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Health Matters

Battle against hospital-acquired infections continues

Conway McLean, DPM, Journal columnist

Health care in the modern era is a complex entity, with multiple components and many “players in the game.” When it comes to more involved services, tests or procedures, a centralized location, equipped to provide high tech tests and specialized surgical facilities, is usually the place to go. Generally, this is a hospital. Although there has been an obvious reduction in the length of stay, many problems require care in such a facility. Unfortunately, this is often a good place to get sick.

Microbes are an integral part of our world and have been for a long time. Although some of us try, we are not able to make our homes sterile or avoid contact with these denizens of the microscopic world. Despite progress in public health methodologies and practices, infections continue to develop in patients in hospitals world-wide. As should be obvious, hospitals are an environment where both infected persons and persons at increased risk come together, a situation ripe for complications.

An all too common scenario: someone gets admitted to a hospital due to some condition….and then develops a separate and unrelated problem, usually an infection of some type. These are called Hospital Acquired Infections (H.A.I.) and occur far too often. Each day, one out of 25 patients in the U.S. contracts a hospital-acquired infection. These infections are a tremendous cause of sickness, disability and death. The financial loss is estimated at billions of dollars annually. These infections were long accepted by physicians as an inescapable hazard of hospitalization. Our thinking has changed and we now know that certain straightforward approaches can prevent many of these common afflictions.

These are classified as nosocomial infections, as in a condition caused by the interventions or treatment of any health care provider. HAI’s are defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection. This also includes infections acquired in the hospital but appearing after leaving the facility. And the numbers seem to be increasing according to some sources, although definitive statistics are difficult to find. One study found the percentage of hospitals achieving zero infections has declined dramatically since 2015, not a good indicator.

Between 5 and 10 percent of all patients contract at least one hospital-acquired infection in the US and this results in billions of wasted health care dollars, even worse an astounding 90,000 deaths annually. These also lead to an increase in the number of days patients stay in the hospital. HAI’s are one of the most common complications of care in these institutions.

Many factors may lead to one of these infections. This population commonly has an impaired immune system due to disease, age, or medical therapy. The increasing number of invasive procedures create many opportunities for microorganisms. Fortunately, contact between the patient and a bug does not necessarily result in a disease, since many factors influence the nature and frequency of one of these unwanted infections.

The likelihood of an infection partially depends on the characteristics of the organism, including its resistance to antimicrobial agents, how deadly it is, and the amount of infected material transferred. An obvious component is the advancing age of the US population over the last century, with a very related issue being the greater prevalence of chronic diseases.

Numerous opportunities for the spread of bacteria and other microbes can be found: from common catheterizations leading to urinary tract infections, the use of central lines causing blood borne infections, surgical site infections, and being placed on a ventilator which fosters pneumonia. One of the more challenging of these illnesses is a Clostridium difficile infection. This difficult disorder is typically referred to as a C. diff infection and often results from excessive antibiotic use. Sadly, the incidence seems to be on the rise. The increasing threat has spurred the development of new strategies to combat this menace.

A critical strategy involves limiting antibiotic use (a major cause of these infections). Patient isolation procedures to prevent patient-to-patient transmission of the bacteria is another fundamental approach. Also important: improved cleaning of the environment of care is being implemented as another method. Patient rooms are being looked at as a frequent site of transference. Lastly but not least, hand hygiene would seem an obvious approach.

Logically, proper hand washing should be a mainstay of preventative strategies for reducing hospital acquired infections. The effectiveness of this simple act has been known for decades, yet surprisingly, hand hygiene rates among all clinicians has historically been low. But rates have improved of late with increased emphasis on traditional educational techniques, enhanced monitoring of hand hygiene, and others. The latest data provide strong evidence linking these efforts to a reduction in HAI rates.

Delivering quality care should be the goal of every hospital, which means reducing these nosocomial infections. The consequences of hospital-acquired infections are evident not just at an individual patient level but also at the community level where these have resulted in more cases of multi-drug-resistant bacteria. As expected, these add up to increased hospital readmissions.

Clearly, some straightforward approaches can prevent many common HAIs. Hospitals must prioritize efforts to reduce the burden of these infections, utilizing measures and methods already in hand. Recent years have brought about a change in regulations and hospitals are required to institute infection tracking systems: the numbers are out there. Robust prevention strategies and, as always, education can go a long way to reducing the debilitating and costly consequences of these often preventable, sometimes dangerous, infectious illnesses.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.

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