Nosocomial infections and infection control

Hospital patients are susceptible to infection because of underlying diseases and medical interventions such as surgery, intubation or antibiotic use, and also their exposure to microorganisms from other patients, the hospital environment or hospital staff. An average of 5–10% of in-patients have a nosocomial infection, with highest rates in surgical and intensive care units. Most of these infections fall into one of five categories: line-associated infections and bacteraemia, surgical wound infection, nosocomial pneumonia, catheter-associated urinary tract infection, and gastrointestinal infection, including Clostridium difficile and norovirus. Many nosocomial infections are due to antibiotic-resistant organisms such as meticillin-resistant Staphylococcus aureus and multi-resistant Gram-negative organisms, which are selected by the antibiotic-rich hospital environment, but less resistant community pathogens may also cause hospital infection. Measures to prevent nosocomial infection are varied, and include aseptic handling of wounds, hand washing before and after every patient contact, and restrained antibiotic use. Recent public anxiety about nosocomial infection has led to increased political interest, with mandatory surveillance and publication of infection rates, financial incentives to reduce infections, and development of ‘care bundles’ – packages designed to ensure compliance with several different control measures.