Health care Associated Infections


Editors:

Elham Reshid and Hailemariam Shimelis : Click for the PDF version


As a better reflection of the diverse healthcare settings currently available to patients, the term Healthcare-Associated Infections (HAI) replaced old ones such as nosocomial, hospital-acquired or hospital-onset infections. HAIs are defined as most infections that become clinically evident after 48 hours of hospitalization without evidence of incubation at the time of admission to a healthcare setting. HAIs are caused by viral, bacterial, and fungal pathogens; the most common types are bloodstream infection (BSI), pneumonia (e.g., ventilator-associated pneumonia [VAP]), urinary tract infection (UTI), and surgical site infection (SSI).

Since not all bacterial or fungal growth on a culture is pathogenic and because such growth may reflect simple microbial colonization, interpretation of cultures should take into account the clinical presentation of the patient, reason for obtaining the test, process by which the specimen was obtained, and presence or absence of other supporting evidence of infection.

Once it is confirmed, symptomatic treatment of shock, hypoventilation, and other complications should be provided, along with administration of empiric broad-spectrum antimicrobial therapy.

Thus, empiric therapy should consider broad spectrum coverage, including Pseudomonas aerginosa and resistant strains along with multidrug-resistant (MDR) pathogens in pneumonia. Risk factors for MDR include antimicrobial therapy over the past 90 days, current hospitalization of 5 days or more, high frequency of antibiotic resistance in the community or hospital and immunosuppression.

Empiric therapy should not continue more than 48 hours and susceptibility results should be made available by this time. Otherwise, it seems that we are encouraging empiric therapy to continue indefinitely. For most bacterial organisms, the duration of therapy is 10-14 days after blood cultures be-come negative while there is no clear consensus for VAP and UTI; many experts treat for 14-21 days.

Overall, both developed and resource-constrained countries are facing with the burden of HAIs with a higher rate of morbidity and mortality and longer hospital stay in Africa. Hence, continued surveillance, along with sound infection control programs, not only lead to decreased HAIs but also better prioritization of resources and efforts to improving medical care.

References:

http://emedicine.medscape.com/article/967022-overview    

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530249/  

http://emedicine.medscape.com/article/967022-overview#aw2aab6b2b2   

ftp://ftp.cdc.gov/pub/eid/vol4no3/adobe/weinstein.pdf

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