Hospital-acquired infections, also called nosocomial infections, are usually ones that first appears three days after a patient is admitted to a hospital or other health-care facility.  About 5-10% of patients admitted to hospitals in the United States develop these particular infections and they are normally related to a procedure or treatment used to diagnose or treat the patient’s illness or injury.  Amazingly, approximately 25% of these infections can be prevented by healthcare workers taking proper precautions when caring for patients. 

          All hospitalized patients are susceptible to contracting a nosocomial infection. Some patients are at greater risk than others–young children, the elderly and persons with compromised immune systems.  Other risk factors for getting a hospital-acquired infection are a long hospital stay, the use of indwelling catheters, failure of healthcare workers to wash their hands and overuse of antibiotics.

          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 and is referred to as a localized infection.   A generalized infection is one that enters the bloodstream and causes systemic symptoms such as fever, chills, mental confusion or low blood pressure.  This is very serious and can lead to sepsis, a rapidly progressive multi-organ infection, sometimes called blood poisoning that can result in death.

          Urinary tract infection (UTI) is the most common type of hospital-acquired infection and has been shown to occur after urinary catheterization.  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.  Invasive surgical procedures also increase a patient’s risk of getting an infection by giving bacteria a route into normally sterile areas of the body.  The infection can come 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.  

          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. 

          Fever is often the first sign of infection.  Other signs include 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.

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

  • Adopt an infection control program and a monitoring program to track infection rates to see if they go up or down.
  • 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.
  • 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.

As healthcare professionals, we need to do everything humanly possible to prevent these hospital-acquired infections.  Of all the precautions listed above, the most critical is proper hand-washing.  In addition, it is our ethical duty to inform visitors and patients alike, the responsibilities that they need to carry out in the prevention of nosocomial infections.



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