thumb Controlling nosocomial infection is to implement QA/QC measures to the health care sectors, and evidence-based management can be a feasible approach. For those with ventilator-associated or<unk><unk>  pneumonia, controlling and monitoring<unk>  indoor air quality needs to be on agenda in management, whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced. To reduce the number of<unk> s, the state of Maryland implemented the Maryland<unk><unk>  Conditions Program that provides financial rewards and penalties for individual<unk> s. An adaptation of the Centers for Medicare & Medicaid Services payment policy causes poor-performing<unk> s to lose up to 3% of their inpatient revenues, whereas<unk> s that are able to decrease<unk> s can earn up to 3% in rewards. During the program's first two years, complication rates fell by 15.26% across all<unk><unk>  conditions tracked by the state (including those not covered by the program), from a risk-adjusted complication rate of 2.38 per 1,000 people in 2009 to a rate of 2.02 in 2011. The 15.26% decline translates into more than $100 million in cost savings for the health care system in Maryland, with the largest savings coming from avoidance of urinary tract infections, sepsis and other severe infections, and pneumonia and other lung infections. If similar results could be achieved nationwide, the Medicare program would save an estimated $1.3 billion over two years, while the US health care system as a whole would save $5.3 billion. Sanitation<unk> s have sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventive measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections. More careful use of antimicrobial agents, such as antibiotics, is also considered vital. As many<unk> s caused by bacteria such as methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, and Clostridium difficile are caused by a breach of these protocols, it is common that affected patients make medical negligence claims against the<unk>  in question. Sanitizing surfaces is part of control measures to reduce nosocomial infections in health care environments. Modern sanitizing methods such as Non-flammable Alcohol Vapor in Carbon Dioxide systems have been effective against gastroenteritis, methicillin-resistant Staphylococcus aureus, and influenza agents. Use of hydrogen peroxide vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria, such as Clostridium difficile, where alcohol has been shown to be ineffective. Ultraviolet cleaning devices may also be used to disinfect the rooms of patients infected with Clostridium difficile or methicillin-resistant Staphylococcus aureus after discharge. Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotics and other antimicrobial drugs to help treat illness; this may increase the selection pressure for the emergence of resistant strains. Sterilization Sterilization goes further than just sanitizing. It kills all microorganisms on equipment and surfaces through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure. Isolation Isolation is the implementation of isolating precautions designed to prevent transmission of microorganisms by common routes in<unk> s. (See Universal precautions and Transmission-based precautions.) Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission for example isolation of infectious cases in special<unk> s and isolation of patient with infected wounds in special rooms also isolation of joint transplantation patients on specific rooms. Handwashing Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient. Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions. The spread of nosocomial infections, among immunocompromised patients is connected with health care workers' hand contamination in almost 40% of cases, and is a challenging problem in the modern<unk> s. The best way for workers to overcome this problem is conducting correct hand-hygiene procedures; this is why the WHO launched in 2005 the GLOBAL Patient Safety Challenge. Two categories of micro-organisms can be present on health care workers' hands: transient flora and resident flora. The first is represented by the micro-organisms taken by workers from the environment, and the bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group is represented by the permanent micro-organisms living on the skin surface (on the stratum corneum or immediately under it). They are capable of surviving on the human skin and to grow freely on it. They have low pathogenicity and infection rate, and they create a kind of protection from the colonization from other more pathogenic bacteria. The skin of workers is colonized by 3.9 x 104 – 4.6 x 106 cfu/cm2. The microbes comprising the resident flora are: Staphylococcus epidermidis, Staphylococcus hominis, and Microccocus, Propionibacterium, Corynebacterium, Dermobacterium, and Pitosporum spp., while transient organisms are Staphylococcus aureus, and Klebsiella pneumoniae, and Acinetobacter, Enterobacter and Candida spp. The goal of hand hygiene is to eliminate the transient flora with a careful and proper performance of hand washing, using different kinds of soap, (normal and antiseptic), and alcohol-based gels. The main problems found in the practice of hand hygiene is connected with the lack of available sinks and time-consuming performance of hand washing. An easy way to resolve this problem could be the use of alcohol-based hand rubs, because of faster application compared to correct hand-washing. Improving patient hand washing has also been shown to reduce the rate of nosocomial infection. Patients who are bed-bound often do not have as much access to clean their hands at mealtimes or after touching surfaces or handling waste such as tissues. By reinforcing the importance of handwashing and providing sanitizing gel or wipes within reach of the bed, nurses were directly able to reduce infection rates. A study published in 2017 demonstrated this by improving patient education on both proper hand-washing procedure and important times to use sanitizer and successfully reduced the rate of enterococci and Staphylococcus aureus. All visitors must follow the same procedures as<unk>  staff to adequately control the spread of infections. Moreover, multidrug-resistant infections can leave the<unk>  and become part of the community flora if steps are not taken to stop this transmission. It is unclear whether or not nail polish or rings affected surgical wound infection rates. Gloves In addition to hand washing, gloves play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in<unk> s. First, they are worn to provide a protective barrier for personnel, preventing large scale contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. In the United States, the Occupational Safety and Health Administration has mandated wearing gloves to reduce the risk of bloodborne pathogen infections. Second, gloves are worn to reduce the likelihood that microorganisms present on the hands of personnel will be transmitted to patients during invasive or other patient-care procedures that involve touching a patient's mucous membranes and nonintact skin. Third, they are worn to reduce the likelihood that the hands of personnel contaminated with micro-organisms from a patient or a fomite can transmit those micro-organisms to another patient. In this situation, gloves must be changed between patient contacts, and hands should be washed after gloves are removed. Antimicrobial surfaces Micro-organisms are known to survive on inanimate ‘touch’ surfaces for extended periods of time. This can be especially troublesome in<unk>  environments where immunodeficient patients are at enhanced risk for contracting nosocomial infections. Patients with<unk> s are predominantly<unk> ized in different types of intensive care units (ICUs). Touch surfaces commonly found in<unk>  rooms, such as bed rails, call buttons, touch plates, chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper towel, soap), dressing trolleys, and counter and table tops are known to be contaminated with Staphylococcus, methicillin-resistant Staphylococcus aureus (one of the most virulent strains of antibiotic-resistant bacteria) and vancomycin-resistant Enterococcus. Objects in closest proximity to patients have the highest levels of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. This is why touch surfaces in<unk>  rooms can serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to patients. A number of compounds can decrease the risk of bacteria growing on surfaces including: copper, silver, and germicides. There have been a number of studies evaluating the use of no-touch cleaning systems particularly the use of ultraviolet C devices. One review was inconclusive due to lack of, or of poor quality evidence. Other reviews have found some evidence, and growing evidence of their effectiveness.
Hospital-acquired infection
Laboratory-acquired infection
Transfusion transmitted infection
Foodborne illness
Disseminated disease
Gulf War syndrome
Spillover infection
Blood-borne disease