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Healthcare Associated Infections (HAIs)

Part 1 – A World-Wide Problem

“It may seem a strange principle to enunciate, as the very first requirement in a hospital, that it should do the sick no harm” Florence Nightingale, 1859

1. Introduction

Healthcare-associated infections (HAIs) are defined as infections occurring in a healthcare setting that were not present prior to a patient entering that care setting. These infections can develop either as a direct result of healthcare interventions or from being in contact with a healthcare setting.

Within a general hospital, HAIs are more likely to occur among patients who become vulnerable to infection due to factors, such as extended and inappropriate use of invasive devices and antibiotics, undergoing a high-risk and sophisticated procedure, being immunocompromised and other severe underlying conditions.

The most well-known healthcare-associated infections, for which mandatory reporting is currently required, include those caused by meticillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C difficile) and Escherichia coli (E coli). Other gram-negative bacteria (including antibiotic-resistant bacteria) and norovirus can also cause healthcare-associated infections.

There are multiple transmission routes for HAIs including direct contact, indirect transmission through surfaces, droplet infection, airborne particles, release of ‘dust’ into the air and through hospital procedures such as catheterisation, dressings etc.

2. WHO - Global report on infection prevention and control

Patients afflicted with other conditions and seeking care or accessing preventive services such as vaccination in good health, find themselves with the risk of being infected with a Hospital Acquired Infection.

Facilities can be the entry point for outbreaks or become amplifiers of pathogen transmission, with subsequent spread of outbreaks to the community. Out of 100 patients hospitalised, seven will be infected with an HAI, the risk doubling and being up to 20 times higher in low- and middle-income countries.

The more ill and fragile patients get, the higher becomes the risk of HAIs and their deadly consequences. Deaths are increased two to threefold when infections are resistant to antimicrobials.

Moreover, the experience accumulated in the past two years during the COVID-19 pandemic unequivocally shows that both patients and health workers can be at high risk of being infected with SARS-CoV-2 during health care delivery and need to be protected.

3. The UK Experience

A 2017 study of NHS costs and outcomes attributable to health care associated infections in England during 2016/2017 scaled up to the entire UK,came to the following conclusions:

An estimated 1,850,840 HAIs costing the NHS £3.4 billion annually, and accounting for 35,800 patient deaths, 8.9 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days) and 100,200 days of absenteeism among front-line Health Care Professionals (HCPs).
The annual incidence of HAIs among patients in acute care European hospitals is reported to be 1 in 18 and an estimated 3.5% of patients who acquire a HAI are reported to die from their infection.
The costs incurred to manage a patient who acquires a HAI is around three times higher than that of managing a patient without a HAI. This potentially represents a significant cost as inpatients who acquire a HAI are likely to have their length of admission extended by 9 – 15 days.
With 35,800 annual deaths, HAIs far surpass other leading causes of accidental UK deaths: motor vehicle accidents (1,700 annual deaths), poisoning (4,860 annual deaths), and falls (6,400 annual deaths).

In England, every NHS hospital must have an infection prevention protocol in place and hand hygiene, antimicrobial stewardship and environmental cleanliness are currently identified as key strategies to combat HAIs.

The impact of the COVID-19 Pandemic in UK Hospitals

The impact of COVID-19 on HAIs in the UK was significant. It is estimated that nearly 20% of symptomatic COVID-19 patients in hospitals in England, that is some 26,600 patients, acquired their infection in hospital settings during the first wave (from January to July 2020 inclusive).

4. The Australian Experience

Various recent studies of costs and outcomes attributable to health care associated infections in Australia suggest that:

There are around 165,000 healthcare associated infections (HAIs) in Australian health facilities each year, making them the most common complication affecting patients in hospital. The latest 2018 study indicated an overall HAI prevalence of 1 in 10 resulting in circa 7500 deaths.
It is estimated that HAIs account for two million hospital bed days in Australia each year owing to an extended hospital stay of circa 18 days.
As the national average cost per admitted acute overnight stay is £1170 each the result of this longer stay, involving a hospital-acquired infection, may therefore lead to an additional £21,400 in extra costs, or £3.5 billion overall.

5. The United States Experience

One of the significant differences between the US and the UK is the prevalence of single occupancy patient rooms rather than multiple occupancy wards.

Various recent studies of costs and outcomes attributable to health care associated infections in the USA came to the following conclusions:

There are around 1.7m healthcare associated infections (HAIs) in US health facilities each year, an overall HAI prevalence of 1 in 31, resulting in circa 100,000 – 170,000 deaths annually (estimates vary).
The 5 most common HAIs are estimated to result in an annual cost to the health care system of nearly $10 billion annually. Some cost estimates are significantly higher.
It is estimated that HAIs account for 15.3 million hospital bed days in the USA each year owing to an extended hospital stay of circa 9 days.

6. Conclusions

The rate of Hospital Acquired Infections is a serious world-wide problem.

Considerable investment has been made in training, improving behaviours, adopting best practice in cleaning and sanitisation protocols and in reporting. While this has led to greater consistency and some improvement the problem remains significant, as emphasised by the surge in cross infections during the COVID pandemic.

To date, the application of technologies to combat HAIs, including automated hand hygiene monitoring, touchless technology, fluorescent marking of high-touch surfaces to ensure cleaning, copper germicidal surfaces and antimicrobial textiles, has been limited. Had these technological ‘fixes’ been highly successful, the take up would be much greater than it has been.

To really make an impact, we need to be able to remove the infective agents from the air and surfaces wherever they are. This is where Airora comes in, see Part 2.

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