One major issue affecting both healthcare workers and patients across the globe is the prevalence of hospital-acquired infections, commonly referred to as HAIs. In the past decades, it was determined that hospital-acquired infections were simply a consequence of receiving medical care and that the risk associated with HAIs were lesser than the risk of going without medical intervention. However, in the past decade, health professionals’ stance on HAIs have shifted greatly. Hospital-acquired infections are now considered to be 100% preventable, and the occurrence of such is simply unacceptable. The most common types of HAIs will be discussed, as well as their prevalence in hospitals across the United States. Specifically, why hospital-acquired infections are so pervasive, as well as how they spread will be looked into. Finally, HAI prevention strategies will be discussed along with current regulations put in place to rectify the issue.
Many patients are unaware of the risks that they are taking simply entering a hospital, and hospitals are to blame. Many organizations across the United States are accusing hospitals of hiding or otherwise ignoring the issue of hospital-associated infections. In one of many studies conducted on the pervasiveness of HAIs, it was estimated that “hospital-acquired infection increased hospital care cost of a patient by $10,375 and it increases the length of stay by 3.30 days” (Hassan, Tuckman, Patrick, Kountz, & Kohn, 2010, p. 82). This estimate is an example on a per-patient basis. The majority of hospital patients are completely unaware that by seeking medical care, there is a possibility that they would end up paying $10,000 or more on top of the cost of care for the condition they originally sought care for. On a nation-wide basis, it is suggested that the “aggregate costs of hospital-associated infections in the United States may vary from $5 billion to $29 billion” (Hassan et al., 2010, p. 82). The statistics on the actual costs of HAIs incurred on a yearly basis vary greatly from study to study, hence the wide estimation of $5 to $29 billion dollars. The reason for the large gaps in estimation is mainly due in part to the Health Insurance Portability and Accountability Act (HIPAA). The implementation of this act resulted in increased difficulty for researchers to conduct their studies regarding hospital-acquired infections as the act strives to protect patient confidentiality. While the reporting of the number of HAIs per hospital are available, the exact numbers of each type of infection are limited in availability as a result of HIPAA. The most common types of HAIs found across the United States were found to be bloodstream infections associated with central-line catheters, ventilator-associated pneumonia, MRSA, Clostridium defcile, and catheter-associated urinary tract infection (Halpin, Milstein, Shortell, Vanneman, & Rosenberg, 2011). All of these most common infections are 100% preventable, yet the prevalence of them is still so high. An infection rate of “5.7 infections per 100 admissions” (Hassan et al., 2010, p. 83) was found as well as a “4.31% mortality rate attributable to infection” (Hassan et al., 2010, p. 83). While these numbers may seem small, they are actually staggering. They represent 5.7 out of 100 people that unnecessarily acquired an infection that is 100% preventable, as well as 4.31% of those who suffered from infection, died a completely unnecessary death. It is extremely important to identify the cause behind the occurrence of these infections as well as understand how they spread in order to find a solution to combat this rising issue.
Finding the cause of hospital-acquired infections and understanding how these infections spread is key to terminating this national health issue. Many factors can influence a person’s level of susceptibility to certain infections. These factors include the type of surgery the patient is receiving, the length of stay, as well as the steps taken in preparation for medical care. While a simple infection may not seem to be a huge cause for concern it is important to remember the lasting effects that infections can leave. These include, “short-term pain and suffering, long-term disability, increased resistance of microorganisms to antimicrobials, prolonged hospital stays, and additional financial burden for health systems, and higher costs for patients” (Szymczak, 2013, p. 7). Immunosuppressive therapies have been used increasingly to treat various conditions, which commonly leaves patients with compromised immune systems even after they are discharged from the hospital. As increasingly invasive procedures have become practiced with more regularity throughout hospitals in the United States, it has resulted in more opportunities for infections to take place. With the increase of HAIs, it is ever so important to understand exactly how infections spread. It has been discovered that medical textiles are one of the major causes for the spread of disease and infection in hospitals. Examples of medical textiles include gloves, gowns, and facemasks. While the purpose of medical textiles is to provide protection to health-care workers by preventing contact with pathogens, both through direct contact as well as airborne pathogens, there have been many negative effects associated with them. It was found that “medical textiles can function as a potential vector of transmission. Although not all pathogens can live/culture on textiles surface, research has suggested that medical textiles can be a contributing factor to cross-contamination” (Rucker, Brasch, & Haise, 2011, p. 157) A study regarding the transmission of infection via medical textiles has found evidence that items such as uniforms and scrubs “become increasingly contaminated during clinical care; one case report showed a clear link between contaminated scrubs and the infection of two neurosurgical patients” (Rucker et al., 2011, p. 157). One of the most common hospital-acquired infections, MRSA, is commonly found to be present on health-care workers’ clothes and shared equipment, attributing to the spread of MRSA from an infected patient to a noninfected patient (Perlin, 2017). While obviously health-care workers must wear a uniform, there must be a way to reduce the spread of infection directly associated with medical textiles. Other attributing factors related to the spread of HAIs is the failure to use proper antiseptic when inserting devices such as ventilators, urinary catheters, and central lines; failing to remove equipment promptly when it is no longer needed; failure by health-care workers to use PPE when entering patient’s rooms that may be hosting drug-resistant organisms (Szymczak, 2013). It is extremely important for health-care workers and hospitals to accept responsibility for failure to use PPE for infection control. HAIs are no longer considered an inevitable consequence of medical provision and therefore the occurrence of such is no longer acceptable.
The most important question to ask hospitals in regard to HAIs is what is being done to prevent them? How they spread is known and understood, now hospitals must implement regulation and policy to prevent their occurrence. On a national level, several organizations are applying new regulations to assist in the decrease of HAIs. In California, a new law was passed, and the Hospital Disease Control Program was created and required the Department of Health Services to appoint a Healthcare Associated Infection Advisory Committee, as well as required hospitals to implement procedures to prevent HAIs, as well as mandatory reporting of HAIs to the CDC (Halpin et al., 2011). Thirty-eight states currently have laws mandating the reporting of HAIs. It is specifically important that this information is widely available to the public in order for Americans to make informed decisions when choosing a hospital to receive medical care. A survey of hospital across the United States found that currently, “97.1% of hospitals reported having a formal written plan in place for preventing hospital-acquired infections” (Halpin et al., 2011, p. 723) and that “89.6% of hospitals provided funding for staff to attend training in infection control” (Halpin et al., 2011, p. 723). There has been an increase shown in hospitals across the United States of funding and available continuing education available to health-care workers in an effort to prevent HAIs. The Health Care Association recently introduced a campaign known as the “ABCs” to make PPE easy to understand for everyone, not just health-care workers. The main points of the “ABCs” campaign is; (A) active surveillance, determining which patients are carriers of disease and infection; (B) barrier precautions, the use of PPE; (C) compulsive hand hygiene; (D) disinfection; and (E) environmental cleaning (Perlin, 2017). This campaign makes infection control easily understandable to everyone in a hospital environment, including visitors and patients, so everyone can do their part in infection control and prevention. With the implementation of various policies and regulations, it leaves room to wonder if they have had any positive effect on decreasing the number of HAIs. Some studies have found positive results, for example, it was found that there was a “16.1% decreased incidence of catheter-associated urinary tract infection (CAUTI), a 2.9% decrease in surgical site infections (SSI), a 1.1% decrease in central line-associated bloodstream infection (CLABSI), and a 0.4% decrease in ventilator-associated pneumonia (VAP)” (Deresinski, 2016, p. 35). While the statistical decrease may be small in regard to the number of HAIs, any improvement is important. A number of hospitals reported that they struggle with implementing infection prevention practices and that when such policies are put into place it is extremely difficult to get healthcare workers to comply with them because there is little that can be done to enforce the policies. While the infection prevention methods may seem very simple and straightforward, hospitals across the United States are still struggling to eliminated HAIs.
In conclusion, hospital-acquired infections are no longer deemed an acceptable occurrence in hospitals. While the overall number of HAIs is on the decline, it is important for patients to be aware of the risks associated with medical provisions. Public knowledge of HAIs is increasing thanks to laws passed in many states requiring hospitals to report HAIs to the public. Despite the difficulty associated with infection prevention, hospitals across the United States are doing their part to minimize the occurrence of HAIs through the implementation of policy and procedures for health-care workers, as well as providing training for their employees on infection prevention.