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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