Page 353 - Encyclopedia of Nursing Research

320 n NOSOCOMIAL INFeCTIONS

the construction of hospitals, including site 2005; Gikas et al., 2002; Klavs et al., 2003).
selection, and hospitals for special popula- The HeLICS (Hospital in europe Link for
N tions such as children. Infection Control through Surveillance) data
report that 5 million HCAIs are estimated to
Tamara L. Zurakowski occur in acute care hospitals in europe annu-
ally, representing around 25 million extra
days of hospital stay and an economic bur-
den of €13–24 billion. Mortality due to HCAI
Nosocomial iNfectioNs in europe is estimated to be 1% (50,000 deaths
per year) and contributes to death in at least
2.7% of cases (135,000 deaths per year; http://
Health-care-associated infections (HCAIs) helics.univ-lyon1.fr/helicshome.htm). In the
are a major problem in health care settings united States, the estimated HCAI incidence
globally, making surveillance and preven- rate was 4.5% in 2002, corresponding to 9.3
tion a key priority in institutions commit- infections per 1,000 patient-days and 1.7 mil-
ted to patient safety. Acquisition of an HCAI lion affected patients; approximately 99,000
results in a prolonged hospital stay; increased deaths were attributed to HCAI (Stone,
resistance of microorganisms to antimicrobi- Braccia, & Larson, 2005).
als; additional financial burden for patients, Many factors have been shown to be
their families, and the health services; and associated with the risk of acquiring an
increased patient mortality. HCAI in developed countries. These factors
Global estimates indicate that more than can be related to the infectious agent (e.g.,
1.4 million patients in developed and devel- virulence, capacity to survive in the environ-
oping countries are affected at any time ment, and antimicrobial resistance), the host
(World Alliance for Patient Safety, 2005). It is (e.g., advanced age, low birth weight, under-
difficult to pinpoint exactly how many people lying diseases, state of debilitation, immu-
suffer from HCAI because the diagnosis is nosuppression, and malnutrition), and the
complex, relying on multiple criteria and environment (e.g., ICu admission, prolonged
not on a single laboratory test (Pittet et al., hospitalization, invasive devices and proce-
2005). National surveillance systems exist dures, and antimicrobial therapy). The HCAI
in some countries, for example, the National burden is greatly increased in high-risk
Nosocomial Infection Surveillance system patients such as those admitted to ICus as a
in the united States (http://www.cdc.gov/ result of using various invasive devices (e.g.,
ncidod/dhqp/nnis.html). However, interna- central venous catheter, mechanical venti-
tional comparisons are often difficult due to lation, or urinary catheter; World Health
differences in surveillance methods or lack of Organization, 2005).
national surveillance systems (Cunney et al., The economic burden of HCAI in the
2006). In addition, in some settings such as united States was approximately uS$ 6.5 bil-
long-term care, HCAI appears to be a hidden lion in 2004 (Stone et al., 2005). The most fre-
problem (Ryan et al., 2009). quent type of infection hospital-wide was
In general, 5–15% of hospitalized patients urinary tract infection (36%), followed by sur-
and 9–37% of patients admitted to intensive gical site infection (20%), bloodstream infec-
care units (ICus) acquire HCAIs in devel- tion, and pneumonia (both 11%; Klevens et al.,
oped countries (World Alliance for Patient 2007), which follows the same trend as other
Safety, 2005; vincent, 2003). Reports from developed countries such as Ireland, Scotland,
hospital-wide prevalence rates of patients Wales, and england (Smyth et al., 2008).
affected by HCAI in europe range from Controlling acquisition of HCAIs is an
4.6% to 9.3% (eriksen, Iversen, & Aavitsland, enormous challenge in developing countries