To understand what a nosocomial infection means, the layperson must first consider the meaning of the word from ancient Greek. “Nosos” here means “disease” and “komein” means “to care for” and the word “nosokomeion” stands for the ancient Greek premises of sanatoriums. So a nosocomial infection means nothing more than a hospital infection.
What is a nosocomial infection?
Nosocomial infections are a growing problem in hospitals and long-term care facilities and account for a large proportion of all serious complications there. The quality of nursing and medical care for patients suffers greatly from the increase in nosocomial infections, and patients’ length of stay is extended by up to four days on average, resulting in major financial losses for hospitals that must bill according to “per-case flat rates.” In Germany, an estimated 20,000 people die each year from nosocomial infections and another 500,000 people become infected with pathogens, many of which are already resistant to many common antibiotics. These include multidrug-resistant Staphylococcus aureus or particularly difficult-to-treat E. coli and Klebsiella strains.
Causes
Although in Germany the Infection Protection Act stipulates that hospitals, dialysis facilities, physicians’ offices, and day clinics must prevent nosocomial infection according to the latest medical and scientific findings, this is not mandatorily reviewed. There are guidelines for this purpose from the Commission for Hospital Hygiene and Infection Prevention of the Robert Koch Institute, as well as recommendations for resistance and therapies that must be observed by hospitals in order to prevent the spread of resistant pathogens through a nosocomial infection. In many cases, the spread of hospital germs occurs through human contact, which is why hand disinfection is mandatory when entering and leaving the room. Qualified cleaning and disinfection of all rooms is also imperative, especially in the operating room area, to prevent nosocomial infection.
Symptoms, complaints, and signs
Nosocomial infections can cause a variety of symptoms, depending on the area of the body that is affected. Common general symptoms include fever, cough, headache and aching limbs, and pain and pus formation in joints or surgical wounds. In particular, infections with multi-resistant germs (MRSA) do not respond to conventional antibiotics and therefore cause fever and a general feeling of illness. In the worst case, these pathogens can enter the bloodstream and cause life-threatening sepsis (blood poisoning). Patients who are supplied with a bladder catheter often suffer from cystitis, as infectious agents can rise into the bladder via the catheter tube. The infection may manifest as fever or pain in the back. One of the most common complications during hospitalization is a catheter-associated infection. Bacteria or fungi travel from the skin along a vascular catheter into the vessel, causing inflammation. Nosocomial infections are also manifested by cough, fever, chest pain and shortness of breath. These are almost always signs of pneumonia. Pain, swelling, redness, warmth, and especially pus formation, indicate wound infection after surgery.
Diagnosis and course
Nosocomial infection triggers a wide variety of clinical pictures. In intensive care units, the so-called “ventilator-associated pneumonia” is particularly noticeable; 30,000 people in intensive care units in Germany fall ill with this infection every year. Another nosocomial infection is the “catheter-associated urinary tract infection“. Statistically, this is probably the most common nosocomial infection of all. A feared complication of such urinary tract infections is generalization of the germs from the urinary tract to the entire body, which can lead to sepsis, or septic shock. Another possibility of contracting a nosocomial infection are venous catheters, which are, however, indispensable for many patients – be it for parenteral nutrient supply or the administration of medication. Wound infections that occur after operations are also very common because germs penetrate the unprotected site.
Complications
The complications and further course in this disease usually depend very much on the exact infection. For this reason, no general prediction can be made about the course. However, in cases of severe infection or in cases of blood poisoning, death of the affected person may occur if no treatment of the infection is initiated. However, infections can be relatively well prevented with measures of hygiene, so that the death of the patient occurs only rarely. In many cases, patients also suffer from infections of the urinary tract, resulting in burning pain when urinating. Infections and inflammations of wounds also occur frequently and can delay wound healing. However, all these complaints can be well limited and treated by early diagnosis and treatment, so that no further complications occur. The patient’s life expectancy is also not usually reduced with proper treatment. The treatment itself is usually carried out with the help of antibiotics and leads to success relatively quickly. Further, however, the patient is designated to a longer stay in the hospital.
When should you go to the doctor?
A nosocomial infection is a dangerous infection because the patient’s body is likely weakened by the existing illness that initially brought him or her to the hospital. Furthermore, depending on the pathogen, the immune system is on its own in fighting it, as the pathogens may be immune to known agents. Nevertheless, a nosocomial infection belongs in the hands of a physician, but this is usually already given by the fact that symptoms of the infection appear while the patient is still in the hospital. This is the best possible case, because it means that the infection is detected promptly and treatment can be initiated. In addition, the affected person is under constant medical supervision and thus, if his or her condition worsens, intervention can be taken quickly. On the other hand, if signs of infection appear after discharge from the hospital, the patient should contact the doctor immediately. Especially in the case of symptoms immediately after an operation, there is also nothing to stop the patient from going to the emergency room for this reason. Although it may be a nosocomial infection, it may also be an infection of the surgical wounds with a pathogen that has not developed immunity to common agents. In either case, the physician must clarify the cause and treat the infection quickly, as the patient’s body is now still very weak.
Treatment and therapy
In order to effectively treat a nosocomial infection with the right antibiotics, microbiological tests are essential. For this purpose, the appropriate samples are collected, mounted on culture media, and tested for sensitivity to antibiotics. The nosocomial infection is treated according to the so-called “antibiogram”, whereby in urgent cases antibiotic combinations are already administered as a preventive measure. If pneumonia is suspected, the physician flushes out the lungs with saline solution and sucks out the extracted secretion again, thus obtaining the so-called “bronchial lavage”, in which, in the positive case, the disease-causing bacteria are found. To detect urinary tract infections, a urine sample is required, which is immediately applied to a culture medium and incubated. “Catheter-associated venous infections” can quickly lead to sepsis, which can be detected by means of a “blood culture”. A nosocomial infection with Candida species or Staphylococcus aureus is particularly dangerous here, resulting in a high lethality. The typical wound infection after surgery can be detected with a swab from the affected site, and Staphylococcus aureus and the multidrug-resistant members of this species settle here particularly often.
Outlook and prognosis
The prognosis of hospital-acquired infections must be evaluated according to individual circumstances. The cause of the infection and the pathogens must be clarified in order to assess the further course. In addition, the general health of the individual must also be considered when making the overall prognosis. By their very nature, people are in hospital, nursing wards or under intensive medical care because they have already suffered an underlying illness and have a weakened immune system.This often complicates the treatment options and worsens the further course of the disease. In patients at risk, even mostly harmless germs can therefore lead to serious health consequences. It is therefore possible for a nosocomial infection to develop into a life-threatening condition. The number of people who die each year due to a hospital infection is 30,000. Often, the organism is weakened to such an extent that it can no longer adequately defend itself against infections of all kinds. The prognosis is considerably improved if the affected person has a fundamentally healthy and stable immune system and his or her underlying disease can be classified as of little concern. With a healthy lifestyle, a balanced diet and sufficient rest, recovery can be achieved. Necessary for this is furthermore the clarification of the acquired germ as well as a sufficient medicinal therapy.
Prevention
Because there is no one nosocomial infection, prevention is specific to each clinical picture. “Ventilator-associated pneumonia” requires strict hand hygiene before any activity on the ventilator system, as well as the patient lying in a semi-upright position at a 30° angle. Since external colonization of the catheter tip often triggers the nosocomial infection in venous catheters, there are catheters that are impregnated with antibiotics. A nosocomial urinary tract infection sometimes does not even develop if disposable catheters are used instead of long-term urinary diversion. The goal is to reduce nosocomial infections as much as possible in Germany, as in the Netherlands, and to create a better understanding of hygiene among hospital staff.
Follow-up
Nosocomial infection is an infection caused by so-called hospital germs. Often, these pathogens are multiresistant to antibiotics. Acute therapy is difficult and, depending on the infection, long-term consequences for the patient cannot be ruled out. The follow-up of nosocomial infections is therefore difficult. On the one hand, it must be clarified whether the acute illness could be cured and whether the pathogens have permanently disappeared from the patient’s body with certain strong drugs. On the other hand, late effects on organs or metabolism must be taken into account. Long-term after-effects caused by the drugs used must also be treated and cared for in the aftercare. At regular intervals, the attending specialist will ensure the blood parameters and vital functions as well as the organ function of the organ(s) affected by the infection. In the case of nosocomial infection, there may be late complications, such as impaired heart or lung function. These complications must be ruled out and require close follow-up monitoring. Also, a certain recovery time after acute treatment is essential for the patient- Here, the specialist should advise accordingly and take enough time for the patient and his questions.
This is what you can do yourself
Depending on the type and severity of the nosocomial infection, patients can do a few things themselves to relieve the symptoms and discomfort. First, the body needs plenty of rest. Patients should take a few days off work and eat a light diet during the illness. General measures such as drinking plenty of fluids and avoiding alcohol and cigarettes help with recovery. In addition, other people should be avoided for a certain time to prevent infection. For sore throats, lozenges or salt water solutions for inhalation help. The natural remedy Echinacea strengthens the immune system and can be taken either as a tea or as a plant juice. In the case of a bacterial infection, strict personal hygiene also helps. If the symptoms do not subside despite all this, the family doctor must be consulted. The causative pathogen must be identified, for example by investigating the hospital where the pathogens for the nosocomial infection were picked up. It is possible that a severe infection is present that requires medication in addition to self-treatment. Patients should discuss with their family doctor which measures will best help to combat their individual symptoms.
