a study of nurses' practices, hands were
only cleaned after 30% of patient contacts and after 50% of activities
likely to result in heavy contamination. Poorer hand washing
performance was related to increasing nursing workload and the
reduced availability of hand decontaminating agents. At many
hospitals and clinics, particularly in developing countries, handwash
basins are poorly accessible and the unavailability of soap, sprays,
and hand towels is a regular, annoying occurrence.
Alcoholic hand disinfection is generally used in Europe, while hand
washing with medicated soap is more commonly practised in the
United States. 10 The superiority of one method over the other is a
moot point. Voss and Widmer argue that alcoholic hand disinfection,
with its rapid activity, superior efficacy, and minimal time
commitment, allows easy and complete compliance without
interfering with the quality of patient care. They estimated that given
100% compliance, soap hand washing would consume 16 hours of
nursing time for a 24 hour shift, whereas alcoholic hand disinfection
from a bedside dispenser requires only three hours. Hand washing
using a spray can be accomplished in 20 seconds, compared with 40-
80 seconds for soap.
Theatre staff are sometimes reluctant to remove their wedding rings
when scrubbing up. Higher microbial counts after washing are found
in health workers who prefer not to remove rings, and may put the
