Hospital-Acquired or Nosocomial Infections

FROM THE LECTURE SERIES: An Introduction to Infectious Diseases

By Barry C. Fox, M.D., University of Wisconsin

The importance of hospitals and their benefits to mankind are remarkable. However, there lurks a dark side of the hospital, one in which a patient could actually acquire a nosocomial infection. How is that possible? What are the ways of protecting a patient in hospitals?

A 3D illustration of "Staphylococcus aureus".
Staphylococcus aureus contaminates the clothing of healthcare providers in hospitals. (Image: fotovapl/Shutterstock)

Hospitals have the advantage of offering specialized care, as well as specialized technologies. If someone needs hospitalization, it’s great to have a coordinated team of physicians, nurses, and other healthcare providers with experience to treat such patients.

A trauma center with an experienced team can certainly make the difference between life and death. Similarly, specialists and sub-specialists in all fields at the medical center enable patients to get state of the art medical attention. Yet, despite these benefits, patients can also acquire hospital-based infections in several ways when they are admitted.

This is a transcript from the video series An Introduction to Infectious Diseases. Watch it now, on Wondrium.

Infections with Special Names

Some infections in the hospital are given a special name, known as nosocomial infections, meaning hospital-acquired. The importance of hospital-based or nosocomial infections has always been known to physicians.

The general public was first introduced to these concerns with a report from the Institute of Medicine in 1999. The report concluded that 44,000- 98,000 deaths per year in the United States were due to preventable medical errors in hospitals and a sizable proportion of these were deaths from nosocomial infections.

Teams have been at work at hospitals over the past two decades to reduce the incidence of nosocomial infections and there was a 17 percent decline from 2010-2013.

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The Case of Contaminated Clothing

The white doctor’s coat has been a symbol of the medical profession for over 100 years, giving credibility to those who wear it. But hospitals around the world are starting to ban this tradition, trading it for the short-sleeved scrub-type outfits as they consider white coats to be responsible for hospital-based infections.

Picture of a blue scrubs shirt for medical professional.
Short-sleeved scrub-type outfits are increasingly replacing white coats in hospitals. (Image: Steve Heap/Shutterstock)

Ironically, the white coat came into being in the 19th century partly to prevent cross-contamination. In 2009, Scotland banned all white coats, ties, and accessories to try to prevent infections. Some hospitals in England have already switched to tunic-like scrubs for all doctors.

Several studies have shown that healthcare providers’ clothing is contaminated with a variety of pathogenic germs. Physicians’ white coats, as well as nursing uniforms, may serve as breeding grounds for germs that can be transferred to other healthcare providers or even patients.

Two reports found that 70 percent of physicians admitted never having cleaned their ties. In addition, other studies showed that 33 percent of neckties were contaminated with staphylococcus aureus and other germs, some of which could also be pathogenic.

Other Sources of Infection in a Hospital

Since the 20th century, handshakes have been associated with the transmission of infectious diseases by transferring germs from one person’s hand to another. It’s hard to believe, but handshakes may soon become a thing of the past.

Another hospital-based contamination is through the stethoscope. It is a possible germ-transmitter. Most physicians and nurses do not disinfect their stethoscopes frequently, not even once a month and certainly not after each patient contact. It is used a number of times every day and comes into direct contact with the skin, and may harbor thousands of bacteria.

One study from a Mayo Clinic found that the contamination level of the stethoscope tube was higher than the germs on the back of the examiner’s hand. It is thought that cross contamination can occur via manipulation with contaminated hands, so the decontamination of both the tube and the diaphragm, or listening piece is needed.

Therefore, stethoscopes are likely a significant vector of transmission of non-harmless germs, but also potentially pathogenic bacteria. Patients in isolation already do have a dedicated stethoscope in their rooms, which keeps the germs somewhat under control.

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Most nosocomial infections are bacterial but some can be viral. The major causes are pneumonia, surgical wound infections, and gastrointestinal or GI infections, each at about 20 percent of the total.

Of the pneumonia cases, nearly half are associated with being in the intensive care and connected to a breathing machine known as a ventilator. Pneumonia and bloodstream nosocomial infections though, have the greatest potential for severe consequences, even death.

Urine and blood infections account for an additional 10 percent of cases. Since patients often have catheters placed in their bladders to monitor urine output, or catheters in their arms for intravenous fluids and medications, these anatomical sites are also prone to infection.

Bacterial Nosocomial Infections

"Clostridium difficile" as seen through a magnifying glass.
 Clostridium difficile or C. diff, the single most common intestinal pathogen, causing 12 percent of all nosocomial infections in humans. (Image: Olga Bolbot/Shutterstock)

An increasingly important cause of nosocomial GI infection is the bacterial disease known as Clostridium difficile, often abbreviated as C. diff. This is the single most common intestinal pathogen, causing 12 percent of all nosocomial infections. C. diff can be transmitted by the fecal-oral route with poorly sanitized hands.

Resistant bacteria play a more prominent role in nosocomial infections, as the germs have been kind of hanging out in the hospital environment, such as the bedrails, sinks, and in bathrooms. Some examples include multiple drug resistant Gram-negative bacilli, and Methicillin resistant Staph or MRSA.

Therefore, it is best to avoid being hospitalized unless absolutely necessary.

Common Questions about Hospital-Acquired or Nosocomial Infections

Q: What are nosocomial infections?

Nosocomial infections are infections that are acquired after hospitalization.

Q: Why are some hospitals replacing physicians’ white coats with short-sleeved scrub-type outfits?

Physicians’ white coats may serve as breeding grounds for germs that can be transferred to other healthcare providers or even patients. Therefore, these are being replaced by short-sleeved scrub-type outfits.

Q: What causes GI infections in hospitals?

Clostridium difficile, often abbreviated as C. diff is the bacterium that causes nosocomial GI infection in hospitals. It can be transmitted by the fecal-oral route with poorly sanitized hands.

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