Healthcare-associated infections (HAIs) – also known as nosocomial infections- are a significant threat to patient safety. They are infections in healthcare settings such as hospitals, outpatient facilities, surgery centers, and long-term care facilities. Every day, patients are acquiring infections in places where they are being treated for something else. Most of these infections are preventable.
The Centers for Disease Control and Prevention (CDC) estimates that 5-10% of patients admitted in the United States acquire an HAI each year. It is estimated that approximately 1.7 million infections occur annually; nearly 100,000 patients die as a result. They can be caused by bacteria, a virus, fungus, or parasites.
The most common risk factors for HAIs are invasive procedures, contaminated medical equipment, failure of healthcare workers to wash their hands, and the overuse of antibiotics, which can lead to antibiotic resistance and “superbugs”.
Some examples of HAIs are:
- Methicillin-resistant staphylococcus aureus (MRSA) – a staph infection that is resistant to Methicillin and several other antibiotics. It is this resistance to antibiotics that make MRSA so problematic to treat, and possibly deadly. Under a microscope, MRSA looks like a bunch of berries, clustered like grapes. To the naked eye, it can appear as red around an incision, small blisters on the skin, or large pustules. The far more dangerous form is when it enters the bloodstream, attacks the organs, and leads to sepsis.
- Clostridium difficile (C.diff)– a hospital-acquired infection that affects patients who take antibiotics. It is easily spread, transmitted by touch, and can live on surfaces such as bed rails, linens, remotes, telephones, and fixtures for a long period of time. Symptoms of C.diff include fever, nausea, abdominal cramping, dehydration, and loss of appetite. It is estimated that C.diff causes nearly 500,000 infections annually and 29,000 deaths. A recent study concluded that fluoroquinolone antibiotics such as Cipro (ciprofloxacin) are the main cause of C.diff outbreaks, not dirty hospitals. In order to help prevent C.diff, it is important to use antibiotics vigilantly and only when absolutely necessary and to wash hands with bleach-based cleansers.
- Vancomycin-resistant enterococci (VRE)– Enterococci can cause dangerous infections in parts of the body outside of the intestinal tract and female genital tracts (where colonization of enterococci is normal) like the urinary tract, the bloodstream, a wound or a catheter insertion site if it travels to them. The enterococci infection is caused by the overuse and misuse of antibiotics. As a result, bacteria that should be destroyed by antibiotics have, in many cases, become antibiotic-resistant.
- Carbapenem-resistant Enterobacteriaceae (CRE) and Carbapenem-resistant Klebsiella pneumoniae (CRKP)– CRKP is a type of gram-negative bacteria that can cause infections in healthcare settings such as pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. CRKP is resistant to antibiotics, and patients who acquire it are at risk of death, usually within 30 days. Death rates from this newer superbug have been reported to be between 30 percent and 44 percent. The best way to prevent the transfer of CRKP is by following the standard prevention recommendation for any infection: hand washing and sanitizing.
- Necrotizing fasciitis– Necrotizing fasciitis is a fast-spreading bacterial skin infection that kills the body’s soft tissue. It is also known as “flesh-eating bacteria”. It can be caused by several different kinds of bacteria, including group A Streptococcus (group A strep), Klebsiella, Clostridium, Escherichia coli, Staphylococcus aureus, Aeromonas hydrophila. And methicillin-resistant Staphylococcus aureus (MRSA). The disease develops when bacteria spread after entering the body, often through a break in the skin, like a cut, scrape, burn, insect bite, or puncture wound. The bacteria infects flat layers of fascia, connective bands of tissue that surround muscles, nerves, fat, and blood vessels. Toxins released by the bacteria kill the fascia and surrounding tissues. The bacteria can spread rapidly through the body (sepsis). According to the CDC, 10,000 – 15,000 patients annually are infected with necrotizing fasciitis; of them, 25% will die. Necrotizing fasciitis symptoms usually appear within hours of an injury or wound. Symptoms include pain or soreness, warmth and redness or areas of swelling that spread quickly, ulcers, blisters or black spots on the skin, fever, chills, and fatigue.
- Sepsis– Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. Symptoms include fever, increased heart rate, increased breathing rate, and confusion. Severe cases cause poor organ function or insufficient blood flow. Insufficient blood flow may be evident by low blood pressure, high blood lactate, or low urine output. Septic shock is low blood pressure due to sepsis that does not improve after reasonable amounts of intravenous fluids are given. Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, from severe sepsis as high as 50%, and from septic shock as high as 80%.
While it is impossible to prevent every nosocomial infection, here are some steps you can take to attempt to keep yourself or your loved one from acquiring an infection while in the hospital:
- Know how hospital infections spread. Infections are spread both by touch and through the air.Touch: Every surface in a hospital can carry infection germs such as the telephone, the TV remote, the doctors’ stethoscope, the catheters used in patients, surgical equipment, bed linens, bed rails, bathrooms, and door handles and people.
Airborne: Some infection germs may be airborne through coughing or sneezing. A roommate with pneumonia can transfer pathogens, or a patient with an upper-respiratory infection may be pacing the halls, walking off anesthesia, and cough or sneeze germs to someone else.
- Prepare for your hospital stay. Understanding how infections spread, you can prepare ahead of time by packing some items that will help you fend off those germs. Consider packing antiseptic wipes and sprays will help you kill germs on surfaces. The most effective wipes and sprays contain bleach which is necessary to kill some of the most dangerous germs.
- Don’t be afraid to ask hospital personnel and visitors to wash their hands before touching you or anything in your room. Hand sanitizers or the excuse that they already washed their hands aren’t always enough. As a patient, you have the right to ensure your health and safety.
- Insist that catheters be replaced or removed immediately. Catheters are often a necessary part of effective care, but they must regularly be removed or replaced to reduce the chance of spreading germs.
- If possible, have a patient advocate with you. There may be times when you are sedated or asleep and you may not be able to advocate for yourself. Choose someone assertive enough to insist on safety and be explicit about what your needs are. Also, ensure that they understand that infections are not the only concerns; there are also medication errors or patient misidentification.
For more information on preventing HAIs, please visit the CDC’s website, which can be found here.