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Hospital Associated Infections

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Standard Precautions need to be followed regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These practices are designed to both protect the healthcare provider and prevent the healthcare provider from spreading infections among patients. Standard Precautions include: hand hygiene, use of personal protective equipment (examples of that would be gloves or gowns or masks), safe injection practices, safe handling of potentially contaminated equipment or surfaces in the patient environment, and respiratory hygiene and cough etiquette. Some general principles for Healthcare Professionals include the following: To avoid the spread of bloodborne pathogens and infectious diseases, healthcare professionals have an ethical and professional responsibility to adhere to scientifically accepted or evidence based practices and principles of infection control and to monitor the performance of those for whom the professional is responsible. Multiple organizations publish best practices for infection control. But some states, include a legal responsibility to adhere to infection control practices. Follow the guidelines for your facility. Hospital-associated infection (or HAI), also known as a Nosocomial infections are those that originate or occur in a hospital or hospital-like setting. The CDC estimates that in American hospitals alone, healthcare-associated infections account for 1.7 million infections and 99,000 associated deaths each year. Infections can be associated with the devices used in medical procedures, such as catheters or ventilators. The most common types of hospital associated infections are bloodstream infection, pneumonia ventilator-associated pneumonia, urinary tract infection (UTI), and surgical site infection. A urinary tract infection is the most common type of healthcare associated infection. It is often associated with the placement of a catheter or tube that's used to empty urine from the bladder. Having surgery can increase a patient's risk of getting an infection by giving bacteria a pathway into a normally sterile area of the body. Following surgery, the surgical wound can become infected when the dressing is changed. Ventilator-associated pneumonias occur when Bacteria and other germs get into the lungs from an endotracheal tube that is attached to a ventilator. When the bacteria begin to grow in the tube, an infection develops that leads to pneumonia. Bacteria can enter the body at the site of where an IV or catheter is inserted. A local infection may develop in the skin around the catheter. The bacteria can also enter the blood through the veins that go near the heart and cause a more serious infection called sepsis. The deeper and longer a catheter is in place, the greater the chance of developing an infection. Common pathogens that cause the hospital-associated infections are Staphylococcus aureus, Pseudomonas aeruginosa, E. coli, Klebsiella, and Clostridium difficile. MRSA- methicillin-resistant Staphylococcus aureus. It is a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal. Pseudomonas aeruginosa-- pathogens that are highly resistant to antibiotics. Because antibiotics are usually non-effective, it can lead to a more serious infection: like septicemia, urinary tract infections, pneumonia, or chronic lung infections. Now, for E. Coli-- typically cause is severe stomach cramps, diarrhea (often bloody), and vomiting. Some E. coli strains can be life threatening. Klebsiella is a type of Gram-negative bacteria that can cause different types of healthcare-associated infections, including pneumonia, or bloodstream infections, wound or surgical site infections, and meningitis. Clostridium difficile known as C-Diff can cause gastrointestinal infection. C-diff spores are transferred to patients mainly via the hands and healthcare personnel who have touched a contaminated surface or item. Patients most at risk are the elderly, especially those already on antibiotics. C-diff is often a result of overuse or improper use of antibiotics When it comes to infectious diseases, prevention is the primary strategy for reducing the incidents of hospital acquired infections. Patients are coming to be treated to get more sick, they're coming to get well. And it's yours, and my, responsibility to do what we're supposed to do to make sure that they are getting the best and most healthy treatment possible.

In any healthcare setting, standard precautions must be followed when a patient is either suspected or confirmed of having an infection. In this lesson, we'll dig a little deeper into common infections in healthcare settings, along with certain practices that will help stop the spread of infection and keep you safe.

It's important that you follow all practices that are designed to protect both yourself – the healthcare professional – as well as the patients you serve, as infections can easily spread from patient to healthcare provider and then onward to other patients.

Such practices include:

  • Handwashing and hygiene
  • Use of personal protective equipment like gloves, gowns, and masks
  • Safe injection practices
  • Safe handling of potentially contaminated equipment or surfaces in a healthcare setting
  • Respiratory hygiene and cough etiquette

As a healthcare professional, part of your job is to protect against the spread of bloodborne pathogens and infectious diseases. Furthermore, healthcare providers have an ethical and professional responsibility to adhere to scientifically accepted or evidence-based practices and principles of infection control and to monitor the performance of those for whom the healthcare provider is also responsible.

Pro Tip #1: Multiple states publish best practices for infection control. Some states include a legal responsibility to adhere to these infection control practices that are in place. So, make sure you're following the proper guidelines at your healthcare facility.

Common Hospital Associated Infections (HAI)

Hospital-associated infections are those that originate or occur in a healthcare or healthcare-like setting. If you're thinking that this sounds like an oxymoron, in that people go to hospitals to get well – not sicker – you'd be right, and yet …

Warning: The CDC estimates that each year in the U.S. alone, hospital-associated infections account for 1.7 million infections, and of those cases, 99,000 result in death. That's yearly!

These infections can be associated with a number of procedures and devices, such as the use of catheters and ventilators.

The most common class of hospital-associated infections are bloodstream infections like pneumonia, ventilator-associated pneumonia, urinary tract infections, and surgical site infections.

Urinary Tract Infections

Urinary tract infections are the most common type of hospital-associated infections and are often the result of a catheter or tube that has been used to empty urine from the bladder.

Bacteria can enter the body at the site where an IV or catheter is inserted. Also, a local infection can develop in the skin around the catheter. Bacteria can also enter the blood through veins that go near the heart and cause a more serious infection known as sepsis.

Pro Tip #2: The deeper and longer a catheter is in place, the greater the chance of it resulting in an infection.

Ventilator-Associated Pneumonia

Ventilator-associated pneumonia occurs when bacteria and other germs enter the lungs from an endotracheal tube that has been attached to a ventilator. When bacteria begin to grow in the tube, an infection develops that can lead to pneumonia.

Surgical Site Infections

Having surgery can increase the potential risk of getting an infection, as surgery provides a pathway for bacteria to enter a normally sterile part of the body.

The risk of infection is also present post-surgery, as wounds can easily become infected when dressings are changed.

Common Pathogens that Cause Hospital Associated Infections

There are a few common pathogens most responsible for causing hospital-associated infections, and these are:

  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • E. coli
  • Klebsiella
  • Clostridium difficile (C-diff)

Pro Tip #3: MRSA (Methicillin-Resistant Staphylococcus Aureus) is a strain of staph that is resistant to the broad-spectrum antibiotics that are commonly used to treat it. As a result, and as you might imagine, MRSA can be fatal.

Pseudomonas Aeruginosa

Pseudomonas aeruginosa is another pathogen that is highly resistant to antibiotics. For this reason, it can lead to more serious infections like septicemia, urinary tract infections, pneumonia, and chronic lung infections.

E. Coli

E. coli is characterized by severe stomach cramps, diarrhea (often bloody), and vomiting. Some strains of E. coli can be life-threatening.

Klebsiella

Klebsiella is a gram-negative bacterium that can cause different types of serious hospital-associated infections like pneumonia, bloodstream infections, wound and surgical site infections, and meningitis.

Clostridium Difficile (C-diff)

C-diff can lead to gastrointestinal infections, as spores are easily transferred to patients mainly via the hands of healthcare professionals who previously touched a contaminated surface or piece of equipment.

C-diff is often the result of overuse or improper use of antibiotics. Patients most at risk are the elderly, particularly those who were already on antibiotics.

When it comes to infectious diseases, particularly those that most commonly originate (or are spread) in healthcare settings, prevention is the best strategy for reducing the incidences of hospital-associated infections.

Pro Tip #4: Keep in mind the extraordinary number of infections (1.7 million) that originate each year in American healthcare settings, along with the staggering number of deaths as a result (99,000). Then examine ways in which you, the healthcare provider, can help reduce this risk so that patients can get the help they need, rather than getting sicker.