Nosocomial infections: listening to human experience may help the horse.

This research discusses the history, prevalence, and major issues surrounding nosocomial infections, or hospital-acquired infections (HAIs), which include addressing the problem of antibiotic resistance and exploring potential preventative measures such as improved hygiene and the maintenance of cleanliness in hospital environments.

History of Nosocomial Infections

• The article opens by noting historical instances where the imrplementation of cleanliness procedures dramatically reduced infection rates, such as Semmelweis’s introduction of hand washing in the 19th century.
• Attention to hygiene, disinfection, and sterilization became leading methods for preventing HAIs prior to the development of antibiotics.
• The use of antibiotics further improved patient outcomes, especially their prophylactic use in late 20th century.

Current Situation of Nosocomial Infections

• Nowadays, it’s prevalent that 20% of hospital patients in the UK contract an infection during their stay, of which half are HAIs, with the other half originating in the community and being the reason for hospitalization.
• The true incidence of nosocomial infections might be higher as most surveys do not account for infections developed post hospital discharge.
• Antibiotic overuse and misuse are threats undermining the effectiveness of these agents.

Preventive Measures and Challenges

• Data indicates that with proper resources a 30% reduction in infection rates should be achievable, assisted by practices such as surgical wound infection surveillance and feedback to surgeons.
• The concept of Infection Control Teams, responsible for surveillance, teaching, and training of staff, is becoming increasingly adopted in the UK.
• However, the prevalence of HAIs in the UK doesn’t seem significantly changed between 1981 and 1995, raising considerable concerns.

Antibiotic Resistance and Pathogen Issues

• The paper reflects a worrying evolution in antibiotic resistance, with a shift from aminoglycoside resistant Enterobacteriaceae in the 70s and early 80s to problems with resistant gram-positive bacteria, particularly Staphylococci, in today’s hospitals.
• Most present-day UK hospitals struggle with methicillin resistant Staphylococcus aureus (MRSA), limiting the therapeutic solutions primarily to the glycopeptide antibiotics vancomycin and teicoplanin.
• With an increasing number of immunocompromised patients, many skin commensals, namely coagulase negative Staphylococci, have become significant pathogens.
• The situation is made worse by the recent emergence of Enterococci strains resistant to vancomycin.