Hospital Infections

Hospital · Feb 17, 2021

Seema Madhavan

Seema MadhavanCase Manager

Infections in the hospital are caused by viruses, bacteria, or other microorganisms. Hospital-acquired infections, also called nosocomial infections, are infections that happen within a hospital. According to the CDC, 1 in every 31 patients can get hospital-associated infections. The estimated number of infection cases each year is 1.7 million and accounts for 99,000 deaths per year. The amount of human suffering and financial losses due to these infections places an enormous burden on the healthcare system, and on patients.

 32% of hospital-acquired infections are urinary tract infections, 22% are surgical site infections, 15% are lung infections, and 14% are bloodstream infections.                           

Catheter-associated urinary tract infections   

Urinary tract infections (UTIs) are the most common type of hospital-acquired infection. 75% of UTIs are associated with the use of a urinary catheter. A urinary catheter is a soft tube that is installed to drain urine from the bladder when the bladder cannot be emptied the natural way.

There is a 15%-25% chance that you may receive a urinary catheterization during your stay in the hospital. This puts you at risk for a UTI. If left unaddressed, the infection can travel throughout other areas of the urinary system including the kidneys, turning it into a more severe condition, the worst of which is sepsis, which can be life-threatening. Most UTIs can be treated with antibiotics.

Surgical site infections  

Surgical site infections (SSIs) occur at the site where the surgery was performed. Most SSIs are superficial, involving only the skin. Some spread into the deeper parts of the skin, organs, or around implanted material. SSI develops in 1-3% of the patients who undergo a surgical procedure. An SSI may contain pus, may have an odor, and may be red, painful, and hot to the touch.

Infections can be treated with antibiotics, but if left untreated, may develop into sepsis and spread throughout the body. This is a life-threatening condition that can lead to medical emergencies and multiple organ failures.

The presence of bacteria at the site of surgery can lead to complications after the surgical procedure, even if sterilization procedures and protocols are followed by the hospital.

After the surgery, the bacteria could multiply, triggering the body’s reaction and ultimately causing sepsis. It is still uncommon, occurring in less than 1% of patients. Complications associated with certain diseases like diabetes can also increase the risk for surgical site infection.

These are certain circumstances that may put patients at higher risk for surgical site infections. It goes without saying that the doctors must follow the infection control protocols and strategies to prevent infection. Moreover, while treating high-risk patients, doctors must take additional precautions and educate patients before and after the surgery on how to prevent infections.

Ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) is a complication a patient may get if he or she was placed on a ventilator. A ventilator is a machine that supplies breathable air in and out of the lungs through a tube. Pathogens can enter through this tube and get into the lungs causing a lung infection.  Out of all intensive care unit nosocomial pneumonia infections, 86% are VAP. 

Common considerations to reduce the risk of ventilator-associated pneumonia:

  • Whether to use intubation

  • The placement of the intubation tube (know as an endotracheal tube)

  • Proper feeding of the patient

  • There is no secretion retention and inadequate cough

  • The patient is not immunosuppressed  

  • There is no respiratory tract infection

  • Good oral hygiene

  • Proper positioning of the patient

  • Preventing stress-related bleeding

  • Proper use of antibiotics

The risk of developing an infection is higher in cancer and immunocompromised patients because it is easier for bacteria to invade the lung tissues. Intubation builds up oral and gastric fluid, which blocks airway clearance that forms bacterial colonies and gets transmitted into the lungs. Most of the bacteria causing hospital-acquired pneumonia are multidrug-resistant bacteria. So whenever the infection occurs, it should be diagnosed as early as possible and it is necessary that the doctor chooses the appropriate antimicrobial drug treatment to avoid later complications.

Bloodstream infections

In case of any or all of the conditions mentioned above, when the bacteria from a site (e.g., lungs, skin, or urinary tract) enters into the circulation via the bloodstream, it leads to a serious condition called septicemia or sepsis.

Once the bacteria enter the bloodstream, they are carried throughout the entire body. The body’s immune system releases chemicals into the blood, causing inflammation.

This can disrupt the flow of the blood to the organs and can cause organ failure. In many other cases, there is no organ failure but there is the risk of increased blood pressure, decreased heart function, or septic shock.

Another type of bloodstream infection is central line bloodstream infection or catheter-associated bloodstream infection. This happens when a catheter tube is inserted into your bloodstream to draw blood or give you fluids or medications intravenously.

The bacteria can enter the body through the insertion point and eventually circulate in the bloodstream. Hemodialysis (a procedure for patients with kidney disease) may also introduce bacteria into the blood through the central line.

Catheter-related bloodstream infections have been reported to occur in 3 to 8% of inserted catheters and are the first cause of nosocomial bloodstream infection in intensive care units (ICUs), with 80,000 cases annually.

The various reasons that lead to central line bloodstream infection are:

  • Contamination on insertion site of the blood catheter

  • The bacteria present on the patient’s skin

  • The breach in the infection control practices by a healthcare provider

  • Colonization of bacteria on the central venous catheter tip

  • Contaminated infusion or components of the IV set

  • Spread through the bloodstream from other sites 

  • Non-intact dressing or open wounds

Infections are common with any medical or surgical procedures. It is your doctor’s responsibility to maintain hygiene, use aseptic and sterile instruments, and accurately monitor urine output.

To avoid bloodstream infections, it is crucial that the doctor maintains basic hygiene and follows all sterilization protocols. All healthcare providers must be educated about the procedures involved in using medical instruments.

It is almost impossible for anyone to determine when and where an infection started, and where the bacteria came from, as an infection itself is not a deliberate occurrence initiated by a healthcare provider. Most of the time, the infection isn't caused by a surgeon or medical team but by the bacteria.

The key question then becomes "did the medical staff respond appropriately to the infection and do everything within standard practice to treat it?". If standards of care were not adhered to and you or your loved ones have suffered serious infections or an unfortunate incident like death, then you should speak to a qualified medical malpractice attorney.

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