Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-30T21:51:35.703Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Respiratory Infections

Published online by Cambridge University Press:  02 January 2015

Richard E. Dixon
Richard E. Dixon*
Affiliation:
From the Helene Fuld Medical Center, Trenton, New Jersey, and, Hahnemann University, Philadelphia, Pennsylvania
*
Department of Medicine, Helene Fuld Medical Center. 750 Brunswick Avenue, Trenton, NJ 08638
Get access Rights & Permissions [Opens in a new window]

Abstract

Nosocomial respiratory tract infections are major causes of excessive morbidity and mortality in US hospitals, affecting an estimated five to ten of every 1,000 patients. Patients with serious underlying diseases have an especially high risk of acquiring these infections, and that risk is magnified by exposure to respiratory therapy. Until recently, contaminated respiratory care devices were a major cause of infection, but procedures for the management of these devices have decreased their role substantially. Now, aspiration of oropharyngeal flora appears to be responsible for most cases of bacterial respiratory infections. Therefore, techniques to alter the flora of the oropharynx and to diminish the risk of aspiration are important priorities for infection control. Exposure to intensive care units (ICUs) is also a major risk factor for nosocomial pulmonary infection, and person-to-person spread of microorganisms within ICUs seems to be responsible for some of these infections.

Increasing numbers of pulmonary infections are being caused by newly identified or previously uncommon pathogens, and this shift requires that traditional control techniques be reevaluated to assure that they remain relevant.

Few new techniques have been developed recently to alter host susceptibility, prevent acquisition of virulent pathogens, or eradicate infectious organisms from their sources, but effective infection control programs in hospitals appear to reduce the incidence of nosocomial pulmonary infection, and implementation of these programs deserves serious consideration in all hospitals.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 4 , Issue 5 , October 1983 , pp. 376 - 381
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1983

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Allen, JR, Hightower, AW, Martin, SM, et al: Secular trends in nosocomial infections: 1970-1979. Am J Med 1981; 70:389–392.CrossRefGoogle ScholarPubMed
2.Wenzel, RP: Surveillance and reporting of hospital acquired infections, in Wenzel, RP (ed): CRC Handbook of Hospital Acquired Infections. Boca Raton: CRC Press, 1981, pp 35–72.Google Scholar
3.Haley, RW, Hooton, TM, Culver, DH, et al: Nosocomial infections in US hospitals, 1975-1976: Estimated frequency by selected characteristics of patients. Am J Med 1981; 70:947–959.CrossRefGoogle ScholarPubMed
4.Dixon, RE: Effect of infections on hospital care. Ann Intern Med 1978; 89:749–753.CrossRefGoogle ScholarPubMed
5.Cross, PA, Neu, HC, Aswapokee, P, et al: Deaths from nosocomial infections: Experience in a university and a community hospital. Am J Med 1980; 68:219–223.Google Scholar
6.Haley, RW, Schaberg, DR, Crossley, KB, et al: Extra charges and prolongation of stay attributable to nosocomial infections: A prospective interhospital comparison. Am J Med 1981; 70:51–58.CrossRefGoogle ScholarPubMed
7.Hooton, TM, Haley, RW, Culver, DH: A method for classifying patients according to their nosocomial infection risks associated with diagnoses and surgical procedures. Am J Epidemiol 1980; 111:556–573.CrossRefGoogle ScholarPubMed
8.Hooton, TM, Haley, RW. Culver, DH, et al: The joint associations of multiple risk factors with the occurrence of nosocomial infection. Am J Med 1981; 70:960–970.CrossRefGoogle ScholarPubMed
9.Garibaldi, RA, Brin, MR, Coleman, ML, et al: Risk factors for postoperative pneumonia. Am J Med 1981; 70:677–680.CrossRefGoogle ScholarPubMed
10.Cross, AS, Roup, B: Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 1981; 70:681–685.CrossRefGoogle ScholarPubMed
11.Pierce, AK, Sanford, JP, Thomas, GD, et al: Long-term evaluation of decontamination of inhalation-therapy equipment and the occurrence of necrotizing pneumonia. N Engl J Med 1970; 282:528–535.CrossRefGoogle ScholarPubMed
12.Reinarz, JA, Pierce, AK, Mays, BB, et al: The potential role of inhalation therapy equipment in nosocomial pulmonary infection. J Clin Invest 1965; 44:831–839.CrossRefGoogle ScholarPubMed
13.Pierce, AK, Sanford, JP: Bacterial contamination of aerosols. Arch Intern Med 1973; 131:156–159.CrossRefGoogle ScholarPubMed
14.Metz, DJ, Grieco, MH: Characteristics of Serratia marcescens pneumonia. Arch Intern Med 1973; 132:359–364.CrossRefGoogle Scholar
15.Ringrose, RE, McKown, B, Felton, FG, et al: A hospital outbreak of Serratia marcescens associated with ultrasonic nebulizers. Ann Intern Med 1968; 69:719–729.CrossRefGoogle ScholarPubMed
16.Rhoades, ER, Ringrose, R, Mohr, JA, et al: Contamination of ultrasonic nebulization equipment with gram negative bacteria. Arch Intern Med 1971;127:228–232.CrossRefGoogle ScholarPubMed
17.Grieble, HG, Colton, FR, TJ, Bird, et al: Fine-particle humidifiers: Source of Pseudomonas aeruginosa infections in a respiratory-disease unit. N Engl J Med 1970; 282:531–535.CrossRefGoogle Scholar
18.Smith, PW, Massanari, M: Room humidifiers as the source of Acinetobacter infections. JAMA 1977; 237:795–797.CrossRefGoogle ScholarPubMed
19.Committee on Therapy, American Thoracic Society: Cleaning and sterilization of inhalation equipment. Am Rev Respir Dis 1968; 98:521–522.Google Scholar
20.Haley, RW, Shachlman, RH: The emergence of infection surveillance and control programs in US hospitals: An assessment, 1976. Am J Epidemiol 1980;111:574–591.CrossRefGoogle ScholarPubMed
21.Buxton, AE, Anderson, RL, Werdergar, D, el al: Nosocomial respiratory tract infection and colonization with Acinetobacter calcoacelicus: Epidemiologic characteristics. Am J Med 1978; 65:507–513.CrossRefGoogle Scholar
22.Lareau, SC, Ryan, KJ, Diener, CF: The relationship between frequency of ventilator circuit changes and infection hazard. Am Rev Respir Dis 1978; 118:493–496.Google Scholar
23.Craven, DE, Connolly, MG, Lichtenberg, DA, et al: Contamination of mechanical ventilators with tubing changes every 24 or 48 hours. N Engl J Med 1982; 306:1505–1509.CrossRefGoogle ScholarPubMed
24.Arnow, PM, Chou, T, Weil, D, et al: Nosocomial Legionnaires' Disease-caused by aerosolized tap water from respiratory devices. J Infect Dis 1982; 146:460–467.CrossRefGoogle ScholarPubMed
25.Plum, F, Dunning, MF: Techniques for minimizing trauma to the tracheobronchial tree after tracheotomy. N Engl J Med 1956; 254:193–200.CrossRefGoogle Scholar
26.Pereira, W, Kovnat, DM, Khan, MA, et al: Fever and pneumonia after flexible fiberoptic bronchoscopy. Am Rev Respir Dis 1975; 112:59–64.Google ScholarPubMed
27.Huxley, EJ, Voroslav, J, Gray, WR, et al: Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64:564–568.CrossRefGoogle ScholarPubMed
28.Johanson, WG, Pierce, AK, Sanford, JP: Changing pharyngeal bacterial flora of hospitalized patients: Emergence of gram-negative bacilli. N Engl J Med 1969; 281:1137–1140.CrossRefGoogle ScholarPubMed
29.Valenti, WM, Trudell, RG, Bentley, DW: Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged. N Engl J Med 1978; 298:1108–1111.CrossRefGoogle ScholarPubMed
30.Mackowiak, PA, Martin, RM, Jones, SR, et al: Pharyngeal colonization by gram-negative bacilli in aspiration-prone persons. Arch Intern Med 1978; 138:1224–1227.CrossRefGoogle ScholarPubMed
31.Greenfield, S, Teres, D, Bushnell, LS, et al: Prevention of gram-negative bacillary pneumonia using aerosol polymyxin as prophylaxis. I. Effect on the colonization pattern of the upper respiratory tract of seriously ill patients. J Clin Invest 1973; 52:2935–2940.CrossRefGoogle ScholarPubMed
32.Klastersky, J, Huysmans, E, Weerts, D, el al: Endotracheally administered gentamicin for the prevention of infections of the respiratory tract in patients with tracheostomy: A double-blind study. Chest 1974; 65:650–654.CrossRefGoogle ScholarPubMed
33.Feeley, TW, duMoulin, GC, Hedley-Whyle, J, et al: Aerosol polymyxin and pneumonia in seriously ill patients. N Engl J Med 1975; 293:471–475.CrossRefGoogle ScholarPubMed
34.Stevens, RM, Teres, D, Skillman, JJ, et al: Pneumonia in an intensive care unit: A 30-month experience. Arch Intern Med 1974; 134:106–111.CrossRefGoogle Scholar
35.Lowbury, EJL, Thorn, BT, Lilly, HAet al: Sources of infection with Pseudomonas aeruginosa in patients with tracheostomy. J Med Microbiol 1970; 3:39–56.CrossRefGoogle ScholarPubMed
36.Rose, HD, Babcock, JB: Colonization of intensive care unit patients with gram-negative bacilli. Am J Epidemiol 1975; 101:495–501.CrossRefGoogle ScholarPubMed
37.Maki, D, Hecht, J: Antiseptic-containing handwashing agents reduce nosocomial infections—A prospective study. Read before the Inter-science Conference on Antimicrobial Agents and Chemotherapy, Miami Beach, Florida, October 1982.Google Scholar
38.Rogers, DE: The changing pattern of life-threatening microbial disease. N Engl J Med 1959; 261:677–683.CrossRefGoogle ScholarPubMed
39.Fick, RB, Reynolds, HY: Changing spectrum of pneumonia—News-media creation or clinical reality? Am J Med 1983; 74:1–8.CrossRefGoogle ScholarPubMed
40.Berk, SL, Verghese, A, Holtsclaw, SA, et al: Enterococcal pneumonia: Occurrence in patients receiving broad-spectrum antibiotic regimens and enteral feeding. Am J Med 1983; 74:153–154.CrossRefGoogle ScholarPubMed
41.Arnow, PM, Anderson, RL, Mainous, PD, et al: Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis 1978; 118:49–53.Google Scholar
42.Kugler, JW, Armitage, JO, Helms, CM, et al: Nosocomial Legionnaires' Disease: Occurrence in recipients of bone marrow transplants. Am J Med 1983; 74:281–288.CrossRefGoogle ScholarPubMed
43.Cohen, ML, Broome, CV, Paris, AL, et al: Fatal nosocomial Legionnaires' Disease: Clinical and epidemiologic characteristics. Ann Intern Med 1979; 90:611–613.CrossRefGoogle ScholarPubMed
44.Yu, VL, Zuravleff, JL, Elder, EM, et al: Pittsburgh pneumonia agent may be a common cause of nosocomial pneumonia: seroepidemiologic evidence. Arm Intern Med 1982; 97:724–726.Google ScholarPubMed
45.Kimball, AM, Foy, HM, Cooney, MK, et al: Isolation of respiratory syncytial and influenza viruses from the sputum of patients hospitalized with pneumonia. J Infect Dis 1983; 147:181–184.CrossRefGoogle ScholarPubMed
46.Hall, CB, Douglas, RG, Geiman, JM, et al: Nosocomial respiratory syncytial virus infections. N Engl J Med 1975; 293:1343–1346.CrossRefGoogle ScholarPubMed
47.Meyers, JD, Flournoy, N, Thomas, ED: Nonbacterial pneumonia after allogenic marrow transplantation: A review often years' experience. Rev Infect Dis 1982; 4:1119–1132.CrossRefGoogle ScholarPubMed
48.Abdallah, PS, Mark, JBD, Merigan, TC: Diagnosis of cytomegalovirus pneumonia in compromised hosts. Am J Med 1976; 61:326–332.CrossRefGoogle ScholarPubMed
49.Rubin, RH, Wolfson, JS, Cosimi, AB, et al: Infection in the renal transplant recipient. Am J Med 1981; 70:405–411.CrossRefGoogle ScholarPubMed
50.Braude, AI, Ziegler, EJ, McCutchan, JA, et al: Immunization against nosocomial infection. Am J Med 1981; 70:463–466.CrossRefGoogle ScholarPubMed
51.Fedson, DS: Hospital-based pneumococcal immunization: The epidemiologic rationale and its implementation. Infect Control 1982; 4:303–308.CrossRefGoogle Scholar
52.Pierce, AK, Saltzman, HA: Conference on the scientific basis of respiratory therapy. Am Rev Respir Dis 1974; 110 (pt 2): 1–204.Google ScholarPubMed
53.Hook, EW III, Horton, CA, Schaberg, DR, et al: Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA 1983; 249:1055–1057.CrossRefGoogle ScholarPubMed
54.Petersdorf, RG, Curtin, JA, Hoeprich, PA, el al: A study of antibiotic prophylaxis in unconscious patients. N Engl J Med. 1957; 257:1001–1009.CrossRefGoogle ScholarPubMed
55.Forsgren, A, Schmeling, D: Effect of antibiotics on Chemotaxis of human leukocytes. Antimicrob Agents Chemother 1977; 11:580–584.CrossRefGoogle ScholarPubMed
56.Hauser, WE, Remington, JS: Effect of antibiotics on the immune response. Am J Med 1982; 72:711–716.CrossRefGoogle ScholarPubMed
57.Mandeli, LA: Effects of antimicrobial and antineoplastic drugs on the phagocytic and microbicidal function of the polymorphonuclear leukocyte. Rev Infect Dis 1982; 4:683–696.CrossRefGoogle Scholar
58.Britt, MR, Schleupner, CJ, Matsumiya, S: Severity of underlying disease as a predictor of nosocomial infection: Utility in the control of nosocomial infection. JAMA 1978; 239:1047–1051.CrossRefGoogle ScholarPubMed