Healthcare-Associated Infections: Difference between revisions
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== Introduction == | == Introduction == | ||
'''Healthcare-associated infections''', also referred to as hospital-acquired infections, are infections that are acquired in the course of treatment that did not exist prior to admission<ref name=":0">The burden of health care-associated infection worldwide [Internet]. World Health Organization. 2020 [cited 27 March 2020]. Available from: <nowiki>https://www.who.int/infection-prevention/publications/burden_hcai/en/</nowiki></ref>. HAI can affect healthcare staff, patients, visitors, and can occur in hospitals, nursing homes, or any other health care facility with regular patient contact. Such an infection can also appear after discharge or in the home setting<ref name=":0" />. | |||
= | HAI represents a significant burden and risk to healthcare systems globally, with hundreds of millions of patients affected each year. It results in unnecessary illness and death, increased antibiotic resistance of microorganisms, prolonged length of care, and a resulting increase in cost to hospitals, facilities, patients and families, as well as healthcare systems globally<ref name=":0" />. | ||
== | HAI occurs in all countries regardless of Human Development Index (HDI), but appears to affect patients in low-income and middle-income countries two- to three-fold higher than high-income countries<ref name=":1">Health care-associated infections Key facts [Internet]. [cited 2020]. Available from: <nowiki>https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf</nowiki></ref>. Additionally, the WHO reports that the true impact of HAI is not well-understood due to limited data reliability and lack of surveillance systems for detecting HAI in developing regions<ref name=":0" /><ref name=":2">Allegranzi B, Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011;377(9761):228-241. </ref>. | ||
It is a global priority to address HAI, and effective [[Infection Prevention and Control|infection prevention and control]] (IPC) instituted at the level of governments and healthcare systems is one potential solution. | |||
== HAI Global Burden and Incidence == | |||
Overall, HAI occurs more frequently in developing regions than in developed countries. According to a 2011 WHO report<ref name=":3">World Health Organization. (2011). Report on the burden of endemic health care-associated infection worldwide. World Health Organization.</ref>, HAI occurs at a rate of 7.6 per 100 individuals in high-income countries and a rate of 15.5 per 100 patients in developing countries. In Europe, with an HAI prevalence of 7.1 per 100 patients, that equates to 4.13 million patients every year impacted by an HAI, based on 2011 data<ref name=":3" />. Hospital-wide prevalence in developing countries ranges from 5.7% to 19.1% (pooled, 10.1%). Urinary tract infections are the most common type of HAI in Europe and the U.S., whereas surgical site infections are the most frequent HAI hospital-wide in developing countries<ref name=":3" />. | |||
HAI incidence rates, based on a 2011 WHO report and Lancet meta-analysis, are shown below: | |||
'''Overall HAI Incidence'''<ref name=":2" /><ref name=":3" /> | |||
{| class="wikitable" | |||
!Region Category | |||
!Cases per 100 patients | |||
|- | |||
|Developing* countries | |||
|15.5 | |||
|- | |||
|Europe | |||
|7.1 | |||
|- | |||
|USA* | |||
|4.5 | |||
|} | |||
<nowiki>*</nowiki>Developing: low- and middle-income according to World Bank classification 2009<ref name=":3" /> | |||
<nowiki>**</nowiki>2002 data<ref name=":2" /> | |||
'''ICU-Acquired Infection'''<ref name=":3" /> | |||
{| class="wikitable" | |||
!Region Category | |||
!Cases per 1000 patient-days | |||
|- | |||
|Developing countries | |||
|42.7 | |||
|- | |||
|Developed countries | |||
|17.0 | |||
|- | |||
|USA | |||
|13.6<ref name=":2" /> | |||
|} | |||
<nowiki>*</nowiki>Developed: high-income country, defined according to World Bank classification 2009<ref name=":3" /> | |||
'''Surgical Site Infection'''<ref name=":2" /> | |||
{| class="wikitable" | |||
!Region Category | |||
!Cases per 100 surgical procedures | |||
|- | |||
|Developing countries | |||
|1.2 to 23.6 (pooled = 11.8)<ref name=":3" /> | |||
|- | |||
|Europe | |||
|2.9 | |||
|- | |||
|USA | |||
|2.6 | |||
|} | |||
=== HAI in the ICU Setting === | |||
In particular, HAIs occur most frequently in the ICU setting<ref name=":1" />, where various factors including use of invasive medical devices and lines, prolonged bed rest, multiple comorbidities, and high exposure risk predispose patients to transmission. Additionally, data suggest that 30% of patients in the ICU are affected by at least one episode of HAI<ref name=":1" /><ref name=":3" />. The mean cumulative incidence of infection in adult critically-ill patients is 17.0 episodes per 1000 patient-days. The most common type of HAI among these patients is ventilator-associated pneumonia<ref name=":2" />. High frequencies of infection also occur in association with use of central lines and urinary catheters<ref name=":1" />. | |||
== References == | == References == | ||
<references /> | <references /> | ||
Revision as of 22:02, 30 March 2020
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Introduction[edit | edit source]
Healthcare-associated infections, also referred to as hospital-acquired infections, are infections that are acquired in the course of treatment that did not exist prior to admission[1]. HAI can affect healthcare staff, patients, visitors, and can occur in hospitals, nursing homes, or any other health care facility with regular patient contact. Such an infection can also appear after discharge or in the home setting[1].
HAI represents a significant burden and risk to healthcare systems globally, with hundreds of millions of patients affected each year. It results in unnecessary illness and death, increased antibiotic resistance of microorganisms, prolonged length of care, and a resulting increase in cost to hospitals, facilities, patients and families, as well as healthcare systems globally[1].
HAI occurs in all countries regardless of Human Development Index (HDI), but appears to affect patients in low-income and middle-income countries two- to three-fold higher than high-income countries[2]. Additionally, the WHO reports that the true impact of HAI is not well-understood due to limited data reliability and lack of surveillance systems for detecting HAI in developing regions[1][3].
It is a global priority to address HAI, and effective infection prevention and control (IPC) instituted at the level of governments and healthcare systems is one potential solution.
HAI Global Burden and Incidence[edit | edit source]
Overall, HAI occurs more frequently in developing regions than in developed countries. According to a 2011 WHO report[4], HAI occurs at a rate of 7.6 per 100 individuals in high-income countries and a rate of 15.5 per 100 patients in developing countries. In Europe, with an HAI prevalence of 7.1 per 100 patients, that equates to 4.13 million patients every year impacted by an HAI, based on 2011 data[4]. Hospital-wide prevalence in developing countries ranges from 5.7% to 19.1% (pooled, 10.1%). Urinary tract infections are the most common type of HAI in Europe and the U.S., whereas surgical site infections are the most frequent HAI hospital-wide in developing countries[4].
HAI incidence rates, based on a 2011 WHO report and Lancet meta-analysis, are shown below:
| Region Category | Cases per 100 patients |
|---|---|
| Developing* countries | 15.5 |
| Europe | 7.1 |
| USA* | 4.5 |
*Developing: low- and middle-income according to World Bank classification 2009[4]
**2002 data[3]
ICU-Acquired Infection[4]
| Region Category | Cases per 1000 patient-days |
|---|---|
| Developing countries | 42.7 |
| Developed countries | 17.0 |
| USA | 13.6[3] |
*Developed: high-income country, defined according to World Bank classification 2009[4]
Surgical Site Infection[3]
| Region Category | Cases per 100 surgical procedures |
|---|---|
| Developing countries | 1.2 to 23.6 (pooled = 11.8)[4] |
| Europe | 2.9 |
| USA | 2.6 |
HAI in the ICU Setting[edit | edit source]
In particular, HAIs occur most frequently in the ICU setting[2], where various factors including use of invasive medical devices and lines, prolonged bed rest, multiple comorbidities, and high exposure risk predispose patients to transmission. Additionally, data suggest that 30% of patients in the ICU are affected by at least one episode of HAI[2][4]. The mean cumulative incidence of infection in adult critically-ill patients is 17.0 episodes per 1000 patient-days. The most common type of HAI among these patients is ventilator-associated pneumonia[3]. High frequencies of infection also occur in association with use of central lines and urinary catheters[2].
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 The burden of health care-associated infection worldwide [Internet]. World Health Organization. 2020 [cited 27 March 2020]. Available from: https://www.who.int/infection-prevention/publications/burden_hcai/en/
- ↑ 2.0 2.1 2.2 2.3 Health care-associated infections Key facts [Internet]. [cited 2020]. Available from: https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Allegranzi B, Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011;377(9761):228-241.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 World Health Organization. (2011). Report on the burden of endemic health care-associated infection worldwide. World Health Organization.
