The hospital is the place we go to get well and feel better. But far too often, patients seek medical attention at the hospital for one issue…and end up sick with something entirely different—and more dangerous.
Shocking statistic: Every year, two million patients contract infections in a health-care setting such as a hospital, long-term rehab facility or dialysis center. Nearly 100,000 of them die as a result.
Hospital-acquired infections, now known as healthcare-associated infections (HAIs) or nosocomial infections, can enter the body through the nose, mouth, lungs, skin, blood and urinary tract. They can be bacterial, viral or fungal and include surgical-site infections, catheter-associated urinary tract infections, pneumonia and more.
Why The Uptick in Infections
For years, HAI rates were dropping steadily, thanks to enhanced infection-prevention and control strategies. But the COVID-19 pandemic, which dramatically increased the number of hospitalized patients requiring more frequent and longer use of catheters and ventilators, has led to increases in several common HAIs. And staff and supply shortages haven’t helped matters.
According to a new Centers for Disease Control and Prevention analysis published in Infection Control & Hospital Epidemiology, rates of ventilator-associated events, central line-associated bloodstream infections, catheter-associated urinary tract infections and antibiotic-resistant staph infections (such as methicillin-resistant Staphylococcus aureus—MRSA) increased 45%, 47%, 19% and 33.8%, respectively, from 2019 to 2020—especially during the fourth quarter of the year. Interestingly, surgical-site infection rates did not increase, perhaps because there were fewer elective surgeries.
Anyone can contract an HAI, but certain factors increase risk, including older age, longer hospital stays (or any type of ICU stay), a suppressed immune system, comorbidities such as diabetes, obesity or heart disease and more.
Most Common HAIs
Most HAIs are related to surgical procedures or the insertion of an invasive device. They include…
Catheter-associated urinary tract infection (CAUTI): Between 15% and 25% of hospitalized patients receive a urinary catheter, a thin tube inserted through the urethra to drain urine from the bladder during their stay. Prolonged catheter use is a risk factor for a urinary tract infection (UTI), an infection in any part of the urinary system, including the urethra, bladder or kidneys. Catheter use is associated with 75% of hospital-acquired UTIs. Symptoms include fever, pain or burning in the lower abdomen, and/or bloody urine. The mortality rate is about 2%.
Central line-associated bloodstream infection (CLABSI): A central line is used to deliver medicine, fluids and/or nutrients into a vein near or inside the heart. CLABSI causes a fever and red, sore skin around the entry point of the central line. Another Infection Control & Hospital Epidemiology study found that COVID-19 patients experienced more than five times the number of CLABSIs as those who did not have COVID. Possible reason: Hospitalized COVID patients often receive intravenous antibiotics as well as the steroid dexamethasone to tame the inflammatory response to COVID infection, both of which can be delivered through a central line. Between 12% and 25% of CLABSI patients die from their infections.
Ventilator-associated pneumonia (VAP): A patient may need to be intubated for treatment of respiratory failure or ventilated during a surgery that requires anesthesia. That means a breathing tube is placed into his/her trachea (windpipe), forcing oxygen-enriched gas into the lungs. If germs enter the tube, pneumonia or another infection can develop. New finding: A 2021 Critical Care study found that COVID-19 patients are significantly more likely to develop VAP than patients without COVID, partly but not entirely due to increased duration of ventilation. Symptoms of VAP include fever, faster heart rate, pus in lung secretions and low blood oxygen levels. It has a mortality rate of close to 50%.
Surgical-site infection (SSI): Any type of surgery—from a coronary bypass to a spinal fusion—provides a prime opportunity for germs to sneak into the body. Surgical-site infections often are caused by Staphylococcus aureus or MRSA, an especially dangerous type of staph that is resistant to antibiotics. Symptoms include redness, tenderness and warmth at the site of the surgical incision, fever and delayed healing. When staph or MRSA enters the body, it can spread almost anywhere—to the blood (where it can cause life-threatening sepsis)…lungs (where it can cause pneumonia)…and heart (where it can cause endocarditis, an infection of the heart valves). About 3% of SSI patients die. Note: Bedsores and kidney dialysis also are risk factors for acquiring an SSI.
Clostridioides difficile infections (CDI): Also known as C. diff, this bacteria causes sometimes life-threatening diarrhea, along with fever, abdominal cramping, nausea and appetite loss. Infections usually occur after a patient has been treated with an antibiotic that alters the types of bacteria—good and bad—living in his/her gut, allowing
C. diff to flourish. One in 11 people over age 65 diagnosed with this HAI will die within a month. Interesting: While other HAIs have been increasing in prevalence in the age of COVID, C. diff infections have been decreasing, despite a rise in antibiotic use. This may be attributed to infection-mitigation measures, such as masking and hand hygiene.
COVID-19: A New HAI?
Early in the pandemic, COVID-19 became a type of HAI, with hospitals becoming “an important setting for viral transmission,” per a study in the American Medical Association’s journal JAMA. In China, it’s estimated that 44% of 179 early COVID infections were caught in the hospital, and a July 2020 outbreak in a Massachusetts teaching medical center was attributed to staff removing their masks in a break room.
Thanks to improvements in masking, personal protective equipment (PPE) and hygiene practices, those numbers have dropped significantly…but the risk isn’t gone. A 2021 International Journal of Environmental Research and Public Health study estimates the hospital-acquired COVID-19 rate is 12% to 15%.
How to Protect Yourself or a Loved One
Fortunately, you can influence your care in a way that can keep you from becoming the one in 31 hospital patients with at least one HAI. Here’s how…
If you need a catheter, request it be removed as soon as it is safe to do so. Using a catheter for longer than six days is a risk factor for a CAUTI. Ask your doctor to remove it as early as possible. Always clean your hands before and after touching your catheter, and make sure your urine bag hangs below the level of your bladder to prevent urine from flowing back into your bladder, where it could cause an infection.
Make sure you’re receiving only necessary medications. Antibiotics are notoriously overprescribed, fueling growth of superbugs such as MRSA, which can cause infections at surgical sites, in catheters and other places. Antibiotics also can cause C. difficile. Ask if your antibiotic is absolutely necessary.
Important: Whether you are in the hospital or at home, let your health-care provider know if you have three or more episodes of diarrhea within 24 hours while taking antibiotics. This could be a sign of C. difficile.
Narcotics are problematic, too. They make it harder for older adults, especially men, to urinate, increasing the likelihood of a catheter needing to be inserted.
Ask all visitors to wash their hands before entering your hospital room. This will limit your exposure to staph and other bacteria. About 30% of people have staph living on their skin or in their nose at any given time. They may not get sick from it, but they can spread it to other people.
Research the hospital’s infection rates—if you can choose where you will be treated—by visiting Medicare.gov/hospitalcompare (search for hospitals, rehab facilities or nursing homes). Many will list infection rates (under “Complications & Deaths”) including how they compare to national benchmarks. Note: If you belong to a Medicare Advantage Plan, this link won’t provide information about whether your care will be covered in a certain hospital, so check with your plan.
Address major medical risk factors to stay out of the hospital. You won’t die from an HAI if you’re not in the hospital.
Lose weight if you are overweight or have obesity. Being overweight makes it harder to clear your airway, and excess skin folds are a perfect hiding spot for bacteria looking to cause an infection.
Quit smoking. You’ve heard it before—smokers are more prone to infection.
Get vaccinated against COVID-19. Patients hospitalized with COVID-19 are at a much higher risk of developing a number of HAIs.