Nosocomial infections: Epidemiology, prevention,
control and Surveillance
Abstract
Nosocomial infections, also known as healthcare-associated infections (HAIs), represent a
significant global threat to patient safety, contributing to increased morbidity, mortality, and
healthcare costs. These infections, which arise during medical care and were not present at the
time of patient admission, include bloodstream infections, ventilator-associated pneumonia,
urinary tract infections, and surgical site infections. In addition to viruses and fungi like Candida
and Aspergillus, the main culprits are bacteria, including Staphylococcus aureus, Pseudomonas
aeruginosa, Enterococcus species, and multidrug-resistant strains like MRSA.
Transmission routes span from environmental sources and healthcare personnel to contaminated
equipment. According to epidemiological data, low- and middle-income nations have a higher
incidence of nosocomial infections.
although they remain a serious concern in high-income settings as well. Prevention strategies
emphasize environmental hygiene, hand hygiene, staff training, proper use of medical devices,
and robust waste management. Effective control requires integrated hospital-wide infection
control programs supported by active laboratory involvement. In order to track infection patterns,
direct preventative measures, and enhance patient outcomes, surveillance is essential.
This review provides a comprehensive overview of the etiological agents, types, epidemiology,
and evidence-based measures for the prevention, control, and surveillance of nosocomial
infections.
1. Introduction
Health care-associated infection (HCAI), also known as nosocomial infection, is defined as ‘an
infection occurring in a patient during the process of care in a hospital or other health-care
facility which was not present or incubating at the time of admission. This includes infections
acquired in the hospital, but appearing after discharge, and also occupational infections among
staff of the facility [1]. Theoretically patients (hospitalized or outpatient), healthcare workers
(HCWs) and visitors such as the family members of hospitalized patients can all acquire
nosocomial infection, but it is more difficult to ascertain nosocomial infections in outpatients and
visitors as they could also acquire the infection from the community [2]. The most frequent
HCAIs include urinary tract infections (UTI), surgical site infections (SSI), bloodstream
infections (BSI) and hospital-acquired pneumonia (World Health Organization, 2011) [3,4]
Those are acquired independently during medical operations and are connected to devices, but
the burden of nosocomial infections is also thought to be significantly increased by the spread of
microorganisms among hospitalized patients [5]. Hospital-acquired infections (HAIs) occur
globally in developed and developing countries with high morbidity and mortality For example
in the USA and Europe, HAIs are among the leading cause of death [6, 7]. Bacteria are
responsible for 90% of Nis, while mycobacterial, viral, fungal, or protozoal agents are less
frequently implicated.
The bacteria that commonly cause nosocomial infections include Staphylococcus (S.) aureus,
Streptococcus spp., Bacillus cereus, Acinetobacter spp., coagulase negative staphylococci,
enterococci, Pseudomonas (P.) aeruginosa, Legionella and members of the Enterobacteriaceae
family such as Escherichia (E.) coli, Proteus mirabilis, Salmonella spp., Serratia marcescens and
Klebsiella pneumoniae. However, E. Coli, S. Aureus, enterococci, and P. Aeruginosa have been
the nosocomial infections most commonly reported [8,9].
Hospital-acquired infections are a major challenge to patient safety. Device-associated infections
(i.e., ventilator associated pneumonia, catheter-associated urinary tract infection, and central
catheter-associated bloodstream infection) account for 25.6% of all health care-associated
infections; together, device-associated infections and surgical-site infections (21.8%) account for
47.4% of all health care-associated infections (239 of 504 infections). Nosocomial infections can
have significant negative consequences, including extra
