by Dr. Ramya Chilaka
What’s worse that having a disease? Getting a new one when you go to a hospital to get your first disease treated.
Yup, you heard it right. The hospitals you visit can infect you with a new set of diseases. The infections you catch at hospitals are called hospital-acquired infections or HAIs.
How Do HAIs Occur
HAIs mainly arise from invasive, supportive instruments like endotracheal intubation tubes, intravascular and urinary catheters that have been used to treat patients.
These instruments carry viral, bacterial or fungal pathogens. And patients who have compromised immunity due to their present health issues are naturally prone to such infections.
The following facilitate HAIs:
Uncontrolled use of antibiotics
Improper medical infrastructure
Inadequately trained staff
Improper sterilisation and use of instruments
Common Hospital-Acquired Infections
Ventilator-associated pneumonia (VAP) - Pneumonia, sinusitis and tracheitis are caused by infections associated with endotracheal tubes that are used for respiratory support. These tubes are placed either through the nose or the mouth into the windpipe.
Urinary tract infection (UTI) - A Foley catheter is inserted into the bladder to collect urine. And pathogens present on the Foley catheter cause urinary tract infections.
Surgical site infection (SSI) - A surgical wound gets infected, leading to various other complications. The infection occurs within 30 days after the surgery or within a year of placement of the implant. Data suggests that in India, SSIs affect nearly 2-21% of total inpatients while in the US, this figure is only 2%.
Emergency surgeries lead to more SSIs than elective surgeries. Post-surgical infections at the site of laparoscopic surgery occur due to infections from improperly sterilised laparoscopic instruments.
Bloodstream infections (BSIs) - Caused by intravascular catheters or lines used in ICU setups. These catheters are inserted into the vein for monitoring, administering medicines and providing nutritional support.
Phlebitis, bacteremia and sepsis fall under this category. It’s estimated that intravascular catheters are the reason behind 91% of all BSIs.
Neonates Are At A Higher Risk
Newborns in neonatal ICUs are the most susceptible to hospital-acquired infections. While adults with HAIs exhibit symptoms like fever, rashes, respiratory problems and urinary infections, newborn babies, unfortunately, do not exhibit or present any symptoms.
Some Revealing HAI Stats
A surveillance study was conducted by the WHO in 14 countries from Europe, Southeast Asia, Eastern Mediterranean and Western Pacific. Data was collected from 55 hospitals for nearly 20 years for the sake of this study.
The following is the percentage of patients with HAIs in regions across the world:
Globally - 7 to 12 percent
India - 11 to 83 percent
US - 4.5%
Europe - 7.1%
The International Infection Control Consortium (INCC) conducted a survey in 8 developing countries including India. In India, the survey was conducted in 7 hospitals in 7 cities, covering 10,835 patients from 2004 to 2007.
The survey found that around 4.4% of patients had ICU HAIs, 1.3% had VAPs, 2.7% had BSIs and 0.4% had UTIs.
HAIs lead to increased hospital stays. Moreover, total hospital expenditure nearly doubles due to severe HAIs.
According to data from the Center for Disease Control and Prevention (CDC), death due to HAI is somewhere between 10 to 25% in the world and 20 to 30% in India.
Consequences of HAI
Occasionally leads to death
Lengthened hospital stay
Increased hospitalisation costs
Loss of work
How To Prevent HAIs
Hospital-acquired infections can be prevented with proper invasive instrument selection, sterilisation, insertion, maintenance, and removal when not required.
Prevention of hospital-acquired infections lies in the hands of hospitals. Intensive surveillance and timely reporting of infections help in analysing, correcting and taking preventive steps.
Hospitals must ensure that their staff is given the right training and guidance to avoid HAIs.
That said, no data was collected from government hospitals, where the majority of the Indian population goes for treatment. The Indian government should take proper steps to avoid HAIs in government hospitals.
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