Nosocomial infections lurking in hospital wards

Nosocomial infections lurking in hospital wards

By Bambang Tiong

YOGYAKARTA (JP): It once happened that all the babies in a
ward in a famous Yogyakarta hospital were struck by diarrhea. At
first the hospital thought the cases were attributable to the
garbage dump, but after a more thorough study, it was discovered
that source of the attack was to be found in insufficiently
sterilized baby bottles.

The case above, just like thousands others of the same nature,
is known in medical circles as a nosocomial infection (from the
Greek nosocomium meaning hospital). A nosocomial infection, then,
is one that originates or takes place in a hospital.

"In hospital there are a lot of bacterium that are resistant
to antibiotics," said Dr. Ristanto S. of Gadjah Mada University
in Yogyakarta, and also a core member of the Indonesian
Association of Clinical Microbiologists (PAMKI).

According to him, nosocomial infections are not a new threat,
particularly to inpatients. Their danger has been known of since
the late 18th century, when viruses, bacteria, fungi and
parasites were blamed.

Of these four culprits, viruses and bacterium were the most
dangerous because of the quick and easy way they become resistant
to antibiotics.

The first nosocomial was detected by an obstetrician in
Vienna, Austria, Iqnas Philip Semmelweis, while he was observing
women in labor. What attracted his attention was the fact that 30
percent of women who gave birth in hospital contracted a fever,
while none of those giving birth at home did.

This finding raised many questions among doctors at the time,
who were still unaware of nosocomial dangers.

As time went on, the threats from nosocomial infection
diversified, a fact leading to the surprising discovery by
doctors that 40 percent of Staphylococcus aerus bacterium were
resistant to antibiotics.

"The more advanced a country is the more nosocomial cases will
be found," Ristanto said.

He said that in developed countries medical advances have led
to advanced antibiotics, with the result that many bacterium have
a high resistance against these antibiotics.

Dr. Yovita Y., chairwoman of the nosocomial management team at
Panti Rapih Hospital, Yogyakarta, said that a number of factors
are responsible for the emergence of nosocomial infections:

"A patient in a weak physical condition is more prone to have
a nosocomial infection. Also, if a hospital is not hygienic, the
patients are more likely to suffer nosocomial infections," he
said.

Dr. Ristanto added that hospital visitors were also sometimes
to blame for nosocomial infections.

Someone with tuberculosis, for example, visits a patient
suffering a bout of malaria. As this malaria patient is
physically weak, it is likely that he or she too will get
tuberculosis

"Nosocomial cases are also brought about by interaction
between patients. A malaria patient staying in the same room as a
patient with tuberculosis is also likely to get tuberculosis,"
Risanto said.

The Ministry of Health has issued instructions that every
hospital should have a special team to deal with and cut down to
the minimum the occurrences of nosocomial infections.

The team should be comprised of experts and should also
include hospital security guards, who should be the first people
monitoring visitors to a hospital.

Apart from these internal teams, PAMKI, whose operations are
nationwide, is always ready to fight nosocomial cases across the
country.

This association was established with the following rationale:
"Control over infection in hospital is a necessity in order to
prevent patients from having infection and efforts will be made
in the form of prevention, surveillance and rational therapy."

The basic impetus underlying the establishment of PAMKI was
an awareness of nosocomial hazards, which led to a determination
to cut down on their frequency. Nosocomial infections can and
must be prevented and a patient has the right to enjoy hospital
treatment with the minimum risk of being nosocomially infected.

Therefore, PAMKI is now actively accrediting hospitals to
ensure that they meet the standard set for 12 areas, including
administration, management and medical services.

Ristanto said it was difficult for hospitals to meet the
standards in all the 12 areas because of money. Operating theater
walls, for example, must not have any curves because it is in
these curves that many pathogenic bacteria hide.

PAMKI has defined nosocomial infections as infections that a
patient sustains after having hospital treatment for more than 48
hours, excluding patients who have diseases that incubated while
still at home.

According to a PAMKI study, nosocomial infections are most
likely to be found in intensive care and constitute between 13
percent and 42 percent of all such cases in a hospital. This is
because there are many invasive procedures in intensive care,
such as infusions or transfusions.

The records kept by Dr. Karyadi Hospital in Semarang, Central
Java, say that nosocomial infections are usually found in the
following areas: urethra (42 percent), surgery-related wounds (20
percent), lower respiratory tract (14 percent), blood (8 percent)
and others (16 percent).

Dr. Ristanto said that although PAMKI was established in early
1990, the association has yet to produce maximum results because
of limited funds and reluctance on the part of experts to engage
in social work.

"I have great concerns over the fact that many experts are
unwilling to join the association because it means social work.
In some cases, we have to fork out our own savings. Just imagine,
that for a national organization PAMKI has only 42 members," he
said.

Therefore, at present PAMKI can only observe nosocomial
infections with short incubation periods, such as when a patient
gets a fever when he or she is being treated in hospital. The
association, he added, is still unable to observe nosocomial
infection cases with long incubation periods such as
tuberculosis.

In addition, apart from accrediting hospitals, PAMKI is also
engaged in research to find antibiotics that fight bacterium or
viruses responsible for nosocomial infections.

The first activity in this respect is capturing bacterium and
putting them into a Mullerhinton jelly by means of a disc
dysfunction in order that potent antibiotics may be discovered.

Stressing the dangers of nosocomial infections may bring
about, Dr. Ristanto finally said that some AIDS patients may have
lost their lives not because of HIV infection but because they
contracted a nosocomial infection when they were physically weak.