Healthcare Associated Infections

Table of Contents

Introduction

Healthcare-associated infections (HAI) are diseases or illnesses that are caused by the acquisition of disease-causing bacteria during receiving treatment within healthcare settings and conditions. Healthcare-associated infections are also known as nosocomial infections or hospital-acquired infections and they exist when a patient is undergoing treatment through the use of medical equipment such as ventilators, suctioning equipment, and respiratory machines. These infections usually occur within patients after 48 hours have elapsed since the patient was admitted to the medical facility. Community-acquired infections are the infections that are known to have occurred within the first 48 hours of admission to the medical facility. The reason for this name is because the infections were picked up from the surrounding community before the individual was admitted to the hospital or healthcare facility.

Surgical Site Infections

A surgical site infection (SSI) is defined as an infection that occurs in a patient that has undergone a surgical procedure. The infection usually occurs in the area where the surgery took place and the symptoms that are used to identify the infection include redness or pain in the surrounding area that underwent surgery, signs of fever, and the presence of a cloudy fluid within the surgical wound. “The surgical site infection usually occurs within 30 days of the surgical procedure or within one year if the surgery involved an implant” (Lubin et al 320). The number of people who develop these types of infections is estimated to be 1 to 3 of every 100 patients who undergo surgery. There are various types of SSIs that exist and one type of this infection is known as the superficial incision infection where the skin and subcutaneous tissue that was exposed to the surgery is infected. Another type of SSI is known as the deep incision infection where the deeper soft tissue of the skin, as well as the muscle layers that were exposed to surgery, are infected. The organ space surgical site infection involves infections that occur in the anatomic parts of a patient’s body (Lubin et al 320).

The contributory factors that lead to the incidence of surgical site infections referred to as endogenous sources of SSI as they are contributed by the patient include bacteria that exist on the patient’s skin, the mucous membrane of the bowel, poor nutrition of the patient, obesity, uncontrolled diabetes, the colonization of microorganisms within the patient’s body and altered immune response. The exogenous sources that lead to surgical site infections include pre-operation shaving and skin preparation, organisms or bacteria that have come from members of the surgical team where these organisms exist in their hands, their nose, their hair or other parts of their body, contaminated surfaces within the operating room, antimicrobial prophylaxis, supportive machinery or surgical instruments that are used during the surgery such as gloves, suction equipment, and surgical knives or surgical drains. These exogenous sources of SSIs are usually in the form of aerobic staphylococci pathogens, Escherichia coli, and enterococcus species which are the three pathogens that cause SSIs in patients (Lubin et al 321).

The occurrence of surgical site infection will be determined by the occurrence of several factors which include the number of SSI causing pathogens or bacteria that have entered the wound, the type of pathogen, and its ability to cause a surgical site infection where many SSIs are caused by antimicrobial-resistant pathogens, the defense mechanisms of the host where the occurrence of surgical site infections is determined by the effective elimination of contaminating bacteria at the site of surgery as well as the effectiveness of the patient’s inflammatory response system. Another factor that determines the occurrence of surgical site infections is the number of days that the patient has stayed in the hospital after the surgical procedure. Patients who stay in medical facilities for more than 30 days after they have undergone surgery are more than likely to develop surgical site infections than those who have stayed in the hospital for a shorter duration after undergoing surgery (Lubin et al 322).

Urinary Tract Infections

Urinary tract infections (UTIs) occur when bacteria enter and grow in the urinary tract system of an individual. These bacteria which are invasive in nature usually come from a person’s skin, from the use of various types of birth control pills, or from sexual activity. Urinary tract infections cause various complications in people who have these types of infections with one of these complications being painful and frequent urination, kidney stones and kidney failure or pain during intercourse, acute pyelonephritis which affects the kidneys of a patient, urethritis where the UTIs affect the urethra and acute cystitis which is a bladder infection. The most common causes of UTIs are bacteria and microorganisms that live within the digestive system of a human being and the surrounding skin within the rectum where solid wastes exit the body. The reproductive system of women is also a major cause of urinary tract infections with organisms living within and around the vagina being the major causes of these types of healthcare-associated infections (West 5-7).

The main causal pathogens that lead to UTIs are the Escheria coli pathogens and the staphylococcus saprophyticus which exist in either in digestive, reproductive, or urinary tract systems of individuals. These pathogens cause various signs and symptoms within the patient who is infected with this type of infection some of which include fever, vomiting, nausea, abdominal pain, pain while urinating, blood in the urine or cloudy urine, and the inability to urinate despite the urge. The contributory factors that lead to urinary tract infections sexual activity where the risk of infection increases with an increase in sexual activity, sex where women are more prone to urinary tract infections more than men. This is mostly attributed to the fact that the urethra in women is closer to the rectum system which means that women lack the bacteriostatic properties that can be used to control prostatic secretions (West 29).

Urinary catheters that are used to treat urinary infections or diseases are contributing factors to the occurrence of UTIs in individuals. The obstruction of the closed drainage of the catheter increases the risk of getting urinary tract infections as it allows for the colonization of bacteria within the catheter. These catheters also increase UTI prevalence if an individual is subjected to unnecessary catheterization procedures. Genetics has also been identified as a contributory factor to the incidence of urinary tract infections in individuals as the predisposition of bladder infections might run within the family of the affected individual. Other contributory factors that lead to urinary tract infections include sickle-cell anemia, diabetes, sexually transmitted infections, and the malformation of the urinary tract such as an enlargement of the urethra or prostate glands (West 29).

Indwelling Medical Services

Indwelling medical service deals with the artificial devices that are used by hospitals, healthcare facilities, and ambulatory services to assist patients with their physiological functions as they recover from surgical operations or treatments for their illnesses. The indwelling medical devices are either inserted into the human body for a short period of time or they are placed within the body permanently. An example of an indwelling device that is used for a short period is a catheter which is commonly used in inpatient treatment. The permanent indwelling medical devices include heart valves that are used for patients that suffer heart problems and implants that create an interface between the human tissues and prosthetic materials and surfaces such as ceramics and metals. These prosthetic surfaces and indwelling devices are subject to undergoing some changes due to their interaction with the surrounding human tissue that leads to changes such as oxidation and friction damage (Waldvogel and Bisno ix).

The interaction with the surrounding tissue activates various biological systems within the patient’s body such as inflammation, coagulation, hyperallergic reactions, and tissue integration which increase the incidence of infection within the patient’s body. Indwelling medical devices, therefore, increase the risk of healthcare-associated infections because of the presence of foreign or prosthetic materials that exist in these devices that might increase the incidence of infection once they have been implanted into the patient’s body. The pathogens that lead to indwelling medical device infections are known as the staphylococci which require a low inoculum environment for them to develop once the indwelling device has been implanted (Waldvogel and Bisno ix).

Antibiotic-Associated Diarrhoea

Antibiotic-associated diarrhoea (ADD) is a type of healthcare-associated infection that is caused by an imbalance in the colonized microbiota during antibiotic therapy. Any changes in the colonic microbiota lead to a change in carbohydrate metabolism as well as a decrease in the absorption of fatty acids. ADD also leads to the overgrowth of pathogenic organisms such as the Clostridium difficile which in turn leads to loose or watery stool. Antibiotic-associated diarrhoea is identified by many medical practitioners and researchers to be a side effect of strong antibiotics. Any changes in the stool consistency of patients might complicate the antibiotic treatment or therapy which at times might lead to patients stopping the antibiotic treatment. The contributory factors that lead to the incidence of ADD are antibiotics, antibiotic treatment, and therapy.

The prevalence of ADD varies between the various types of antibiotics where the infection rate for those taking quinolone, tetracycline, or clarithromycin is 5 percent, the rate of infection for those taking ampicillin is 5 to 10 percent and the infection rate for those using a combination of clavulanic acid and amoxicillin treatment is 10 to 20 percent. The above courses of antibiotics can be able to promote intestinal infections which lead to ADD. The major pathogens that cause antibiotic associate diarrhoea include clostridium difficile and klebsiella oxytoca with 10 to 20 percent of ADD infections being caused by the clostridium difficile pathogen (Rambaud et al 2003).

Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) is a medical condition that results from an infection of a person’s lungs. This type of nosocomial pneumonia is a type of hospital-acquired pneumonia (HAP) that occurs in patients that are receiving respiratory treatment through the use of mechanical ventilators. These mechanical ventilators involve the use of endotracheal tubes or tracheostomy tubes that are used to provide respiratory support to the patient. The incidence of ventilator-associated pneumonia is usually high in patients who have undergone endotracheal ventilation for at least 48 hours. Identifying the signs and symptoms of VAP is usually difficult given that the people who are on mechanical ventilation are usually heavily sedated. However, signs and symptoms that can be used to determine whether a person has VAP include low body temperature, de-oxygenation of the patient’s blood, fever, and new purulent sputum. The bacterial pathogens that cause VAP include pseudomonas aeruginosa, enterobacter, Citrobacter, and stenotrophomonas maltophilia (Augustyn 32).

The contributory factors that lead to VAP infection incidences include patients who have been on mechanical ventilation units for more than 48 hours, patients who have immunosuppression or chronic lung diseases, patients who have acute respiratory distress syndrome, or patients undergoing antibiotic treatments. Other factors which contribute to the incidence of VAP in patients include the endotracheal tube and the ventilator circuit where pools of secretions in the cuff of the endotracheal tube might lead to a leakage of bacteria into the trachea of the patient. Improper handwashing practices by nurses or other health workers who handle the endotracheal tubes might also increase the incidence of ventilator-associated pneumonia (Augustyn 32).

Blood Borne Infections

These are infections that are caused by the direct transmission of blood from one individual to another. These transmissions usually occur when a person comes into contact with the affected skin of a person that has been injured or a mucous membrane of an individual that has an infection. Blood-borne infections can also be transmitted through drug use where drug abusers share syringes and needles and through sexual contact with a person that has hepatitis B, hepatitis C, and HIV virus. The risks of infection usually vary with the type of pathogen that is involved where the incidence of BBIs is high in individuals who have been exposed to puncture wounds or cuts or where the material involved in the infection is blood, saliva, mucous, urine, genital secretions, and other body fluids. The risk of transmission is usually higher when the injury or wound is deep or when there is visible blood on the device that will be used to treat the wound or in the case of drug users, the needle that will be used to take the drugs. There are no specific symptoms that can be used to determine whether an individual suffers from a blood-borne infection. Given that these infections are caused by coming into contact with a person that has Hepatitis B or C or the HIV virus, the most appropriate diagnosis would be to perform a blood test if an individual suspects that they have a blood-borne infection (Lindsey 2).

Conclusion

The above essay has focused on the various healthcare-associated infections that exist and their causes as well as contributing factors. More healthcare infections continue to arise especially in the healthcare facilities where patients are exposed to various conditions as they undergo treatment. The above infections, therefore, represent a portion of the infections that are associated with healthcare.

References

Augustyn, Beth. Ventilator associated pneumonia: risk factors and prevention. Critical Care Nurse 27 (2007): 32-39.

Lindsey, Jeffery. Bloodborne pathogens. New York: Jones and Bartlett Publishing, 2007. Print.

Lubin, Michael, Robert, Smith and Thomas (Eds). Medical management of the surgical patient: a textbook of perioperative medicine, 4th Edition. Cambridge, UK: Cambridge University Press, 2010. Print.

Rambaud, Jean Claude, Jean, Paul Buts, Gerard, Corthier and Bernard, Flourie. Gut microflora: digestive physiology and pathogoly. Oxford, UK: John Libbey Eurotext, 2006. Print.

West, Krista. Urinary tract infections. New York: The Rosen Publishing Group, 2007. Print.

Waldvogel, Francis, and Bisno, Alan. Infections associated with indwelling medical services, 3rd Edition. Washington, DC: ASM Press. Print.

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