Nosocomial Infections

Nosocomial infections: what is it?

According to estimates by the ECDC (European Center of Diseases Control), over four million patients develop a nosocomial infection every year. The majority is not due to a lack of hygiene. However, experts estimate that twenty to thirty percent of these infections could be prevented through intensive hygiene and control measures. In a study carried out across Europe in 2011/2012, in which Austrian hospitals were also involved, it was found that one in 18 patients in acute hospitals developed a hospital infection. Nosocomial infections are therefore among the most common complications of a hospital stay…

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• Frequent healthcare-associated infections
• Common pathogens
• Causes & Risk Factors

Frequent healthcare-associated infections

Nosocomial infections must be recorded according to the law on hospitals and health resorts. Like all infections, nosocomial infections are an additional burden for patients. You can increase the length of stay in the hospital. In serious cases, fatal courses are also possible.

The most common nosocomial infections include:

• Urinary tract infections: These usually have few symptoms. Urinary catheters are the most important entry point for germs of a nosocomial urinary tract infection, especially when used for a longer period of time.
• Pneumonia: Seriously ill patients are often affected. The mortality is increased as a result. People with artificial respiration in intensive care units are particularly at risk for pneumonia.
• Wound infections after operations: The frequency depends on the duration of the operation, the type of operation and the severity of the disease. The risk is determined by means of "wound contamination classes" and the so-called ASA score.
• Sepsis ("blood poisoning"): Nosocomial sepsis can be life-threatening and lead to organ failure. However, it is much less common compared to the infections mentioned above.

Common pathogens

The most common microorganisms that cause nosocomial infections include:

• Escherichia coli,
• Staphylococcus aureus,
• Pseudomonas aeruginosa,
• Enterococcus species,
• Coagulase-negative staphylococci,
• Candida,
• Clostridium difficile.

Methicillin-Resistant Staphylococccus aureus (MRSA)

MRSA is not only resistant to methicillin and staphylococcal penicillins, but also to various antibiotics. There are now the following MRSA subgroups:

• HA-MRSA TYPE: Hospital-acquired, nosocomial or “Hospital / health care-acquired / associated” (HA) MRSA type.
• CA-MRSA type: Community acquired / associated (CA) MRSA type acquired outside of a hospital but only diagnosed shortly after admission.
• LA-MRSA type: Livestock-associated (LA) MRSA type associated with domestic animals or farm animals.

For more information, see Antibiotic Resistance.

Causes & Risk Factors

A distinction is made between endogenous and exogenous hospital infections. In the case of exogenous infections, the source of the infection is in the environment, e.g. on the hands, on objects, in the air, etc. Endogenous infections, on the other hand, have two possible pathways:

• First: The patient's normal bacterial flora, which everyone carries in or on themselves, becomes a problem in this case. This mainly happens when the immune system is weakened or a portal of entry is created (e.g. surgical wound).
• Second: “Hospital germs” (multi-resistant pathogens) are gradually becoming part of our own flora and causing infections.

According to the Robert Koch Institute, the following main causes of nosocomial infections can be distinguished:

• Patient factors: weakened due to illness, the risk of developing nosocomial infections increases (especially in old age and with immunodeficiency).
• Microbiological factors: The likelihood and risk of infection depends on the pathogen.
• Environmental factors: Under certain circumstances, hospitals create conditions that are very conducive to the spread of pathogens (e.g. proximity of patients to one another, poor hand hygiene).
• Technical factors: Medical technical aids can promote infections.
• Human factors: Working conditions in health care facilities, e.g. lack of time, can negatively influence hygiene factors.

Hospital stays are therefore associated with an increased risk of contracting an infection. Highly frequent nosocomial infections occur rarely in hospitals.