The envirocare organisation, whose major role is to maintain the hygiene of the public at the sustainable level is currently working with many hospitals around the country and has helped to curb down the problem of poor general hygiene.

This has effectively reduced the spread or contamination of various nosocomial infections that people used to acquire from hospitals.

Betty Mukangira, 28 years old from Rwamagana says that she used to fear getting treatments from Rwamagana hospital previously because the environment at the hospital looked dirty.

She ignored medical services at the hospital for many years but the envirocare has in recent years improved the hospital surroundings and has occasionally consulted the hospital medical services for treatment.      

Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient’s original condition.

Infections are considered nosocomial if they first appear 48 hours or more after hospital admission.

This type of infection is also known as a hospital-acquired infection and some times termed as the health care associated infections.

Doctor Emmanuel Semwaga is a general medical practitioner working at Rwamagana district hospital says that there various reasons as to why people suffer nosocomial infections;

Hospitals house large numbers of people who are sick and whose immune systems are often in a weakened state, Increased use of outpatient treatment means that people who are in the hospital are sicker on average, Medical staff move from patient to patient, providing a way for pathogens to spread, Many medical procedures bypass the body’s natural protective barriers, Sanitation protocol regarding uniforms, equipment sterilization, washing, and other preventative measures may be either unheeded by hospital staff or too lax to sufficiently isolate patients from infectious agents.

Additionally, patients are often prescribed antibiotics and other anti-microbial drugs to help treat illness; this may increase the selection pressure for the emergence of resistant strains.

Doctor Emmanuel reveals that thorough hand washing and use of alcohol rubs by all medical personnel before each patient contact is one of the most effective ways to combat nosocomial infections.

More careful use of anti-microbial agents, such as antibiotics, is also considered vital.

Microorganisms are transmitted in hospitals by several routes, and the same microorganism may be transmitted by more than one route.

There are five main routes of transmission; contact, droplet, airborne, common vehicle, and vector borne.

Contact transmission; the most important and frequent mode of transmission of nosocomial infections, is divided into two subgroups: direct-contact transmission and indirect-contact transmission.

Direct-contact transmission; involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact.

Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.

Indirect-contact transmission; involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients.

Droplet transmission; occurs when droplets are generated from the source person mainly during coughing, sneezing, and talking, and during the performance of certain procedures such as bronchoscopy.

Transmission occurs when droplets containing germs from the infected person are propelled a short distance through the air and deposited on the host’s body.

Airborne transmission; occurs by dissemination of either airborne droplet nuclei (small-particle residue or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent.

Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air handling and ventilation are required to prevent airborne transmission.

Microorganisms transmitted by airborne transmission include mycobacterium tuberculosis and the rubeola and varicella viruses.

Common vehicle transmission; applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.

Vector borne transmission; occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.

Factors that can lead to nosocomial infection
Factors predisposing a patient to infection can broadly be divided into four areas:

People in hospitals are usually already in a poor health state, impairing their defense against bacteria  and advanced age or premature birth along with immunodeficiency due to drugs, illness and irradiations  present a general risk, while other diseases can present specific risks  for instance chronic obstructive pulmonary disease can increase chances of respiratory tract infection.

Invasive devices; for instance intubation tubes, catheters, surgical drains and tracheostomy tubes all bypass the body’s natural lines of defense against pathogens and provide an easy route for infection.

Patients already colonized on admission are instantly put at greater risk when they undergo an invasive procedure.

A patient’s treatment itself can leave them vulnerable to infection for example; immunosuppressant and antacid treatment undermine the body’s defenses, while antimicrobial therapy remove competitive flora and only leaving resistant organisms and recurrent blood transfusions have also been identified as risk factors. 

 Prevention
Isolation; Isolation precautions are designed to prevent transmission of microorganisms by common routes in hospitals.

Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission.

Hand washing and gloving; handwashing frequently is called the single most important measure to reduce the risks of transmitting 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.

Although hand washing may seem like a simple process, it is often performed incorrectly. Healthcare settings must continually remind practitioners and visitors on the proper procedure in washing their hands to comply with responsible hand washing.

Simple hand washing signals can assist healthcare facilities in the prevention of nosocomial infections.

All visitors must follow the same procedures as hospital staff to adequately control the spread of infections.

Visitors and healthcare personnel can equally transmit these infections. Moreover, multi-drug resistant infections can leave the hospital and become part of the community flora the society does not take steps to stop this transmission.

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 hospitals.

First, gloves are worn to provide a protective barrier and to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and non intact skin; the wearing of gloves in specified circumstances to reduce the risk of exposures to blood borne pathogens or germs.

Secondly, 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.

Thirdly, gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or a fomite can transmit these microorganisms to another patient.

In this situation, gloves must be changed between patient contacts and hands should be washed after gloves are removed.

Wearing gloves does not replace the need for hand washing, because gloves may have small, non-apparent defects or may be torn during use, and hands can become contaminated during removal of gloves.

Failure to change gloves between patient contacts is an infection control hazard.

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