Felinoterapie, NCHK

Nosocomial infections (hospital-acquired infections) and felinotherapy

 A nosocomial infection is any infection of exogenous or endogenous origin which has arisen in causal connection with the stay of persons in an outpatient or inpatient health care facility for diagnostic, therapeutic or epidemiological reasons. Nosocomial infections include those that manifest themselves after discharge to home care.
Some of these nosocomial infections can endanger the health of the felinoetrapeutic team not only when working in a healthcare facility but also in a social services facility ((nursing home, residential care facility). For this reason, it is important to become familiar with them and to take the necessary hygienic and preventive measures.

1. Classification according to the site of infection (according to clinical signs)
◦ Urinary tract infection (e.g. bladder, kidney)
        ◦ Infection of the lungs (nosocomial pneumonia)
        ◦ Wound infections (e.g. post-operative infections)
        ◦ Blood infections (bacteraemia)
        ◦ Infection of the meninges (meningitis)

2. Classification by type of pathogen
Classification by occurrence - non-specific (occurring outside healthcare settings, e.g. influenza) and specific (occurring in the hospital setting in connection with diagnostic or therapeutic procedures).
 
 ◦ Bacterial infections: e.g. Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae.
 ◦ Viral infections: these include respiratory viruses (e.g. influenza, respiratory syncytial virus), hepatitis viruses, cytomegalovirus.
 ◦Fungal infections: Candida albicans is a common causative agent of nosocomial fungal infections.
 ◦ Infections caused by resistant strains: For example, resistant strains of Staphylococcus aureus (MRSA), resistant strains of Enterobacteriaceae (ESBL).

Nosocomial infections are also divided into endogenous and exogenous infections according to the source of the infectious agent:

Division into endogenous and exogenous nosocomial infections

Endogenous infection occurs when microorganisms (e.g., bacteria or fungi) present in the patient's body become pathogenic under certain circumstances and cause infection.
These microorganisms may be part of the patient's normal microflora or present in the patient's body in a latent state.
Endogenous infections can arise, for example, as a result of a weakened immune system, the use of antibiotics, surgery, or other factors that upset the balance of microorganisms in the body.

Exogenous infections are caused by microorganisms that enter the patient's body from the external environment.
Microorganisms may be present on surfaces, equipment, clothing, or the hands of healthcare personnel, patients, or visitors.
Exogenous infections can be caused, for example, by failure to follow hygiene measures, inadequate disinfection of the environment or poor sterilisation of equipment.
Dividing nosocomial infections into endogenous and exogenous infections helps to identify the source of infection and to determine measures to prevent and control the spread of infections in the hospital environment.

There are several possible exogenous sources of nosocomial infections that can occur in the hospital environment.
Some of the major exogenous sources of nosocomial infections include:

• Contaminated surfaces and equipment: infectious agents can be transmitted from contaminated surfaces such as beds, tables, grab bars, equipment and other hospital equipment. If disinfection or sterilization is not adequately performed, microorganisms can remain on these surfaces and transmission can occur when patients or healthcare personnel come into contact with contaminated surfaces.

• Healthcare personnel: infectious agents can be transmitted by healthcare personnel if they do not follow strict hygiene practices such as inadequate hand washing, failure to follow protocols for the use of protective equipment (gloves, drapes), or inadequate adherence to patient isolation protocols.

• Patients: infectious agents can be transmitted between patients, especially if they are in close contact. This may include direct contact with an infected person, or airborne transmission if the patient coughs, sneezes or talks. Immunocompromised patients are particularly susceptible to infections.

• Visitors: Visitors or family members of patients may be carriers of infectious agents if they do not follow given hygiene regulations. For example, inadequate hand washing after using the toilet and subsequent contact with the patient can contribute to the transmission of infection.

It is important that hospital facilities have measures in place to prevent the spread of nosocomial infections from these exogenous sources. This includes regular disinfection of surfaces, strict hand hygiene, adherence to patient isolation protocols, and education of healthcare staff, patients, and visitors about hygiene precautions.

Modes of spread of nosocomial infections:
1. Contact transmission : Direct contact with an infected person or contaminated objects.
2. Droplet transmission - Transmission through sneezing, coughing or talking when droplets become airborne.
3. Airborne transmission : Spread of infection by small particles produced by handling infectious material.
4. Food or waterborne transmission - eating contaminated food or drinking contaminated water.

The most common bacterial agents of nosocomial infections
For example, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae.

The most common viral agents of nosocomial infections 
Influenza viruses, respiratory syncytial virus, hepatitis viruses, cytomegalovirus, coronaviruses

The most common mycotic and parasitic agents of nosocomial infections. 
Candida albicans is a common causative agent of nosocomial mycoses
Nosocomial infections caused by parasites are relatively rare, but some parasitic agents may contribute to infections in hospital patients. Several parasites that may be involved in nosocomial infections include:

Enterobius vermicularis - childhood roach: Infection is most common in children and can easily spread in the hospital environment by direct transmission of eggs through contaminated surfaces or objects.

Giardia lamblia: Giardia is a parasitic protozoan that causes an intestinal infection known as giardiasis. Transmission of this infection in hospitals can occur through direct contact with infected stool, contaminated water or improper hand hygiene.

Cryptosporidium spp.: Cryptosporidium is a parasite that causes an intestinal infection called cryptosporidiosis. Infection is usually spread through contaminated water or food. In hospitals, transmission can occur with inadequate water disinfection or food contamination.

Strongyloides stercoralis: This parasite causes a disease called strongyloidiasis. Infection often occurs in immunodeficient patients, such as those taking immunosuppressive drugs. The infection can be transmitted by contact with contaminated soil or through contaminated environments in hospitals.

Parasitic nosocomial infections are relatively rare compared to bacterial and viral infections. Measures to control the spread of parasites include proper hand hygiene, disinfection of surfaces, and adherence to infection prevention protocols in healthcare facilities.

Risk factors for patients, staff and FT in terms of the possibility of contracting nosocomial infections 
Risk factors for patients, staff and other healthcare personnel in terms of the possibility of contracting nosocomial infection may vary. Some of the main risk factors by group:

Risk factors for patients

Immunocompromised: patients with compromised immunity, such as those undergoing chemotherapy, having an organ transplant, having HIV/AIDS or taking immunosuppressive drugs, are more susceptible to nosocomial infections.

Surgical procedures: patients who have undergone surgery are at higher risk of post-operative infections.

Intensive care unit stay: Patients admitted to the intensive care unit are often exposed to invasive procedures (e.g. intubation, catheterization) that may increase the risk of nosocomial infections.

Prolonged hospitalization: prolonged hospitalization increases patients' exposure to infectious agents while decreasing the immune response and increasing vulnerability to infections.

At-risk age groups -newborns and the elderly are more susceptible to infections.

Other underlying diseases - immune disorders, cancer, liver diseases etc..

Nutritional status - malnutrition or obesity

Addictions - alcoholism, drug addiction, smoking.

Risk factors for medical staff and other healthcare personnel

Non-compliance with hygiene practices: poor hand hygiene, improper use of protective equipment (gloves, drapes) and failure to follow strict infection prevention protocols can increase the risk of nosocomial infections among healthcare personnel.
Direct contact with infected patients: healthcare personnel who come into direct contact with infected patients or their body fluids are susceptible to transmission of infectious agents.

Higher risk of exposure to infectious agents : Healthcare personnel who handle contaminated surfaces, equipment and infectious materials may be at higher risk of nosocomial infections.

Risk factors for other healthcare personnel (e.g. physiotherapists, cleaners):
Contact with contaminated material: Other healthcare personnel who come into contact with contaminated material such as used dressings, linen or waste may be at risk of nosocomial infections.

Inadequate hygiene: Failure to follow basic hygiene precautions when handling infectious material or to follow safety procedures may increase the risk of infection.

Transmission of nosocomial infections through hands
Hands are the most important part of the body in the spread of nosocomial infections. They can be a frequent mediator of transmission of infectious agents between surfaces, patients and healthcare personnel. Poor hand hygiene, such as inadequate hand washing or failure to follow prescribed procedures for the use of disinfectants, can lead to the transmission of pathogens.
Hand washing is essential - contaminated hands can transmit infectious agents from the client to the cat. If we are unable to take the client to the washroom/bathroom during felinotherapy, it is essential to carry wet wipes or disinfectant wet wipes. However, consultation with the medical staff of the facility (possible allergies, skin problems of the clients) and consultation with the veterinarian (possible allergies and skin problems of the animal, toxicity of the product) is necessary.  
Good communication with the target facility and early warning to the team of any ongoing infectious disease in the facility is essential.

Proper hand washing procedures :
1. Open the tap and moisten hands with water.

2. Apply sufficient soap (liquid soap preferred) to the palms of one hand.
3. After turning off the tap, begin to lather by rubbing the palms of your hands against each other. Lather on all parts of the hands, including the palms, backs of the hands, fingers and under the nails.

4. Pay special attention to cleaning between the fingers and under the nails where microorganisms can accumulate.

5. Continue rubbing the palms of the hands up to the wrists until we are sure we have cleaned all parts of the hands for at least 20 seconds. The total washing time should be at least 40-60 seconds.

6. Rinse hands thoroughly under running water to remove all foam and soap residue.

7. Use a disposable paper towel or electric hand dryer to dry hands. Avoid using a common towel, which can be a source of contamination.

8. Use a paper towel to close the tap to avoid touching the surface of the hands.

Adherence to proper handwashing techniques is important not only for healthcare personnel but also for patients who should be informed of proper handwashing procedures. This process should be repeated before and after each patient contact, before and after performing medical procedures and before eating.

Possible prevention of nosocomial infections in felinotherapy

As already mentioned, good communication between the key person in the facility and the felinotherapy team is essential. Early warning to the team if an infectious disease is present in the facility is essential. The alert can be sent via messenger, SMS or email, or by phone well in advance of the scheduled visit.
The handler must observe basic hygiene rules and must excuse himself/herself from the visit if he/she becomes ill with an infectious disease. If the cat falls ill, the same rules apply.
The handler shall use a muzzle or respirator if necessary.
Protecting the cat is more complicated. First of all, the veterinarian should be consulted about disinfection options as well as the use of hand sanitizers to avoid using products that could be toxic to the cat. 
In principle, the cat should only consume food and drink water from its own bowls. The food is provided by the handler and the water must be from a safe source.
It is essential to give the cat a long rest after activation and to focus on working with stress and managing it effectively through targeted training.