By Barry C. Fox, M.D., University of Wisconsin
Some infections in the hospital are known as nosocomial infections, meaning hospital-acquired. The major causes of nosocomial infections are pneumonia, surgical wound infections, and gastrointestinal or GI infections. The vast majority of these infections are device- or procedure-related. The healthcare system has a good grasp of how these infections happen and are actively seeking ways to prevent them.
Prevention of Device-Related Infections
Having a catheter in a vein provides a direct entry route for bacteria to enter the blood. These bacteria can crawl down the side of the catheter and into the vein. Alternatively, bacteria can crawl down the inside of the catheters into the bloodstream. When a vascular catheter is inserted directly into a large blood vessel, the risk of infection is higher than those on the arms.
For urinary devices, efforts are focusing on not even placing catheters in the first place, or if needed, removing them as soon as possible, since the risk of infection is proportional to the number of days the catheter is in place.
In case of pneumonia, there is a bundle of interventions such as keeping the head of the bed elevated, and using special disinfectant mouthwashes to reduce infection risk.
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Preventing Transmission
In order to prevent all types of nosocomial infections, the Centers for Disease Control, or CDC, has developed a 12-step plan for preventing infections.
Every hospital has an infection control department. There is an entire healthcare team in the hospital that is working behind the scenes in addition to the primary physician working to prevent infection. The team includes at least one epidemiologist and one or more nurses, to co-ordinate efforts to reduce infections.
There are basic infection control principles that healthcare providers must follow to protect both the patient and themselves from transmittable pathogens. These are known as standard or universal precautions.
Standard or universal precaution measures include hand washing, implementing isolation restrictions, and protecting against blood borne pathogens with personal protective equipment like gloves, gowns, and face shields.
Reducing the Risk of Infection
There are special forms of isolation in the hospital, including contact precautions where providers need to wear gowns and gloves to protect themselves from acquiring germs on their hands and their clothes.
Secondly, there is a provision of droplet isolation, when providers wear a mask. This is used for patients with suspected viral respiratory illnesses, such as influenza.
The hospitals also have a provision for airborne isolation, where special masks are worn, and rooms with special airflow control are needed for diseases such as chicken pox and tuberculosis where the germs can spread beyond 6 feet.
The infection control department is responsible for ensuring that appropriate level of isolation is instituted with every patient that’s admitted.
Enhanced Contact Precautions
A special type of isolation is necessary for patients who are known to be positive for the bacterium C. diff. This includes not only gowns and gloves, but also special mandatory hand washing with soap and water to remove spores from healthcare provider’s hands.
C. diff produces spores, which contaminate the hospital environment such as beds, guardrails, and intravenous pumps. Spores are not only highly contagious, but also cannot be killed with alcohol alone, hence the need for washing hands with soap and water.
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Sterilization and Disinfection
When surgery is performed, it is not unusual for infection to enter sterile body spaces, such as the inside of the abdomen. Physicians in the operating room wear sterile gloves, a sterile gown, and a mask to prevent them from coughing or sneezing into the wound.
The use of instruments in the operating room also require preparations. Instruments undergo either high-temperature steam sterilization in an autoclave, gas sterilization with low-temperature ethylene oxide gas, or hydrogen peroxide gas plasma.
Disinfection is one step short of sterilization, and cleaners used have all the elements that give hospitals their unique smell.
Antibiotics Prophylaxis in Surgery
One additional principle of infection prevention in the operating room is antibiotic prophylaxis in surgery. In nearly all surgery, there is some minor contamination of the wound, no matter how well the surgical site is scrubbed with antimicrobial soap, and no matter how careful the surgeons are in operating.
So, having antibiotics in the tissues of the surgical wound where that minor contamination might occur has been shown to greatly reduce the risk of infection.
Antimicrobial Stewardship
Another CDC initiative is to use antimicrobial agents wisely. Stopping antibiotics when infection is unlikely or cured is essential. There is a relatively new program for hospitals that has been effective for the past decade known as antimicrobial stewardship.
The two main goals of antimicrobial stewardship are to eliminate unnecessary antibiotic use and to improve the quality of use through constructing hospital guidelines for antibiotic use, restricting last resort antibiotics to cases that are absolutely necessary and educating physicians and other staff about why this is necessary.
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Precautions to be Taken by the Patient
What can patients do to protect themselves in the hospital? Patients can discourage visits from people who are ill. They can also ask visitors to sanitize their hands and follow hospital isolation precautions when they come into the room. In some instances, visitors will be asked to wear a gown and gloves. These are simple but effective ways to help control disease spread.
We all have a role to play in people staying as healthy as possible when they are in the hospital or even in a medical clinic. If you are coming to a medical clinic to visit with a cough, ask for a mask to protect yourself and protect others while they are ill.
By working together, patients, visitors and healthcare workers can lower the hospital-acquired infection risks.
Common Questions about Prevention of Nosocomial Infections in Hospitals
Hand washing, implementing isolation restrictions, and use of personal protective equipment like gloves, gowns, and face shields are the standard or universal precautions that are followed by healthcare providers.
Antimicrobial Stewardship is a CDC initiative to eliminate unnecessary antibiotic use, and to improve the quality of use through constructing hospital guidelines.
For urinary devices, efforts are focusing on not even placing catheters in the first place, or if needed, removing them as soon as possible, since the risk of infection is proportional to the number of days the catheter is in place.
