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Nosocomial Infection Rate & Long-Term Acute Care

Nosocomial infections are acquired after hospital admission by patients showing no prior signs of infection. Such infections affect patients in hospitals, long-term acute care facilities, nursing homes, rehabilitation centers, dialysis clinics and other healthcare settings. Since 2008 the infections have been known as healthcare associated infections, or HAIs. By 2009 no data were available on infection rates because reporting is voluntary. To address the infection problem, the focus is on aggressive infection control programs.

  1. Background

    • The Centers for Disease Control estimates that approximately 1.7 million patients acquire HAIs, with 99,000 associated deaths, each year, and that HAIs affect between 5 and 10 percent of hospitalized patients. The most prevalent infections acquired during hospital or other healthcare facility stays are pneumonia and bloodstream, surgical site and urinary tract infections. These data are based on mathematical projections from reported hospital data.

    Long-term Acute Care

    • Long-term acute care facilities (LTACs) were established in the early 1990s to continue intensive treatment for patients with severe conditions after hospital discharge. These conditions include resistant infections, including HAIs. Patients were expected to require specialized care for an average of 25 days, and then return home. No data are available on numbers of patients entering LTACs with HAIs, or acquiring HAIs in an LTAC.

    Sources of HAI

    • Infections spread in many ways. Transmission can occur from patient to patient; caregiver to patient; patient to caregiver; visitors to patients; staff to staff. Some transmission occurs through touch and some through the air (via sneezing or coughing). Other culprits are improperly cleaned or sterilized medical instruments, environmental factors such as contaminated heating or air conditioning equipment, or devices such as ventilators or catheters that harbor infection-producing organisms. Tracking the source of infections is time-consuming and frequently unproductive; preventing infections from spreading through rigorous infection control programs is more effective, especially considering the problems caused by antibiotic-resistant organisms. Of particular concern are antibiotic resistant organisms such as methicillin-resistant staphylococcus aureus (MRSA).

    Infection Control

    • In the May-June, 2001 issue of the "Canadian Journal of Infectious Disease" Dr. L.E. Nicolle reported that in the early 1980s "... an effective infection control program ... and a nosomocial surveillance program including surgical wound infection rate feedback to surgeons ... decreased the prevalence of endemic nosocomial infections in acute care facilities by 30 to 50 percent." Healthcare facilities are increasingly instituting infection control programs that include staff training, rigorous hand washing procedures, wearing of gloves, scrupulous cleaning and sterilization of medical instruments, appropriate use of antiseptics in surgery, safe handling of contaminated waste, appropriate decontamination of all linens and gowns and safety precautions when handling bodily fluids or blood products.

    Future Reporting Systems

    • The Centers for Disease Control's National Healthcare Safety Network (NHSN) was established in 2005 to serve as a single national database to estimate the magnitude and trends of the HAI problem. The NHSN is mandated to facilitate quality improvement activities and assist healthcare institutions develop effective surveillance methods to recognize and intervene in patient safety problems. The NHSN encourages all types of healthcare facilities to report their data; by the end of 2009, 2,000 hospitals in 19 states were contributing. The data do not reflect, however, the experience of LTACs.

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