What are Health care Associated Infections (HAI)?

What are Healthcare Associated Infections (HAI)?

• Health care Associated Infections (HAI) are the infections acquired in the health care settings.
• HAIs are the infections that a patient get while receiving treatment for medical or surgical conditions.
• HAI are not related to the original illness that patients bring.
• Infections which patients can get at a healthcare facility while being treated for other disease or conditions is known as HAI.
• These infections must be developed during hospitalization.
• Health care associated infection is also known as ‘nosocomial infections’ or ‘hospital acquired infections.’
• Health care associated infection (HAI) also include infections acquired by patients in the hospital or facility but appearing after discharge, and occupational infections among staff.
• To be considered as health care associated infection, the infection should neither be present nor incubating at the time of patient’s admission to hospital.
• It is mostly caused by viral, bacterial, and fungal infection.

Key Facts about Health care Associated Infections:

• Among every 100 hospitalized patients, 7 people in developed countries and 10 people in developing countries will suffer from HAI.
• The economic burden of HAI is more in low- and middle-income countries as compared to high income countries.
• Urinary Tract Infection is the most common HAI in high income countries.
• Prevalence of health care-associated infection in developed countries varies between 3.5% and 12%.
• According to the European Centre for Disease Prevention and Control, average prevalence of HAI is 7.1% in European countries.
• Prevalence of health care-associated infection varies between 5.7% and 19.1% in low- and middle-income countries.
• Surgical site infection is the leading HAI in low resource settings
• Newborns are at higher risk of acquiring HAI in developing countries.

Risk factors associated with Health care Associated Infections (HAI):

Three elements are required for the transmission of the HAI. They are:

• Source of microorganisms: It includes the varieties of exogenous microorganism exposed during the delivery of health care services.
• Host susceptibility: It includes the patient’s susceptibility of developing an infection after the exposure to pathogenic organism.
• Means of transmission: It includes mainly four common routes of transmission: contact (direct and indirect), respiratory droplets, airborne spread, and common vehicle through which infections gets transmitted.

Common types of Health care Associated Infections (HAI):

1. Central line-associated bloodstream infection (CLABSI)

• Central line is placed into a major vein near heart to give medicines and take blood.
• A serious infection can take place if pathogens enter into the blood stream through it.
• Therefore, a strict protocol must be followed while inserting the line keeping sure it is sterile.

2. Surgical site infection (SSI)

• This can happen after the surgery on the part where surgery took place.
• It can either be superficial or deep or deeper within the body with more serious complications.

3. Catheter-associated urinary tract infection (CAUTI)

• It is the most common type of HAI.
• The risk factor is the prolonged use of urinary catheter for draining urine.
• Therefore, catheter should be used in appropriate indications and removed as soon as they are no longer required.

4. Ventilator-Associated Pneumonia (VAP)

• Ventilator tubes help to get oxygen to lungs.
• An infection occurs when germs enters to the lungs through the tube and result in VAP.

Diseases/microorganism generally present in hospital setting which can be easily transmitted are:

• Influenza
• Tuberculosis
• HIV/AIDS
• Hepatitis
• Sepsis
• Staphylococcus
• Clostridium, etc.

Importance of Health care Associated Infections (HAI):

• HAI are threat to patient safety and has significant source of complications for the continuum of care
• These infections can cause illness ranging from mild to extremely serious life threatening conditions.
• It has the potential to spread out easily to various other health care facilities
• These also leads to prolonged hospital stays and increase in out-of pocket expenditure leading to financial burden
• However research studies shows that HAI can be prevented through various strategies
• Efforts on national leadership in surveillance, outbreak investigations, laboratory research can prevent healthcare-associated infections

Factors that increase the risk of Health care Associated Infections (HAI):

According to World Health Organization (WHO), factors that can cause HAI are:

• Prolonged and inappropriate use of invasive devices and antibiotics
• Highly risky and sophisticated procedures
• Immuno-suppression and other severe underlying patient conditions
• Insufficient application of standard and isolation precautions.
• Inadequate environmental hygienic conditions and waste disposal
• Poor infrastructure
• Insufficient equipment
• Understaffing
• Overcrowding
• Poor knowledge and application of basic infection control measures
• Lack of procedure
• Lack of knowledge of injection and blood transfusion safety
• Absence of local and national guidelines and policies

Preventive Measures for Health care Associated Infections:

There are various ways that can be applied for preventing healthcare associated infections. They are:

• Maintaining proper hand washing hygiene in the health care facilities by the health service providers
• Proper use of personal protective equipment like gloves, mask, face shields while coming in contact with the patients
• Implementing standard precautions
• Proper prescriptions of antibiotics and ensure of proper use of it to prevent antibiotic resistance
• Decontaminating the hospital setting environment
• Strengthening surveillance system and reporting mechanism of HAI for early detection and prevention of infection
• Reducing the possibility of infection during surgery by following all necessary protocols
• Ensuring minimum requirements in terms of facilities and dedicated resources
• Carrying out various research and validating surveillance protocols for development of evidence-based guideline for prevention of HAI
• Strictly adhering to evidence-based guideline in the hospital settings
• Using improved and advanced technology
• Following/complying with occupational health and safety protocols of health care workers
• Ensuring necessary vaccination
• Controlling endemic diseases in the hospital settings
• Sensitization and awareness among the staffs
• Improving accountability of the staffs

Challenges for Preventing Health care Associated Infections (HAI):

• Countries lack appropriate surveillance system for health care associated infections.
• Lack of appropriate standard criteria for diagnosing the infection.
• Limited public attention and awareness regarding HAI.
• Limited accountability among the staffs and health care personnel.
• Limited research to develop evidence-based guideline for prevention of HAI.
• Lack of compliance to the cleanliness and infection prevention measures.

Impact of Health care Associated Infections (HAI):

• Increased cost of care and financial burden for the health system
• Increased Out of Pocket Expenditure in low- and middle-income countries.
• High cost for patients and their families
• Increased hospital stays
• Creates long term disability
• Increased resistance to anti-microbials
• Increased unnecessary deaths

References and For More Information:

https://www.cdc.gov/hai/infectiontypes.html

https://www.ncbi.nlm.nih.gov/books/NBK2683/

https://patientcarelink.org/improving-patient-care/preventable-mortality/  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245375/#b1-idr-11-2321

https://my.clevelandclinic.org/health/diseases/16397-avoiding-healthcare-associated-infections-hais

https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections

https://apic.org/monthly_alerts/what-are-healthcare-associated-infections/

https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf