Imagine going to the hospital to treat one illness, only to discover that you’ve contracted a new infection while receiving care. Unfortunately, healthcare-acquired infections (HAIs) are much more common than patients realize. According to the U.S. Centers for Disease Control and Prevention (CDC), one in 31 hospital patients on any given day will have an HAI. HAIs don’t just put patients’ health at risk; they can also add significant costs to healthcare bills. With careful infection control and efforts by both physicians and patients, it is possible to prevent and control infections acquired in a healthcare environment. Doctors share a comprehensive overview of healthcare-associated infections (HAIs), including their causes, prevention, and treatment options.
What Are Healthcare-Acquired Infections?
Healthcare-acquired infections, or HAIs, are infections patients acquire while or shortly after getting healthcare treatment. Most HAIs are contracted in hospital settings, but they can also occur in long-term care facilities and other clinics. “The most common types are pneumonia, urinary tract infections, infections from indwelling devices and/or surgical sites, skin infections, and infections from the gastrointestinal system,” says Charlisa Gibson, MD, a pulmonologist with the medical intensive care unit at NYU Langone Health.
HAIs can have a serious impact on patient outcomes. “HAIs can mean longer hospital stays, more treatments, and a higher risk of complications. This is especially true for the elderly or immunocompromised,” says Dr. Uma Darji at WakeMed Brier Creek. HAIs lead to increased healthcare costs for new tests and medications. Sometimes, even re-admission to hospitals is required to treat them.
Common Types of HAIs
Central Line-Associated Bloodstream Infections (CLABSIs)
Central line-associated bloodstream infections (CLABSIs) occur when germs or bacteria enter the bloodstream through a central line. This central line could be through a tunnelled catheter, an implanted port, or a peripherally inserted central catheter (PICC), meant to administer medication, fluids, or draw blood for medical tests. CLABSIs are preventable by physicians and healthcare workers following infection control guidelines.
Catheter-Associated Urinary Tract Infections (CAUTIs)
The most common healthcare-acquired infections are catheter-associated urinary tract infections (CAUTIs). CAUTIs are urinary tract infections caused by bacteria or germs entering the urinary tract through a catheter. Risk factors include age, gender, diabetes, and the length of time the catheter has been in place. The best prevention strategies are to take infection control precautions, regularly clean drainage bags, and remove the catheter as soon as medically feasible.
Surgical Site Infections (SSIs)
A surgical site infection (SSI) is when bacteria enter the site of a recent surgery (usually within 30 days), causing an infection. Three types of SSIs typically occur. A superficial incisional SSI is an infection around the skin where the incision was made. A deep incisional SSI is an infection that occurs in the muscle and tissue area beneath the skin near the incision. An organ or space SSI is an infection in any other area of the body near the site of the surgery, including an organ or space between the organs.
Long surgeries, emergency procedures, weight, age, and pre-existing conditions – like cancer, diabetes, or immunocompromising illnesses – can affect the likelihood of an SSI. To avoid germs entering the site of a surgery, patients should limit touching the wound and follow post-surgery care instructions to prevent contracting an infection.
Ventilator-Associated Pneumonia (VAP)
Ventilator-associated pneumonia is a lung infection that occurs when a patient is on a ventilator, often for more than 48 hours. It is caused by bacteria getting into the lungs. Smoking is a significant risk factor for developing VAP or any other respiratory infections. Raising the bed, clean dental hygiene, and following careful infection control steps can prevent VAP.
Causes and Risk Factors
HAIs are caused by bacteria, germs, or fungi. Common bacteria that could cause an HAI include gram-negative bacteria, Clostridioides difficile (C. diff), hepatitis, and methicillin-resistant Staphylococcus aureus (MRSA). Getting treatment at a hospital or health care facility that involves injections, surgery, ventilators, or catheters puts a patient at risk for an HAI. Other healthcare-related risk factors could include improper hygiene or contaminated equipment.
“Common risk factors that can predispose someone to develop an HAI include older age and/or frailty, being in an immunocompromised state, obesity, diabetes mellitus, chronic kidney disease, heart failure, poor nutritional status, and cancer,” says Dr. Gibson.
Prevention Strategies
“The best prevention strategies start with the basics, which include strict hand hygiene, proper sterilization and disinfection of rooms/equipment, appropriate use of antibiotics (using them when unnecessary leads to resistance), and limiting any foreign bodies to only when truly necessary,” says Dr. Darji. Staying up to date on vaccinations, using personal protective equipment like masks. More broadly, it is imperative to frequently clean tools and spaces in a medical facility.
Healthcare facilities are obliged to abide by very high cleanliness and sterilization standards. Still, with many patients crossing paths in high-traffic hospitals and clinics, there are many risk factors. Similarly, each patient varies in their susceptibility to infection. “In general, the longer a patient is in the hospital, the higher their risk of HAI,” Dr. Darji adds. Being aware of the risks of HAIs and having open communication with the treating physician are essential steps to lower the risks of HAIs.
Diagnosis and Treatment
Depending on the type of infection, symptoms that would lead to a diagnosis might look a bit different. Regardless, it’s important to treat an HAI quickly and correctly to limit the financial and health impact of contracting one.
A range of clinical assessments, testing, and monitoring can lead to an HAI diagnosis. Some of these tests might include blood cultures, urine samples, and imaging to determine if there’s an infection. Alternatively, a physician might be able to simply diagnose an HAI based on history, length of hospital stay, and symptoms the patient is experiencing.
Antibiotics, antiviral therapies, or antifungal medications are often the primary treatment for an HAI. When medically feasible, doctors and nurses may remove or replace the line – like catheters, ventilators, or ports – where the infection has developed.
The Role of Healthcare Providers and Facilities
Healthcare providers and facilities have a responsibility to patients to minimize the spread of contagions and bacteria. It is important for healthcare providers, clinics, and hospitals to follow the strict sterilization protocols and infection prevention and control guidelines.
Healthcare facilities also monitor and report HAIs to ensure progress is being made to minimize the spread of infection in their healthcare environments. The CDC, for example, publishes data and reports to track which areas need assistance under two HAI surveillance systems: the National Healthcare Safety Network (NHSN) and the Emerging Infections Program Healthcare-Associated Infections – Community Interface (EIP HAIC). Research and collaboration play an important role in collectively improving the incidence of HAIs, as well as keeping patients and the broader population informed.
Patient Education and Advocacy
It is not only up to healthcare providers to minimize healthcare-acquired infections. “From doctors/nurses to patients/families—everyone has to use best practices,” says Dr. Darji. Patient education and advocacy, as well as physician-patient collaboration, are an important part of keeping everyone healthy.
It’s just as important to have patients involved in preventing infections. “Having too many visitors in the hospital when you are weak is not always the best idea—especially if they don’t wash their hands when arriving,” Darji says. “Patients and families should always ask questions, report any new symptoms, and follow all instructions carefully.”
Frequently Asked Questions (FAQ)
“What are the most common HAIs?”
The most common HAIs are foreign body infections, surgical site infections, and ventilator-associated pneumonia.
“How can I protect myself from HAIs?”
You can protect yourself from HAIs in several ways. Hand washing or using an alcohol-based hand rub, and, if relevant, don’t touch the area where the surgery or foreign body/line is. Stay up to date on vaccinations and quit smoking. Ask questions to your physician questions about HAIs and minimizing the risk.
“What are the signs and symptoms of an HAI?”
Signs and symptoms of an HAI could depend on the type of HAI, but they could include fever, chills, redness of an area, coughs, diarrhea, heart palpitations, shortness of breath, pain when urinating, and even confusion or mental fogginess.
“How are HAIs treated?”
HAIs are treated with antibiotics, antiviral therapy, or antifungal medication, as well as sometimes removing the line. Supportive care, like hydration and rest, can also help somebody heal from an HAI.
“What are healthcare facilities doing to prevent HAIs?”
Healthcare facilities and physicians should follow strict infection control guidelines, including sterilization and personal protective equipment requirements. They are also practicing antimicrobial stewardship to prevent antibiotic resistance. Healthcare facilities also report data on HAIs to keep track of progress.
Final Notes
Healthcare-acquired infections are common infections that occur in hospitals or other healthcare facilities. HAIs are an unintended occurrence, often following a procedure or treatment like a surgery or catheter implant. HAIs are preventable with increased caution from both practitioners and patients. Patient safety and infection control are paramount. Despite increased health risks associated with HAIs, they are also treatable, often with antibiotics. Ultimately, patients should advocate for themselves and communicate any concerns about potentially contracting an HAI with their healthcare team. Seek further information from reputable sources to stay informed on HAIs and how patients can help prevent them. Be vigilant and don’t be afraid to ask medical providers questions. It is their job to support your health.
