Nosocomial Infections

Summary

A "nosocomial infection" is an infection acquired in a hospital by a patient receiving care for another condition. This type of infection always originates in a hospital. It is also referred to as a "hospital-acquired infection" or "HAI".


A Serious Healthcare Problem

According to the Centers for Disease Control and Prevention (CDC), approximately one out of every 20 hospitalized patients in the U.S. contracts a nosocomial infection. In other words: 5% of all hospitalizations or nearly 2 million people each year.

A CDC report [PDF - 367KB] from 2002 estimated 1.7 million nosocomial infections in the U.S., resulting in 99,000 deaths. A 2009 report by Emory University [PDF - 116KB] reaffirmed the estimate of 99,000 deaths per year.

The Committee to Reduce Infection Deaths (RID), however, a privately run nonprofit, claims the numbers of infections and deaths are actually higher than CDC estimates. RID counts the number of lives lost each year at around 103,000.

The founder of RID, Betsy McCaughey, points out: "Hospital infections kill more Americans each year than AIDS, breast cancer and auto accidents combined."

According to the CDC, nosocomial infections are the sixth leading cause of death in the United States.

A Global Problem

Nosocomial infections are a serious health issue in many countries around the world.

A study of 55 hospitals in 14 countries by the World Health Organization (WHO) found that almost 9% of hospitalized patients acquired a nosocomial infection.

Nosocomial Infection Rates in Selected European Countries
France 5.4% (2006)
Italy 6.7% (2000)
United Kingdom 8.2% (2006)
Switzerland 7.2% (2004)
Finland 8.5% (2005)
Source: Wikipedia.org

The Financial Burden

Beyond the cost in terms of human lives (approx. 100,000 deaths/year), the CDC calculates [PDF - 835KB] the total financial cost of nosocomial infections to U.S. hospitals to be $35-$45 billion per year.

Then there are the other financial costs. By remaining hospitalized and missing work, patients may have to give up wages and pay more out-of-pocket expenses. The costs to government and insurance companies are also enormous. Longer hospital stays also limit access to hospital resources by other patients.


Types of Infections

Common types of nosocomial infections include:

  • Urinary tract infection
  • Bloodstream infection
  • Surgical site infection
  • Pneumonia
  • Skin infection
  • Gastrointestinal infection
  • Central nervous system infection

Common pathogens that cause nosocomial infections include:

  • Staphylococcus aureus (bacteria)
  • Clostridium difficile (bacteria)
  • Pseudomonas aeruginosa (bacteria)
  • Escherichia coli (bacteria)
  • Candida albicans (fungi)
  • Aspergillus (fungi)
  • Respiratory Syncytial (virus)
  • Influenza (virus)

Although acquiring an infection in a hospital may seem safe and convenient, the opposite may be true. A nosocomial infection may be more dangerous than other infections because microorganisms in hospitals tend to develop a resistance to antibiotics, making the infection more difficult and expensive to treat.


Control & Prevention

In the United States, nosocomial infections are not only a leading cause of death, but they are also a leading cause of preventable death. The fact is that most of these infections and resulting deaths didn't have to happen.

To understand why these infections are preventable it is important to understand how they occur in the first place.

Hospitals are, paradoxically, hazardous places for patients. All ingredients for an infection are readily available:

  1. At-Risk Patients. Hospital patients are people who are sick, injured or in need of treatment/surgery. They have weakened immune systems, open wounds or other vulnerabilities. These people are susceptible to infection, even by germs that are harmless to healthy people.
  2. Efficient Vectors. Nosocomial infections can be transmitted by medical equipment, hospital staff, patients, visitors, water, air or any other vectors (agents that act as carriers or transporters of germs).
  3. Unsterile Environment. In a hospital, dangerous germs are everywhere.

With all three ingredients available in one place, a hospital is an ideal place to acquire an infection.

Risk Factors

Below are a few hospital risk factors for nosocomial infections:

  • A nurse with a cold
  • A stethoscope that wasn't properly sterilized
  • A catheter that was carelessly inserted or removed
  • Poor ventilation in the building
  • Re-using disposable medical supplies
  • Un-washed hands (Note: Simply putting gloves on without first washing hands is not a good solution, as the germs from the hands will be passed onto the gloves.)

Hospitals that don't constantly maintain a sterile environment may facilitate the spread of infections. When a hospital patient comes into contact with, for example, a doctor who didn't wash his hands, the risk of infection is significant.

As most hospitals are aware of this problem and have established policies to minimize infection risk, most infections today occur when there is a failure to adhere to the policies and practices in place to ensure a sterile environment. In other words, they are the result of human error, apathy or incompetence.

There are many ways to minimize the risk of acquiring or spreading nosocomial infections. Hospitals and patients both have roles to play.

Techniques for Preventions

Below are a few techniques to prevent nosocomial infections:

What hospitals can do:
  • Hand Hygiene: Of the many ways to combat hospital infections, the most effective weapon is the simple and routine act of hand-washing. A thorough washing removes microorganisms from the hands and prevents their potential transfer. All hospital personnel should wash their hands before and after contact with patients and medical equipment. All visitors should also wash their hands before nearing a patient. Hospitals should facilitate good hand hygiene by providing easy access to soap and water, and by placing wall-mounted hand sanitizers outside all patient areas.
  • Training: All hospital workers (including ambulance teams) should receive continual training in preventing and managing nosocomial infections.
  • Monitor Infection Rates: Infections should be closely monitored at all levels. Surgeons should be aware of the infection rate among their patients. Hospital divisions should know their rates. These statistics will be useful in developing strategies to minimize infections.
  • Monitor Indoor Air Quality and Water Supplies
  • Outbreak Control: What measures are in place to identify infections early? Once an outbreak is identified, what is the process for managing and controlling the outbreak?
  • Policy Development: Practices, policies and guidelines should be constantly evaluated and enhanced.
What patients can do:
  • Learn how hospital infections work. A patient who understands how these infections happen and spread is more likely to avoid acquiring one. Having a friend or family member nearby who is also well-educated on the matter is also good for prevention.
  • Check the hospital infection rate. When a choice is available, the patient should avoid hospitals (and doctors, for that matter) with higher infection rates.
  • Ask questions. Although it may feel awkward or rude, it is important for patients to ask questions. Did you see the doctor wash her hands? If not, ask her if she did before she treats you. Did you see the nurse open a new syringe? If not, ask her if this is its first use. Ask to have the room cleaned if it looks dirty to you. Recognize that asking questions may ultimately save your life.
  • Minimize Hospital Stay. The shorter the time you spend in the hospital, the smaller the risk you take of getting an infection.
  • Hold them accountable. (This recommendation may be more suitable for patient advocacy groups, but intrepid individuals should try, as well.) Pressure hospital management to publish infection rates, if they don't already. When infection rates are made public hospitals will be under constant pressure to keep the rates as low as possible.

The techniques listed above are by no means exhaustive. For more ways to prevent nosocomial infections see the following resources:


Related Videos

Combating Deadly Hospital Infections (2:12 minutes), ConsumerReports
Coming Clean: Fighting Hospital Infections (1:46 minutes), Lee Memorial Health System

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