Claire Dawson
Hospital-acquired infections (HAIs) are illnesses that patients can contract while receiving healthcare. They are typically not present or incubating at the time of hospital admission and usually manifest 48 hours after. HAIs can spread through various means, including direct person-to-person contact, indirect contact with contaminated surfaces or equipment, or as a result of specific medical treatments. While not all infections can be prevented, proper infection control procedures, such as hand hygiene, patient placement, and the use of personal protective equipment (PPE), are crucial to reducing the spread of HAIs.
| Characteristics | Values |
|---|---|
| Type of Infections | Surgical Site Infections (SSI), Clostridium Difficile Infections (CDI), Catheter-associated Urinary Tract Infections (CAUTI), Central Line-associated Bloodstream Infections (CLABSI), Hospital-acquired Pneumonia (HAP), Ventilator-associated Pneumonia (VAP), Carbapenem-resistant Enterobacterales (CRE), Clostridium Sordellii, Gram-negative Bacteria, Staphylococcus Aureus (Staph), Methicillin-resistant Staphylococcus Aureus (MRSA), NTM, Pseudomonas Aeruginosa, Klebsiella |
| Causes | Certain medical treatments, microorganisms from the patient's body, microorganisms from outside sources, existing infections brought into the hospital, antibiotic use, gastric acid suppressants, non-selective non-steroidal anti-inflammatory drugs (NSAIDs), comorbidities, age, diabetes, obesity, nutritional status, colonization, co-existing infections, duration of the procedure, skin antisepsis, surgical technique, antimicrobial prophylaxis, antibiotic resistance, antiviral resistance, antifungal resistance, poor hand hygiene, contaminated food or water, coughs, sneezes, touch, surfaces, air |
| Prevention | Hand washing with soap and water, alcohol-based disinfectant, gloves, masks, gowns, skin decontamination, antibiotic prophylaxis, antimicrobial stewardship, infection control procedures, patient isolation, patient education, safe management of care equipment and environment, specialist cleaning procedures, patient placement, personal protective equipment (PPE), antibiotic treatment |
What You'll Learn
Person-to-person transmission
Respiratory droplets are generated when an infected person coughs, sneezes, or even speaks, releasing tiny particles containing viruses or bacteria into the air. These droplets can then be inhaled by another person, leading to the spread of infections such as influenza, the common cold, or even COVID-19. During the COVID-19 pandemic, it became evident just how easily this virus could be transmitted from person to person in hospital settings.
Physical touch is another means of person-to-person transmission. When an infected person touches surfaces or objects after coughing or sneezing into their hands, they contaminate these surfaces with their respiratory droplets. Other individuals who touch these surfaces may pick up the microorganisms and transfer them to their mucosal surfaces, such as the eyes, nose, or mouth, leading to infection. This is why hand hygiene is of utmost importance in hospitals, with initiatives like the "clean care is safer care" program advocating for proper handwashing techniques to prevent the spread of infections.
In addition to respiratory droplets and touch, close contact with infected individuals can also lead to person-to-person transmission. Certain microorganisms, such as tubercle bacilli, varicella, and rubeola virus, can remain suspended in the air for extended periods and spread to nearby individuals. This type of transmission is particularly relevant in hospital settings, where patients and healthcare workers are in close proximity.
To prevent person-to-person transmission in hospitals, various measures can be implemented. These include encouraging proper handwashing techniques, providing hand sanitizing stations throughout the hospital, ensuring adequate patient placement and isolation, and promoting the proper use of personal protective equipment (PPE) for healthcare workers and patients when necessary. Additionally, educating patients and staff about infection control practices and promoting good hand hygiene can significantly reduce the spread of infections within healthcare facilities.
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Medical treatments
Some infections can spread as a direct result of certain medical treatments. Surgical site infections (SSIs) can occur after invasive procedures that involve making incisions in a patient's skin. Despite being performed in highly controlled sterile environments, incision wounds can still get contaminated by microorganisms from the patient's body or from outside sources.
Catheter-associated urinary tract infections (CAUTIs) are another type of HAI that occurs after a urinary catheter is placed in a patient. Central line-associated bloodstream infections (CLABSIs) are infections in the blood that occur when a central line, a tube that carries medicine and treatments into a patient's body, is used.
Infections can also occur from the use of antibiotics. Clostridium difficile infections (CDIs) can be triggered when antibiotics cause a bacterial imbalance in the gut. Additionally, the use of intravenous antibiotics has been linked to an increased risk of MDR infections, which are resistant to multiple types of antibiotics.
To prevent the spread of infections during medical treatments, proper infection control procedures are essential. This includes the use of personal protective equipment (PPE), adherence to hand hygiene protocols, and regular cleaning and disinfection of medical equipment and the care environment. Patients can also play a role in preventing HAIs by practising good hand hygiene, completing prescribed antibiotic courses, and reporting any concerning symptoms to healthcare providers.
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Hand hygiene
A specific hand-washing technique should be followed to thoroughly clean hands at key touchpoints, such as before and after interacting with a patient and their surroundings. Patients should also be advised to follow good hand hygiene guidelines, and hospitals should provide plenty of handwashing stations.
Handwashing with soap and water or using an alcohol-based disinfectant before and after each patient visit is vital in reducing transmission rates of MDR pathogens. This simple practice can help prevent the spread of infections and improve patient safety.
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Patient placement
One key aspect of patient placement is the isolation of patients with known or suspected infections. Healthcare facilities should have guidelines and protocols in place to ensure proper isolation procedures, thereby minimising the risk of cross-transmission of infectious agents. Isolation facilities should be prioritised based on the specific infectious agent involved. When single-bed rooms are limited, patients with conditions that facilitate the transmission of infection or those at increased risk of adverse outcomes should be given priority.
Another important consideration in patient placement is the assessment of patients' potential to transmit infections. This assessment should be conducted upon admission to the healthcare facility and continuously reviewed throughout the patient's stay. Patients with symptoms such as unexplained loose stools, vomiting, fever, or respiratory symptoms may pose a cross-infection risk. Additionally, patients who have been hospitalized outside the current healthcare facility within the last 12 months should be considered for placement assessment.
In acute care hospitals, patients requiring contact or droplet precautions are typically placed in private rooms. Airborne precautions are also necessary to prevent and control infections spread via aerosols from an individual's respiratory tract. Healthcare staff should assess the transmission route of the infectious agent and apply appropriate transmission-based precautions (TBPs) to minimise the risk of transmission.
Furthermore, patient placement should be informed by a comprehensive infection risk assessment for each patient. This assessment helps identify patients with a high risk of cross-infection, who can then be isolated appropriately. Overall, effective patient placement, along with other infection control measures such as hand hygiene, personal protective equipment (PPE), and environmental cleaning, plays a vital role in preventing the spread of infections within healthcare settings.
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Personal protective equipment (PPE)
It is crucial for healthcare workers to follow proper protocols for using, maintaining, and disposing of PPE. Before and after interacting with patients, healthcare workers should perform hand hygiene and change their gloves and gowns. After caring for patients with infectious diseases, such as COVID-19, healthcare workers must immediately remove PPE in the reverse order and wash their hands. Proper disposal of PPE is essential to prevent the spread of infections and minimize the impact on the environment. Infected PPE should be separated from other waste streams to prevent groundwater contamination.
Healthcare organizations must ensure an adequate supply of PPE for their staff and partner with authorized distributors to maintain inventory. The use of PPE in healthcare settings has increased significantly since the COVID-19 pandemic, with many hospitals facing shortages of PPE for frontline workers. The pandemic has highlighted the importance of PPE in preventing illnesses, injuries, and deaths, and it has become the new norm for healthcare workers to protect themselves and their patients.
PPE is an essential component of infection prevention and control in hospitals. By following proper PPE protocols, healthcare workers can effectively protect themselves and others from hazardous materials and infectious diseases.
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Frequently asked questions
Hospital-acquired infections (HAIs) are infections that patients get while receiving healthcare or shortly after. HAIs can spread through treatment or from person-to-person (through touch, surfaces, or air).
Common HAIs include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP).
Risk factors for HAIs include patient factors such as age, underlying disease, severity of illness, immune status, and recent antibiotic use. Certain patient endogenous organisms and cross-contamination in the healthcare setting can also contribute to the risk of infection.
HAIs can be prevented through proper hand hygiene, infection control procedures, patient placement, and the use of personal protective equipment (PPE). Isolation of high-risk patients and regular cleaning and disinfection of equipment and the environment are also important.
Challenges in treating HAIs include antibiotic resistance, antiviral resistance, and antifungal resistance, where pathogens evolve and become unresponsive to standard treatments.
