Question

The Gram-negative bacillus bacteria Klebsiella pneumoniae is a major cause of nosocomial infections, primarily among immunocompromised patients. The emergence of new strains has left few treatment options, making infection containment critical.

Recently, the U.S. National Institutes of Health Clinical Center experienced an outbreak of K. pneumoniae that affected 18 patients, 11 of whom died.

In addition to standard PPE and aseptic technique - think creatively and propose

2 stronger disinfection protocols that a hospital could use to prevent future infections:

Answer 1

Nosocomil infections also called hospital acquired infection  are types of infection that are not present at the time of hospitalization but acquired by the patient during his course of hospitalization. They can be exteremely serious or highly fatal. Health care professionals often serves as the vector for this kind of infection transmission. Different protocols can be used to monitor and prevent cross infection. Important among them are use of PPE personal protection equipments and using proper aseptic techniques PPE consist of use of glove, mask, gowns while treating patients who have contagious disease. Aseptic technique include measures to reduce the transmission of pathogen from one place to another and also reducing the chance of pathogen exposure to the patients.

Other measures that can be used hand in hand are

1) Source isolation : of the infected patients. The source of infection should be founded out as early as possible and Highly infected patients should be treated under strict isolation inorder to prevent the cross contamination. Suspect or  affected patients should be isolated under the standard precautions. Proper aseptic techniques should be used to while treating them. Isolation rooms should have tight fitting door, glass partition for monitoring and negative pressure ventilation.

2) Protective isolation: Immunocompromised patients, old age patients, patients with major organ failure, patients on immunosuppressive drugs, trauma cases are at high risk of acquiring the infection. They should be properly isolated inorder to minimize the chance of acquiring opportunistic infection. They should have closed room with tight fitting door and positive pressure ventilation.

3) Environmental Hygiene: maintain proper hygiene of the hospital environment. Cleaning must be executed with proper antibacterial agents or throughoughly with soap an water. Superficial cleaning increase the chance of spread of pathogens into larger surface hence through cleaning must be executed. When the protective filim formed by organic matter or dirt is removed pathogens get dried off and eventually die

4) Sterilization and Disinfection : sterilization and disinfectant should be carried out according to protocols. Disinfection reduces the number of microorganisms  without completly eliminating the them, while sterilization removes both the vegetative spores as well as bacteria. There is no ideal disinfectant they can be selected depending upon the necessity and availability. While using on intact skin disinfectant with less toxic levels are used.

5)Precaution for specific nosocomial infections: in case of ventilator associated pneumonia avoid intubation whenever possible, prefer oral intubation, regular use of chrolhexidine mouth rinses, reduce re intubation. In case of preventing UTI use catheter only when required and immediate removal after the requirement. Urine bag should not be allowed to touch the floor.

6) other methods include frequent hand-washing or scrubbing because hand is the most common vehicle of transmission, proper handwashing to be done before touching the patent after touching the patient and surrounding, before and after of any procedures. Vigorous scrubbing shoube done at least for 15 sec.  use of mask, glove, gown other personal protection shields.

7)Proper education and trainthe professionals and paramedics about the cross infection, contamination of the environment, and importance of maintaining self and environmental hygiene.