Nosocomial infections

About 1 patient in 10 acquires a nosocomial infection. Such infections are increasingly the subject of media and political scrutiny, with mandatory national surveillance programmes beginning. Patients are vulnerable to infection for many reasons ' surgery, immunosuppression, intravenous devices, proximity to other patients. Antibiotics have led to the selection of resistant organisms (typical 'hospital organisms', including MRSA, Clostridium difficile and VRE), but it is important to note that most nosocomial infections are probably still caused by patients' own bacterial flora. The principal clinical problems encountered are nosocomial pneumonia, surgical wound infections, line infection/bacteraemia, urinary sepsis and C. difficile diarrhoea. Cross-infection with blood-borne viruses is a potential problem but is rare. Measures to control or prevent nosocomial infections include attention to basic hygiene and handwashing by all staff (and provision of adequate sinks), appropriate isolation of infectious patients, prudent use of antibiotics to minimize selection of resistance, sterilization of surgical instruments, decontamination of endoscopes, asepsis in surgery and during the care of wounds and lines, appropriate antibiotic prophylaxis, and safe disposal of needles and other sharps. Ensuring staff are immune to, or vaccinated against, infections such as TB, rubella, and varicella will prevent illness in staff and consequently in their patients. Staff infected with hepatitis B/C or HIV are usually not allowed to perform surgery, because they may infect their patients. Engineering/design considerations are important but often unnoticed; they include adequate space, appropriate ventilation of theatres and isolation rooms, and provision of a safe, Legionella-free water supply.