SUB-PROBLEMS INCLUDING LEADING TO IMPAIRMENT AND BEST PRACTICES FOR ACUTE CARE HOSPITALS
The concept of the prevention of the spread of infection in hospitals goes back to a least 1771 when Thomas Percival wrote Internal Regulation of Hospitals and there was a move to provide isolation for patients with infectious diseases and to improve the sanitation of the facilities. In subsequent generations as scientific knowledge improved concerning the spread of disease, new techniques were used to reduce the level of infections occurring in the institutions. Additional concern was shown during the Civil War, Crimean War, World War I, and World War II because of the continuing high level of infections in patients.
In addition, microorganisms constantly change and therefore new problems arise. For example, in 1954 in courses in medical microbiology taught in colleges, Staphylococcus aureus was used as an indicator organism. Shortly thereafter it was discovered that one of the serotypes had become resistant to penicillin and then became a hospital problem for infection control. Methicillin resistant S. aureus (MRSA) is now a worldwide problem in hospitals and in communities (especially in areas where there is close contact and contaminated surfaces utilized by sports teams, child day care centers, prisons, injection drug users, military personnel living in dormitories, and Native Americans), causing bacterial infections involving the bloodstream, lower respiratory tract, skin, and soft tissues.
Based on data from the National Nosocomial Infection Surveillance System collected by the Centers for Disease Control and Prevention (CDC) in 2002, it was estimated that there were 1.7 million cases of healthcare-associated infections in US hospitals. It was estimated that approximately 99,000 people died from these infections. The yearly direct hospital cost of treating healthcare-associated infections in the United States in 2007 dollars ranges from $28.4 billion to $33.8 billion. (See endnote 2.) (These numbers vary from year to year and increase or decrease according to the level of performance of staff and the availability of infectious agents in communities. These numbers also only represent hospitals and not the total healthcare system.)
Although there are some new organisms that are causing infections in hospitals and in the community today, there are many organisms which were present in the past that are still creating serious problems. Many of the protocols used in the past are still beneficial if applied appropriately and consistently. The CDC has always been involved in advocating high-level standards of performance to prevent and control healthcare-associated infections. However, these protocols are only recommendations to be followed by hospitals and are not mandated by law. The problem is that once we reduce infections, we get complacent and loosen our approach to preventive measures. This leads to increased infections and a new surge of resistant organisms as well as an increase in healthcare- associated infections.
The level of healthcare-associated infections is being exacerbated by improper and too frequent use of antibiotics. Further, when patients do not complete the antibiotic program, they are in effect destroying those microorganisms which are most easily killed but perpetuating those that are most resistant. Antibiotic resistance from microorganisms may also be occurring because of the extensive use of antibiotics in animals.
Minimal discussion will be presented concerning the very substantial area of potential healthcare-acquired infections associated with medical/nursing techniques. Most of the discussion will be about the potential for the spread of microorganisms, which can be the cause of healthcare-acquired infection through contact with equipment, air, water, linens, surfaces of all types, food, and hands.