Common Nosocomial Infections Nosocomial, or hospital-associated, infections represent a significant challenge in healthcare settings. Despite advancements in medical technology and infection control practices, these infections continue to result in increased morbidity, mortality, and healthcare costs. This article explores the scope and impact of nosocomial infections, the role of nursing in preventing and managing these infections, and the importance of adherence to hygiene protocols.
Nosocomial Infections and Surveillance Data
Nosocomial infections are a serious concern in healthcare, with approximately two million cases occurring annually in the United States. These infections significantly impact patient outcomes by increasing morbidity, mortality, and healthcare costs (U.S. Department of Health & Human Services, 2000). Surveillance data indicate a rising trend in nosocomial infection rates, from 7.2 per 1,000 patient days in 1975 to 9.8 per 1,000 patient days in 1995—a 36% increase despite a reduction in the average length of hospital stays from 7.9 to 5.3 days over the same period.
Category of Infection and Stay Time
Hospital surveillance data indicate a nosocomial infection rate of approximately 5%, equivalent to five infections per 1,000 patient days. However, this rate may reach up to 10% in larger institutions (Wenzel & Edmond, 2001). The length of hospital stays due to nosocomial infections can vary significantly:
- Urinary Tract Infection (UTI): Up to 4 additional days.
- Surgical-Site Infection (SSI): Up to 8 additional days.
- Bloodstream Infection: Up to 21 additional days.
- Pneumonia: Up to 30 additional days.
Common Nosocomial Infections
Nosocomial infections can have severe consequences, with mortality rates for bloodstream infections and pneumonia reaching as high as 50% and 71%, respectively. The attributable mortality rates for these infections range from 16% to 35% (Jarvis, 1996).
- Bloodstream Infections: Often associated with central venous catheters (CVCs), particularly in intensive care units (ICUs). Approximately 80,000 CVC-associated bloodstream infections occur annually in U.S. ICUs (O’Grady et al., 2002).
- Pneumonia: The second most common nosocomial infection in the United States, after UTIs. It can extend a hospital stay by 7 to 30 days, at an average cost of $4,947 (Jarvis, 1996). Nosocomial pneumonia is primarily bacterial, with gram-negative bacilli and pathogens like Staphylococcus aureus (especially methicillin-resistant S. aureus [MRSA]) and Streptococcus pneumoniae being significant causes. Patients on mechanical ventilation are at the highest risk for developing nosocomial pneumonia (Tablan et al., 1994).
- Surgical-Site Infections (SSIs): Rank third among reported nosocomial infections, accounting for 14% to 16% of all infections (Mangram et al., 1999). SSIs can prolong hospital stays by 7 to 8 days at an average cost of $2,734. The primary criterion for SSIs is that they occur within 30 days post-surgery (or within one year with an implant). Most SSIs are diagnosed after patients are discharged from the hospital, with up to 72% identified post-discharge in some studies (Avato & Lai, 2002).
Nosocomial Infection and Mortality Rate
Nosocomial infections are the fifth leading cause of death in the United States, with approximately 90,000 deaths annually attributed to them (Haley et al., 1985). The total cost of these infections was estimated to exceed $4.5 billion in 1992, equivalent to $5.7 billion in 2001 (CDC, 1992; Stone, Larson, & Kawar, 2002). The average cost of managing nosocomial infections ranges from $576 for each UTI to $22,000 for each bloodstream infection (Jarvis, 1996).
Hygiene Maintenance and Outcomes
Hand hygiene is the most crucial infection control practice for preventing the transmission of pathogenic microorganisms. Studies demonstrate a strong relationship between improved hand hygiene and reduced infection rates (CDC, 2002; Pittet, 2001).
However, adherence to recommended hand-hygiene practices among healthcare providers remains suboptimal, with compliance rates averaging around 40% (CDC). Alcohol-based hand rubs have been shown to be more effective than traditional handwashing due to their convenience, time efficiency, and ability to sustain compliance while reducing infection rates (Pittet, 2001).
Research comparing alcohol-based hand rubs with conventional handwashing using antiseptic soap found that the former was significantly more effective in reducing hand contamination (Girou et al., 2002). Another study demonstrated that introducing easily accessible dispensers with waterless alcohol-based antiseptics led to higher handwashing rates among healthcare providers (Bischoff et al., 2000).
The CDC’s revised hand hygiene guidelines strongly recommend using alcohol-based hand rubs for routine decontamination of hands in clinical settings. However, the guidelines emphasize that hands must be washed with soap or an antimicrobial product and water when visibly soiled or contaminated with blood or other body fluids.
Nursing Role to Prevent or Minimize Nosocomial Infection
Nurses play a critical role in preventing and minimizing nosocomial infections and represent the first line of defense against these adverse outcomes.
A study by the American Nurses Association (2000) identified five adverse outcomes related to nurse staffing: length of stay, pneumonia, postoperative infections, pressure ulcers, and UTIs. Multiple regression analyses showed statistically significant inverse relationships between nurse staffing and all five outcomes.
Impact of Nurse Staffing on Infection Rates:
A recent study reported that a higher proportion of care hours provided by registered nurses (RNs) was associated with lower rates of nosocomial infections (Needleman et al., 2002). Other studies have shown that healthcare facilities with appropriate levels of nursing staff can prevent infections. For example:
- Increased RN Staffing Reduces Infection Rates: Cho et al. (2003) found that a 10% increase in RN staffing decreased the odds of a patient acquiring nosocomial pneumonia by 9.5%.
- Post-Surgical Adverse Events: Kovner et al. (2002) found an inverse relationship between RN staffing levels and post-surgical adverse events.
- Educational Level of Nurses: Aiken et al. (2003) found that surgical patients cared for in hospitals where a higher proportion of direct care RNs held bachelor’s degrees had better survival rates compared to those treated in hospitals with a lower proportion of bachelor’s-degree-holding staff nurses.
While these studies do not establish direct causation, they suggest that nurses who incorporate evidence-based infection prevention and control practices into their daily routines can reduce infectious adverse events, decrease the odds of failure to rescue, and lower healthcare costs.
Nursing Strategies to Prevent Nosocomial Infections
Nurses can employ several strategies to prevent nosocomial infections:
- Adherence to Hand Hygiene Protocols: Nurses should consistently follow hand hygiene guidelines, including using alcohol-based hand rubs or washing hands with soap and water when visibly soiled.
- Use of Personal Protective Equipment (PPE): Proper use of PPE, such as gloves, gowns, masks, and eye protection, helps prevent the transmission of infections, especially in high-risk areas like ICUs.
- Catheter and Line Care: Nurses should follow evidence-based guidelines for the insertion, maintenance, and removal of catheters and central lines to minimize the risk of bloodstream infections.
- Environmental Cleaning and Disinfection: Regular cleaning and disinfection of patient care areas and equipment are crucial to reduce the risk of environmental contamination.
- Patient Education: Educating patients and their families about infection prevention practices, such as hand hygiene and respiratory etiquette, empowers them to participate in their care and prevent the spread of infections.
- Monitoring and Surveillance: Nurses should participate in ongoing monitoring and surveillance of infection rates and contribute to data collection efforts to identify patterns and develop targeted interventions.
Conclusion
Nosocomial infections pose a significant challenge to healthcare providers, leading to increased morbidity, mortality, and healthcare costs. Nurses play a pivotal role in preventing and managing these infections through adherence to infection control protocols, appropriate staffing, and the implementation of evidence-based practices. By actively participating in infection prevention efforts, nurses can help reduce the burden of nosocomial infections, improve patient outcomes, and contribute to safer healthcare environments.