What is a nosocomial infection and why is it dangerous?

Hospital-acquired, or nosocomial, infections are those that can be contracted while receiving medical care. This usually occurs in hospitals, although it can also happen in dialysis centers and long-term care facilities, such as geriatric centers.

Pathogens can be bacteria, viruses or fungi. Many of them are also resistant to antibiotics. In one American study, scientists estimated that among all hospital-acquired infections, about 16% are caused by such microorganisms.

Among the particularly dangerous ones are antibiotic-resistant Acinetobacter and Enterobacteriaceae , Candida auris fungi and clostridia that causes diarrhea ( C. difficile).

Serious complications can also be caused by enterobacteria that produce β-lactamase, which makes them more resistant to antibiotics, methicillin-resistant Staphylococcus aureus ( S. aureus ), vancomycin-resistant enterococcus , carbapenem-resistant Pseudomonas aeruginosa ( P. aeruginosa ) .

How common are nosocomial infections?

Nosocomial infections occur quite often, all over the world.

Thus, in 2015 in the United States, hospital-acquired infections attacked 3.2% of all hospitalized patients.

Things are no better in Europe. In one 2016 study , researchers estimated that 6.5% of patients in acute care hospitals contracted hospital-acquired infections, while 3.9% of patients in long-term care facilities contracted hospital-acquired infections.

According to a 2013 Russian study , the prevalence of NI in emergency hospitals in 18 cities was 7.6%.

Based on these data, scientists calculated that the average number of hospital-acquired infections throughout the country should be about 2.3 million cases per year.

How can you get a hospital-acquired infection?

Infections can enter the body in different ways. Below we list common routes of infection and possible complications.

Through the introduction of a venous catheter

When a catheter is inserted, bacteria and fungi from the skin can transfer to the inside of the medical equipment and then into the bloodstream and infect the person.

Complications from infections may include suppurative thrombophlebitis, endocarditis, septic arthritis, osteomyelitis, abscess formation, and sepsis.

By airborne droplets or through ventilation

If bacteria from the air or contaminated aerosols are inhaled, hospital-acquired pneumonia may develop within 48 hours .

The infection can also enter the respiratory tract due to tracheal intubation during artificial ventilation. This condition is called ventilator-associated pneumonia and occurs in 5–15% of patients who undergo the procedure.

Antibiotic-resistant bacteria are often transmitted this way. Infection is fraught with respiratory failure, accumulation of pus and fluid under the lining of the lungs, and sepsis.

Through insertion of a urinary catheter

Infection occurs in 15–25% of patients when a urological catheter is inserted.

Infection can spread to the upper part of the urinary system – the kidneys and ureters, and also result in sepsis.

Through water and food

Through the fecal-oral route, that is, through contaminated food that has been touched with unwashed hands, you can catch the bacterium Clostridium difficile.

1. difficile producestoxins that attack intestinal epithelial cells and cause tissue damage, diarrhea, and colitis.

Complications can include recurrent and persistent infections, toxic dilatation of the colon – excessive expansion of its lumen, dehydration and sepsis.

During surgical operations

2-5% of patients develop infections within 30 days after surgery or 90 days after implant placement . They can affect only the skin and subcutaneous fat or spread to muscles, fascia and internal organs.

Infection can slow wound healing and cause implant failure, so that the person will need further surgery. Bacteria can also cause abscess formation , infect body cavities and cause sepsis.

What is the danger of nosocomial infection?

Complications arising from contracting nosocomial infections greatly increase the risk of death of patients. This is especially dangerous for those who are already in critical condition.

In an international study with data from 14 thousand people from 75 countries, scientists calculated that a person who contracted an NI had twice the risk of dying than those who managed to avoid this fate. Finnish scientists obtained similar figures after checking the data of more than 8 thousand patients.

Norwegian researchers assessed the condition of more than 19 thousand patients over 7 years and found that the risk of dying when infected with NI increases by 1.5 times.

In addition, infection increases the length of hospital stay by an average of two weeks. And people who catch several NIs at once can be delayed for almost a month.

Who is most vulnerable to hospital-acquired infections?

Anyone can contract hospital-acquired infections, but there are factors that increase the risk:

• elderly age;
• transfer of a patient from one hospital to another;
• long-term hospitalization;
• hospitalization after emergency surgery or injury;
• surgery on the gastrointestinal tract;
• organ transplantation;
• use of invasive devices of all types, especially central venous catheter;
• artificial ventilation ;
• taking antimicrobial drugs, especially cephalosporins;
• severe underlying disease or the presence of additional ones, such as kidney failure, malignant neoplasms, HIV, suppressed immunity, chronic obstructive pulmonary disease.

How to protect yourself from hospital-acquired infections

It will not be possible to completely protect yourself from such an infection , even if the medical institution follows absolutely all prescribed standards. However, proven strategies to control NI can prevent 65–70% of bloodstream and urinary tract infections and 55% of pneumonia and surgical infections.

Reducing risks largely depends on health workers. They must wash their hands thoroughly, wear a mask, gloves and goggles when in contact with infected patients, and keep hospital equipment and rooms clean. Additionally, since taking antibiotics increases the risk of NI infection, doctors should not prescribe them unnecessarily.

But the patient can do little to prevent infection. But there are still a few measures you can take:

1. Tell your doctor if you were transferred from another hospital or if you have recently had an infection.
2. Ask your doctor what measures they take to protect patients from hospital-acquired infections.
3. If you have a catheter, ask every day when it can be removed.
4. If you are expecting surgery, ask your doctor how to prepare for it to reduce the risk of infection.
5. Wash your hands regularly and make sure hospital staff do the same before touching you. Remind your visitors of this if they visit you in the hospital.
6. You can check with your doctor whether you really need to take antibiotics and for how long.
7. Monitor your condition. If you have signs of infection or complications such as fever, confusion, difficulty breathing, excessive clammy sweat, severe pain, tachycardia, tell your doctor immediately. This may be a sign of sepsis.
8. If you are taking antibiotics and have had three episodes of diarrhea in the last 24 hours, tell your doctor. This may be a sign of  difficile infection.

If you doubt that your doctor has prescribed the appropriate treatment for you, consult with another specialist to get a second opinion.