Hospital-acquired infections

A hospital-acquired infection is usually one that first appears three days after a patient is admitted to a hospital or other health-care facility. Such infections are also called nosocomial infections.

About 5-10% of patients admitted to hospitals in the United States develop one of these infections, which are usually related to a procedure or treatmentused to treat the patient.

Hospital-acquired infections can be caused by bacteria, viruses, fungi, or parasites. These microorganisms may already be present in the patient's body ormay come from the environment, contaminated hospital equipment, healthcare workers, or other patients. An infection may start in any part of the body. Alocalized infection, such as at an abdominal surgery site, is limited to a specific part of the body and has local symptoms. A generalized infection enters the bloodstream and causes general systemic symptoms such as fever, chills,low blood pressure, or mental confusion.

Hospital-acquired infections may develop from surgical procedures, cathetersplaced in the urinary tract or blood vessels, or from material from the noseor mouth that is inhaled into the lungs. The most common types of hospital-acquired infections are urinary tract infections (UTIs), pneumonia, and surgical wound infections. Ulcers can also become infected.

All hospitalized patients are susceptible to contracting a nosocomial infection. Some patients are at greater risk than others, such as young children, the elderly, and persons with compromised immune systems. Other risk factors for getting a hospital-acquired infection are a long hospital stay, theuse of indwelling catheters, failure of healthcare workers to wash their hands, and overuse of antibiotics.

Other hospital procedures that put patients at risk for nosocomial infectionare gastrointestinal procedures, obstetric procedures, and kidney dialysis.

Fever is often the first sign of infection. Other symptoms and signs of infection are rapid breathing, mental confusion, low blood pressure, reduced urineoutput, and a high white blood cell count.

An infection is suspected any time a hospitalized patient develops a fever that cannot be explained by a known illness. Some patients, especially the elderly, may not develop a fever. In these patients, the first signs of infectionmay be rapid breathing or mental confusion.

Hospital-acquired infections are serious illnesses that cause death in about1% of cases. Rapid diagnosis and identification of the responsible microorganism is necessary, so treatment can be started as soon as possible.

Hospitals and other healthcare facilities have developed extensive infectioncontrol programs to prevent nosocomial infections. These programs focus on identifying high risk procedures and other possible sources of infection. Highrisk procedures such as urinary catheterization should be performed only whennecessary and catheters should be left in for as little time as possible. Medical instruments and equipment must be properly sterilized to ensure they are not contaminated. Frequent handwashing by healthcare workers and visitors is necessary to avoid passing infectious microorganisms to hospitalized patients.

Antibiotics should only be used when necessary. Use of antibiotics creates favorable conditions for infection with the fungal organism Candida. Overuse of antibiotics is also responsible for the development of bacteria thatare resistant to antibiotics.

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