Hospital acquired infections

Hospital acquired infections - What it is

Hospital acquired infections are infections that are acquired in the hospital setting, usually occurring 48 hours after admission to the healthcare facility. They can be caused by viral, bacteria and/or fungal pathogens. Such infections can be transmitted through contact, droplet or airborne transmission, or through contaminated items such as medications, devices or equipment. Examples of hospital acquired infections include pneumonia, urinary tract infection, bloodstream infection, surgical wound infection, device related infections and Clostridium difficile associated diarrhoea. Some of these infections are associated with drug resistant organisms which are hard to treat.

Hospital acquired infections - Symptoms

Patients with hospital acquired infections may develop fever occurring 48 hours after hospitalization. They may also complain of chills, rigors, giddiness, palpitations and experience lethargy. Some may experience non-specific symptoms and the infection is picked up on routine blood test showing elevated inflammatory markers. In other instances, the signs and symptoms may be more specific depending on the organ involved. Apart from fever, one may also experience the following:

With pneumonia, one may experience shortness of breath, cough, chest pain with deep breathing.
With urinary tract infections, there may be pain or burning sensation with passing urine, pain above pubic bone and/or in the flanks, blood in urine, cloudy urine, or decreased urine output.
Patients with bloodstream infections may feel sick and unwell with non-specific symptoms. The infection can also spread to other parts of the body such as the skin, bones, joints, heart or other internal organs. When abscesses form, they may cause pain.
Surgical wound infections / device related infections. The surgical wounds may appear red, feel warm to touch and experience pain with palpation. Pus may be expressed in severe cases.
Hospital acquired diarrhoea can also develop, and this is often associated with Clostridium difficile infection associated with antibiotic use. One may experience nausea, anorexia, abdominal pain, with loose watery stools or bloody stools.

Hospital acquired infections - How to prevent?

Every individual plays a part in the prevention of hospital acquired infections, healthcare workers, patients and visitors alike.

Healthcare workers play their part in the prevention of transmission of infection by exercising infection control measures such as hand hygiene (handwashing with soap and water or the use of alcohol-based hand disinfectant) before and after patient encounter as well as donning of protective barrier (gloves and gowns) and respiratory masks in the appropriate setting. Also, they are advised to take medical leave when they are unwell.

When medical instruments are no longer required for the care of the patient, they are removed as soon as possible to reduce the risk of hospital acquired infections.

Patients can also play an active role. When they have recovered from their acute illness, by actively participating in rehabilitation activities to improve their mobility and functional status, they can reduce their risk of respiratory tract and urinary tract infections.

Visitors who are unwell are advised to stay home instead of coming to the hospital for visitation.

For individuals who have potential or actual transmissible infections, they are usually nursed in special wards (isolation facility) with specific precautions as advised by the infection control prevention team.

Hospital acquired infections - Causes and Risk Factors

Hospital acquired infections can arise because the patient is debilitated and frail, with impaired immunity. Patients may also catch infections from visitors who are unwell, or acquire them through contact with other patients or healthcare workers. This highlights the importance of good infection control practices in the hospital.

The development of hospital acquired infections also depends on the complex interaction between patient factors, healthcare environmental factors and procedural factors. In general, those at risk of hospital acquired infections are elderly, frail and/or bedbound patients with poor nutritional status. They are also likely to have chronic medical conditions (e.g. diabetes, chronic lung diseases, chronic heart conditions, chronic renal failure, chronic liver disease, stroke, neurodegenerative conditions, autoimmune disorders, haematological disorders or underlying malignancy), undergone recent surgery / procedures or have medical instruments in situ. Transplant recipients are also at high risk of hospital acquired infections.

Paradoxically, patients who are on antibiotics are also at risk of hospital acquired infections, specifically, Clostridium difficile associated diarrhoea, which is a form of antibiotic associated diarrhoea. Antibiotics which are no longer indicated should be discontinued.

Hospital acquired infections - Diagnosis

Basic laboratory tests to trend inflammatory markers and evaluate organ function are often performed. To find out the exact cause of the infection, cultures (blood, urine, body fluid or tissue culture) are often collected.

Depending on the clinical picture, further tests such as imaging (X-rays, computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound scans) may be ordered.

Hospital acquired infections - Treatments

Principles of therapy include looking for the source of the infection, treating the acute infection and providing recommendations to prevent the infection from recurring.

Treatment for the infection is based on the clinical picture, patient factors and is guided by microbiological culture results.