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[Factors that contribute to health care associated infections: how to prevent them]
M J Corrales-Fernández1, M T Gea-Velázquez de Castro, R Limón-Ramírez
1Servicio de Medicina Preventiva y Calidad Asistencial, Hospital Universitari Sant Joan d'Alacant, Sant Joan d'Alacant, Spain. mcorrales@umh.es
Insights
A significant portion of hospital-acquired infections (HCAI) are preventable. Implementing proper protocols for aseptic techniques, catheter use, and patient monitoring can reduce HCAI rates.
Area of Science:
- Infectious Diseases
- Healthcare Quality Improvement
- Epidemiology
Context:
- Health Care-Associated Infections (HCAI) represent a significant burden on patient safety and healthcare systems.
- Understanding the characteristics and preventability of HCAI is crucial for developing effective infection control strategies.
Purpose:
- To characterize patient and medical care factors associated with Health Care-Associated Infections (HCAI).
- To determine the proportion of HCAI that are avoidable and identify associated risk factors.
- To assess differences in characteristics between avoidable and unavoidable HCAI.
Summary:
- A retrospective study of Spanish cohort data found that 2.3% of patients acquired HCAI, with 60.2% deemed avoidable.
- Patients with HCAI were older and had more intrinsic risk factors; however, medical care extrinsic factors did not differ between avoidable and unavoidable HCAI.
- Key factors contributing to HCAI included urinary, nasogastric, and central venous catheters, surgical admissions, and prolonged hospital stays. Preventative strategies focused on aseptic techniques, catheter management, and vulnerable patient care.
Impact:
- Identifies specific modifiable risk factors for HCAI, enabling targeted interventions.
- Highlights the importance of protocol adherence in preventing infections.
- Provides evidence for improving medical care quality and patient safety by reducing HCAI.
Objective:
To determine the patient and medical care characteristics of Health Care-Associated Infections (HCAI) and to determine whether or not there are any differences between those that may be avoidable.
Method:
A retrospective cohort study, based on three Spanish cohort studies of Adverse Events associated with hospitalization. The medical records were reviewed to assess whether or not the health care was the causing factor of the HCAI. We carried out the analyses using the same methodology as the National Study on the Adverse Effects associated with hospitalization (ENEAS). After reviewing the patient medical records to identify the HCAI associated factors, the reviewers gave a valued judgment on how likely the health care was the cause of the infection (HCAI) and whether there was evidence that they could have been avoided.
Results:
A total of 2.3% the patients in the study had one or more HCAI, with 60.2% of them being avoidable. The patients who had an HCAI were older and had a greater number of intrinsic and extrinsic risk factors. There was a significant difference in the presence of some intrinsic risk factor between patients who had an HCAI and those with an avoidable HCAI, but there were no differences as regards medical care extrinsic risk factors. The factors that best explained the HCAI were different for each one of the most common infection locations. Generally, the factors which best explained the HCAI were: urinary catheter (OR=2.4), nasogastric tube (OR=1.9) or central venous catheter (OR=1.8). Similarly, hospital admissions through a surgery department or a hospital stay longer than a week were identified as main factors, (OR=1.6), (OR=7.5), respectively. The best strategies to avoid an HCAI were: proper management of any aseptic technique and use of catheter (25.5%), a proper follow-up of the bladder catheterisation protocols (20%) and a proper health care follow-up of vulnerable patients (16.5%).
Conclusion:
Patients with an HCAI showed significant different characteristics from those who did not have an HCAI. The preventability is an independent valued judgment from the causality, and is associated to whether the proper protocol has been implemented or not. To identify these weaknesses enables us to establish strategies to improve the quality of medical care.
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