In the U.S. more than 4,600 patients per day become infected as a result or complication of their medical care. No one feels the true cost of health care infections as much as the patients, their families and the caregiver staff. Health care associated infections affect everyone involved.
With more than 1.7 million health care associated infections per year in the United States, and the problem of antibiotic -resistance ever widening, the need for prevention looms heavier now more than ever before. Of the 4,600 patients infected daily, 271 die from their infections. Every day.
In total, that’s more than 99,000 people in the U.S. annually with more people dying of these infections than all of the people in the U.S. who die each year of AIDS, breast cancer and automobile accidents COMBINED.
A nosocomial infection - also called “health care-acquired infection” can be defined as:
An infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other health care facility in whom the infection 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.
Despite progress in public health and hospital care, infections continue to develop in hospitalized patients, and may also affect hospital staff. Many factors promote infection among hospitalized patients: decreased immunity among patients; the increasing variety of medical procedures and invasive techniques creating potential routes of infection; and the transmission of drug - resistant bacteria among crowded hospital populations, where poor infection control practices may facilitate transmission.
Health care - acquired Infections (or health care - associated infections) encompass almost all clinically evident infections that do not originate from patient's original admitting diagnosis. Within hours after admission, a patient's flora begins to acquire characteristics of the surrounding bacterial pool.
The Two Most Frequent Types of Infections
#1: Urinary Tract Infection (UTI) is the most common type of hospital -acquired infection and has been shown to occur after urinary catheterization. Catheterization is the placement of a catheter through the urethra into the urinary bladder to empty urine from the bladder; or to deliver medication, relieve pressure, or measure urine in the bladder; or for other medical reasons. Normally, a healthy urinary bladder is sterile, with no harmful bacteria or other microorganisms present.
Although bacteria may be in or around the urethra, they normally cannot enter the bladder. A catheter, however, can pick up bacteria from the urethra and give them an easy route into the bladder, causing infection. Bacteria from the intestinal tract are the most common type to cause UTIs. Patients with poorly functioning immune systems or who are taking antibiotics are also at increased risk for UTI caused by a fungus called Candida. The prolonged use of antibiotics, which may reduce the effectiveness of the patient's own immune system, has been shown to create favorable conditions for the growth of this fungal organism.
#2: Pneumonia is the second most common type of hospital - acquired infection. Bacteria and other microorganisms are easily introduced into the throat by treatment procedures performed to treat respiratory illnesses. Patients with chronic obstructive lung disease, for example, are especially susceptible to infection because of frequent and prolonged antibiotic therapy and long-term mechanical ventilation used in their treatment. The infecting microorganisms can come from contaminated equipment or the hands of health care workers as procedures are conducted such as respiratory intubation, suctioning of material from the throat and mouth, and mechanical ventilation. Once introduced through the nose and mouth, microorganisms quickly colonize the throat area. This means that they grow and form a colony, but have not yet caused an infection. Once the throat is colonized, it is easy for a patient to aspirate the microorganisms into the lungs, where infection develops that leads to pneumonia.
Invasive surgical procedures increase a patient's risk of getting an infection by giving bacteria a route into normally sterile areas of the body. An infection can be acquired from contaminated surgical equipment or from the hands of health care workers. Following surgery, the surgical wound can become infected from contaminated dressings or the hands of health-care workers who change the dressing.
Other wounds can also become easily infected, such as those caused by trauma, burns, or pressure sores that result from prolonged bed rest or wheel chair use.
Many hospitalized patients need continuous medications, transfusions, or nutrients delivered into their bloodstream. An intravenous (IV) catheter is placed in a vein and the medications,
blood components, or liquid nutritional are infused into the vein.
Bacteria from the surroundings, contaminated equipment, or health care workers' hands can enter the body at the site of catheter insertion. A local infection may develop in the skin around the catheter. The bacteria can also enter the blood through the vein and cause a generalized infection. The longer a catheter is in place, the greater the risk of infection. Other hospital procedures that may put patients at risk for nosocomial infection are gastrointestinal procedures, obstetric procedures, and kidney dialysis.
Fever is often the first sign of infection. Other symptoms and signs of infection are rapid breathing, mental confusion, low blood pressure, reduced urine output, and a high white blood cell count. Patients with a UTI may have pain when urinating and blood in the urine. Symptoms of pneumonia may include difficulty breathing and inability to cough. A localized infection begins with swelling, redness, and tenderness on the skin or around a surgical wound or other open wound, which can progress rapidly to the destruction of deeper layers of muscle tissue, and eventually sepsis.
Diagnosing an Infection
An infection is suspected any time a hospitalized patient develops a fever that cannot be explained by the underlying illness. Some patients, especially the elderly, may not develop a fever. In these patients, the first signs of infection may be rapid breathing or mental confusion. Diagnosis of a hospital-acquired infection is determined by:
Evaluation of symptoms and signs of infection
Examination of wounds and catheter entry sites for redness, swelling, or the presence of pus or an abscess
A complete physical examination and review of underlying illness
Laboratory tests, including complete blood count (CBC) especially to look for an increase in infection-fighting white cells; urinalysis, looking for white cells or evidence of blood in the urinary tract; cultures of the infected area, blood, sputum, urine, or other body fluids or tissue to find the causative organism
Chest x ray may be done when pneumonia is suspected to look for the presence of white blood cells and other inflammatory substances in lung tissue
Review of all procedures performed that might have led to infection
Fungal infections are treated with anti fungal medications. Examples of these are amphotericin B, nystatin, ketoconazole, itraconazole, and fluconazole. Viruses do not respond to antibiotics. A number of antiviral drugs have been developed that slow the growth or reproduction of viruses, such as acyclovir, ganciclovir, foscarnet, and amantadine.
Cultures of blood, urine, sputum, other body fluids, or tissue are especially
important in order to identify the bacteria, fungi, virus, or other microorganism
causing the infection.
Once the organism has been identified, it will be tested again for sensitivity to a range of antibiotics so that the patient can be treated quickly and effectively with an appropriate medicine to which the causative organism will respond.
While waiting for these test results, treatment may begin with common
broad-spectrum antibiotics such as penicillin, cephalosporins, tetracyclines, or
More and more often, some types of bacteria are becoming resistant to these standard antibiotic treatments, especially when patients with chronic illnesses are frequently given antibiotic therapy for long periods of time.
When this happens, a different, more powerful, and more specific antibiotic
must be used to which the specific organism has been shown to respond.
Two strong antibiotics that have been effective against resistant bacteria are vancomycin and imipenem, although some bacteria are developing resistance
to these antibiotics as well.
The prolonged use of antibiotics is also known to reduce the effectiveness of the patient's own immune system, sometimes becoming a factor in the development of infection.
Hospitals take a variety of steps to prevent nosocomial infections, including:
Adopting an infection control program such as the one sponsored by the U.S. Centers for Disease Control (CDC), which includes quality control of procedures known to lead to infection, and a monitoring program to track infection rates to see if they go up or down.
➠ Employing an infection control practitioner for every 200 beds
➠ Identifying high-risk procedures and other possible sources of infection
➠ Strict adherence to hand-washing rules by health care workers and visitors to avoid passing infectious microorganisms to or between hospitalized patients
➠ Strict attention to aseptic (sterile) technique in the performance of procedures, including use of sterile gowns, gloves, masks, and barriers
➠ Sterilization of all reusable equipment such as ventilators, humidifiers, and any devices that come in contact with the respiratory tract
➠ Frequent changing of dressings for wounds and use of antibacterial ointments under dressings
➠ Remove nasogastric (nose to stomach) and endotracheal (mouth to stomach) tubes as soon as possible
➠ Use of an antibacterial-coated venous catheter that destroys bacteria before they can get into the blood stream
➠ Preventing contact between respiratory secretions and health care providers by using barriers and masks as needed
➠ Use of silver alloy-coated urinary catheters that destroy bacteria before they can migrate up into the bladder
➠ Limitations on the use and duration of high-risk procedures such as urinary catheterization
➠ Isolation of patients with known infections
➠ Sterilization of medical instruments and equipment to prevent contamination
➠ Reductions in the general use of antibiotics to encourage better immune response in patients and reduce the cultivation of resistant bacteria
WHAT PATIENTS AND THEIR FAMILIES CAN DO
The old joke about never wanting to go to a hospital because that’s where the sick people are is no joke at all. It’s true. Bacteria is naturally present in areas where populations of sick people reside; this is not a secret. But, there are ways to protect yourself or loved ones from becoming infected.
Again, hand hygiene is key. Hands remain the primary way that most germs are transmitted from one person to another. It’s now considered EXPECTED PROCEDURE in a health care environment that caregivers wash or sanitize their hands EVERY SINGLE TIME BEFORE AND AFTER they touch a patient.
Knowing this is important information that you can use to be proactive in your care.
HOW TO PROPERLY WASH YOUR HANDS
Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others. Washing your hands with regular soap and clean running water for 20 seconds does the job just fine however,
if soap and clean water are not available, an alcohol-based product is another effective way to clean your hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are fast acting.
When washing hands with soap and water:
Wet your hands with clean running water and apply soap. Use warm water if it is available. Rub hands together to make a lather and scrub all surfaces. Continue rubbing hands for 20 seconds. Need a timer? Imagine singing "Happy Birthday" twice through to a friend! Rinse hands well under running water. Dry your hands using a paper towel or air dryer.
If possible, use your paper towel to turn off the faucet. Remember: If soap and water are not available, use alcohol -based gel to clean hands.
When using an alcohol-based hand sanitizer:
1. Apply product to the palm of one hand.
2. Rub hands together.
3. Rub the product over all surfaces of hands and fingers until hands are dry.
PREVENTION BEGINS WITH LEADERSHIP
Much has been discussed and contemplated regarding the prevention of health care acquired infections but the key point in every initiative remains that the top administration of the facility or system must strongly support a well-communicated whole prevention effort.
Making their stance known among all hospital employees as well as physicians and surgeons and taking definitive action to ensure compliance of hand hygiene best practices as well as other prevention guidelines seems to provide a strong base upon which all other patient safety initiatives can be built.