Nosocomial infections

Hospital-acquired infections (HAI), also called nosocomial infections, are infections that are acquired by patients in the hospital setting anywhere after 48 hours of being admitted to the hospital or other health institution. The acquired infection is not directly related to the original condition for which the patient reported. However HAIs come about as a result of a procedure or treatment that utilized in the diagnosis or treatment of patients (Rizzo & Odle, 2006). Hospital acquired infections are the leading cause of complications in patients that are hospitalized (Mohr, Peninger, & Ostrosky-Zeichner, 2005).

Researchers estimate that the prevalence of HAIs is approximately between five and ten percent of admitted patients in the United States (Rizzo & Odle, 2006). Additional data from the Centers for Disease Control and Prevention (CDC) suggest that yearly about just under two million hospitalized patients develop an HAI (CDC, 2007). Furthermore close to 100,000 of these patients eventually die, as a consequence of the infection (CDC, 2007). McCaughey further exemplifies the true prevalence of HAIs, estimating that one in 20 hospitalized patients develop and HAI resulting in 20 million infections yearly (as cited in Stommen, 2007).

In addition the prevalence of HAIs varies considerably depending on the nature of the infections developed and the characteristic of the patient affected. Patients admitted in the intensive care units (ICU) of hospitals are the most at risk for the development of HAIs. Mohr et al. (2005) estimate that 10 percent of patients undergoing acute care are infected annually. For patients in the ICU this figure increases exponentially to as much as 30 percent (Mohr et al. , 2005). Common HAIs

Hospital-acquired infections can manifest themselves in any of a number of forms, and which infection a patient may develop or may be at risk for developing depends heavily on heir own physical condition, the purpose of their stay in the hospital and the nature of the hospital environment in which they are staying (Rizzo & Odle, 2006). HAIs can arise as a result of surgical procedures, the use of catheters in the urinary tract or blood vessels, or from substances inhaled into the lungs (Rizzo & Odle, 2006). According to the CDC there are four common types of HAIs which contribute the most significant to HAI cases in the United States.

In terms of rank order health-care acquired urinary tract infections (UTI) are the most prevalent, accounting for 32 percent of HAIs nationwide (CDC, 2007). This type of HAI develops subsequent to the insertion of a urinary catheter in patients hospitalized. Urinary catheter insertion or more appropriately catheterization, is the insertion of a catheter into the bladder via the urethra. This procedure serves a variety of medical purposes including removing urine from the bladder, reducing bladder pressure, measuring the urine contents of the bladder and introducing medicine into the bladder, among others.

This procedure is often necessary and unavoidable, particularly for patients on which invasive procedures will be done. A UTI develops when unusual bacteria enters the urinary tract and begins to produce complications. The bladder is customarily sterile, free from bacteria and microorganisms. Normally though bacteria may be present in the body and in the area of the urethra, these bacteria are usually unable to enter the bladder. However when a catheter is present, the catheter is able to pick up bacteria and transport it into the bladder. When this happen an infection soon develops.

Bacteria entering the urethra from the intestinal tract are usually the primary sources of bacteria entering the bladder (Rizzo & Odle, 2006). Of course it is also possible to develop a UTI in the absence of catheterization but this is not frequently the case. Well over 80 percent of health-care associated UTI occurs in the presence of catheterization and thus this is the greatest risk factor for the development of this particular HAI (Mohr et al. , 2005). The presence of a UTI is usually manifested by pain during urination as well as the presence of blood in the urine.

The effects of UTIs acquired in the healthcare setting can be quite costly. Figures published in 1996 estimated that healthcare associated UTIs cost on average between $558 and $593 for each infection. Of course over ten years later this figure must be significantly higher. Furthermore patients who develop UTIs under these conditions spend on average an additional one to four days in hospital (Mohr et al. , 2005). The second most prevalent HAIs are those that are brought about during or as a result of surgical procedures.

Patients develop infections at the site of the surgery. The CDC estimates that these account for 22 percent of HAIs. Among patients hospitalized for the purpose of surgery solely, these infections are the leading cause of HAIs among this population. Estimates suggest that just over four percent or one in every 24 patients undergoing inpatient surgery, develop an infection in their surgical wound Hollenbeak et al. (2006). These HAIs can have significantly and deadly effects on the affected patients.

The specific means of acquiring this HAI is hinged on numerous factors. The susceptibility of the patient to infections and their level of exposure are two of the most important factors in predicting whether or not a surgical patient will develop wound infections. Susceptibility to this HAI is usually heightened for patients depending on their age, the presence and stage of diabetes mellitus, and the length of time they were in the hospital prior to the surgery. Additionally some surgical procedures put patients at a greater risk than others.

Research has shown that surgical wound infections are greater among patients who undergo abdominal surgery, colon surgery, gastric surgery, and liver or pancreas surgery (Hollenbeak et al. , 2006). In terms of exposure, risk for surgical wound infections is heightened by unhealthy practices either within the hospital itself, or on the part of the clinical personnel dealing with the patient. The level of traffic through the operating room during surgery, the introduction of foreign bodies to the wound, lengthy surgeries and other surgical practices may affect patients’ likelihood of infection (Hollenbeak et al.

, 2006). One of the major issues that have been debated in contemplating this issue is proper hygienic practices specifically in relation to washing hands between patients and the administration of antibiotics which increase the risk of infections. The third most prevalent HAI is pneumonia according to the CDC. However Hoffken and Niederman (2002) as well as Rizzo and Odle (2006) put this infection at number two in the rank.

Nosocomial pneumonia or hospital-acquired pneumonia is defined as pneumonia occurring greater than or equal to 48 hours after hospital admission and excluding any infections that existed or was developing at the moment of admission to the hospital (Hoffken & Niederman, 2002). According to the CDC these infections account for 15 percent of HAIs in hospitalized patients (CDC, 2007). In terms of prevalence it is estimated that between five and ten patients, out of every 1000 admitted without any major risk factors may develop pneumonia.

The situation of patients admitted to the ICU and who are put on mechanical ventilators is even worse and may even represent somewhere between six and thirty times this number (Hollenbeak et al. , 2006). The resulting costs for these types of infections are also considerable. Mohr et al (2005) estimate these patients will spend on average seven to 30 days extra in the hospital. In terms of dollar figures the cost for each instance of health-care associated pneumonia infections ranges from anywhere between $4947 and $40, 000.

This infection is often associated with mechanical ventilation in the ICU (Mohr et al. , 2005). Pneumonia develops when unwanted bacteria and similar microorganisms pass through the respiratory machine and enter the throat and eventually the lungs. These unwanted intruders may have been present on equipment that was contaminated and not properly sterilized or during treatment by health care personnel who fail to take precautionary measures to ensure that the patient’s environment remains sanitary.

In addition to mechanical ventilation, other procedures such as respiratory intubation and the use of suction to remove items from the throat and mouth. Once the alien bacteria enter the throat they settle on the wall of the throat and colonize the area. As they grow they spread within the throat until eventually during respiration they are easily passed from the throat into the lungs (Rizzo & Odle, 2006). Health care workers can easily detect the presence of pneumonia. Patients may have problems breathing properly and may be coughing abnormally. If the infection is localized it may cause some amount of swelling.

The infected area may show signs of redness and tenderness (Rizzo & Odle, 2006). Mohr et al. (2005) suggest that the length of time the patient is on the mechanical ventilator may be a significant factor in determining whether or not pneumonia develops. Therefore preventing or decreasing this HAI involves expediting the weaning process from mechanical ventilation (Mohr et al. , 2005). The fourth most prevalent HAI, according to the CDC, are infections of the bloodstream. They account for 14 percent of these infections among hospitalized patients (CDC, 2007).

Mohr et al. (2005) estimate that this infection can increase the number of days that a patient remains hospitalized by between seven and 24 days. The additional cost for each case of healthcare associated bloodstream infection is between $3061 and $40, 000 (Mohr et al. , 2005). Bloodstream infections more commonly develop in the presence of intravascular catheters. These catheters are often unavoidable, particularly for patients administered to the ICU. However, the use of intravascular catheters is a risk factor for bloodstream infections.

Catheter-related bloodstream infections are very dangerous to patients. Bloodstream infections are particularly dangerous because they are generalized, entering the bloodstream and displaying multiple symptoms such as ever, chills, low blood pressure, or mental confusion (Rizzo & Odle, 2006). It has been estimated that approximately 80, 000 bloodstream infections occur in ICUs each year in the US (CDC, 2007). The best preventative mechanism against these infections is to remove the intravascular catheter once it is no longer needed. Key causes of HAIs

As indicated above there are a number of factors that may lead to the development of hospital acquired infections depending on the nature of the infection. Often these factors are as a result of necessary procedures that are done on the patient and in some instances the infections are unavoidable. However the prevention of these infections is not totally out of the control of health care personnel, at least not in all cases. Researchers have shown that the underlying cause of HAIs is the presence of unwanted bacteria, viruses, fungi, or parasites (Hoffken & Niederman, 2002; Rizzo & Odle, 2006).

These dangerous microorganisms may come from any of a number of sources. They may be present in the patient’s body, they may be present in the hospital environment, they may come from infected hospital equipment, health care workers may transfer these microorganisms to patients and so too can other patients or visitors to the health care institution (Rizzo & Odle, 2006). Any invasive procedure may potential put patients at risk for developing HAIs. Additionally all patients who are hospitalized may be prone to developing an HAI.

The causes of HAIs that have already been highlighted are the presence of intravascular or urinary catheters, the use of mechanical ventilators or suction or the presence of a wound following surgery. In addition some patients are at a higher risk than others for HAIs. 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.

However the most prevalent and alarming practice that has been associated with HAIs involves issues that, once effectively managed at the administrative level, would lead to a significant reduction in the occurrence of HAIs. This refers to the hygienic practices of health care personnel (Stommen, 2007). As indicated previously, practices as simple as sanitizing hands in between patient care and wearing gloves are often ignored by clinicians, yet this practice has been consistently linked with HAIs.

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