When a stay in hospital makes you sicker

One in 10 patients are infected in hospital, and it's not always with what you think.

When a stay in hospital makes you sicker

1 in 10 patients are infected in hospital, and it's not always with what you think

Drips and other medical devices were potential sources of infection. But no-one expected to find hospital-acquired pneumonia and urinary tract infections. from www.shutterstock.com Philip Russo, Monash University and Brett Mitchell, University of Newcastle

Most people expect hospital treatment to make them better. But for some, a stay in hospital can actually make them sicker. Their wound might get infected after an operation or they might get a blood infection as a result of a medical procedure.

Our study, published in the international journal Antimicrobial Resistance and Infection Control, found one in 10 adult patients in hospital with an acute (short-term) condition had a health scare associated infection.

In the first study of its kind in Australia for over 30 years, we also uncovered unexpected infections, like pneumonia and urinary tract infections, as well as high numbers of patients with multi-drug resistant organisms (superbugs).

Read more: Infections, complications and safety breaches: why patients need better data on how hospitals compare

Why do we need to keep track of infections?

Most of these infections can be prevented. So it is important to know what type of infections they are, how common they are and which patients get them. Once we have this information, we can work out a way to prevent them.

Left unchecked, these infections can make already sick patients sicker, can divert hospital resources unnecessarily, and can kill.

Most hospitals in Australia have ongoing surveillance for specific infections, such as wound and bloodstream infections.

Some states have well coordinated programs like the Victorian program VICNISS, leading to detailed data on healthcare-associated infections. This data is then used to inform hospital strategies on how to prevent infections. However, this type of surveillance method requires extensive resources and does not capture all infections that occur in a hospital.

Instead, we conducted a “point prevalence” survey, which takes a snapshot of the current situation on any given day. This is less resource intensive than ongoing surveillance and it provides valuable information on the distribution and occurrence of all infections in a hospital.

Read more: Some private hospitals are safer than others, but we don't know which

In Europe, the European Centre for Disease Prevention and Control co-ordinates national point prevalence studies every four years. These have provided valuable insight into the burden of healthcare-associated infections. They have also been used to track the emergence of multi-drug resistant organisms in Europe. The US, Singapore and many other countries also run them.

Most hospital infections can be prevented. Santypan/Shutterstock

Unlike most OECD countries, Australia does not have a national healthcare-associated infection surveillance program and does not undertake national point prevalence studies.

The only national data routinely collected relates to bloodstream infections caused by the microorganism Staphylococcus aureus. These infections are serious but rare and represent only a tiny fraction of all infections in hospitals.

Read more: Golden staph: the deadly bug that wreaks havoc in hospitals

To improve our understanding of healthcare-associated infections across Australia, we used the same study method as the Europeans. Over a four-month period in 2018, we visited 19 large hospitals across Australia and collected information on all infections in adult acute inpatients. Four of the hospitals were regional, the others major city hospitals.

What infections did we find?

Of the 2767 patients we surveyed, we found 363 infections in 273 patients, meaning some patients had more than one infection. The most common infections were wound infections after surgery (surgical site infections), pneumonia and urinary tract infections. These accounted for 64 per cent of all the infections we found.

This is important as most hospitals do not normally look for pneumonia or urinary tract infections and there is no routine statewide or national surveillance for these.

Our findings mean these infections are commonly occurring but undetected. A potential source of information on these types of infections is hospital administrative coding data. However, these codes were mainly designed for billing purposes and have been shown to be unreliable when it comes to identifying infections.

Read more: We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?

We also found patients with a medical device, such as a large intravenous drip or urinary catheter (a flexible tube inserted into the bladder to empty it of urine), were more likely to have an infection than those who did not.

Intensive care units treat patients who are gravely unwell and at greater risk of infection. So it was unsurprising to find that 25 per cent of patients in intensive care units had a healthcare-associated infection.

The emergence of multi-drug resistant organisms (superbugs) is a concern worldwide. Previously unknown, our study revealed that 10 per cent of the adult acute inpatients in our study had a multi-drug resistant organism.

What have other studies found?

For the first time in 34 years, we have a glimpse of how common healthcare-associated infections are in Australian hospitals. Although the only other previous study was larger, a major strength of our study is that we used the same two trained data collectors to collect the data from all hospitals.

This reduced the potential inconsistency in finding infections that might occur if hospital staff collected their own data. It also minimised the use of hospital resources to undertake the survey.

Importantly though, we did not survey all types of hospitals. It is possible that if the same survey was extended to include children, babies and cancer hospitals, higher rates of infection may be found given the vulnerability of these patients.

What can we do better?

As one of the authors has previously noted, a major gap in Australia’s effort to combat healthcare-associated infections, and the emergence of multi-drug resistance organisms, is the lack of robust national data.

This means we cannot measure the effect of national policy or guidelines despite significant investment.

In the absence of a national surveillance program, we recommend that large-scale point prevalence surveys, including smaller hospitals, specialist hospitals and the private sector be undertaken regularly. Data generated from these studies could then be used to inform and drive national infection prevention initiatives.The Conversation

Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash University and Brett Mitchell, Professor of Nursing, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    28th Aug 2019
    Hospitals used to be a pristine environment that was until cleaning and cooking jobs were contracted out to profiteering Corporations.
    28th Aug 2019
    When I was a nurse, back in the sixties, part of our routine every day was to damp dust all surfaces, and hands were thoroughly washed between each patient. During a recent stay I hardly saw any cleaning staff most days, although the bathrooms were cleaned daily. I had to ask repeatedly for pain medications, sometimes waiting up to 2 hours. The same to have my water bottle refilled, while being told to "drink plenty of water".
    28th Aug 2019
    Doctors are the worst offenders in hospitals going from patient to patient without washing their hands or using hand sanitiser! That is exactly how cross contamination occurs with infections.
    28th Aug 2019
    I've had 2 operations in 2 years at the NORTHERN hospital in Melbourne. Each time I finished up with raging infections.
    The 2nd infection was treated with massive doses of anti biotics which then
    caused a C difficile infection. This in turn resulted in 3 more hospital stays, confined in isolation, and treated by the infectious diseases team.
    28th Aug 2019
    golden staff is the bain of all hospitals and even nursing homes ... the simple way to treat is dice fresh onion up and place it in socks and wear on the feet (so they can absorb juices) for a few hours ...
    28th Aug 2019
    golden staff is the bain of all hospitals and even nursing homes ... the simple way to treat is dice fresh onion up and place it in socks and wear on the feet (so they can absorb juices) for a few hours ...

    28th Aug 2019
    This is exactly what one would expect of public hospitals under the woeful LNP government.
    28th Aug 2019
    So they were perfect with no cross infections and gourmet meals under the ALP were they?
    28th Aug 2019
    I’ve long wondered why hospital patients get infections and not nurses or doctors. I wondered about the beds as only sick people used them. Bingo. Read “ is your hospital bed killing you “, and be terrified.

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