Hospitals have dominated the news in recent years, less so for their achievements and more so for the panic-inducing infections patients are contracting while under hospital care. Hospital-acquired infections, also known as nosocomial infections, are infections and illnesses that patients or hospital staff may acquire in the hospital setting, either as a by-product of the health practitioner’s job, or for patients, following anything from routine to major medical procedures.
According to the CDC, in the United States alone, nearly 2 million hospital-acquired infections are treated per year, with an estimated 99,000 proving fatal. Some estimates claim that there are over 40,000 errors made in hospitals per day which could lead to infection and/or death. Among hospital-acquired infections the most commonly diagnosed and treated are urinary tract infections, surgical site infections, bloodstream infections and pneumonia.
With method of transmission regularly being through health care worker to patient contact, or even vice versa, most nosocomial infections are actually highly preventable, and by and large only occur when a relaxed attitude to sanitation is undertaken at the facility. All told, hospital borne illnesses are said to affect roughly one in 25 patients and cost the U.S. healthcare system an estimated $4.5 billion to $11 billion to diagnose and treat annually.
While the amount of patients who actually get infected from hospital-acquired infections is extremely small, and your chances of becoming one of those unlucky few is extremely rare, it does happen; here is a list of ten hospital-acquired infections to be aware of, and probably afraid of, next time you visit the E.R.
10 Puerperal Fever
A rare disease today that afflicts women during childbirth, puerperal fever was once known as the “Doctor’s Plague” due to the fact that it was indeed the doctors themselves, unaware of germs and proper hygiene, that would spread the disease to the woman while giving birth. An illness that can result in fatal genital tract sepsis, this illness is still contracted in hospitals today, with Caesarean sections being the biggest risk factor. The most common symptoms are a high fever, inflammation of the inner lining of the uterus and the membrane lining of the abdomen. If sepsis has not yet set in, puerperal fever can be treated with antibiotics and the prognosis is good; if sepsis has set in then it becomes a much more difficult issue. While extremely rare in the west today, 3 out of every 100,000 women still suffer from puerperal fever.
9 Bloodstream Infections
Bloodstream infections comprise roughly 10% of all illnesses contracted in hospital care per year in the United States. The primary method of contraction in over 84% of reported cases is the catheterization process, either before or during. Lack of appropriate hygiene practices amongst health practitioners is deemed the cause of bloodstream infection, where the CDC guidelines for proper sterilization before insertion of the catheter is lacking, or where maintenance of the catheter is neglected. Bloodstream illnesses cost a patient an added $6,000 to $30,000 in medical bills depending on the severity, while costing the healthcare system up to $3 billion a year. Furthermore, the CDC reports a mortality rate of 1 in 4 relating to hospital-borne bloodstream illnesses.
8 Surgical Site Infections
It is not unheard of to contract a mild infection post-surgery; often times only the skin is involved and it is similar in nature to the type of infection one may acquire after cutting themselves. Symptoms include red, swollen skin and perhaps some discharge and pain. Antibiotics generally clear these up and that’s the end of it. Sometimes however, surgical site infections can develop into far more deadly concerns if they spread to the tissue beneath the skin and especially the organs. In these extreme cases further surgery involving the skin or organs is necessary in order to combat the infection, resulting in greater medical distress and cost to the patient, and a heavier burden on the health care system. Again, improper sterilization of medical equipment, or improper hygiene by health care workers is the biggest culprit in contracting a surgical site infection.
7 Clostridium Difficile Colitis
Essentially a virulent strain of diarrhea, there are many mild cases of Clostridium Difficile Colitis, or CDI that infect people every year. Most symptoms are mild to severe symptoms that mimic the flu, ranging from diarrhea to abdominal pain and bloating. In some cases however, the bacterial infection can lead to a life-threatening inflammation of the colon. In a hospital setting CDI is spread through person-to-person contact, so when improper hygiene is practiced, an outbreak can occur, which has particularly dire consequences for the infirm and elderly. Over the past decade, outbreaks of CDI have been reported across the world with many leading to serious illness and death in patients. In the United States alone CDI kills an estimated 14,000 people annually.
6 Vancomycin-Resistant Enterococcus
Enterococcus is bacteria commonly found in the stomach of healthy people. Largely, Enterococcus poses no real risk to the healthy public as a whole, as it affects those with compromised immune systems most. Vancomycin is the antibiotic that had been traditionally used to fight off the bacteria. In the hospital is where Enterococcus becomes a concern, most notably now that Vancomycin-resistant strains have been identified. The bacteria can, like most other bacterias, cause a host of different health problems ranging from ulcers and wound infections to sepsis, pneumonia and meningitis. In the United States Vancomycin-resistant Enterococcus is relatively new, and accounts for 4% of all hospital acquired illnesses.
5 Ventilator-Associated Pneumonia
In patients with underlying respiratory, cardiac or immune system problems, mechanical ventilator-assisted breathing while in the hospital is not uncommon. These patients have severe enough conditions that required hospitalization in the first place, making ventilator-associated pneumonia all the more dangerous for their compromised immune systems to combat. As a method of transmission, a bacterium travels through the breathing tube of the patient and enters the lungs, eventually colonizing and resulting in pneumonia. Symptoms of the illness present themselves as fever, lowered body temperature, a lack of oxygen in the blood and pus in the sputum. VAP is diagnosed by taking chest x-rays and blood cultures. Up to 28% of patients receiving assisted breathing acquire ventilator-associated pneumonia and up to 50% die from the illness.
4 Pseudomonas Aeruginosa
A bacteria that can cause a host of different types of infections, Pseudomonas Aeruginosa is responsible for everything from pneumonia to heart conditions. While healthy individuals with a non-compromised immune system are rarely at any risk from Pseudomonas Aeruginosa, those within the healthcare system are particularly susceptible, specifically those on ventilators and those with post-op surgical infections. It is estimated that 4 of every 1000 patients are infected by the bacteria, resulting in roughly 10% of all hospital infections in the U.S. Because it is a bacteria of opportunity, it most often infects those in intensive care such as extreme burn victims, and those with cancer. Due to the nature of the infected patient's weakened immune system, the mortality rate can be upwards of 50%.
3 Necrotizing Fasciitis
More commonly and disturbingly known as the “Flesh Eating Disease”, Necrotizing Fasciitis is an extremely dangerous, life-threatening condition. Caused by the bacteria streptococcus, the bacteria invade and then spread toxins throughout the body. The infection initially presents with a fever and vomiting, before the skin and, if untreated, eventually muscle and organs, begin to be destroyed by the bacteria. Treatment must be received immediately in order to survive the infection, but even still many who have suffered Necrotizing Fasciitis will remain permanently scarred, disfigured, or live with an amputation as a result. Within the hospital setting, the most common route of infection is through an open wound from injury, or from surgery. The CDC reports around 15,000 cases of hospital-acquired Necrotizing Fasciitis per year, with roughly 3,000 of those resulting in death.
2 Methicillin-Resistant Staphylococcus Aureus
Known colloquially as MRSA, Methicillin-resistant Staphylococcus Aureus is an extremely difficult-to-treat bacteria because it has become resistant to virtually all forms of treatment. The bacteria are also difficult to treat because of the many different places within the body that it may colonize and spread infection. The nostrils, urinary tract, respiratory system and the always potentially dangerous open wound, are all places that MRSA infection may begin. Because the bacteria move quickly, generally within 24-48 hours, it is especially vital for treatment, most often with Vancomycin, to commence immediately after diagnosis. Within 72 hours MRSA may become resistant to treatment and manifest in a myriad of ways, such as blood infections, toxic shock syndrome and flesh eating pneumonia (yup, seriously) a condition in which a patient coughs up blood while their lung and throat tissue is eaten away by the bacteria. Though still a serious health risk in a hospital setting, CDC studies show that there have been 30,800 less serious MRSA infections and 9,000 fewer deaths in hospital patients today than in 2005.
1 Carbapenem-Resistant Enterobacteriaceae
Carbapenem-resistant Enterobacteriaceae or CRE, are a type of germ that have become extremely resistant to antibiotics, thus making them difficult to treat. Like most of the illnesses on this list, CRE poses no real threat to healthy individuals, but in a healthcare setting, CRE can prove disastrous. Those most susceptible to illness are patients that are receiving treatment via ventilators or catheters or have recently had a transplant. CRE is known in the healthcare world as the “nightmare bug” because of its much higher mortality rate than even MRSA. While a still relatively uncommon hospital-acquired infection as of yet, many healthcare professionals fear the beginnings of a new super bug within the hospital setting because incidents have risen over the past decade. Again, like many other bacteria on this list, CRE causes a varying number of illnesses, from pneumonia and urinary tract infections to far more serious blood infections. It is once CRE attacks the blood that it becomes truly dangerous and nearly impossible to treat; the mortality rate of a CRE blood infection is upwards of 60% making this hospital-acquired infection the deadliest in the world.
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