Why people catch infections in hospitals, and how to avoid getting sick

I’d like to talk a bit about nosocomial infections, or healthcare-associated infections (HAIs).  These are infections that are acquired in a health care setting, such as when a patient contracts an infection when he is hospitalized, unrelated to his initial disease process.

Usually nosocomial infections are thought of as being synonymous with “hospital acquired” infections, and they often are. But, realistically, they can also be contracted in other settings like: nursing homes, dialysis units, clinics, urgent cares, and other related sites.

Infection by Shutterstock

Infection by Shutterstock

HAIs are a significant cause of death in the US (and other countries). They may be the 10th leading cause of death, though there is some disagreement on this. Not all HAIs are fatal, of course, but many will make a patient even more ill (increasing morbidity) than he was when he initially sought medical help. In addition, when a patient gets an HAI, the cost of treating him increases, sometimes by hundreds of thousands of dollars for just one HAI depending on how severe it is. The CDC says that there were about 35.1 million hospital admissions in 2010 (note that this is not including nursing home patients, dialysis patients and others who went to non-hospital sites). The CDC estimates that as many as 1 out of 20 patients may develop an HAI. That would be millions of HAIs from hospital admissions alone. And the cost? Low-end estimates tend to be around $7 billion dollars/year.

What kind of infections are HAIs?

HAIs can be pneumonias, urinary tract infections, post-op infections, tuberculosis, septicemia, endocarditis, meningitis, hepatitis, infectious diarrheas and others. They can be caused by a wide variety of organisms: dozens of kinds of bacteria and viruses. They may make the patient so ill that he may need prolonged care in an ICU, ventilatory support, surgery, IV antibiotics and other treatments. And, even if the patient gets “well,” (meaning, the infection is eliminated) he may have long lasting aftereffects of the disease process. These sequelae can be anything from surgical scars, to heart damage, to a stroke or other very serious consequences. The patient who walked in to the health care facility, may now need to be wheeled out and placed in a nursing home.

Why are there HAIs?

There are a number of reasons. First being that in all of these places where nosocomial infections occur, there are a number of sick people in close proximity, some with infectious diseases. That patient next to you in the waiting room may have the flu. Your hospital roommate may have an undiagnosed infectious disease. One of your visitors may have a cold. A hospital staff member may have tended a patient with an infection and not washed his hands.

Another reason is that invasive procedures are done in healthcare settings. A central IV line gets placed. A Foley urinary catheter is inserted. Patients have surgeries done. All of these, and others, can serve as sites for infectious organisms to enter the body.

Additionally, more and more patients are treated in outpatient settings. The ones admitted to the hospital are often those more severely ill, perhaps older, who may have compromised immune systems. Also, sometimes inappropriate or incorrect use of antibiotics plays a role. Many bacteria are showing resistance to antibiotics and are becoming harder to eliminate when they cause an infection.

How are HAIs treated?

The source of the infection needs to be found. Sometimes that’s not always easy. That skin abscess may not be what’s causing the septicemia. The specific organism (or sometimes, organisms) needs to be identified and its sensitivity to a variety of antibiotics need to be determined. The appropriate antibiotic, route, dose and duration of treatment need to be selected. The antibiotic therapy may need to be changed if necessary, depending on the patient’s response.

Initially, until the organism is identified, the patient may be placed on one or more antibiotics, hoping that they will slow or eliminate the infection while lab results are pending. After identification, the antibiotics may be changed. Prevention is paramount. Many HAIs can be prevented, morbidity decreased, lives saved and costs lowered. Hand washing is extremely important for prevention of patient-to-patient transmission along with the use of gloves. Proper sterilization of reusable equipment is mandatory. Incineration of contaminated and disposable equipment is required. Decontamination of surfaces is required. Some pathogens can remain infectious for a reasonably long time under certain circumstances. Many facilities restrict visitors during flu season, ask visitors to not visit if they don’t feel well and limit visits by children.

And education is vital. Patients, visitors, staff all need to be instructed on how to help prevent HAIs. Health care sites make use of infection control teams to help educate and monitor infections. They often work in conjunction with quality assurance and quality control (QA/QC) teams, as well, to follow infections, complications and monitor HAI-related statistics,

What can you do to prevent becoming a victim of an HAI?

Protect yourself and be proactive. Get the vaccines that you need, when you need them: flu, pneumonia, shingles, hepatitis, etc.

When you’re in a health care setting, be alert. Is a patient coughing or sneezing in the waiting room? Move away from him.

Make sure that any staff member who is going to touch you has washed his hands and is wearing gloves. If not, speak up.

If someone is going to break your skin (injection, IV, sutures, etc.) or insert a device like a urinary catheter, again, make sure that hands have been washed, gloves worn, your skin has been decontaminated and only sterile items are used.

If you’re suspicious that an item is not sterile or has been contaminated, speak up and ask that a new one be used.

Most of the staff you encounter will be trained on how to perform these procedures properly. But everyone can slip up.

Wash your hands after leaving the facility. Your hands may have easily come in contact with a variety of microorganisms from door handles, sinks, counters and other things. Much better to be a little extra cautious than to wind up as one of the millions of those who gets a nosocomial infection.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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33 Responses to “Why people catch infections in hospitals, and how to avoid getting sick”

  1. lucy says:

    I love how these cautions are always paired with a “what you can do” consisting of speaking up and asking staff (including docs) to wash and glove up. They get mightily offended and don’t really care about treating you then.

    When
    I was a kid, every member of staff washed their hands upon entering my
    examining room. Nowadays that’s rare. Is it a wonder HAIs are up? I want
    to know why they’re too lazy/apathetic to do a simple action like wash
    their hands.

  2. DocP says:

    I would add another precaution. Request (demand) a different hospital room if your roommate is coughing excessively. A friend of ours died of pneumonia several weeks after surgery, despite weeks of treatment in ICUs. His wife noticed that, post surgery, he was placed in a hospital room with a roommate who was coughing excessively. She didn’t make the (possible) connection until after his death. Sadly, he was quite wealthy and could have easily afforded a private room.

  3. Ericka says:

    It’s easy to find the cause of infection especially when it started or is happening in the hospitals. Sometimes nurses and doctors may have forget to perform the basic hand washing or surgical hand washing every before and after their duties to every patient. Sometimes, unnecessary practices of patients causes the spread of infection.

    Project Manager- Online Project Management Software

  4. Lyla says:

    You should put an amazon order button on your site to make extra money. People can order from Amazon through you and you get a per centage.

  5. karmanot says:

    Books were the wonders of the olden days Zorbie. :-)

  6. Zorba says:

    LOL! Ask Pappa Bear, sweetie. He will know. ;-)

  7. zorbear says:

    Book? What’s a “book”, precious? Is that something like a Kindle or an iPad for old people?
    :-?

  8. Zorba says:

    Oh, yes, I agree.
    To a certain extent, we have to rely on our immune systems. But we have to be sensible, too. ;-)

  9. dula says:

    Wow. The little buggers have mastered preemptive war.

  10. dula says:

    OMG I never considered proper handbag hygiene!! There’s a funny scene in that movie The Guilt Trip. She uses a portable hook that she hangs her purse on in public. I do think about my cell phone though. I have to set it down on a fresh kleenex/napkin when out of pocket. Cell phones and keyboards have more bacteria than a public toilet seat.

  11. Zorba says:

    LOL! Not much we can do to mitigate all the horrors of aging, k., but every little bit helps! ;-)

  12. karmanot says:

    Who knew? The stratagems we elders do to navigate the horrors of decrepitude. Let’s write a book!

  13. karmanot says:

    OMG!

  14. UncleBucky says:

    ‘Tis true. Again, the saying is, you go to a hospital to die. But they kick you out before you can spoil their record.

  15. UncleBucky says:

    I think so. I think that she had a latent infection that grew and grew more uncontrollable. Actually, I also had a gall bladder-ectomy/-spoon-outomy and shortly afterwards I developed an infection that took a while to squeeze out. I am OK now, but there is I think some damage due to that.

    She was in the ER, ICU and a regular hospital room while they figured out that she had a staph infection. Then she was transported to a nice recovery place where they gave her 6 weeks of antibiotics. That was then ended when she showed “zero” infection. Aha. And what happened, was what next to zero was left was MRSA. And at the same time was hiding out as a veggie growth on her heart valve. Then when it was released from the antibiotic holddown, it went nuts and she had endocarditis.

    Funny thing (no, it’s not) about endocarditis. You don’t have to be a senior to die from it. Our ophthamologist’s nephew got an infection from a cut or abrasion in a locker room they think. He was not feeling well, and they ER’d him and it was found he had endocarditis. He died within days. He was 18.

    Soooo…. TEH Bacteria is stronger than we are. And we are ingesting all this junk that nails our immune system, and so guess what? Bacteria +1, Us, -1.

    Arggh.

  16. Zorba says:

    I use a cane, too, as karmanot does. I really had not thought of disinfecting the bottom of the cane! I think I need to stow some bleach spray or something similar by the front door.
    The other thing that women in particular need to think about is, where do they put their purses when they are using the toilet in a public restroom? For pity’s sake, do not put them on the floor! Hang them on the hook that is usually available. If a toilet does not have a hook, I hang the (long) strap of my purse around my neck while I “do my business.” And also, never put your purse on the kitchen table or the kitchen counter! This would apply to men and women who carry briefcases around all the time, too.

  17. dula says:

    Sorry about your mom. I hope I’m reading your post wrong, but are you suggesting that her staph infection somehow remained dormant in her system after gall bladder surgery and came to attack after two years?? Maybe I shouldn’t know.

  18. dula says:

    Lol I never thought of using product while at a store. Brilliant. You may consider disinfecting the bottom of your cane, or you may be tracking things into your home. I was on crutches a while back and came from the hospital thinking I was tracking in MRSA from the possibly blood soaked floors. I had to leave the crutches at my door and crawl on the floor to the kitchen and get bleach spray to disinfect the rubber nubs on me sticks. Ugh.

  19. karmanot says:

    I know the feeling. The other day I had to use the restroom in Safeway. I had to skip over the puddles with my cane to reach the john and then when I took a look it reminded me of Calcutta of 40ty years ago. Afterward ,I went to the kitchen aisle, sprayed my self down with Lysol disinfectant and a shot or two of Fabreze.

  20. karmanot says:

    My god UB, what a horror story. Sorry about you mother’s passing. Not only do we have the world’s most expensive health care, but despite the mythology of excellence, one of the most incompetent.

  21. What exactly is your point? We have to post a photo with the story as that’s the way the template works. Of the ten stories on the home page, 8 of the 10 have photos from the story itself. Or you can go to page 2, the first archive page, and 8 of the 10 stories have photos from the story itself: http://aravosis.wpengine.com/page/2 So I’m not sure I understand the rude comment about “yet another pointless meaningless photo” when the overwhelming majority of our photos are from the story itself. Your comment comes across as somewhat rude, particularly since it’s not even correct.

    And more generally, this site has been on life support for a year. I was going to close down at Christmas because the money is gone. It disappeared in 2009 when the economy crashed and my income dropped to 25% of what it once was. Now I’m at about 40% of what it once was. ( You should try paying your mortgage after more than half of your salary disappeared 5 years ago :) Yes, you see a lot of ads, they bring in nothing compared to what they brought in before the crash. So we needed to redesign the site to, among other things, have more images as that tends to be more appealing to people, and thank god it’s helped bring more readers and page views, and I did not have to close the site last Christmas as planned.

    I’d hope that as someone who regularly visits this site that you’d extend me a bit more courtesy.

  22. UncleBucky says:

    Yep. My Mom developed a staph infection (probably MRSA) about year or two after having gall bladder surgery. In the nursing home she received antibiotics intravenously. After reducing the infection to almost zero (a-hem) she was going home. But then she got sick again and in the ER it was judged that she had endocarditis and by the time we found out, it was two days and she had passed. That was in June 2009.

  23. Naja pallida says:

    Seems to me that such vague extrapolation shouldn’t be necessary, this kind of data should be tracked in exquisite detail. You’d think the health care industry and health insurance industry would demand it. But it seems like they’re happier to keep their head in the sand as long as the profits keep rolling in.

  24. dula says:

    Ugh I have become a paranoid person. I used to drop food on the ground and pick it up and eat it. Now, I can’t touch door knobs without a paper towel. When I return home every day, I wash from my elbows down. If I have to go to the doctor I cannot sit down or touch the elevator buttons. Ugh.

  25. Dave of the Jungle says:

    My own Mother died following successful emergency coronary bypass surgery when she contracted an MRSA infection and then hospital pneumonia.

  26. lynchie says:

    Here is a rough idea of cost. More than car insurance but as with all insurance based on # of claims, amount paid out etc.

    http://www.ehow.com/about_5514154_average-cost-medical-malpractice-insurance.html

  27. Thom Allen says:

    Malpractice insurance rates vary quite a bit depending on state, type/scope of practice and specialty, to name a few.

    A pediatrician who gives in office allergy shots pays a much higher premium than a pediatrician who doesn’t, in general. A friend who does internal medicine and pain management was paying ~$13,600/year ten years ago in Pennsylvania. OBs, ophthalmologists, neurosurgeons, most surgical specialties pay a lot. OBs were paying so much, that some counties in Pennsylvania became devoid of OBs. They either closed their practices and retired, moved to nearby states with lower rate, or refused to take new OB patients.
    If I were paying my own malpractice insurance right now for general internal medicine, I’d be paying close to $750/month.

  28. Thom Allen says:

    Those statistics are estimates of total adverse events, not HAIs. AE’s may include HAIs but also include a number of other things. For example, a patient is given a drug and has an allergic reaction. That’s an AE but not an HAI, The statistics I used are specific for nosocomial infections.

    Additionally, the author states:

    “In the four studies, which examined records of more than 4,200
    patients hospitalized between 2002 and 2008, researchers found serious
    adverse events in as many as 21 percent of cases reviewed and rates of
    lethal adverse events as high as 1.4 percent of cases.

    By combining the findings and extrapolating across 34 million
    hospitalizations in 2007, James concluded that preventable errors
    contribute to the deaths of 210,000 hospital patients annually.”

    About 4,000 records were examined out of THIRTY FOUR MILLION and the author extrapolated that, therefore, about a half million people die from AEs. That could be true, but the number could be both larger or smaller than that. Depending on what is considered an adverse event, the type of hospital (acute care, chronic care, VA, military base hospital, pediatric), age of the patients studied, acuity of the disease process that put the patient in the hospital initially, etc. Also, those 4,000 records were drawn from four separate studied that could have had different definitions of AEs, different study populations, be from different geographic regions, etc. So, this data needs to be examined somewhat skeptically.

  29. dan says:

    nicho is a truth and logic hero.

    Thoma strings thoughts together almost as randomly as I do.

  30. nicho says:

    The malpractice insurance cost for the average doctor is actually quite low — despite the howling you hear from the medical corporations. Slightly more than car insurance.

  31. lynchie says:

    That is also why malpractice insurance costs are rising for hospitals and doctors. the want to limit liability. Doctors and hospitals are also fighting new Medicare reimbursements what are based on outcomes. If a surgeon/hospital has high infections, re admittance, etc. they get paid less money and they don’t like being held accountable.

  32. emjayay says:

    Yet another pointless meaningless Shutterstock photo, this time of a model wearing a surgical mask.
    Sometimes a picture deducts meaning rather than adding, which is the case for all worthless posed with models wearing costumes provided by a costumer Shutterstock photos.

  33. nicho says:

    It’s actually much worse

    http://blogs.kqed.org/stateofhealth/2013/09/23/how-many-die-from-medical-mistakes-in-u-s-hospitals/

    In 2010, the Office of Inspector General for the Department of Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

    Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death.

    That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.

    But now we know why the medical-industrial complex wants to do away with malpractice suits.

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