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What factors do you believe play a role in NOSOCOMIAL INFECTIONS (hospital aquired)??

Free of blaming, assuming or anything lets say is unproductive Let us brainstorm a few ideas on causes of nosocomial infection. Share your wisdom please. Feel free to share your stories as well. . . stories shape our culture and initiate change!!

Take into account problems with

HOST DEFENSES
we all know that a person who is on antibiotic treatment or chemotherapy become suseptible but what can we empower a patient to do to stay as immuno-protected as possible--
ie what role does the health of our GUT play in making us suseptible?
what role does hygeine and mobility play in making us suseptible?

ENVIRONMENT
We all know people feel like it is a terrible thing to go to the hospital thinking they may come down with something worse than they went in for, we have also heard the horror stories. What sorts of things in the environment could make patients less suseptible, and what is making them more suseptible.

look at things like Jessica Green's talk on microbial diversity in the air

MIND/BODY RELATIONSHIP
what role does percieved isolation, loss of hope, worthlessness, cause the body to be suseptible


If there is a good response to do so I will update the question with an outline of the responses to save people energy in sorting through all of the responses and will time stamp the last update at the bottom of this page.

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  • Aug 15 2011: Cleanliness - Hand Washing by medical personnel
    Sterility - Equipment used
    • Aug 15 2011: hand-washing:
      yes mechanical hand-washing with soap and water is undervalued by many staff

      sterility: many things play into this.
      how long we use our disposable equipment for a patient
      in the same respect is it more harmful to change the equipment? (lines and tubes being utilized on patients)
      there is a lot of research for things like this and many protocols in place

      I am pretty sure central lines are the HAI (hospital acquired infections) source that they have not found the best way to prevent yet actually. (the lines that go directly into an artery and therefore can cause the most trouble)
    • Aug 15 2011: Parthasarathy, I should have addressed this from a global standpoint, I am sorry for discounting your location.

      what practices in India are used to sterilize?
  • Aug 20 2011: Soory for the delay. Autoclaving, chemical sterilization etc. I have found another reason for HAI- Medical personnel!!!!. The ties physicians wear are washed infrequently.
  • Aug 16 2011: In 1980, while studying viruses and evolution in college, my instructor said he saw no purpose for viruses in evolution. I suddenly realized he was wrong, since a virus is merely DNA cased in protein, which is injected into a cell. This was nothing more than an upload of information at the cellular level.

    It was then I hit on the "cockroach theory of history". If we trey to poison cockroaches, and they now get fat off things that used to kill them, why wouldn't microbes adapt in the same fashion to our attempts to kill them off? I asked my instructor why wouldn;t germs develop immunities to penicillin, since germs themselves are seeking a toehold on survival the same as any organism.

    I had stumbled on an idea that later became known as epigenetics. Viruses inform bacteria, and by a cut and paste of DNA, they constantly inform different species and cause necesary adaptation at the cellular level. The more we try to kill them off, the more they adapt like the cockroaches, and we have to deal with the consequences. Many familiar with epigenetics now suggest we learn to live cooperatively with germs, instead of trying to kill them.
  • Aug 16 2011: Is there a possibility that hospitals could teach patients the risks of infections while hospitalized and offer a list of things to do prior (if scheduled, prevenatively) while in hospital and prevenatively, especially for the older population more at risk for a long stay?

    If we draw awareness to the risk would it create fear or help patients?
    my thoughts are they already have fear and they may trust the institution for being up front about the issue
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    Aug 16 2011: Lot's of valid points discussed below.
    Following points also plays a role

    Non compliance to anti-biotic leading resistance & hospital got all kind of patients so it can harbour those rsistant microbes.
    Inadequate & irresponsible use of antibiotics by doctors in many part of the world is also cause of resistance to antibiotic hence emergence of so called super bug.

    Even a very effective antibiotic to certain microbes in hospital setting can cause nosovomial infection of other microbes to which that antibiotic is not effective. With in body actually due to inter and intra specific competition in normal situation there is a balanced population of different parasitic and non parasitic microbes. Killing one or other microbes effectivley by antibiotics opens up the opportunity for other microbes to grow exponentially. If that is an resistant one , then one might end up having another infection.

    Last not least hospitalized patients means , their host defence mechanism might not be at optimal level , so that also makes them susceptible to nosocomial infection.

    Please these are some thoughts not being a scietist or doctor , so might have some flaw, so would be grateful if anyone points out that.....so can learn
  • Aug 15 2011: Obviously the largest factor is hospitals. I don't mean to be facetious, although most days I just can't resist, but if you group large amounts of sick people together and then lock them in a contained environment then bad stuffs a gonna happen.
  • Aug 15 2011: Two very good books in this regard: "Survival of the Sickest" by Dr. Sharon Moalem, and "Global Brain, by Howard Bloom". Both books explore the relatively new idea that viruses became the "cut and paste" engine of microbial evolution, and we are the results. Also, a study of epigenetics is helpful
  • Aug 15 2011: Hospital-acquired infections owe their presence partly due to the lack of hygiene amongst medical staff / human error/other unprofessional occurrences. Fortunately, these could be rooted out by simply cautioning the staff. These problems are pointed out by previous posters.


    However, what worries me the most is the new generation of ultra-resistant microorganisms, emerging as immune survivors from the bombardment of antibiotics, used extensively in hospital environments to maintain sterility. Such breeds (MRSA, VRE, Tuberculosis etc.) lead to practically incurable illnesses. Honestly, this issue lacks proper attention.
    • Aug 15 2011: Yes superbugs lack proper attention. Is this perhaps because people feel it is insurmountable?

      What do you believe is the root of the 'unprofessional behavior' that you speak of, what factors are leading to the lack of proper hygiene and disregard of proper sterile technique ect ?
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        Aug 16 2011: the focus of the medical and scientific communities in relation to combating superbugs appears to be either pharmacuetical or developing gene therapies ....not much attention at all is paid to phage therapy which has been proven to work on number of bacterial infections ....
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    Aug 15 2011: medical and nursing staff not washing hands at all or properly in between working with patients .......if the people who do stand up to the people who don'tt and the hospital backs them a lot would change ..........unfortunately our society will rush towards some costly technology or chemical before it will focus on the proper utilisation of H2O and soap .....
    • Aug 15 2011: I agree, this is because I was taught well- There is an idea that we MUST pump in and pump out and sometimes there is data being collected to make sure we do. What I mean is pumping the hand sanitizer on our way into a patients room and on our way out. There are potentially two problems with this.

      hand sanitizer: pump in and out
      1) lost sense of need for hand-washing
      2)could this impair our body's defenses against the microbes it comes into contact with, would this effect our patients?

      I do not believe that hand washing is the only answer to the problem- and I swear this topic could be it's own question, how to change hand-washing practices in hospitals. . .
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        Aug 15 2011: yeah probably not the only answer but one thats forgotten so often ........there has been a breakdown in understanding over the years of what is a "sterile field" and how to maintain it in a hospital setting ......

        with hand pumps there is the potential for "leftovers" at the end of the pump nozzle sitting and collecting bacteria which gets passed on to the next person .....simple hand washing with soap and water, and perhaps having YOUR OWN moisturiser, works well ......

        keeping it simple, inexpensive and accessible should be a major focus IMO