Emori TG, Banerjee SN, Culver DH, et al.
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For solid-organ transplant recipients, risk factors for invasive aspergillosis have not been studied as extensively. Arrange for laboratory tests to be available to clinicians, for use when clinically indicated, to promptly confirm the diagnosis of influenza and other acute viral respiratory illnesses, especially during November-April Isolation is the implementation of isolating precautions designed to prevent transmission of microorganisms by common routes in hospitals.
Si les infections nosocomiales ne peuvent être totalement évitées, le strict respect des règles d'hygiène permet d'en diminuer le risque. Un point s'impose à ce sujet. Caractéristiques des maladies nosocomiales. Une infection est dite nosocomiale lorsqu'elle n'existait pas lors de l'entrée de la personne à l'hôpital.
Definición. Una infección nosocomial es una infección contraída durante una estancia en un centro de salud. Una infección se considera nosocomial si aparece al menos 48 horas después de entrar en las instalaciones de salud. Este período se extiende hasta los 30 días si la infección aparece donde se realizó una cirugía y se tiene en cuenta hasta 1 año en caso de que se hayan ...
Indemnisation des victimes d'accidents médicaux - Oniam
Bienvenue à l'ONIAM. L’Office National d’Indemnisation des Accidents Médicaux, des Affections Iatrogènes et des Infections Nosocomiales (ONIAM) est un établissement public créé par la loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé.
Las infecciones nosocomiales pueden ser adquiridas en diversas regiones del cuerpo, siendo que los tipos más comunes son: 1. Neumonía. La neumonía adquirida en el hospital suele ser grave y es más común en las personas que están hospitalizadas o que tienen dificultades para deglutir, por el riesgo de aspiración de alimentos o de la saliva.
Consultado el 2 de diciembre de Juan H Jara". Nosocomial acquisition of the hepatitis C virus - Journal of Hepatology. Archivado desde el original el 4 de mayo de Consultado el 16 de febrero de ENEAS Informe.
Archivado desde el original el 31 de marzo de Archivado desde el original el 21 de junio de At one hospital, immunosuppressed patients were restricted from taking showers, and, for these patients, only sterile water was used for drinking or flushing nasogastric tubes In another hospital, a combined approach consisting of continuous heating, particulate filtration, ultraviolet treatment, and monthly pulse hyperchlorination of the water supply to the bone-marrow transplant unit was used to decrease the incidence of Legionnaires disease The decision to search for hospital environmental sources of Legionella sp.
Aspergillus sp. Nosocomial aspergillosis has been recognized increasingly as a cause of severe illness and mortality in highly immunocompromised patients e. Hospital outbreaks of pulmonary aspergillosis have occurred primarily in granulocytopenic patients, especially those in bone-marrow transplant units Although invasive aspergillosis has been reported in recipients of solid-organ e.
The efficacy of infection- control measures, such as provision of protected environments and prophylaxis with antifungal agents, in preventing aspergillosis in solid-organ transplant recipients has not been well evaluated ,,, In one study of heart-transplant recipients, using only protective isolation of patients did not prevent fungal infections The reported attributable mortality from invasive pulmonary aspergillosis has differed depending on the patient population studied.
In severely immunocompromised patients, primary Aspergillus sp. Subsequently, the fungus might disseminate via the bloodstream to involve multiple other deep organs ,, A role for nasopharyngeal colonization with Aspergillus sp. Conversely, colonization of the lower respiratory tract by Aspergillus sp. Diagnosing pneumonia caused by Aspergillus sp. Histopathologic demonstration of tissue invasion by fungal hyphae has been required in addition to isolation of Aspergillus sp.
However, when Aspergillus sp. Routine blood cultures are remarkably insensitive for detecting Aspergillus sp. Antigen-based serologic assays are being developed in an attempt to allow for the rapid and specific diagnosis of Aspergillus sp. The primary risk factor for invasive aspergillosis is severe and prolonged granulocytopenia, both disease- and therapy-induced The tendency of bone-marrow-transplant recipients to contract severe granulocytopenia i. Although both autologous and allogeneic bone-marrow-transplant recipients are severely granulocytopenic for up to 4 weeks after the transplant procedure, acute or chronic graft-versus-host disease also could develop in allogeneic-transplant recipients.
Consequently, in developing strategies to prevent invasive Aspergillus sp. After hospital discharge, patients especially allogeneic-transplant recipients might continue to manifest severe granulocytopenia and, therefore, are susceptible to fungal exposures at home and in ambulatory-care settings.
To help address the problem of invasive aspergillosis in bone-marrow-transplant recipients, various studies are in progress to evaluate newer methods of a enhancing host resistance to invasive fungal and other infections and b eliminating or suppressing respiratory fungal colonization of the upper respiratory tract. These methods include, respectively, the use of granulocyte-colony-stimulating factors and intranasal application of amphotericin B or oral or systemic antifungal drug prophylaxis , For solid-organ transplant recipients, risk factors for invasive aspergillosis have not been studied as extensively.
In one study of liver-transplant recipients, risk factors for invasive infection with Aspergillus sp. Aspergillosis in immunosuppressed patients also has been associated with other hospital environmental reservoirs. Such reservoirs include contaminated fireproofing material, damp wood, and bird droppings in air ducts ,, A single case of nosocomial Aspergillus sp.
However, additional cases may remain undetected without an active search that includes an intensive retrospective review of microbiologic, histopathologic, and postmortem records; notification of clinicians caring for high-risk patients; and establishment of a system for prospective surveillance for additional cases.
When additional cases are detected, the likelihood is increased that a hospital environmental source of Aspergillus sp. New molecular typing techniques i. Outbreaks of invasive aspergillosis reinforce the importance of maintaining an environment as free as possible of Aspergillus sp. To achieve this goal, specialized services in many large hospitals -- particularly bone-marrow transplant services -- have installed "protected environments" for the care of their high-risk, severely granulocytopenic patients and have increased their vigilance during hospital construction and routine maintenance of hospital air- filtration and ventilation systems to prevent exposing high-risk patients to bursts of fungal spores ,,, Although the exact configuration and specifications of the protected environments might differ between hospitals, such patient-care areas are built to minimize fungal spore counts in air by maintaining a filtration of incoming air by using central or point-of-use high- efficiency particulate air HEPA filters that are capable of removing The air usually exits at the opposite end of the room, and ultra-high air-change rates i.
The net effects are essentially sterile air in the room, minimal air turbulence, minimal opportunity for microorganism build-up, and a consistently clean environment The laminar-airflow system is effective in decreasing or eliminating the risk for nosocomial aspergillosis in high-risk patients ,,, However, such a system is costly to install and maintain. Less expensive alternative systems with lower air-change rates i.
However, studies comparing the efficacy of these alternative systems with laminar-airflow rooms in eliminating Aspergillus sp.
One hospital that employed cross-flow ventilation, point-of-use HEPA filters, and 15 air changes per hour reported that cases of nosocomial aspergillosis had occurred in patients housed in these rooms, although this rate was low i. However, these infections had been caused by A. Copperquinolinolate was used on environmental surfaces contaminated with Aspergillus sp.
Viruses can be an important and often unappreciated cause of nosocomial pneumonia Although the early diagnosis and treatment of viral pneumonia infections have been possible in recent years , many hospitalized patients remain at high risk for developing severe and sometimes fatal viral pneumonia , These data and reports of well-documented outbreaks involving nosocomial viral transmission indicate that measures to prevent viral transmission should be instituted.
Nosocomial respiratory viral infections a usually follow community outbreaks that occur during a particular period every year , , b confer only short-term immunity , c affect both healthy and ill persons ,,, , and d have exogenous sources. Influenza and RSV infections contribute substantially to the morbidity and mortality associated with viral pneumonia, and the epidemiology of both viral infections has been well researched; for these reasons, this section concerning viral pneumonias focuses on the principles of, and approaches to, the control of these two types of infection.
Recommendations for preventing nosocomial pneumonia caused by infection with other viral pathogens were published previously Infection usually causes mild or moderately severe upper respiratory illness. However, both life-threatening pneumonia and bronchiolitis have occurred in immunocompromised patients, the elderly, and children who have chronic cardiac and pulmonary disease ,,,, , Recent surveillance of 10 U.
During community outbreaks of RSV, children who have respiratory symptoms at the time of hospital admission are often reservoirs for RSV , The clinical characteristics of RSV infection, especially in neonates, are often indistinguishable from those of other viral respiratory tract infections , Culture of RSV from respiratory secretions is the standard for diagnosis.
The benefit of using these tests to identify infected patients depends on the sensitivity and specificity of the test. In general, once laboratory-confirmed cases of RSV infection are identified in a hospital, a presumptive diagnosis of RSV infection in subsequent cases with manifestations suggestive of RSV infection may be acceptable for infection-control purposes.
The portal of entry is usually the conjunctiva or the nasal mucosa Inoculation by RSV-contaminated hands is the usual way of depositing the virus onto the eyes or nose , Hands can become contaminated by handling either the respiratory secretions of infected persons or contaminated fomites , Potential sources include patients, HCWs, and visitors. Because infected infants shed large amounts of virus in their respiratory secretions and can easily contaminate their immediate surroundings, they are a major reservoir for RSV HCWs might become infected after exposure in the community or in the hospital and subsequently transmit infection to patients, other HCWs, or visitors , Different combinations of control measures, ranging from the simple to the complex, have been effective in varying degrees in preventing and controlling nosocomial RSV infection , Thus, other preventive measures are usually necessary to prevent RSV infection.
The wearing of gloves and gowns has been associated with decreased incidence of nosocomial RSV The wearing of gloves has helped decrease transmission of RSV, probably because the gloves remind HCWs to comply with handwashing and other precautions and deter them from touching their eyes or nose.
In addition, the use of eye-nose goggles rather than masks has protected HCWs from infection; however, eye-nose goggles are not widely available and are inconvenient to wear , Additional measures may be indicated to control ongoing nosocomial transmission of RSV or to prevent transmission to patients at high risk for serious complications resulting from the infection e. The following additional control measures have been used in various combinations: a using private rooms for infected patients OR cohorting infected patients, with or without preadmission screening by rapid laboratory diagnostic tests; b cohorting HCWs; c excluding HCWs who have symptoms of upper respiratory tract infection from caring for uninfected patients at high risk for severe or fatal RSV infection e.
Although the exact role of each of these measures has not been determined, their use for controlling RSV outbreaks seems prudent. Pneumonia that occurs in patients who have influenza can be caused by the influenza virus, a secondary bacterial infection, or a combination of both Influenza typically occurs on a seasonal basis during December-April; during this period, peak influenza activity in an affected community usually lasts weeks , Nosocomial outbreaks can occur in a community affected by an influenza epidemic; these outbreaks are often characterized by abrupt onset and rapid transmission Although the period of greatest communicability is during the first 3 days of illness, the virus can be shed both before the onset of symptoms and for greater than or equal to 7 days afterward ,, Influenza is clinically indistinguishable from other febrile respiratory illnesses; however, during outbreaks with laboratory- confirmed cases, a presumptive diagnosis of the infection can be made for illnesses that have similar manifestations Historically, diagnosis of influenza was made by virus isolation from nasopharyngeal secretions or by serologic conversion, but recently developed rapid diagnostic tests that are similar to culture in sensitivity and specificity now enable early diagnosis and treatment of cases and provide a basis for prompt initiation of antiviral prophylaxis as part of outbreak control High-risk persons include persons 6 months years of age who are receiving long-term aspirin therapy and persons who either a are greater than or equal to 65 years of age; b are in long-term-care units; or c have either chronic disorders of the pulmonary or cardiovascular systems, diabetes mellitus, renal dysfunction, hemoglobinopathies, or immunosuppression , Patients who have musculoskeletal disorders that impede adequate respiration also may be at high risk for complications resulting from influenza.
When high vaccination rates are achieved in closed or semi-closed settings, the risk for outbreaks is reduced because of induction of herd immunity , When an institutional outbreak is caused by influenza type A, antiviral agents can be used both for treatment of ill persons and as prophylaxis for others Two related antiviral agents, amantadine hydrochloride and rimantadine hydrochloride, are effective against influenza type A but not against influenza type B , These agents can be used in the following ways to prevent illness caused by influenza A virus: a as short-term prophylaxis for high-risk persons after late vaccination; b as prophylaxis for persons for whom vaccination is contraindicated; c as prophylaxis for immunocompromised persons who might not produce protective levels of antibody in response to vaccination; d as prophylaxis for unvaccinated HCWs who provide care to patients at high risk for infection, either for the duration of influenza activity in the community or until immunity develops after vaccination; and e as prophylaxis when vaccine strains do not closely match the epidemic virus strain Amantadine has been available in the United States for many years; rimantadine has been approved for use since Both drugs protect against all naturally occurring strains of influenza A virus; thus, antigenic changes in the virus that might reduce vaccine efficacy do not alter the effectiveness of amantadine or rimantadine.
In addition, they can reduce the severity and duration of illness caused by influenza A virus if administered within hours after onset of symptoms , Compared with rimantadine, amantadine has been associated with a higher incidence of adverse central nervous system CNS reactions e.
The drug package inserts for amantadine and rimantadine contain important information regarding administration of these drugs. Guidelines for the use of amantadine and rimantadine and considerations for the selection of these drugs were published previously by the Advisory Committee on Immunization Practices ACIP The emergence of amantadine- and rimantadine-resistant strains of influenza A virus has been observed in persons who have received these drugs for treatment of the infection , The primary focus of efforts to prevent and control nosocomial influenza is the vaccination of high-risk patients and HCWs before the influenza season begins ,, Although influenza can be transmitted via the airborne route, the efficacy of placing infected persons in rooms that have negative air pressure in relation to their immediate environment has not been assessed.
In addition, this measure may be impractical during institutional outbreaks that occur during a community epidemic of influenza because many HCWs and newly admitted patients could be infected with the virus; thus, the hospital would face the logistical problem of accommodating all ill persons in rooms that have special ventilation. Although the effectiveness of the following measures has not been determined, their implementation could be considered during severe outbreaks: a curtailment or elimination of elective admissions, both medical and surgical; b restriction of cardiovascular and pulmonary surgery; c restriction of hospital visitors, especially those who have acute respiratory illnesses; and d restriction of HCWs who have an acute respiratory illness from the workplace These recommendations are presented in the following order based on the etiology of the infection: bacterial pneumonia, including Legionnaires disease; fungal pneumonia i.
Each topic is subdivided according to the following general approaches for nosocomial infection control:. As in previous CDC guidelines, each recommendation is categorized on the basis of existing scientific evidence, theoretical rationale, applicability, and economic impact ,, However, the previous CDC system of categorizing recommendations has been modified as follows:. These recommendations are based on strong rationale and suggestive evidence, even though definitive scientific studies may not have been done.
Educate HCWs regarding nosocomial bacterial pneumonias and infection-control procedures used to prevent these pneumonias Conduct surveillance of bacterial pneumonia among ICU patients at high risk for nosocomial bacterial pneumonia e. Include data regarding the causative microorganisms and their antimicrobial susceptibility patterns 2,3. Express data as rates e. Do not routinely perform surveillance cultures of patients or of equipment or devices used for respiratory therapy, pulmonary- function testing, or delivery of inhalation anesthesia 65,, Thoroughly clean all equipment and devices before sterilization or disinfection ,, Sterilize or use high-level disinfection for semicritical equipment or devices i.
Follow disinfection with appropriate rinsing, drying, and packaging, taking care not to contaminate the items in the process. Do not reprocess equipment or devices that are manufactured for a single use only, unless data indicate that reprocessing such items poses no threat to the patient, is cost-effective, and does not change the structural integrity or function of the equipment or device , Mechanical ventilators, breathing circuits, humidifiers, and nebulizers.
Do not routinely sterilize or disinfect the internal machinery of mechanical ventilators ,, Wash hands after performing the procedure or handling the fluid ,, Ventilator breathing circuits with hygroscopic condenser-humidifiers or heat-moisture exchangers.
Follow manufacturers' instructions for using and maintaining wall oxygen humidifiers unless data indicate that modifying the instructions poses no threat to the patient and is cost-effective Between uses on different patients, change the tubing, including any nasal prongs or mask, used to deliver oxygen from a wall outlet.
Small-volume medication nebulizers: "in-line" and hand-held nebulizers. Between uses on different patients, replace nebulizers with those that have undergone sterilization or high-level disinfection ,,,, Use only sterile fluids for nebulization, and dispense these fluids aseptically ,,,,,, If multi-dose medication vials are used, handle, dispense, and store them according to manufacturers' instructions ,, Do not use large-volume room-air humidifiers that create aerosols e.
Sterilize large-volume nebulizers that are used for inhalation therapy e. Between uses on different patients, sterilize or subject to high-level disinfection portable respirometers, oxygen sensors, and other respiratory devices used on multiple patients , Do not routinely sterilize or disinfect the internal machinery of anesthesia equipment Clean and then sterilize or subject to high-level liquid chemical disinfection or pasteurization reusable components of the breathing system or patient circuit e.
No Recommendation for the frequency of routinely cleaning and disinfecting unidirectional valves and carbon dioxide absorber chambers Periodically drain and discard any condensate that collects in the tubing of a breathing circuit, taking precautions not to allow condensate to drain toward the patient. After performing the procedure or handling the fluid, wash hands with soap and water or with a waterless handwashing preparation ,,, No Recommendation for placing a bacterial filter in the breathing system or patient circuit of anesthesia equipment 1,,,, Do not routinely sterilize or disinfect the internal machinery of pulmonary-function testing machines between uses on different patients , Sterilize or subject to high-level liquid-chemical disinfection or pasteurization reusable mouthpieces and tubing or connectors between uses on different patients, OR follow the device manufacturers' instructions for their reprocessing ,, Wear gloves for handling respiratory secretions or objects contaminated with respiratory secretions of any patient , When changing a tracheostomy tube, use aseptic techniques and replace the tube with one that has undergone sterilization or high-level disinfection.
No Recommendation for wearing sterile gloves rather than clean but nonsterile gloves when suctioning a patient's respiratory secretions. If the open-suction system is employed, use a sterile single-use catheter. Use only sterile fluid to remove secretions from the suction catheter if the catheter is to be used for re-entry into the patient's lower respiratory tract No Recommendation for preferential use of the multiuse closed-system suction catheter or the single-use open-system catheter for prevention of pneumonia , Change the entire length of suction-collection tubing between uses on different patients.
Change suction-collection canisters between uses on different patients except when used in short-term-care units. If the maneuver is not contraindicated, elevate at an angle of the head of the bed of a patient at high risk for aspiration pneumonia e. Routinely verify the appropriate placement of the feeding tube Routinely assess the patient's intestinal motility e.
No Recommendation for the preferential use of small-bore tubes for enteral feeding No Recommendation for administering enteral feeding continuously or intermittently 70,, No Recommendation for preferentially placing the feeding tubes e. No Recommendation for using orotracheal rather than nasotracheal tube to prevent nosocomial pneumonia No Recommendation for routinely using an endotracheal tube with a dorsal lumen above the endotracheal cuff to allow drainage i.
Before deflating the cuff of an endotracheal tube in preparation for tube removal, or before moving the tube, ensure that secretions are cleared from above the tube cuff. If stress-bleeding prophylaxis is needed for a patient receiving mechanically assisted ventilation, use an agent that does not raise the patient's gastric pH 22,34,,, , No Recommendation for routine acidification of gastric feedings to prevent nosocomial pneumonia Instruct preoperative patients, especially those at high risk for contracting pneumonia, regarding frequent coughing, taking deep breaths, and ambulating as soon as medically indicated during the postoperative period , Patients at high risk include those who will receive anesthesia -- especially those who will have an abdominal, thoracic, head, or neck operation -- and those who have substantial pulmonary dysfunction e.
Encourage postoperative patients to cough frequently, take deep breaths, move about the bed, and ambulate unless these actions are medically contraindicated ,, Control pain that interferes with coughing and deep breathing during the immediate postoperative period by a using systemic analgesia , , including patient-controlled analgesia , with as little cough-suppressant effect as possible; b providing appropriate support for abdominal wounds, such as tightly placing a pillow across the abdomen; or c administering regional analgesia e.
Use an incentive spirometer or intermittent positive-pressure breathing equipment on patients at high risk for contracting postoperative pneumonia ,,,,, See Section III-B-1 above for definition of high-risk patients. Vaccinate patients at high risk for complications of pneumococcal infections with pneumococcal polysaccharide vaccine.
Such patients include persons ages greater than or equal to 65 years; adults who have chronic cardiovascular or pulmonary disease, diabetes mellitus, alcoholism, cirrhosis, or cerebrospinal fluid leaks; and children and adults who are immunosuppressed or who have functional or anatomic asplenia or HIV infection Do not routinely administer systemic antimicrobial agents to prevent nosocomial pneumonia 74,91,,, Use of rotating "kinetic" beds or continuous lateral rotational therapy.
No Recommendation for the routine use of kinetic beds or continuous lateral rotational therapy i. Educate a physicians to heighten their suspicion for cases of nosocomial Legionnaires disease and to use appropriate methods for its diagnosis and b other hospital personnel i. Establish mechanism s to provide clinicians with appropriate laboratory tests for the diagnosis of Legionnaires disease , , Maintain a high index of suspicion for the diagnosis of nosocomial Legionnaires disease, especially in patients who are at high risk for acquiring the disease.
Such patients include those who are immunosuppressed e. No Recommendation for routinely culturing water systems for Legionella sp. Primary prevention preventing nosocomial Legionnaires disease when no cases have been documented. Use only sterile not distilled, nonsterile water to fill reservoirs of devices used for nebulization ,,,, When a new hospital building is constructed, place cooling tower s in such a way that the tower drift is directed away from the hospital's air-intake system and design the cooling towers such that the volume of aerosol drift is minimized , For operational cooling towers, install drift eliminators, regularly use an effective biocide, maintain the tower according to the manufacturer's recommendations, and keep adequate maintenance records Appendix D ,, No Recommendation for treating water with ozone, ultraviolet light, or heavy-metal ions ,, Secondary prevention response to identification of laboratory- confirmed nosocomial legionellosis.
If a case is identified in a severely immunocompromised patient e. If severely immunocompromised patients are not being treated in the hopsital, conduct an epidemiologic investigation via a retrospective review of microbiologic, serologic, and postmortem data to identify previous cases, and begin an intensive prospective surveillance for additional cases of nosocomial Legionnaires disease. If evidence of continued nosocomial transmission is not present, continue the intensive prospective surveillance as described in II-B-3 for at least 2 months after the date surveillance was initiated.
Decontaminate the heated-water system either by superheating i. Post warning signs at each outlet being flushed to prevent scald injury to patients, staff, or visitors. Depending on local and state regulations regarding potable water temperature in public buildings , in hospitals housing patients who are at high risk for acquiring nosocomial legionellosis e.
No Recommendation for treatment of water with ozone, ultraviolet light, or heavy-metal ions ,,, Clean hot-water storage tanks and water heaters to remove accumulated scale and sediment Restrict immunocompromised patients from taking showers, and use only sterile water for their oral consumption until Legionella sp.
Options for repeat decontamination include either the intensive use of the same technique used for initial decontamination or a combination of superheating and hyperchlorination. Educate HCWs about nosocomial pulmonary aspergillosis, especially with respect to immunocompromised patients, and about infection-control procedures used to reduce its occurrence Maintain a high index of suspicion for the diagnosis of nosocomial pulmonary aspergillosis in patients who are at high risk for the disease i.
Patients who have received solid-organ transplants and patients who have hematologic malignancies and are receiving chemotherapy also are at high risk for acquiring the infection if they are severely granulocytopenic ,,, Maintain surveillance for cases of nosocomial pulmonary aspergillosis by periodically reviewing the hospital's microbiologic, histopathologic, and postmortem data.
No Recommendation for performing routine, periodic cultures of a the nasopharynx of high-risk patients or b devices, air samples, dust, ventilation ducts, and filters in rooms occupied by high-risk patients ,,,, When constructing new specialized-care units for patients at high risk for infection, ensure that patient rooms have adequate capacity to minimize fungal spore counts via maintenance of a HEPA filtration, b directed room airflow, c positive air pressure in patients' rooms relative to the air pressure in the corridor, d properly sealed rooms, and e high rates of room-air changes ,,,,, Air filtration.
Install, either centrally or at the point of use i. Directed room airflow. Place air-intake and exhaust ports such that room air comes in from one side of the room, flows across the patient's bed, and exits on the opposite side of the room , Well-sealed room.
Construct windows, doors, and intake and exhaust ports to achieve complete sealing of the room against air leaks , Room-air pressure. Ensure that room-air pressure can be maintained continuously above that of the corridor e. Room-air changes. Ventilate the room to ensure greater than or equal to 12 room-air changes per hour are maintained 1,,, No Recommendation for the preferential installation of a particular system, such as one with ultra-high air change rates i.
Formulate hospital policies to minimize exposures of high-risk patients to potential sources of Aspergillus sp. No Recommendation for prophylactic use of copperquinolinolate biocide in fireproofing material ,,, Place patients who are at high risk for infection in a protected environment that meets the conditions described in Sections II-Aa through II-Ae ,,,,,, Routinely inspect air-handling systems in hospital areas in which patients at high risk for infection are housed, maintain adequate air exchanges and pressure differentials, and eliminate air leakages.
Coordinate repairs of the system with the relocation of patients who are at high risk for infection to other hospital areas that have optimal air-handling capabilities ,, Minimize the length of time that patients who are at high risk for infection are outside their rooms for diagnostic procedures and other activities; when such patients leave their rooms, require them to wear well-fitting masks capable of filtering Aspergillus sp.
Prevent dust accumulation by damp-dusting horizontal surfaces on a daily basis, regularly cleaning ceiling tiles and air-duct grates when the rooms are not occupied by patients, and maintaining adequate seals on windows to prevent outside air from entering the room, especially in areas occupied by patients at high risk for aspergillosis Systematically review and coordinate infection-control strategies with personnel in charge of hospital engineering, maintenance, central supply and distribution, and catering , When planning hospital construction and renovation activities, assess whether patients at high risk for aspergillosis are likely to be exposed to high ambient-air spore counts of Aspergillus sp.
Construct barriers between patient-care and construction areas to prevent dust from entering patient-care areas; these barriers e. Direct pedestrian traffic from construction areas away from patient-care areas to limit the opening and closing of doors or other barriers that might cause dust dispersion, entry of contaminated air, or tracking of dust into patient-care areas ,,, Clean newly constructed areas before allowing patients to enter the areas , Eliminate exposures of patients at high risk for aspergillosis to activities that might cause spores of Aspergillus sp.
Eliminate exposures of patients at high risk for aspergillosis to potential environmental sources of Aspergillus sp. Prevent birds from gaining access to hospital air-intake ducts The following procedures should be followed if a case of nosocomial aspergillosis occurs:.
Begin a prospective search for additional cases in hospitalized patients and an intensified retrospective review of the hospital's microbiologic, histopathologic, and postmortem records.
If evidence of continuing transmission is not present, continue routine maintenance procedures to prevent nosocomial aspergillosis see Sections II-B-1 through II-B If evidence of continuing Aspergillus sp. Collect environmental samples from potential sources of Aspergillus sp. Depending on test availability, perform molecular subtyping of Aspergillus sp. If air-handling systems that supply air to areas in which high-risk patients are housed are not optimal, consider temporary deployment of portable HEPA filters until rooms with optimal air-handling systems are available for all patients at high risk for invasive aspergillosis.
If an environmental source of exposure to Aspergillus sp. Administer cytokines, including granulocyte-colony-stimulating factor and granulocyte-macrophage-stimulating factor, to increase host resistance to aspergillosis by decreasing the duration and severity of chemotherapy-induced granulocytopenia , No Recommendation for administration of intranasal amphotericin B or oral antifungal agents including amphotericin B and triazole compounds to high-risk patients for prophylaxis against aspergillosis ,, Educate personnel regarding the epidemiology, modes of transmission, and means of preventing transmission of RSV , Establish mechanism s by which the appropriate hospital personnel are promptly alerted to any increase in RSV activity in the local community.
During December-March and periods of increased prevalence of RSV in the community, attempt prompt diagnosis of RSV infection by using rapid diagnostic techniques as clinically indicated for pediatric patients, especially infants, and for immunocompromised adults who have a respiratory illness at the time of hospital admission , Wash hands after removing gloves.
See II-Aa. Wearing a gown. Wear a gown if clothing could be soiled by the respiratory secretions of a patient e. Limiting visitors. Do not allow persons who have symptoms of respiratory infection to visit uninfected pediatric, immunosuppressed, or cardiac patients Use of private rooms, cohorting, and patient-screening. To control ongoing RSV transmission in the hospital, admit young children who have symptoms of viral respiratory illness to single rooms if possible, OR perform RSV-screening diagnostic tests on young children at the time of hospital admission and cohort them according to their RSV-infection status ,, , Personnel cohorting.
During an outbreak of nosocomial RSV, cohort personnel as much as practical i. Postponing patient admission. During outbreaks of nosocomial RSV, postpone elective admission of uninfected patients at high risk for complications from RSV infection.
Wearing eye-nose goggles. Educate HCWs about the epidemiology, modes of transmission, and means of preventing transmission of influenza ,, Establish mechanism s by which the appropriate hospital personnel are promptly alerted of any increase in influenza activity in the local community.
Arrange for laboratory tests to be available to clinicians, for use when clinically indicated, to promptly confirm the diagnosis of influenza and other acute viral respiratory illnesses, especially during November-April Offer vaccine to outpatients and inpatients at high risk for complications from influenza, beginning in September and continuing until influenza activity has begun to decline , ,, Patients at high risk for complications from influenza include persons greater than or equal to 65 years of age; persons who are in long-term-care units; or persons who have chronic disorders of the pulmonary or cardiovascular systems, diabetes mellitus, renal dysfunction, hemoglobinopathies, or immunosuppression; persons 6 months years of age who are receiving long-term aspirin therapy ; and persons who have musculoskeletal disorders that impede adequate respiration.
Vaccinate HCWs before the influenza season begins each year, preferably between mid-October and mid-November. Until influenza activity declines, continue to make vaccine available to newly hired personnel and to those who initially refused vaccination.
If vaccine supply is limited, give highest priority to vaccination of HCWs caring for patients at greatest risk for severe complications from influenza infection see Section II-A-1 Keep a patient who has suspected or confirmed influenza in a private room or, unless medically contraindicated, in a room with other patients who have confirmed influenza. As much as feasible, maintain negative air pressure in rooms of patients for whom influenza is suspected or diagnosed, or place persons who have influenza-like illness together in a hospital area that has an independent air-supply and exhaust system ,,, Institute the wearing of masks among persons -- except those immune to the infecting virus strain -- who enter the room of a patient who has influenza ,, Restrict hospital visitors who have a febrile respiratory illness.
Curtail or eliminate elective medical and surgical admissions as necessary. Restrict cardiovascular and pulmonary surgery to emergency cases only. Early in the outbreak, obtain nasopharyngeal-swab or nasal-wash specimens from patients who recently had onset of symptoms suggestive of influenza for influenza virus culture or antigen detection. Administer current influenza vaccine to unvaccinated patients and HCWs, especially if the outbreak occurs early in the influenza season , When a nosocomial outbreak of influenza A is suspected or identified:.
Administer amantadine or rimantadine for prophylaxis to all uninfected patients in the involved unit who do not have contraindications to these drugs. Administer amantadine or rimantadine for prophylaxis to unvaccinated HCWs who do not have medical contraindications to these drugs and who are in the involved unit or providing care to patients at high risk for infection Discontinue amantadine or rimantadine if laboratory tests confirm or strongly suggest that influenza type A is not the cause of the outbreak If the cause of the outbreak is confirmed or believed to be influenza type A AND vaccine has been administered only recently to susceptible patients and HCWs, continue amantadine or rimantadine prophylaxis until 2 weeks after the vaccination Interrupting person-to-person transmission of microorganisms.
See Section III, A-E. References CDC. Guidelines for preventing the transmission of tuberculosis in health-care facilities, MMWR ;43 No. Horan TC, White JW, Jarvis WR, et al. Nosocomial infection surveillance, MMWR ;35 No. Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection.
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Am Rev Respir Dis ; Torres A, Aznar R, Gatell JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Chastre J, Fagon JY, Soler P, et al. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med ; Fagon JY, Chastre J, Hance AJ, et al.
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Rodriguez de Castro F, Sole Violan J, Lafarga Capuz B, Caminero Luna J, Gonzalez Rodriguez B, Manzano Alonso JL. Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients. Davidson M, Tempest B, Palmer DL. Bacteriologic diagnosis of acute pneumonia: comparison of sputum, transtracheal aspirates, and lung aspirates. JAMA ; Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C.
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Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation. Johanson WG Jr, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract.
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Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Salata RA, Lederman MM, Shlaes DM, et al. Diagnosis of nosocomial pneumonia in intu-bated, intensive care unit patients. Pham LH, Brun-Buisson C, Legrand P, et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients: comparison of a plugged telescoping catheter with the protected specimen brush.
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Quantitative culture and gram stain of sputum in pneumonia. Lowry FD, Carlisle PS, Adams A, Feiner C. The incidence of nosocomial pneumonia following urgent endotracheal intubation. Infect Control ; Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation.
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Nosocomial Definition of Nosocomial by Merriam-Webster
Nosocomial definition is - acquired or occurring in a hospital. How to use nosocomial in a sentence. Did you know?
Chapter III. Nosocomial infection surveillance 16 Objectives 16 Strategy 16 Implementation at the hospital level 17 Implementation at the network (regional or national) level 27/04/ · (medicine, chiefly of infections or their causal Arising from hospital treatment or environment.· (uncommon) Of, relating to, or happening in a hospital. (Can we find and add a quotation of Dunglison to this entry?) , VM/SAC, Veterinary Medicine and Small Animal Clinician, Unique Nosocomial Treatment After this, I applied a. Une infection nosocomiale est une infection contractée dans un établissement de santé. Le terme «nosocomial» vient du grec ancien nosos, maladie et de komein soigner, qui forment le mot nosokomia, soins qu’on donne aux cooldevice.eu infection est dite nosocomiale ou hospitalière, si elle est absente lors de l'admission du patient à l'hôpital et qu'elle se développe 48 heures au.
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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq cdc. Type Accommodation and the title of the report in the subject line of e-mail. This document updates Jean Paul Moulin replaces CDC's previously published "Guideline for Prevention of Nosocomial Pneumonia" Infect Control ;, Respir Care ;, and Am J Infect Control ; This revised guideline is designed to reduce the incidence of nosocomial pneumonia and is intended for use by personnel who are responsible for surveillance and control of infections in acute-care hospitals; the information may not be applicable in long-term-care facilities because of the unique characteristics of such settings.
This revised guideline addresses common problems encountered by infection- control practitioners regarding the prevention and Anime Monster Anal of nosocomial pneumonia in U.
New sections on Legionnaires disease and pneumonia caused by Aspergillus sp. Lower respiratory tract infection caused by Mycobacterium tuberculosis is not addressed in this document. Part I, "An Overview of the Prevention of Nosocomial Pneumonia, ," provides the background information for the consensus recommendations of the Hospital Infection Control Practices Advisory Committee HICPAC in Part II, "Recommendations for Prevention of Nosocomial Pneumonia.
Although patients receiving mechanically assisted ventilation do not represent a major proportion of patients who have nosocomial pneumonia, they are at highest risk for acquiring the infection. Because intubation and mechanical ventilation alter first-line patient defenses, they greatly increase the risk for nosocomial bacterial pneumonia.
Pneumonias caused by Legionella sp. RSV infection Film Pirno Gratis occurs after viral inoculation of the conjunctivae or nasal mucosa by contaminated hands. Traditional preventive measures for nosocomial pneumonia include decreasing aspiration by the patient, preventing cross-contamination or colonization via hands of personnel, appropriate disinfection or sterilization of respiratory-therapy devices, use of available vaccines to protect against particular infections, and education of hospital staff Vanessa Paradis Nude patients.
New measures being investigated involve reducing oropharyngeal and gastric colonization by pathogenic microorganisms. This document updates and replaces CDC's previously published "Guideline for Prevention of Nosocomial Pneumonia" Infect Control ;, Respir Care ;and Am J Infect Control ; This revised guideline addresses common problems encountered by infection-control practitioners regarding the prevention and control of nosocomial pneumonia in U.
Lower respiratory tract infection caused by Mycobacterium tuberculosis is not addressed in this document; CDC published such recommendations previously 1. Department of Health and Human Services; the Director, CDC; and the Director, National Center for Infectious Diseases NCIDCDC, regarding the practice of hospital infection control and strategies for surveillance, prevention, and control of nosocomial infections Junge Geile Titten U.
HICPAC also advises CDC on periodic updating of guidelines and other policy statements regarding prevention of nosocomial infections. This guideline is the first of a series of CDC guidelines being revised by HICPAC and NCID. This guideline can be an important resource for educating health-care workers HCWs regarding prevention and control of nosocomial respiratory tract infections.
Because education of HCWs is the cornerstone of an effective infection-control program, hospitals should give high priority to continuing infection-control educational programs for these personnel. Traditional preventive measures for nosocomial pneumonia include decreasing aspiration by the patient, preventing cross-contamination or colonization via hands of HCWs, appropriate disinfection or sterilization of respiratory-therapy devices, use of available vaccines to protect against particular infections, and education of hospital staff and patients.
The Nosocomiales distribution of etiologic agents that cause nosocomial pneumonia differs between hospitals because of different patient populations and diagnostic methods employed Similarly, cultures of bronchoscopic specimens obtained from mechanically ventilated patients who had pneumonia have rarely yielded anaerobes ,9,11,14, Only one study, which was based primarily on cultures of transtracheal aspirates obtained from patients not receiving mechanically assisted ventilation, Gw2 Horologicus a predominance of anaerobes 4.
However, Staphylococcus aureus especially methicillin-resistant S. In addition, Haemophilus influenzae has been isolated from mechanically ventilated patients who Michaela Conlin Naked pneumonia that occurred within hours after intubation Hana Nitsche Nackt, In hospitals participating in the NNIS, Pseudomonas aeruginosa, Enterobacter sp.
Nosocomial bacterial pneumonia has been difficult to diagnose 7,8,16, Frequently, the criteria for diagnosis have been fever, cough, and development of purulent sputum, in conjunction with radiologic evidence of a new or progressive pulmonary infiltrate, a suggestive Gram stain, and positive cultures of sputum, tracheal aspirate, pleural fluid, or blood 3,4,23,25, Although clinical findings in conjunction with cultures of sputum or tracheal specimens may be sensitive for bacterial pathogens, they are highly nonspecific, especially in patients receiving mechanically assisted ventilation 8,9,18,29,31, ; conversely, cultures of blood or pleural fluid have very low sensitivity 8,18,19, Because of these problems, a group of investigators recently formulated consensus recommendations for standardizing methods used to diagnose pneumonia in clinical research studies of ventilator-associated pneumonia These methods involve bronchoscopic techniques such as quantitative culture of PSB 5,13,15,27,31,38,41,47,48bronchoalveolar lavage BAL 7,12,41,47,and protected BAL pBAL Familien Sex Videos These methods are invasive and might cause complications such as hypoxemia, bleeding, or arrhythmia 8,13,42,44,52,55, In addition, the sensitivity of the PSB procedure may be decreased for patients receiving antibiotic therapy 9,13, Nonbronchoscopic NB procedures e.
The use of these bronchoscopic and nonbronchoscopic diagnostic tests could help to better define the epidemiology of nosocomial pneumonia, especially in patients receiving mechanically assisted ventilation; however, additional studies are needed to determine each test's applicability in daily clinical practice.
Inthe overall incidence of lower respiratory tract infection was six cases per 1, discharged patients 2. The Nosocomiales per 1, discharged patients ranged from 4. Nosocomial bacterial pneumonia often has been identified as a postoperative infection 62, Other risk factors include hour ventilator-circuit changes, hospitalization during the fall or winter, stress-bleeding prophylaxis with cimetidine either with or without antacidadministration of antimicrobials, presence of a nasogastric tube, Kaho Shibuya trauma, and recent bronchoscopy 6,34,35, The NNIS has stratified the incidence density of nosocomial pneumonia by patients' use of mechanical ventilation and type of intensive-care unit ICU.
From throughthe median rate of ventilator-associated pneumonia cases per 1, ventilator-days ranged from 4. In comparison, the median rate of nonventilator-associated pneumonia cases per 1, ICU-days ranged from zero cases in pediatric and respiratory ICUs to 3. Nosocomial pneumonia has been associated with high fatality rates. Patients receiving mechanically assisted ventilation have higher mortality rates than do patients not receiving ventilation support; however, other factors e.
Nosocomial pneumonia is a major infection-control problem because of its reported frequency, associated high fatality rate, and attendant costs. In addition, bacterial translocation from the gastrointestinal tract has been hypothesized recently as a mechanism for infection. Persons who swallow abnormally e. The high incidence of gram-negative bacillary pneumonia in hospitalized patients might result from factors that promote colonization of the pharynx by gram-negative bacilli and the subsequent entry of these organisms into the lower respiratory tract 33, Although aerobic gram-negative bacilli are recovered infrequently or are found in low numbers in pharyngeal cultures of healthy persons 88,92the likelihood of colonization substantially increases in comatose patients, in patients treated with antimicrobial agents, and in patients who have hypotension, acidosis, azotemia, alcoholism, diabetes mellitus, leukocytosis, leukopenia, pulmonary disease, or nasogastric or endotracheal tubes in place 33,91,93, Oropharyngeal or tracheobronchial colonization by gram-negative bacilli begins with the adherence of the microorganisms to the host's epithelial cells 90, Adherence may be affected by multiple factors associated with the bacteria e.
Although the exact interactions between these factors have not been fully elucidated, studies indicate that certain substances e. Conversely, certain conditions e. The stomach also might be an important reservoir of organisms that cause nosocomial pneumonia 34, The role of the stomach as Celebrity Nude Beach a reservoir might differ depending on the patient's underlying conditions and on prophylactic or therapeutic interventions 22, In healthy persons, few bacteria entering the stomach survive in the presence of hydrochloric acid at pH less than 2However, when gastric pH increases from the normal levels to greater than or equal to 4, microorganisms are able to multiply to high concentrations in the stomach , Other factors e.
Bacteria also can enter the lower respiratory tract of hospitalized patients through inhalation of aerosols generated primarily by contaminated respiratory-therapy or anesthesia-breathing equipment Outbreaks related to the use of respiratory-therapy equipment have Lucy Nude Fairy Tail associated with contaminated nebulizers, which are humidification devices that produce large amounts of aerosol droplets less than 4 um via ultrasound, spinning disk, or Nosocomiales Venturi mechanism , When the fluid in the reservoir of a nebulizer becomes contaminated with bacteria, the aerosol produced may contain high concentrations of bacteria that can be deposited deep in the patient's lower respiratory tract , Contaminated aerosol inhalation is particularly hazardous for intubated patients because endotracheal and tracheal tubes provide direct access to the lower respiratory tract.
In contrast to nebulizers, bubble-through or wick humidifiers primarily increase the water-vapor or molecular-water content of inspired gases.
Although heated bubble-through humidifiers generate aerosol droplets, they do so in quantities that may not be clinically important; wick humidifiers do not generate aerosols. Bacterial pneumonia has resulted, in rare instances, from hematogenous spread of infection to the lung from another Amateur Porn Reddit site e.
Another mechanism, translocation of viable bacteria from the lumen of the gastrointestinal tract through epithelial mucosa to the mesenteric lymph nodes and to the lung, has been demonstrated in animal models Translocation is postulated to occur in patients with immunosuppression, cancer, or burns ; however, data are insufficient to describe this mechanism Nosocomiales humans Although specific risk factors have differed between study populations, they can be grouped into the following general categories:.
The association between colonization of the oropharynx 88,tracheaor stomach ,, and predisposition to gram-negative bacillary pneumonia prompted efforts to prevent infection by using either prophylactic local application of antimicrobial agent sor local bacterial interferenceAlthough early studies suggested that the first method i. The second method i. However, the efficacy of this method for general usage has not been evaluated. Sucralfate, a cytoprotective agent that has little effect on gastric pH and may have bactericidal properties of its own, has been suggested as a potential substitute for antacids and H-2 blockers In one study of a large number of patients, the incidence of early-onset pneumonia i.
Conversely, a meta-analysis of data from eight earlier studies and a later study comparing sucralfate with ranitidine did not indicate a strong association between nosocomial pneumonia and drugs that increase gastric pH. Selective decontamination of the digestive tract SDD is another strategy designed to prevent bacterial colonization and lower respiratory tract infection in mechanically ventilated patients SDD is aimed at preventing oropharyngeal and gastric colonization with aerobic gram-negative bacilli and Candida sp.
Various SDD regimens use a combination of locally administered nonabsorbable Celeb Nude Fakes Tumblr agents, such as polymyxin and an aminoglycoside either tobramycin, gentamicin, or, rarely, neomycin or a quinolone either norfloxacin or ciprofloxacin coupled with either amphotericin B or nystatin. The local antimicrobial preparation is applied as a paste to the oropharynx and administered either orally or via the nasogastric tube four times a day.
In addition, in many studies, a systemic intravenous antimicrobial e. Two recently published reports of large, double-blind, placebo- controlled trials demonstrated no benefit from SDDOne of these studies, which was conducted in France, noted that the incidence of gram-negative bacillary pneumonia decreased significantly after SDD, but this decrease was not accompanied by a decrease in pneumonia from all causes In the other study, no differences were noted between patients randomly assigned to SDD or placebo treatment conditions; however, both patient groups also received simultaneous treatment with intravenous cefotaxime Thus, currently available data do not justify the routine use of SDD for prevention of nosocomial pneumonia in ICU Kegy Mario Maker. SDD may be ultimately useful for specific subsets of ICU patients, such as patients with trauma or severe immunosuppression e.
A new approach advocated to prevent oropharyngeal colonization in patients receiving enteral nutrition is Javicia Leslie Nude reduce bacterial colonization of the stomach by acidifying the enteral feed Although the absence of bacteria from the stomach has been confirmed in patients given acidified enteral feeding, the effect on the incidence of nosocomial pneumonia has not been evaluated Placement of an enteral tube may increase nasopharyngeal colonization, cause reflux of gastric contents, or allow bacterial migration via the tube from the stomach to the upper airwayWhen enteral feedings are administered, gross contamination of the enteral solution during preparation and elevated gastric pH 70, may lead to gastric colonization with gram-negative bacilli.
In addition, gastric reflux and aspiration might occur because of increased intragastric volume and pressure 70, Although prevention of pneumonia in such patients may be difficult, methods that make regurgitation less likely e. Patients receiving continuous, mechanically assisted ventilation have times the risk for acquiring nosocomial pneumonia compared with patients not receiving ventilatory support 34,63,65, This increased risk was attributed partially to carriage of oropharyngeal organisms upon passage of the endotracheal tube into the trachea during intubation, as well as to depressed host defenses secondary to the patient's severe underlying illness 6,34,35, In addition, bacteria can aggregate on the surface of the tube over time and form a glycocalyx i.
Some researchers believe that these bacterial aggregates can become dislodged by ventilation flow, tube manipulation, or suctioning and subsequently embolize into Nosocomiales lower respiratory tract and cause focal pneumonia ,