Gürkan MERT, Hanefi GÜL CEM, Can Polat EYİGÜN

Hastane ortamından oluşan hastane enfeksiyonları epidemiyolojisi

Hastane ortamları, nozokomiyal enfeksiyonların en önemli kaynağıdır. Hastane ortamı ile hastanenin havası, suyu ve ortamda bulunan tıbbi malzemeler ve eşyalar, hastanın yiyecek, içecekleri ve eşyaları anlaşılmaktadır. Bunlar içinde enfeksiyon açısından en önemlileri hava ve sudur. Bu enfeksiyonların gelişiminde konak,mikroorganizma ve çevresel faktörlerin birbiriyle etkileşimleri söz konusudur. Canlı ve cansız kaynaklarda bulunan mikroorganizmalar hastane ortamındaki bireylere farklı yollardan bulaşabilmektedir. Hastane ortamı pek çok komponenti içinde barındırdığı için gelişebilecek enfeksiyonlar ile savaşı güç ve karmaşık kılmaktadır. Bu derlemede hastane ortamlarında enfeksiyon kaynağı olabilecek hangi patojenlerle karşılaşabileceği, bu patojenlerin bulaş yollarının belirlenmesi, sıklık sıraları, koruma ve kontrol yöntemleri gözden geçirilmiştir.

Epidemiology of hospital infections: From the hospital environment

Hospital environments are the most important source of nosocomial infections. The concept of the hospital environment that includes the hospital's air, water and environment, medical equipments, the patient's food, drinks and articles. Air and water are the most important in terms of infection within them. There are interactions with each other host, microbial and environmental factors in the development of these infections. The microorganisms live or inanimate resources can be transmitted from different ways to the individuals in the hospital environment. The hospital environment contains many components. Therefore, infections with the war are difficult and complex. In this review which, may be a source of infection in hospital environments encountered pathogens, the determination of routes of transmission of pathogens, frequency ranges, protection and control methods are reviewed.

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1 Guidelines for Environmental Infection Control in Health-Care Facilities, Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Centers for Disease Control and Prevention (CDC) Atlanta, GA, 2003.
2 Sigler L, Kennedy MJ. Aspergillus, Fusarium, and other opportunistic moniliaceous fungi. Eds.: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH: Manual of clinical microbiology. 7th edition. Washington, D.C. American Society for Microbiology, 1999, p. 1212-1241.
3 Sigler L, Verweij PE. Aspergillus, Fusarium, and other opportunistic moniliaceous fungi. Eds.: Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH: Manual of clinical microbiology. 8th edition, vol 2. Washington, D.C. American Society for Microbiology, 2003, p. 1726-1760.
4 Anastasi A, Varese GC, Marchisio VF. Isolation and identification of fungal communities in compost and vermicompost. Mycologia. 2005; 97: 33-44
5 Kwon Chung KJ, Bennett JE. Medical Mycology. Philadelphia; Lea and Fabinger, 1992.
6 Manuel R, Kibber C. The epidemiology and prevention of invaziv aspergillosis. J Hospital Infect. 1998; 39: 95-109.
7 VandenBergh M, Verweij P, Voss A. Epidemiology of nosocomial fungal infections: invazive aspergillosis and the environment. Diagn Microbiol Infect Dis. 1999; 34: 221-227.
8 Wenzel R, Brewer T, Butzler JP. A guide to infection control in the hospital. 3rd edition. International Society for Infectious Diseases, Boston. 2004, p. 204-239.
9 Blanc DS, Petignat C, Janin B, et al. Frequency and molecular diversity of Pseudomonas aeruginosa upon admission and during hospitalization: a rospective epidemiologic study. Clin Microbiol Infect. 1998; 4: 242-247.
10 Bertrand X, Thouverez M, Patry C, Balvay P, Talon D. Pseudomonas aeruginosa: antibiotic susceptibility and genotypic characterization of strains isolated in the intensive care unit. Clin Microbiol Infect. 2001; 7: 706-708.
11 Ruiz L, Dominguez MA, Ruiz N, Vinas M. Relationship between clinical and environmental isolates of Pseudomonas aeruginosa in a hospital setting. Arch Med Res. 2004; 35: 251-257.
12 Lasheras A, Guisset O, Boulestreau H, et al. Reservoirs and transmission of Pseudomonas aeruginosa in intensive care unit. Med Mal Infect. 2006; 36: 99-104.
13 Blanc DS, Nahimana I, Petignat C, Wenger A, Bille J, Francioli P. Faucets as a reservoir of endemic Pseudomonas aeruginosa colonization/infections in intensive care units. Intensive Care Med. 2004; 30: 1964-1968.
14 Schelenz S, French G. An outbreak of multidrug-resistant Pseudomonas aeruginosa infection associated with contamination of bronchoscopes and an endoscope washerdisinfector. J Hosp Infect. 2000; 46: 23-30.
15 Cobben NA, Drent M, Jonkers M, Wouters EF, Vaneechoutte M, Stobberingh EE. Outbreak of severe Pseudomonas aeruginosa respiratory infections due to contaminated nebulizers. J Hosp Infect. 1996; 33: 63-70.
16 Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis. 2006; 42: 692-699.
17 Wareham DW, Bean DC, Khanna P, et al. Bloodstream infection due to Acinetobacter spp: epidemiology, risk factors and impact of multidrug resistance. Eur J Clin Microbiol Infect Dis. 2008; 27: 607-612.
18 Cisneros JM, Reyes MJ, Pachon J, et al. Bacteriemia Due to Acinetobacter baumannii: Epidemiolgy, Clinical Findings, and Prognostic Features. Clin Infect Dis. 1996; 22: 1026-1032
19 Timsit JF, Gattait V, Misset B, et al. The digestive tract is a major site for Acinetobacter baumannii colonization in intensive care unit patients. J Infect Dis. 1993; 168: 1336-1337.
20 Villarino ME, Stevens LE, Schable B, et al. Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients. Infect Control Hosp Epidemiol. 1992; 13: 201-202.
21 Kerr KG, Corps CM, Hawkey PM. Infections due to Xanthomonas maltophilia in patients with hematologic malignancy. Rev Infect Dis. 1991; 13: 762.
22 Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinteobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med. 2003; 29: 471-475.
23 Elting LS, Khardori N, Bodey GP, et al. Nosocomial infection caused by Xanthomonas maltophilia: a case control study for predisposing factors. Infect Control Hosp Epidemiol. 1990; 11: 134-138.
24 Mayhall CG. Hospital Epidemiology and Infection Control. Baltimore. Williams & Wilkins, 2004, p. 587.
25 Borriello SP. Pathogenesis of clostridium difficile infection. J Antimicrobiol Chemother. 1998; 41: 21-27.
26 McFarland LV, Stamm WE. Review of Clostridium difficile associated diseases. Am J Infect Control. 1986; 14: 99-109.
27 Rutala WA, Gergen MF, Weber DJ. Inactivation of spores by disinfectants. Infect Control Hosp Epidemiol. 1993; 14: 36-39