Hospital acquired infections in Scottish hospitals
Hospitals are, by nature, places where people have a high risk of acquiring infections. This is because they have concentrations of sick people. The fact that all sick people from the surrounding community converge at the hospital increases the probability of one getting ill while in this environment.
It is an old problem
Globally, hospital-acquired infections affect 4.5% of all hospitalised patients. They are the sixth leading cause of mortality in the US responsible for almost 100,000 deaths annually. The figures for some European countries are worse than those of the US. They constitute a significant drain on the healthcare budget costing billions of pounds annually in treatment and productivity costs.
Hospital-acquired infections are an old problem in Scottish hospitals. However, the health system has made significant improvements over the years. For instance, the frequency of Staphylococcus aureus infections has reduced from a monthly average of 200 to 110 cases over the past decade. The rate of infection has stagnated in recent years with no significant change since 2012.
Common infections
The most diagnosed infections include respiratory, urinary tract and bloodstream infections. Bacterial infections are a leading cause of hospital infections responsible for most urinary tract and respiratory system infections. Urinary tract infections are the most prevalent while respiratory and blood infections have the highest rate of morbidity and mortality.
Staphylococcus aureus infections are rather common because it is a bacterium that is abundant in nature. Indeed, health statistics indicate that this bacterium causes an average of 110 infections in Scottish hospitals per month. E. col is a bacterium found in the digestive system of most animals, including humans. It is dispersed through contamination, animal contact and poor hygiene. Some strains cause serious infections, but most strains only cause mild conditions that recover without medication. E. coli causes almost 400 infections in Scottish hospitals every month.
Clostridium difficile or C. diff is a common bacterium found in soil and causes bowel infections that may deteriorate to diarrhea. It does not adversely affect healthy people in the community. However, it is a common infection for hospitalised patients who have been taking antibiotics for a prolonged period. It causes an average of 350 infections every month at Scottish hospitals.
Methicillin-resistant Staphylococcus aureus (MRSA) often christened “hospital superbug” in the media, is the most infamous hospital-acquired infection. It is a variant of Staphylococcus aureus infection that is resistant to conventional remedies and mostly affects hospitalised patients. Such patients are vulnerable because they have wounds or catheters that allow pathogens to enter the body. Their weak immune system makes them vulnerable while the concentration of sick people makes it easy to spread. The recent outbreak of MRSA was attributed to over-prescription and the misuse of antibiotics by the general public making the bacteria resistant to first-line drugs.
Weakened immune system
The majority of the people in hospitals are patients whose immune system may already be compromised, making them vulnerable to infections. The recent spate of hospital-acquired infections at the Queen Elizabeth University Hospital in Glasgow is a clear demonstration of this fact. Two of the patients died from an infection associated with fungicides found in most residential properties. The third patient acquired a fungal infection caused by spores found in organic matter.
Similarly, the two babies that died at the Princess Royal Maternity Hospital had acquired a bacterial infection. The strain of bacteria that caused this infection, Staphylococcus aureus, is commonly found on the human skin and is often harmless. It is transmitted through touch or coming into contact with body fluids. Such infections only occur among individuals with a weak immune system.
Dependence on intrusive devices
Hospitalised patients are vulnerable to these infections due to increased opportunities for infection during and after surgical procedures. Moreover, a substantial number of patients are reliant on invasive medical devices.
Hospital-acquired pneumonia is one of the most lethal infections in healthcare environments and is often caused by mechanical ventilation.
Bloodstream infections are most common among patients using central vascular catheters but can also result from infections in other parts of the body.
Similarly, most urinary tract infections are associated with the use of urethral catheters.
Some of the bacteria strains that cause these infections are resistant to first-line antibiotics, making them hard to manage. For instance, a report from Greece indicated that 85% of the bacteria strains obtained from ICU patients were drug-resistant.
Interventions
Research indicates that at least 30% of hospital-acquired infections are preventable. Most inquiries into the problem point at both individual errors and systemic failures. Researchers suspect that some infections are misdiagnosed, leading to inappropriate antibiotic prescriptions. The misdiagnosis increases resistance and toxicity, escalating the risk of adverse outcomes and high healthcare costs.
Research indicates that the use of evidence-based interventions such as impregnating catheters with antibiotics can significantly reduce the risk of this infection. More importantly, hospital staff should be trained on how to identify infections and best practices for managing them.
Delayed intervention is a major cause of mortality among patients with bloodstream infections. Due to the frequency of multidrug-resistant infections among hospitalised patients, some practitioners recommend broad-spectrum antibiotics for initial treatment. The healthcare professional can then conduct blood cultures to facilitate personalised treatment.
The Scottish health ministry has devised a national control strategy for hospital-acquired infections that outlines ten precautionary measures. The systemic interventions include screening patients for infection, rigourous protocols for personal hygiene and creating a safe hospital environment for patients and staff. In the case of an outbreak, all hospitals have an elaborate plan to manage it in the shortest time possible.
Bottom line
Hospital-acquired infections are an inherent part of any healthcare system. They are inevitable due to the confluence of factors that make hospitals more prone to spawning infections than other environments in the community. However, with appropriate individual and systemic interventions, they can be reduced to a minimum.
