الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Nosocomial infection (NI) or hospital acquired infection (HAI) can be defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection . This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility . Among the more industrialized and developed nations, the World Health Organization found 8.7 % of all hospitalized patients to have nosocomial infections. While HAI are an important health care concern worldwide , they are especially troublesome in developing nations. Nosocomial infection rates range from 1% in Northern Europe, especially the Netherlands, which introduced extremely aggressive infection control measures, to 40% in some parts of Asia, South America, and sub-Saharan Africa . Nosocomial infections (NI) contribute significantly to morbidity and mortality, as well as to excess costs for hospitalized patients. According to the available evidence, the impact of Health care associated infection (HCAI) implies prolonged hospital stay, long-term disability, increased resistance of microorganisms to antimicrobials, massive additional financial burden for health systems, high costs for patients and their family, and unnecessary deaths .The increased length of stay for infected patients is the greatest contributor to cost . Direct transmission from another host (healthy or ill) or from an environmental reservoir or surface by direct contact or direct large-DROPlet spread of infectious secretions is the simplest route of agent spread. Examples of direct-contact transmission routes include kissing (infectious mononucleosis), shaking hands [common cold (rhinovirus)], or other skin contact (e.g., contamination of a wound with Staphylococci or Enterococcus spp. during trauma, surgical procedures or dressing changes) . Potentially pathogenic micro-organisms can colonize environmental surfaces in the hospital environment and so act as a source for outbreaks of nosocomial infection. Studies have presented evidence that the majority of Gram-positive bacteria, including Staphylococcus aureus and Enterococcus spp., are able to survive for months on dry surfaces. Gram-negative bacteria, such as Klebsiella spp., Escherichia coli, and Acinetobacter spp. can also survive for a relatively long time on inanimate surfaces, while common fungi such as Candida spp. have similar properties. Environmental conditions such as low temperature or humidity appear to be crucial for the persistence of these organisms on inanimate surfaces . The highest prevalence of HAI occurred in ICUs and acute care surgical and orthopedic settings. Old age, multiple morbidities or disease severity, and decreased immunity increase patient susceptibility. Poor infection control measures are an overall risk factor as are certain invasive procedures including central venous or urinary catheter placements. Antimicrobial misuse is associated with drug-resistant HAI . Urinary tract, respiratory tract, surgical site, skin and bloodstream infections are currently recognized as the major nosocomial infections. However, it is becoming increasingly clear that gastroenteritis outbreaks are also a major burden on the health services of industrialized nations . Analysis of nosocomial pathogens has relied on a comparison of phenotypic characteristics such as biotypes, serotypes, bacteriophage or bacteriocin types, and antimicrobial susceptibility profiles. This approach has begun to change over the past 2 decades, with the development and implementation of new technologies based on DNA, or molecular analysis. These DNA-based molecular methodologies, include pulsed-field gel electrophoresis (PFGE) and other restriction-based methods, plasmid analysis, and PCR-based typing methods. There are a number important attributes for successful typing schemes: the methodologies should be standardized, sensitive, specific, objective, and subject to critical appraisal. All typing systems can be characterized in terms of typeability, reproducibility, discriminatory power, ease of performance and interpretation, and cost (in terms of time and money) . The use of strain typing in infection control decisions is based on several assumptions: (i) isolates associated with the outbreak are recent progeny of a single (common) precursor or clone, (ii) such isolates will have the same genotype, and (iii) epidemiologically unrelated isolates will have different genotypes . Molecular techniques can be very effective in tracing the spread of nososcomial infections due to genetically related pathogens, which would allow infection control personnel to more rationally identify potential sources of pathogens and aid infectious disease physicians in the development of treatment regimens to manage patients affected by related organisms. Therefore, the use of molecular tests is essential in many circumstances for establishing disease epidemiology, which leads to improved patient health and economic benefits through the reduction of nosocomial infections . Infection control (IC) activities are still developing in many health institutions in Egypt. The national infection control program was started in 2003 by the Ministry of Health and Population. The national IC strategic plan entailed instituting IC programs in all hospitals in Egypt by 2010 . The components of an infection control program are drawn from regulatory requirements, current nursing home practices, and extrapolations from hospital programs. The limited resources affect the type and extent of programs developed . The infection control program should include some form of surveillance for infections, an epidemic control program, education of employees in infection control methods, policy and procedure formation and review, an employee health program, a resident health program, and monitoring of resident care practices. The program also may be involved in quality improvement, patient safety, environmental review, antibiotic monitoring, product review and evaluation, resident safety, prepareness planning, and reporting of diseases to public health authorities .