The occurrence and undesirable complications from hospital acquired infections (HAIs) have been well recognized for the last several decades. The occurrence of HAIs continues to escalate at an alarming rate. HAIs originally referred to those infections associated with admission in an acute-care hospital (formerly called a nosocomial infection). These unanticipated infections develop during the course of health care treatment and result in significant patient illnesses and deaths (morbidity and mortality); prolong the duration of hospital stays; and necessitate additional diagnostic and therapeutic interventions, which generate added costs to those already incurred by the patient’s underlying disease (Bauman, 2011). HAIs are considered an undesirable outcome, and as some are preventable, they are considered an indicator of the quality of patient care, an adverse event, and a patient safety issue. Patient safety studies published in 1991 reveal the most frequent types of adverse events affecting hospitalized patients are adverse drug events, nosocomial infections, and surgical complications (Aboelela, 2006). Over years there is an alarming increase in HAI, which is influenced by factors such as increasing inpatient acuity of illness, inadequate nurse-patient staffing ratios, unavailability of system resources, and other demands that have challenged health care providers to consistently apply evidence-based recommendations to maximize prevention efforts. Despite these demands on health care workers and resources, reducing preventable HAIs remains an imperative mission and is a continuous opportunity to improve and maximize patient safety. Another factor emerging to motivate health care facilities to maximize HAI prevention efforts is the growing public pressure on State legislators to enact laws requiring hospitals to disclose hospital-specific morbidity and mortality rates. Institute of Medicine report identified HAIs as a patient safety concern and recommends immediate and strong mandatory reporting of other adverse health events, suggesting that public monitoring may hold health care facilities more accountable to improve the quality of medical care and to reduce the incidence of infections. Monitoring both process and outcome measures and assessing their correlation is a model approach to establish that good processes lead to good health care outcomes. Process measures should reflect common practices, apply to a variety of health care settings, and have appropriate inclusion and exclusion criteria. Examples include insertion practices for central intravenous catheters, appropriate timing of antibiotic prophylaxis in surgical patients, and rates of influenza vaccination for health care workers and patients. Outcome measures should be chosen based on the frequency, severity, and preventability of the outcome events. Examples include intravascular catheter-related blood stream infection rates and surgical-site infections in selected operations. Although these occur at relatively low frequency, the severity is high—these infections are associated with substantial morbidity, mortality, and excess health care costs—and there are evidence-based prevention strategies available (Filetoth, 2003).
PATIENTS RISK FACTORS FOR HEALTH CARE-ASSOCIATED INFECTIONS
Transmission of infection within a hospittal requires three elements: a source of infecting microorganisms, a susceptible host, and a means of transmission for the microorganism to the host. During the delivery of health care, patients can be exposed to a variety of exogenous microorganisms (bacteria, viruses, fungi, and protozoa) from other patients, health care personnel, or visitors. Other reservoirs include the patient’s endogenous flora (e.g., residual bacteria residing on the patient’s skin, mucous membranes, gastrointestinal...