“The first step in infection control is hand hygiene.”

U.S. Library of Medicine National Institutes of Health NCBI

“Create daily and terminal cleaning protocols and checklists for patient-care areas and equipment. Perform daily cleaning using a C. difficile sporicidal agent (EPA List K agent). Clean and disinfect the patient-care environment (including the immediate vicinity around a CDI patient and high touch surfaces) at least once a day, including the toilets.  Clean and disinfect all shared equipment prior to use by another patient.”

CDC Centers for disease control and prevention

The purpose of this article is to help broaden the public in knowing about HAIs including how their family or friend should be cared for when in a hospital with what they can do when visiting a loved one in a health facility for both the patient’s and visitor’s benefit.  

History of HAIs

Let us start with some history. In England in the 1830s, the term hospitalism was coined by Sir James Simpson to describe HAIs. In those days, it was believed that infection was spread because of inadequate ventilation and stagnant air. To prevent infection, windows were opened, and whenever possible care was taken to prevent overcrowding of hospital rooms. Little was known about microbes and their pathogenicity, and consequently little was done about personal hygiene. In Victorian society, the idea of one’s personal hygiene being connected to infection was taken personally and was met with great resistance.

Despite the efforts of medical personnel, many patients died of overwhelming sepsis following preventable infections. In the late 1860s after much persistence, Joseph Lister, a British surgeon, introduced the concept of antisepsis, which significantly decreased death from postoperative infection. After penicillin was introduced in 1941, postsurgical infection rates and deaths from postsurgical pneumonia were both dramatically decreased.

Today, modern medicine has brought a more thorough understanding of pathogens and the epidemiology of the diseases they cause. Unfortunately, in spite of the vast amounts of medical advances that have occurred over the years, the healthcare industry is still faced with the enormous task of preventing and reducing the risk of HAIs.

Today HAIs are defined as nosocomial infections which are infections that are acquired in hospitals and other healthcare facilities (like a nursing home or subacute rehab facility). To be classified as a nosocomial infection the patient must have been admitted for reasons other than an infection. He or she must also have shown no signs of active or incubating infection upon admission.

On average, nosocomial patients stay in the hospital 2.5 times longer than patients without infection. An estimated 40 percent of nosocomial infections are caused by poor hand hygiene (WHO). Hospital staff can significantly reduce the number of cases with regular hand washing. They should also wear protective garments and gloves when working with patients.

Invasive procedures increase the risk of nosocomial infections. Noninvasive procedures are recommended when possible. Most nosocomial infections are due to bacteria. Since antibiotics are frequently used within hospitals, the types of bacteria and their resistance to antibiotics is different than bacteria outside of the hospital. Nosocomial infections can be serious and difficult to treat, especially if it’s a multi-resistant bacteria.

What put’s a person at risk?

Harmful microbes are all around us, and although infection poses a threat to everyone, certain people are more at risk of infection. For example, people in healthcare facilities are more at risk than those in the community simply because they are exposed to others who are infected with disease-causing organisms. These people are exposed to so many other peoples germs and bacteria as opposed to a private home simply puts you at potential for picking up them if not proper prevention is carried out by all that come in contact with you, starting simply with hand washing by the patient and those that see the patient (medical staff to visitors).

Even more at risk are special populations of patients, such as those with compromised immune systems, those who have undergone recent surgery, those with poor nutritional status, and those with open wounds. Patients undergoing certain medical procedures, such as intubations and central lines, are also at increased risk. Medical devices also carry a risk of infection. Urinary catheters, central lines, mechanical ventilation equipment, and surgical drains all put patients at risk for infection. Any foreign object in the body or any unnatural opening of the body (surgical wound or trauma wound) puts that individual at risk for local infection to that area and if left untreated goes to general infection (temp greater than 100.5 or 101 F).

Further, certain medications and various chemotherapies weaken patients’ immune systems, leaving patients more vulnerable to infection. The length of time spent in a healthcare facility also affects the risk of infection: The longer the stay, the longer that person is exposed to much more bacteria than at home putting greater risk of that patient’s chances of acquiring a HAI. Over 25 years ago and further back the doctors kept patients in the hospital longer than needed thinking this was the best care for the patient but now it’s get the patient out as soon as possible when the patient has reached clearance by MD’s to be discharged safely home and either the pt is back to normal or can safely heal at home exposed to less bacteria and germs since the hospital has so much more obviously due to population.

The most common method of transmission is by direct contact with an infectious microorganism. Sputum, blood, and feces are common vehicles for microbe transmission. Healthcare workers and patients spread microbes via droplets generated by talking, sneezing, or coughing. Small particles of evaporated droplets (droplet nuclei) and dust particles carry microorganisms and spread infection over long distances.

Infection can also be spread through inanimate objects known as fomites, such as improperly sterilized medical equipment that is used on more than one patient. Healthcare workers who move from patient to patient carry infectious organisms on their clothes, stethoscopes, and phones. Other modes of transmission include the spread of infectious agents through food and water or through vectors, such as mosquitoes, flies, and rats.

Though hospitals throughout America have this problem to face in all hospitals in America and elsewhere, these facilities have developed infection control people who continuously make policies/procedures in their facilities to prevent the spread of infection through all routes with the knowledge we know today as opposed to 25 years ago and further back regarding infection.

“The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program estimates that 42,220 new cases of liver and intrahepatic bile duct cancer will be diagnosed in the United States and some 30,200 people are expected to die of primary adult liver cancer in 2018. The five-year survival rate is just 17.7 percent. Having hepatitis B, hepatitis C, or cirrhosis are significant risk factors for adult primary liver cancer.”

American Association For Cancer Research (AACR) Foundation

“Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common form of liver disease in children and has more than doubled over the past 20 years.  About 100 million individuals are estimated to have NAFLD.”

The American Liver Foundation

“Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% – 10% percent of the liver’s weight is fat, then it is called a fatty liver (steatosis).”

American Liver Foundation

“The liver has many functions, including detoxifying of harmful chemicals, breakdown of drugs, filtering of blood, secretion of bile and production of blood-clotting proteins.”

MAYO CLINIC

“As the liver plays such a critical part in ridding the body of toxins, and extracting and storing nutrients for the body to use, children born with a congenital liver disease usually become ill as young infants.”

Health24.com

“The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can’t feel the liver, because it’s protected by the rib cage.”

WEB M.D.

“Domestic abuse is a pattern of coercive, controlling behavior that is a pervasive life-threatening crime affecting people in all our communities regardless of gender, age, sexual orientation, race, ethnicity, religion, social standing and immigration status.”

The Center for Family Justice