Hospital-acquired infections or HAI’s are classified as infections a patient may contract while being treated for an unrelated issue in hospital or healthcare facility. Patients who contract HAI’s are often immune-compromised making them more susceptible to opportunistic bacteria causing infection and major complications to treatment, often causing patients to succumb to their illness.
According to the Centres for Disease Control and Prevention (CDC), it is estimated that 1 in 25 inpatients have an infection related to their hospital stay, while in Canada that statistic is 1 in 10. In addition, there are soaring costs associated with treating HAI’s that place a massive economic burden on governments and insurance providers. In the United States alone it is estimated HAI’s cost upwards of $9.8 billion dollars annually while in Canada the cost is $1 billion dollars.
Patients who are immune-compromised, combined with hospitals acting as reservoirs for antibiotic-resistant bacteria create a perfect storm and significantly threaten modern medicine. HAI infections are caused by bacteria, fungi or viruses and in some dire circumstances combinations of the three. The top five HAI’s reported in the United States are central line-bacteremia, ventilator-associated pneumonia, surgical site infections, infections in the colon caused by Clostridium difficile, and catheter-associated urinary tract infections. In Canada, urinary tract and colon infections by C. difficile are the most common.
Accruing data on HAI’s are now closely being monitored by hospitals and healthcare facilities while improved hygiene protocols and policies are being implemented. However, rates of specific HAI’s are stagnant or increasing in number, partly due to antibiotic resistance.
Cases of methicillin-resistant Staphylococcus aureus (MRSA) can infect the bloodstream causing bacteremia. In 2013, the CDC reported 11,285 deaths in the United States due to MRSA. The second most common HAI, Ventilator-associated infection, increased 5% in the United States in 2013. Data from inpatient rehabilitation hospitals was even worse. These facilities showed a 7% increase in catheter-associated urinary tract infections and 17% increase in MRSA compared to the national average.
In Canada, the rates of hospital-acquired infections have also increased or stayed the same since 2012 despite initiatives aimed at greater hand hygiene compliance and greater awareness of gaps in patient room cleaning protocols. From 2012-2016 MRSA infections remained consistent across Canada while the number of vancomycin-resistant enterococci bloodstream infections increased from 92 to 121.
One of the most dangerous HAI’s that have dramatically increased in number is the carbapenem-resistant Enterobacteriaceae or CRE. These infections have among the worst prognosis since they are resistant to carbapenems, a highly potent class of antimicrobial. The carbapenems are deemed “antibiotics of last resort” because they are relied upon in cases where infections are resistant to all other antibiotics. In the United States, there are approximately 9,000 hospital-acquired carbapenem-resistant Enterobacteriaceae (CRE) cases per year where half of all CRE bloodstream infections result in death. In Canada, CRE infections in hospitals went from 39 cases in 2012 to 93 cases in 2016. Once bacteria become resistant to carbapenems clinicians and doctors are often left with no antibiotic options to treat an infection making treatment impossible.
Hospitals that implement handwashing programs, improved cleaning and sanitation practices and staff training must still contend with compliance by health-care workers, visitors and patients. All the while, the cost of HAIs are increasing as antibiotics become less effective due to resistance. The solution to reducing the number of HAIs and saving patients’ lives relies on a synergistic approach that includes improved hospital hygiene, antibiotic stewardship and a concerted sustained effort, to develop smarter antimicrobial and antibiotic options. Without this synergistic approach, the problem will continue to grow and will eventually lead to the end of the modern medical era.