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Common Antimicrobial Resistant Bacteria
Nosocomial infections continue to increase in the developed world with most infections being caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus and gram negative-bacteria (Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiella pneumoniae). These gram negative-bacteria are resistant to penicillin derivatives through the production of beta-lactamases, but also are becoming resistant to aminoglycosides and carbapenems. These resistant pathogens are also increasingly documented in developing countries.3 Infections with MRSA are common and resistance to methicillin continues to grow. Forty to sixty percent of all S. aureus acquired in the hospital are methicillin-resistant and typically multidrug resistant. The disease is a common complication of wounds, lower respiratory tract infections, septicemia, invasive devices, pressure sores, burns, and ulcers. In recent years, nosocomial transmission of community -acquired, multidrug-resistant organisms including pneumococcus, Mycobacterium tuberculosis, salmonella spp, shigella spp, and V. cholerae has been documented in developing countries.5 Extensively drug-resistant (XDR) tuberculosis has spread among hospitalized patients in South Africa. According to a recent study, about 1,300 cases of XDR tuberculosis are predicted to occur in a single region of South Africa by the end of 2012 (if no new interventions are introduced), more than half of which are likely to be nosocomially transmitted.6 The prevalence of active TB and the presence of susceptible HIV-infected patients in the hospital, combined with inadequate IC practices and procedures, increase the likelihood that M. tuberculosis will be transmitted in hospital settings. The spread of bloodborne viruses and bacteria also represent significant threats to health care staff and patients. HIV, as well as hepatitis B and C, can be transmitted through needle sticks and blood transfusions. Transmissible pathogens may also put patients and staff at risk for fungal infections (candida), protozoal infections, scabies, giardiasis, amebiasis, and some vector-borne diseases.
Root Causes
Root causes of nosocomial infections and AMR problems in hospitals include the following—
• Lack of training in basic IC
• Lack of an IC infrastructure and poor IC practices (procedures)
• Inadequate facilities and techniques for hand hygiene
• Lack of isolation precautions and procedures. Large medical and surgical wards promote the transfer of infections to other patients and health care personnel
• Use of advanced, complex treatments without adequate supporting training and infrastructure, including— Invasive devices and procedures o Complex surgical procedures
Interventional obstetric procedures
Intravenous catheters, fluids, and medications o Intravenous catheters
Urinary catheters
Mechanical ventilators • Inadequate sterilization, disinfection, and hospital cleaning procedures and practices