It's a paradox.  People go into the hospital to get well.  Yet, every year in the U.S. over 2 million of them go into hospitals and get sick with a hospital-acquired infection.  The outcome can be deadly.  Over 100,000 patients die from these infections each year – more than car accidents, breast cancer and AIDS combined – according to the Committee to Reduce Infection Deaths (RID).  And, they're expensive.  It's been estimated that patients who contract an infection in the hospital stay an average of 20.6 days compared with 4.5 days for other patients, and their hospital stays cost six times more.  The estimates for society as a whole range from $5 to $30.5 billion every year.

If these numbers surprise you, you're not alone.  The topic has gotten sporadic exposure in the press, but since many states don't require hospitals to tally and report infections, they're just not high profile enough to stay on our radar. 

When you stop to consider it, the prevalence of hospital acquired infections makes sense.  Hospitals house large numbers of people who are sick: some with communicable diseases and many with poorly functioning immune systems.  Medical devices, like catheters, and surgical procedures provide easy routes for infection to enter the body.  Most importantly, there's a plethora of ways for pathogens  to spread as medical staff move from patient to patient and visitors come to call.   

A hospital-acquired infection is exactly what it sounds like – an infection that happens as a result of treatment in a hospital but is secondary to a patient's original admitting diagnosis. Infections are considered hospital-acquired if they first appear 48 hours or more after hospital admission or within 30 days after discharge.  All hospitalized patients are at risk of acquiring them but some people are at greater risk than others: premature babies, young children, the elderly, the severely ill, and those with chronic conditions or undergoing treatments that undermine the immune system.  These infections are most commonly caused by bacteria  but can also spring from viruses,  fungi, or parasites.  Frighteningly, many of them are caused by multidrug-resistant superbugs such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). 

Medical professionals admit there's been a mindset that hospital-acquired infections are simply bad luck and something to be expected.  Fortunately, that attitude is changing.  While not all hospital-acquired infections can be prevented, the vast majority of them can.  Thanks to rigorously implemented infection prevention procedures, many hospitals have demonstrated dramatic improvements.

It turns out that preventive measures are fairly straightforward.  For the most part, they come down to basics including: 

• Thorough hand washing or use of alcohol rubs by all medical personnel before each patient contact
• Wearing gloves, aprons or gowns in appropriate circumstances
• Thorough environmental cleaning
• Proper sterilization techniques of all instruments
• Screening patients for disease causing germs and isolating those with contagious conditions
• Judicious use of catheters and ventilators and special procedures in inserting and maintaining them
• Careful use of anti-microbial agents, such as antibiotics, including:
• Giving preventive antibiotics in the hour before surgery
• Choosing the right antibiotic
• Ending antibiotics on time to avoid the breeding of antibiotic-resistant bacteria

Today, patient-focused advocacy groups are calling for more stringent and clearer guidelines than those already in place, as well as increased government oversight.  A 2008 report from the Government Accountability Office suggests that Medicare and the CDC, in particular, should establish clear guidelines as to which infection-control practices they consider to be most important and that federal regulators should do more to push hospitals to meet those standards.  Some consumer advocates say the situation won't improve dramatically until hospitals are required to make their infection rates public.  While many states* have reacted by passing legislation to make reporting mandatory, opponents worry that it will be difficult to fairly compare hospitals.  Hospitals that look harder for problems may have higher rates but not necessarily have more infections and those that routinely treat higher risk patients will be at a disadvantage. 

Given the situation, what can you do as a patient to better your odds of avoiding a hospital-acquired infection?  Get educated.  Ask questions.  Observe your healthcare workers.  Speak up.  Don't worry about being assertive.  A clean environment and good infection control practices are your right.  After all, it's your life.   
    

Learn more about Hospital Acquired Infection:

Key Point 1: Of all illnesses, infections are among the most common cause of death in U.S. hospitals.  Hospital Acquired Infections are now recognized as a major cause of sickness and death. 

Key Point 2:  Hand washing by hospital staff, patients and visitors is an effective way to prevent hospital acquired infections.  Screening and environmental cleaning are very important but are not effective without hand washing. 

Key Point 3: While the burden of decreasing the number of hospital acquired infection cases lies with the healthcare system, patients can also take steps to protect themselves.

* Nineteen states (as of March 2008) require reporting of hospital-acquired infections and some have additional laws that specifically require MRSA reporting.  The states are Colorado, Connecticut, Delaware, Florida, Illinois, Maryland, Minnesota, Missouri, New Hampshire, New York, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont and Washington.