They’re everywhere. Even as you’re reading these words, germs like bacteria, viruses and mold are circulating in the air and on the surfaces around you. They’re even inside your body. While the word “germs” conveys sickness and disease, most microorganisms in the environment and in our bodies cause no harm and can play critical roles for health. However, the global COVID-19 pandemic has again raised the specter of germs and how they can negatively impact our daily lives.
One of the key factors that led to the current public health crisis was the impact of the virus on our healthcare facilities. Emergency Rooms and Intensive Care Units were suddenly inundated with patients gravely ill with the coronavirus. Making matters worse, due to the unexpected shortage of personal protective equipment (PPE), existing patients and healthcare staff alike risked exposure to the virus within their healthcare facilities. In some areas, the number of cases of reported strokes and heart attacks decreased during this time because people were too afraid to go to the hospital1. Meanwhile, the notion of contracting an infection while in a healthcare setting went from a vague possibility to a terrifying reality for thousands of patients.
Infections versus Diseases
Before diving deeper into healthcare-associated infections (HAIs), let’s take a step back and explore diseases and infections in general. Most people tend to use these terms interchangeably, but they mean different things. Disease refers to a condition of the body when it isn’t in its best form (i.e., healthy). Diseases can be caused by several things, only one which is related to microbes and infections:
- Environmental factors
Infections occur when the body is attacked or invaded by microorganisms, the pathogens begin multiplying, and the body’s immune system responds.2 Because they can cause diseases as well as being problematic in themselves, infections should be prevented as much as possible.
What Causes Infections
Microorganisms that can cause infections are called pathogens or infectious agents fall into five categories:3
- Helminths (worms)
Each category has several well-known infections4:
- Strep Throat
- Urinary Tract Infections
- Chicken Pox
- Common cold
- Athletes Foot
The category of an infectious agent helps to determine how best to treat the associated infection. For example, antibiotics are routinely used to treat bacterial infections, but they’re often useless for a viral infection. The treatment for a fungal infection would do little to help heal strep throat and so on.
What are Healthcare-Associated Infections (HAIs)?
Healthcare-associated infections, sometimes known as nosocomial infections, are a category of infections based on how or where people acquire them. As the name implies, HAIs are infections that patients acquire while they are in a hospital or other healthcare facility. This means that along with recuperating from the original illness or procedure that brought them to the facility, patients are now trying to recover from an additional infection and its effects. The Centers for Disease Control (CDC) report that on any given day, about 1 in 31 hospital patients has a HAI.5
Most HAIs stem from medical equipment or devices entering the patient’s body. The most common HAIs of this type are:
· Catheter-associated urinary tract infection (CAUTI)
· Central line-associated bloodstream infection (CLABSI)
· Surgical site infection (SSI)
· Ventilator-associated events (VAE)
As you can imagine, the incision or insertion area can literally open the body up to potential pathogens, and the bacteria, viruses, and fungi most commonly associated with HAIs are particularly tenacious: 6
- Acinetobacter (bacteria) –Acinetobacter infections happen most often in ICUs and rarely occur outside of healthcare settings.
- Burkholderia cepacia (bacteria) – This group of bacteria is often resistant to common antibiotics. It poses little medical risk to healthy people but is a known cause of infections in hospitalized patients, especially those with weakened immune systems.
- Candida auris (fungi) – Healthcare facilities in several countries have reported Candida auris as causing severe illness in their patients. It often doesn’t respond to common antifungals, making the infections very hard to treat.
- Clostridioides difficile (bacteria that forms spores) – Commonly known as C. diff, these bacteria cause up to half a million illnesses each year, according to the CDC, and has grown difficult to treat. It’s highly contagious.
- Enterobacteriaceae (bacteria) – This group of bacteria are difficult to treat because of their high levels of resistance to antibiotics. Escherichia coli (E. coli) is an example of Enterobacteriaceae that continues to evolve into more dangerous forms.
- Hepatitis (virus) – Hepatitis is a group of viral infections that can be passed via needle sticks and other similar medical treatments, so both patients and healthcare workers are at risk for this HAI
- Influenza (virus) – The flu virus is a community-associated infection that is very contagious, and its easy transmission makes it a prevalent HAI during especially flu season.
- Methicillin-resistant Staphylococcus aureus (bacteria) – MRSA is a type of staph bacteria that is resistant to certain antibiotics that causes both Community Acquired Infections (CAIs) and HAIs. If left untreated, MRSA can lead to sepsis.
- Norovirus (virus) – Noroviruses are a group of viruses that briefly cause gastroenteritis in healthy people, but the infection can become more severe in patients in healthcare settings.
- Pseudomonas (bacteria) – The bacteria that most often causes infections in patients is called Pseudomonas aeruginosa and can cause infections in the blood, lungs, or other parts of the body after surgery.
- Staphylococcus aureus (bacteria) – Known commonly as staph, these bacteria are present in 30% of people in their noses or skin. Usually, staph isn’t an issue in healthy people but can cause infections sometimes. In healthcare facilities, these staph infections can become serious or fatal.
- Mycobacterium tuberculosis (bacteria) –This microbe can cause tuberculosis (TB) and is spread through air. It can travel long distances, and cases of multidrug-resistant tuberculosis are on the rise.
Surgery or catheter use isn’t a prerequisite for getting a HAI, as this list of pathogens shows. A person with a compromised immune system can become more susceptible to a virus or bacteria, and the infection it causes can be much worse because of the person’s weakened health. And by definition, a hospital patient could be described as a person with a weakened immune system. Some bacteria and viruses attack healthy people, which means healthcare workers are also at risk of HAIs.
A study published in the Journal of the American Medical Association in 2013 estimated that the top five HAIs cost healthcare organizations over $9 billion dollars annually in the United States. The authors noted, “As one of the most common sources of preventable harm, health care-associated infections (HAIs) represent a major threat to patient safety."7
What Can Be Done About HAIs
Given the serious nature of HAIs, eliminating and preventing them is critical for any facility that provides health-related services. The U.S. Department of Health and Human Services has developed a National HAI Action Plan in an effort to address the issue.8 Breaking the chain of infection, as shown in the infographic from the Association for Professionals in Infection Control and Epidemiology (APIC), is one of the most effective ways to reduce HAIs. No matter what kind of pathogen is involved, there are six points at which the chain of infection can be broken, stopping a germ from infecting others.9 The six links include:
- The infectious agent
- The place where the pathogen lives (Reservoir)
- The way the pathogen leaves its host (Portal of exit)
- The way the pathogen is spread to the new host (Mode of transmission)
- The way the pathogen enters the new host (Portal of entry)
- The susceptible host
Each link in the chain provides an opportunity for patients, healthcare workers, and facility staff to help prevent spreading infections though some simple yet effective actions, including:
- Consistent, frequent, and thorough hand hygiene
- Regular cleaning and disinfecting of the facility
- Proper and consistent use of PPE
- Sterilization of medical instruments and equipment
- Maintaining vaccinations and using antibiotics wisely
- Avoiding others when sick or contagious
Compare the costs associated with these efforts to the billions spent managing and treating HAIs, and infection prevention becomes a more attainable goal for any healthcare facility, regardless of size, staffing, or budget.
By understanding a little more about what can cause illnesses and possible exposure points, you are better equipped to maintain your good health – even when you are sick. This applies whether you’re the patient, the healthcare worker, the facility staffer, or just a member of the community. As the recent pandemic has demonstrated, when it comes to staying healthy, everyone’s effort matters.If you’re interested in learning more about how Contec Professional can help you combat HAIs in your healthcare facility, please contact us.