Hospital-Acquired Infections Health Article

Definition

A hospital-acquired infection is usually one that first appears three days after a patient is admitted to a hospital or other health-care facility. Infections acquired in a hospital are also called nosocomial infections.

Description

About 5–10% of patients admitted to hospitals in the United States develop a nosocomial infection. Hospital-acquired infections are usually related to a procedure or treatment used to diagnose or treat the patient's illness or injury. About 25% of these infections can be prevented by healthcare workers taking proper precautions when caring for patients.

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, healthcare 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 of the wound becomes red, hot, and painful. A generalized infection is one that enters the bloodstream and causes general systemic symptoms such as fever, chills, low blood pressure, or mental confusion.

Hospital-acquired infections may develop from surgical procedures, catheters placed in the urinary tract or blood vessels, or from material from the nose or mouth that is inhaled into the lungs. The most common types of hospital-acquired infections are urinary tract infections (UTIs), pneumonia, and surgical wound infections.

Causes and symptoms

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 are more likely to get an infection. 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.

Any type of invasive procedure can expose a patient to the possibility of infection. Common causes of hospital-acquired infections include:

• Urinary bladder catheterization
• Respiratory procedures
• surgery and wounds
• intravenous (IV) procedures

Urinary tract infection (UTI) is the most common type of hospital-acquired infection. Most hospital-acquired UTIs happen after urinary catheterization. Catheterization is the placement of a catheter through the urethra into the urinary bladder. This procedure is done to empty urine from the bladder, relieve pressure in the bladder, measure urine in the bladder, put medicine into the bladder, or for other medical reasons.

The healthy urinary bladder is sterile, which means it doesn't have any bacteria or other microorganisms in it. There may be bacteria in or around the urethra but they normally cannot enter the bladder. A catheter can pick up bacteria from the urethra and allow them into the bladder, causing an infection to start.

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 risk for infection by a fungus called Candida.

Pneumonia is the second most common type of hospital-acquired infection. Bacteria and other microorganisms are easily brought into the throat by respiratory procedures commonly done in the hospital. The microorganisms come from contaminated equipment or the hands of health care workers. Some of these procedures are respiratory intubation, suctioning of material from the throat and mouth, and mechanical ventilation. The introduced 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 inhale the microorganisms into the lungs.

Patients who cannot cough or gag very well are most likely to inhale colonized microorganisms into their lungs. Some respiratory procedures can keep patients from gagging or coughing. Patients who are sedated or who lose consciousness may also be unable to cough or gag. The inhaled microorganisms grow in the lungs and cause an infection that can lead to pneumonia.

Surgical procedures increase a patient's risk of getting an infection in the hospital. Surgery directly invades the patient's body, giving bacteria a way into normally sterile parts of the body. An infection can be acquired from contaminated surgical equipment or from health-care workers. Following surgery, the surgical wound can become infected. Other wounds from trauma, burns, and ulcers may also become infected.

Many hospitalized patients need a steady supply of medications or nutrients delivered to their bloodstream. An intravenous (IV) catheter is placed in a vein and the medication or other substance is infused into the vein. Bacteria transmitted from the surroundings, contaminated equipment, or healthcare workers' hands can invade the site where the catheter is inserted. 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 put patients at risk for nosocomial infection are gastrointestinal procedures, obstetric procedures, and kidney dialysis.

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 coughing. A localized infection causes swelling, redness, and tenderness at the site of infection.