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healthcare-associated infection

Etiology: 1) associated with a variety of causes, including a) use of medical devices, such as catheters & ventilators b) complications following a surgical procedure c) transmission between patients & healthcare workers d) antibiotic overuse 2) major types of infection a) urinary tract infections (34-36%) - catheter-associated urinary tract infections (75%) - catheter-associated urinary tract infections increased 6% from 2009 to 2013 [9]* b) surgical site infections (17-20%) c) bloodstream infections (11-14%) - sepsis associated with intravascular catheters d) pneumonia (11-13%) - ventilator-associated pneumonia e) infections associated with Clostridium difficile & MRSA f) 40% of elderly with bacteremia, 25% culture S aureus 3) risk factors include interruptions & working with colleagues [14] * the only major type of infection to have increased from 2009 to 2013 [9] Epidemiology: - one of 10 leading causes of death in the US [3] - more common in elderly - nursing home care - 50% of all major complications of hospitalization (nosocomial infection) - home health - hemodialysis - wound management - surgical-site infections & pneumonia most common [7] - Clostridium difficile most common pathogen [7] Laboratory: - see ARUP consult [4] Management: - hand hygiene is the single most important measure to reduce risk of healthcare-associated infections [3] - should be performed at a minimum before & after every patient contact [3] - exercise standard precautions to prevent transmission of infection - airborne precautions - contact precautions - droplet precautions - avoid unnecessary catheterizations - leave catheters in place only as long as necessary - only trained personnel should insert catheters - use a cap, mask, sterile gown & gloves, & a large sterile drape for inserting central venous catheters - do not remove hair prior to surgery unless it will interfere with the operation, then, use electric clippers - preoperative antimicrobial prophylaxis - body temperature control during surgery - glycemic control in diabetics undergoing cardiac surgery - drain & discard condensate that collects in mechanical ventilator tubing - remove endotracheal tube as soon as possible - elevate head of the bed to reduce risk of aspiration of gastric contents - combination of quality improvement strategies may diminish healthcare-associated infection rates in hospitals [5] - audit & feedback - organizational change - clinician education - with or without provider reminder systems - no strategy with strong evidence base [5] - coordination of public health departments & hospitals can reduce healthcare-associated infections [10]

Related

standard precautions

Specific

nosocomial infection; nursing home acquired infection

General

infection (infectious disease) iatrogenic disease

References

  1. Crane SJ et al, Bloodstream infections in a geriatric cohort: A population- based study. Am J Med 2007, 120:1078 PMID: 18060929
  2. HHS Action Plan to Prevent Healthcare-Associated Infections: Executive Summary http://www.hhs.gov/ophs/initiatives/hai/exsummary.html
  3. Medical Knowledge Self Assessment Program (MKSAP) 15, 17, 18. American College of Physicians, Philadelphia 2009, 2015, 2018.
  4. ARUP Consult: Health Care-Associated Infections - Nosocomial Infections deprecated reference
  5. Hidron AI, Edwards JR, Patel J et al NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol. 2008 Nov;29(11):996-1011. PMID: 18947320
  6. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008 Jun;36(5):309-32. PMID: 18538699
  7. Magill SS et al Multistate Point-Prevalence Survey of Health Care-Associated Infections. N Engl J Med 2014; 370:1198-1208. March 27, 2014 PMID: 24670166 http://www.nejm.org/doi/full/10.1056/NEJMoa1306801
  8. Agency for Healthcare Research and Quality Prevention of Healthcare-Associated Infections. Closing the Quality Gap. Revisting the State of the Science. Excecutive Summary Evidence Report/Technology Assessment Number 208 http://www.effectivehealthcare.ahrq.gov/ehc/products/335/1335/EvidenceReport208_CQG-HAI_ExecutiveSummary_20121127.pdf
  9. Centers for Disease Control and Prevention (CDC) National and State Healthcare Associated Infections. Progress Report. Jan 2015 http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf
  10. Slayton RB et al Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities - United States MMWR. August 4, 2015 / 64(Early Release);1-7 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0804a1.htm
  11. Yokoe DS, Anderson DJ, Berenholtz SM et al A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol. 2014 Aug;35(8):967-77. PMID: 25026611 Free PMC Article
  12. Sievert DM, Ricks P, Edwards JR et al Antimicrobial-resistant pathogens associated with healthcare- associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013 Jan;34(1):1-14. PMID: 23221186
  13. Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev. 2011 Jan;24(1):141-73. Review. PMID: 21233510 Free PMC Article
  14. Arvidsson L, Lindberg M, Skytt B, Lindberg M. Healthcare personnel's working conditions in relation to risk behaviours for organism transmission: A mixed-methods study. J Clin Nurs. 2021 Jul 4. PMID: 34219318
  15. Centers for Disease Control and Prevention (CDC) Healthcare-associated Infections (HAIs) http://www.cdc.gov/HAI/surveillance/index.html