<Tr> <Td> Indirect - contact transmission </Td> <Td> This involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients . In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes . </Td> </Tr> <P> Controlling nosocomial infection is to implement QA / QC measures to the health care sectors, and evidence - based management can be a feasible approach . For those with ventilator - associated or hospital - acquired pneumonia, controlling and monitoring hospital indoor air quality needs to be on agenda in management, whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced . </P> <P> To reduce HAIs, the state of Maryland implemented the Maryland Hospital - Acquired Conditions Program that provides financial rewards and penalties for individual hospitals based on their ability to avoid HAIs . An adaptation of the Centers for Medicare & Medicaid Services payment policy causes poor - performing hospitals to lose up to 3% of their inpatient revenues, whereas hospitals that are able to avoid HAIs can earn up to 3% in rewards . During the program's first 2 years, complication rates fell by 15.26 percent across all hospital - acquired conditions tracked by the state (including those not covered by the program), from a risk - adjusted complication rate of 2.38 per 1,000 people in 2009 to a rate of 2.02 in 2011 . The 15.26 - percent decline translates into more than $100 million in cost savings for the health care system in Maryland, with the largest savings coming from avoidance of urinary tract infections, septicemia and other severe infections, and pneumonia and other lung infections . If similar results could be achieved nationwide, the Medicare program would save an estimated $1.3 billion over 2 years, while the health care system as a whole would save $5.3 billion . </P> <P> Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventive measures . Thorough hand washing and / or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections . More careful use of antimicrobial agents, such as antibiotics, is also considered vital . </P>

Which of the following is an example of nosocomial infection