Hospital-acquired infections





Definition

A hospital-acquired infection, also called a nosocomial infection, is an infection that first appears between 48 hours and four days after a patient is admitted to a hospital or other health-care facility.


Description

About 5–10% of patients admitted to acute care hospitals and long-term care facilities in the United States develop a hospital-acquired, or nosocomial, infection, with an annual total of more than one million people. Hospital-acquired infections are usually related to a procedure or treatment used to diagnose or treat the patient's initial illness or injury. The Centers for Disease Control (CDC) of the U.S. Department of Health and Human Services has shown that about 36% of these infections are preventable through the adherence to strict guidelines by health care workers when caring for patients. What can make these infections so troublesome is that they occur in people whose health is already compromised by the condition for which they were first hospitalized.

Hospital-acquired infections can be caused by bacteria, viruses, fungi, or parasites. These microorganisms may already be present in the patient's body or may come from the environment, contaminated hospital equipment, health care workers, or other patients. Depending on the causal agents involved, an infection may start in any part of the body. A localized infection is limited to a specific part of the body and has local symptoms. For example, if a surgical wound in the abdomen becomes infected, the area around the wound becomes red, hot, and painful. A generalized infection is one that enters the bloodstream and causes systemic symptoms such as fever, chills, low blood pressure, or mental confusion. This can lead to sepsis, a serious, rapidly progressive multi-organ infection, sometimes called blood poisoning, that can result in death.

Hospital-acquired infections may develop from the performance of surgical procedures; from the insertion of catheters (tubes) into the urinary tract, nose, mouth, or blood vessels; or from material from the nose or mouth that is aspirated (inhaled) into the lungs. The most common types of hospital-acquired infections are urinary tract infections (UTIs), ventilator-associated pneumonia, and surgical wound infections. The University of Michigan Health System reports that the most common sources of infection in their hospital are urinary catheters, central venous (in the vein) catheters, and endotrachial tubes (tubes going through the mouth into the stomach). Catheters going into the body allow bacteria to walk along the outside of the tube into the body where they find their way into the bloodstream. A study in the journal Infection Control and Hospital Epidemiology shows that about 24% of patients with catheters will develop catheter related infections, of which 5.2% will become bloodstream infections. Death has been shown to occur in 4–20% of catheter-related infections.


Causes

All hospitalized patients are at risk of acquiring an infection from their treatment or surgery. Some patients are at greater risk than others, especially young children, the elderly, and persons with compromised immune systems. The National Nosocomial Infection Surveillance System database compiled by the CDC shows that the overall infection rate among children in intensive care is 6.1%, with the primary causes being venous catheters and ventilator-associated pneumonia. The risk factors for hospital-acquired infections in children include parenteral nutrition (tube or intravenous feeding), the use of antibiotics for more than 10 days, use of invasive devices, poor postoperative status, and immune system dysfunction. Other risk factors that increase the opportunity for hospitalized adults and children to acquire infections are:

  • a prolonged hospital stay
  • severity of underlying illness
  • compromised nutritional or immune status
  • use of indwelling catheters
  • failure of health care workers to wash their hands between patients or before procedures
  • prevalence of antibiotic-resistant bacteria from the overuse of antibiotics

Any type of invasive (enters the body) procedure can expose a patient to the possibility of infection. Some common procedures that increase the risk of hospital-acquired infections include:

  • urinary bladder catheterization
  • respiratory procedures such as intubation or mechanical ventilation
  • surgery and the dressing or drainage of surgical wounds
  • gastric drainage tubes into the stomach through the nose or mouth
  • intravenous (IV) procedures for delivery of medication, transfusion , or nutrition

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.

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 nutritionals 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 .


Symptoms

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.


Diagnosis

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 infectionfighting 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

Treatment

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 erythromycin. 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.

Fungal infections are treated with antifungal 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.

Prevention

Hospitals take a variety of steps to prevent nosocomial infections, including:

  • Adopt 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.
  • Employ an infection control practitioner for every 200 beds.
  • Identify 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.
  • Prevent 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.

Resources

BOOKS

Andreoli, T. E., J. C. Bennet, C. C. Carpenter, and F. Plum. Cecil Essentials of Medicine. Philadelphia: W.B. Saunders Co., 1997.

Schaffer, S. D., et al. Infection Prevention and Safe Practice. New York: Mosby-Year Book, 1996.

ORGANIZATIONS

U.S. Center for Disease Control and Prevention (CDC). 1600 Clifton Road, Atlanta, GA 30333. 404-639-3311. http://www.cdc.gov/health/disease.htm .

OTHER

"Safer Hospital Stay, and Reducing Hospital-Born Infections." Health Scout News, 2003 [cited July 7, 2003]. http://www.healthscout.com .


Toni Rizzo
L. Lee Culvert



User Contributions:

Dr.Latika Shah
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Apr 11, 2006 @ 9:09 am
I am working in New Civil Hospital,Surat,Gujarat,India.I am microbiologist.I like your article.I want to study about what is rate of hospital aquired infection in our hospital and which infection is common.Please guide me for that.

Thanks
Dr. Mohamed
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Oct 7, 2006 @ 6:18 pm
Well organized, concized and meticulous article. Easy to read and understanding
ishrat
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Jan 28, 2008 @ 2:02 am
i m a PhD student.topic of my research is rate of nosocomial infection in ICUS in my city.can u guide me inthis regard what kind of step i should taken to support my topic to make is precious.i have collected organisms by using conventional methods.i want to go ahead with some advanced steps using globally by technically advanced countries. thanks.waiting for your response.
vgyugandhar
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Apr 9, 2008 @ 12:00 am
I am a PhD student, and I am working on vancomycin resistant S.aureus.Because S.aureus ia one of the commonest causes of nosocomial infections, while searching in the net i found this article.This is a very good article and gives clear and brief explanation on hospital borne infections.
But on more thing I am expecting from this article is,you gave matter on pneumonia and candida, but may also cover other important hospital acquired infectious agents particularly on bacterial infections,that may give completness to this article.
Definetly it is a good artical for easy understanding and the way of representation is also good.
somasundaram
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May 10, 2008 @ 12:00 am
am working as A Quality Manager in hospital lookingafter NABH actitvities & Infection control.
this is article is very useful to implement in our hospital setup.
thanks
sunil sharma
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Jul 14, 2008 @ 4:04 am
for some new information.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
kahesi
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Nov 20, 2008 @ 3:03 am
i am student
am doing a research on nosocomial infections in a small hospital. i would appreciate it if you sent me related articles. thank you very much
gayathrijegan
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Dec 21, 2008 @ 4:04 am
I am doing MPH first year. It gives me clear and understandable way of explanation.thanks. Is there any regulations for maintaining quality control system especially in private hospital care set up / corporate hospital???
shahin dalal
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Dec 23, 2008 @ 12:00 am
I am a lecturer in B.Sc nursing college. as i m going to teach this topic to my students n also going to conduct a seminar in our hospital among all health care members of my hospital.. i would be thankfull to u if u would update my knowledge regaring it n send me an articles.
nisha
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Mar 23, 2009 @ 9:09 am
i am B.Sc Nsg student i would like to know that whether these infections causes the visitors seriously ill and if they require hospital treatment or not? Or is it confined only among patients?
Eugene (Gene) Cole
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May 15, 2009 @ 6:06 am
Thank you for your article on HAI (Hospital Acquired Infections).
Is there a resource or database which I can utilize to determine
rate of occurence in particular regions or specific hospitals.
Please share these resources for my use and for the benefit of
others in my same situation.
richard anfoh
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Nov 19, 2009 @ 3:15 pm
This infection is not widely known but is dangerous.
Badru Adewale
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Jan 21, 2010 @ 3:15 pm
Satisfactory.Am doing a work similar to Ishrat.I need your assistance in this regard as well.I wish you could link me with Ishrat to share ideas.Thanks.
Adewale
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Aug 15, 2010 @ 11:23 pm
Very exellent article.
I am working in this field.It is very difficult to get accurate,unbiased and complete data on Hospital Acquired Infections from Government,Semigovernment & Privated hospitals especially in India.
The experts are requested to share thir views/remarks and suggestions about it.
Thanks
Anil Arekar
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Sep 27, 2010 @ 9:09 am
HELLO,CAN U PLEASE TELL ME THE MOST COMMON PATHOGEN INVOLVED IN THE HOSPITAL ACQUIRED INFECTION?
AND WHAT ARE THE CRITERIA TO DIFFERENTIATE IT FROM COMMUNITY ACQUIRED INFECTION?THANK YOU...
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Oct 4, 2010 @ 12:12 pm
I am internal medicine, work at Center of Infectious Disease in Wahidin Sudirohusodo Hospital Makassar Indonesia, I wish you could sent to my e-mail your full articel and another articel,tahmk you
Laurie McNally
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Oct 8, 2010 @ 9:09 am
I am using this article on HAI's for a research class. (undergraduate) I was wondering when the article was written? I need to reference it APA style and have no publication date. If you can give it to me, I would appreciate it. Thanks, Laurie McNally
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Nov 16, 2010 @ 10:10 am
This article made me cry because my father die for a nosocomial infection in Puerto Rico. It`s so sad that he go to the hospital for health and leave died. A productive man of our society die because hospital personnel did not follow the guidelines. This reality still continue in our hospitals. As professional nurse and nursing professor I fight everyday with this inhuman practice. Thanks, I use your articles for my nursing courses.
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Nov 29, 2010 @ 4:04 am
what is the factor that cause infection in hospital setting?
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Dec 18, 2010 @ 4:04 am
iam working as a microbiologist and infection control secretary and this is very helpful to me to improve and standardise our set up i would like to know more about prevention of vap in nuerosurgical cases
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Dec 30, 2010 @ 11:11 am
Is there a database to show the incidence of HAIs at specific hospitals? What about deaths due to HAIs? How do hospitals report them and are they required to? I am a journalist working on an article about HAIs. Thanks for your help. Anyone else with info: feel free to contact me at jejackson@columbiatribune.com
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Jan 27, 2011 @ 1:13 pm
great article this is great for the phlebotomy class I am currently taking it may help with homework assignment.
Yuki
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Feb 18, 2011 @ 10:10 am
nosocomial infections occur in hospitals and generally occurs in patients bedrest where they received treatment for longer.
when a patient with MRSA disease, including antibiotic-resistant group, and exposed nosocomial infections, how the efforts made?
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Feb 19, 2011 @ 7:07 am
hello,

I am a hospital administration student. I've taken up a study on awareness of hospital acquired infection among patients visitors, can you please guide me. can you please send me some of the related article.
Thank You
Kruthi Basavaraj
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Apr 5, 2011 @ 4:16 pm
thanks alot for this usefule article ,

Nada Ahmed
egyptian pharmacy student
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Apr 16, 2011 @ 12:12 pm
Iam student and need urgent answer about this question:
what interpretations can you give to : changeable bacterial flora in infected wounds from 2 - 6 weeks hospitalized patients.
thanks for your help
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Apr 16, 2011 @ 1:13 pm
Iam student and need urgent answer about this question:
what interpretations can you give to : changeable bacterial flora in infected wounds from 2 - 6 weeks hospitalized patients.
thanks for your help
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Aug 12, 2011 @ 8:08 am
Iam an advocate for a client who had a percutanious transluminal coronary angioplasty/stenting procedure following an acute infarct3 days ago, she suffered refractory spasms of the artery in her left arm where they tried to insert the catheter or stent this was retracted and they successfully completed the procedure through her groin. she has been informed and is being treated for an infection with antibiotics so delaying her return home could this be a hospital borne infection
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Oct 14, 2011 @ 11:23 pm
iam working as a microbiologist and infection control secretary and this is very helpful to me to improve and standardise our set up i would like to know more about prevention of vap in nuerosurgical cases
mary
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Aug 31, 2012 @ 9:21 pm
What year was this article published?

Thank you,

Mary
kamara Babra
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Oct 31, 2012 @ 8:08 am
Thank you for the information, it gives me some points on hospital acquired infection. At the same time i get to see where I might have contributed to put patients at risk of the infection. Today i saved one patient because am a ware I will save more
Babra Ug
lynn mary
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Mar 12, 2013 @ 2:02 am
Nice article,am a B.Sc nursing student and am currently working on a seminar on the challenge of hospital acquired infection on quality nursing pratice,please can you send me more articles related to it,thanks.
flora
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Apr 25, 2013 @ 11:11 am
I am a student of Microbiology / Biotechnology in Western Delta University, Oghara Delta state, Nigeria. Am currently working on a seminar topic which is based on hospital acquired infection and am so grateful for the information displayed. Please can you send me more articles ralated to it.
DEBBIE
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Aug 12, 2013 @ 10:10 am
After the infection has set in what is the protacol for the patient? Also hydration, vomiting,shaking. Should you have another 2 surgerys after being infection. This is within one month 3 total surgeries. Two of them within one week apart.

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