Ashley, Alta

Maine Department of Health and Welfare

English

Maine State Documents (Maine State Library)

Maine State Library Digital Maine Health & Human Services Documents Health & Human Services 2-1-1960 Epidemiology of Hospital Centered Infections Maine Department of Health and Welfare Alta Ashley Maine Department of Health and Welfare Follow this and additional works at: https://digitalmaine.com/dhhs_docs Recommended Citation Maine Department of Health and Welfare and Ashley, Alta, "Epidemiology of Hospital Centered Infections" (1960). Health & Human Services Documents. 30. https://digitalmaine.com/dhhs_docs/30 This Text is brought to you for free and open access by the Health & Human Services at Digital Maine. It has been accepted for inclusion in Health & Human Services Documents by an authorized administrator of Digital Maine. For more information, please contact statedocs@maine.gov. D e a n  H .  F i s h e r , M.D.C O M M I S S I O N E RState Of MaineDepartment of Health and WelfareReprinted from the February I960 issue ofThe Journal of The Maine Medical AssociationEpidemiology Of Hospital Centered InfectionsA l t a  A s h l e y , M.D., M.P.H.*The modern hospital serves a varied role; a place of healing for the sick and maimed, workshop for physi­cians, research laboratory for the study of diseases and their cures, and as a health education center for the pro­fessional staff, physician, patients and general public. A century ago, the hospital was little more than a place to die. Death was frequent and it mattered little whether it was from the original affliction or from in­fection acquired within the hospital.For the past few years it has become evident that even in the best modern hospital, acquired infection is not unknown. This is especially true with regards to nursery infections and post-operative and post-partum staphylococcal infections. Such hospital centered infec­tions are unfortunate, expensive, often tragic; and are in the most part preventable. Every means possible must be used to prevent them.The control of hospital centered infections requires unrelenting effort cn the part of all persons involved with the care and comfort of the hospitalized individual. An understanding of epidemiologic factors relative to spread of disease is desirable in formulating procedures for the control of ( hospital centered) infection.Infection is the result of the interaction of three factors; virulence of the organism, the resistance of the host, and the size of the inoculum. Two other factors to be considered in hospital centered infections are the reservoir (infected persons brought into the milieu) and vectors or transmitting agents ( insects, healthy car­riers, infected food, and contaminated inanimate ob­jects). Whatever modifies the interplay of these fac­tors affects the outcome e.g. tends to suppress the rate of infection. The modes of spread (vehicles), the sus­ceptibility of the organism to changes in the environ­ment, the age, sex, and distribution of the host and reservoir and location and type of infection determine the methods of control.The portal of exit of an infecting agent is one of the most important factors in determining its ease of spread.* District Health Officer.Most agents use but one portal of exit. If there are two one is definitely subordinant to the other, e.g. polio­myelitis (fecal over respiratory) smallpox (respiratory over skin lesions). Infectious diseases to which human infection is a blind alley, e.g. trichinosis, malaria, tet­anus, need no isolation techniques to control spread; diseases contracted through venereal contact almost ex­clusively can be handled easily in open wards. Respira­tory spread is constant, spread through fecal contamina­tion is intermittent, not only because defecation is in­termittent but actual excretion of organisms into the fecal contents is also intermittent in some diseases, for example in the typhoid-dysentery group.Susceptibility of the organism to changes in environ­ment plays a large role in disease control. The spread of organisms which are susceptible to drying can be retarded by controlling the immediate environment of the patient through gowning, masking and handwash­ing. Those organisms which resist drying or high tem­peratures such as spore formers, the virus of serum hepatitis, and the staphylococcus, require much more rigid control of the air, clothing and equipment to pre­vent their spread.The staphylococcus, which may be excreted by the respiratory tract, the skin, in the feces; or carried with­out infection in the nose, throat, on clothing and skin; resists changes in environment — drying, short periods of heat, chemicals ( chemotherapeutic agents) and taxes man’s ingenuity to develop measures of control.The modern hospital is by its very nature an excellent example of the interplay of these factors. The very young, the very old, the maimed and debilitated make up a large part of hospital population. They are also the group which is most highly susceptible to infection, and which are most in need of hospital care. Infections which have failed to respond to home care are also found in hospitals! The causative organisms have al­ready acquired, to a large degree, resistance to many antibiotics. Thus, within most hospital walls are con­gregated many sources of infection and a group of per­sons highly susceptible to those infections.Hospital centered staphylococcal infection is a prime example of the effect of drugs on an infecting organ­ism. The widespread use of antibiotics both within the hospital and in the community at large has apparently destroyed the balance between saprophytic and patho­genic organisms so that drug-resistant pathogenic organ­isms have increased to levels enabling them to infect apparently healthy hosts. Means of attack are to try to restore the saprophytic-pathogenic balance through the regulation and limitation of drug therapy, to find an effective agent to destroy the organism in the environ­ment, and to improve isolation techniques.Diseases such as smallpox, typhoid, diphtheria and polio in which effective active immunization is avail­able are best controlled by diminishing the susceptibility of the host through prophylactic immunization. Im­munity against such diseases among hospital staffs should be kept at as high levels as possible through periodic inoculations. The use of influenza vaccine in season is also recommended.Susceptibility of exposed individuals can be reduced also through passive immunization produced by means of gamma globulin in such diseases as infectious hepa­titis, measles and german measles; by diphtheria anti­toxin and by hyper-immune pertussis serum when indi­cated.Staff members at risk regarding tuberculosis should be protected by constant vigilance through skin testing and roentgen chest examination. Under certain cir­cumstances, the use of BCG may be considered as a means of protection.The danger of outbreaks of common contagious dis­eases can be minimized in pediatric departments by careful admission histories as to possible prior exposure, immunization and contagious disease experience of all children admitted; isolation of those with fever of un­determined origin; use of passive immunizing agents in exposed susceptibles; and discharge of susceptible patients who can be safely discharged before onset of communicable state, and isolation of those not able to be discharged.Isolation techniques are means by which we try to reduce the spread of disease through controlling the environment, including the vehicles of spread (flies, fomites, foods, and healthy carriers).Enteric diseases are spread in large part through fecal contamination of the environment although entero­viruses may also be isolated early from throat washings. The excreta, then, must be handled with care; enema cans, bedpans, etc. must be sterilized; personal linen and bedding must be regarded as contaminated; and all un­used foods, drink, and objects handled by the patient destroyed or cleansed. Persons working about such a patient should be gowned, and great care must be taken as to hand washing when leaving the room. Isolation in separate quarters is desirable for such patients and especial attention paid to fly control. Persons coming in direct contact with cases of enteric disease, such assalmonellosis and shigellosis must have their urine and stools cultured in order to be sure infection has not taken place during the time of exposure.In the control of diseases spread by droplet infection without evidence of spread through fecal contamination, the point of attack is the reduction of droplet con­tamination of the air breathed by contacts through masking, ultra-violet irradiation of the air, air condition­ing, chemical prophylaxis, and care in disposal of mate­rial soiled by sputum. Frequent examination and culture of the nose and throat of attendants is most important when colonization of healthy persons occur, as in staphy­lococcal, streptococcal or diphtheritic infections.Constant watch for evidence of infection must be maintained, particularly in post-operative and post­partum patients, newborns and infants. Diarrhea or a sudden rise or drop in temperature in a newborn are signs of impending danger from infection for which a source should be sought and from which other mem­bers of the nursery should be protected by strict isolation techniques. Development of skin lesions, however in­significant, among these patients and their associates, is an indication of a possible staphylococcal outbreak with­in the hospital or ward.The spread of infection from the hospital to the community is an ever present problem. When patients who have entered a hospital with infection or who have acquired infection while hospitalized are discharged with infection still present, the family should be in­structed in proper techniques for handling such patients and in the need for release cultures, if such are required by the Rules and Regulations of the Bureau of Health.Staphylococcal infection poses a particular problem in this regard. Often, hospital discharge occurs during the incubation period or the patient develops inapparent infection which none-the-less renders him a source of infection to others. This is particularly true of post­partum patients and newborns. When a staphylococcal problem is known to exist in a hospital, follow-up of discharged patients should be done either by telephone or through public health nursing services.If recently discharged patients are readmitted because of staphylococcal infections, it is apparent that a hospital-centered problem exists. Diligent search for the source of infection must be made and appropriate means of combatting the infection instituted.It is the legal responsibility of the administrator of a hospital to report to the Local Health Officer or to the Bureau of Health all cases of reportable diseases. Occur­rence of any unusual communicable disease or any out­break should be reported immediately to the Bureau of Health. This is a most important step in the finding of sources of such infections, which may be unrecognized in a community, particularly one remote from the hospital.With proper attention to means of infection control the modern hospital need not fear that it will return to play the role of pest house or become a source of in­fection for its patients, staff or the community.

Epidemiology of Hospital Centered Infections

https://digitalmaine.com/cgi/viewcontent.cgi?article=1030&context=dhhs_docs

Epidemiology of Hospital Centered Infections

Abstract

Similar works

Full text

Available Versions

Maine State Documents (Maine State Library)