Healthcare Associated Infections: what they are and what to do

14 Apr Healthcare Associated Infections: what they are and what to do

Healthcare associated infections (HAIs) are acquired infections. They are the most frequent and most serious complication to healthcare that can occur in any care setting, including acute care hospitals, day-hospitals/day-surgery, long term healthcare facilities, clinics, home care and territorial residential structures.
HAIs include infections transmitted from the outside (exogenous), from person to person or through care operators and the environment, and infections caused by bacteria present in the body (endogenous).

There are many causes:
the gradual introduction of new health technologies, with the prolonged use of invasive medical devices and complex surgical interventions, which, while improving therapeutic possibilities and the outcome of the disease, can encourage the entry of microorganisms into normally sterile body sites
weakening of the body’s defence system (immunosuppression) or serious concomitant diseases
the poor application of environmental hygiene and infection prevention and control measures in healthcare settings
the emergence of antibiotic resistant bacterial strains, mainly due to the improper or excessive use of pharmaceuticals, which further complicates the course of many HAIs.
These infections have a significant clinical and economic impact: according to the <350>first global report</350> of the World Health Organization, HAIs cause prolonged hospital stay, long-term
disability, increased resistance of microorganisms to antimicrobials,
a massive additional financial burden for health systems, high costs
for patients and their families, and excess deaths.

https://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf

Each year in Europe, HAIs cause:
16 million additional days of hospitalization
37,000 attributable deaths
110,000 deaths for which the infection is a contributing cause.

Costs are estimated at approximately 7 billion Euros, which includes only direct costs.
HAIs are a frequent phenomenon
A <351>recent national prevalence study</351>, conducted using the ECDC protocol, found that the frequency of patients with an infection contracted during hospitalization was 6.3 per 100 patients, in home care 1 patient per 100 contracts a HAI.
Not all HAIs can be prevented, but it is currently estimated that more than 50% can be.
Most HAIs affect the urinary tract, the respiratory system, surgical wounds and systemic infections (sepsis, bacteraemia).
The most frequent are urinary infections, which alone account for 35-40% of all hospital infections.
https://assr.regione.emilia-romagna.it/it/servizi/pubblicazioni/rapporti-documenti/studio-prevalenza-europeo-ICA-ospedali-acuti

The microorganisms involved

The microorganisms involved vary over time.
Until the early 1980s, HAIs were primarily due to gram-negative bacteria (for example, E. coli and Klebsiella pneumoniae).
Then, due to antibiotic pressure and the greater use of plastic healthcare devices, infections caused by gram-positive bacterial (especially Enterococci and Staphylococcus epidermidis) and by fungi (especially Candida) have increased, while those caused by gram-negative bacteria have decreased.
However, recently, some gram-negative bacteria, such as carbapenemase-producing enterobacteriae (CPE) and Acinetobacter spp., which are responsible for serious infections, have become very common in hospital settings.

Risk and transmission factors

The people at the greatest risk of contracting a HAI are the patients; however, staff and visitors are also exposed and can be affected.
Like other infections, depending on the microorganism, HAIs can be transmitted by direct contact, from person to person (mainly through the hands) or by air (droplets emitted during speech, sneezing or coughing) or indirectly via contaminated objects (such as diagnostic or care instruments or common objects).
(source <352>www.salute.gov.it</352>)

https://www.salute.gov.it