The Public Health Institute explains that a hospital-acquired infection is any infection that develops in a patient after spending at least 48 hours in a hospital facility, and that was not even present in the incubation phase at the time of admission for diagnosis or treatment.
They can also occur after discharge from hospital if they are directly related to previous hospital treatment or medical intervention.
Infections that are evident or in the incubation phase upon admission are not classified in this category.
How common are hospital infections?
Estimates show that hospital-acquired infections occur in 5–10 percent of all hospitalized patients.
In specialized and tertiary institutions, this frequency may be even higher, and in some intensive care units it can reach 25 percent.
In Montenegro, the incidence of hospital infections is within the global average, ranging from five to 15 percent, depending on the type of institution, department, and working conditions.
Why are hospital infections a serious problem?
Hospital infections:
- prolongs patients' hospital stays by an average of 5–7 days,
- increase the costs of treatment,
- complicate the underlying disease,
- increase the risk of death,
- they reduce patients' quality of life and cause additional stress.
For example, in the United States, nearly two million patients develop hospital-acquired infections each year, and treatment costs increase by more than $4.5 billion.
What types of hospital infections are the most common?
The most common hospital infections are:
- urinary tract infections, most often associated with catheters – about 40 percent,
- surgical wound infections – about 25 percent,
- respiratory system infections, including pneumonia, especially in patients on mechanical ventilation – about 10 percent,
- Blood infections, including sepsis – about 10 percent,
- gastrointestinal infections, as well as infections of the skin, bones and central nervous system – about 15 percent.
What are the most common causes of hospital infections?
Hospital infections can be caused by:
- Bacteria, such as:
Staphylococcus aureus (uključujući MRSA), Escherichia coli, Klebsiella spp., Clostridium difficile (C. diff), Pseudomonas aeruginosa, Enterococcus spp.
- Viruses, such as:
hepatitis B i C, citomegalovirus (CMV), influenca, SARS-CoV-2, RSV i rotavirus.
- Fungi, most often:
Candida spp. i Aspergillus spp.
Less commonly, infections can also be caused by parasites, especially in immunocompromised individuals.
Of particular concern is the spread of antibiotic-resistant microorganisms, such as MRSA (methicillin-resistant Staphylococcus aureus), which further complicates treatment.
How are hospital infections transmitted?
Infections are transmitted in several ways:
- by direct contact, most often through contaminated hands of staff,
- indirectly, through instruments, surfaces and equipment, such as stethoscopes and bedding,
- by air, coughing and sneezing,
- medical procedures, through catheters, needles, transfusions and surgeries,
- due to inadequate ventilation, crowded rooms and poor sanitary conditions.
Hands are the most common source of infection in a hospital environment.
Who is most at risk?
Not all patients are at equal risk.
The most at-risk groups include:
- newborns and premature babies,
- people over 60 years of age,
- patients in intensive care units,
- immunocompromised individuals, including people with HIV, malignant diseases and transplant patients,
- patients undergoing invasive procedures, such as intubation, catheterization and hemodialysis.
How is a hospital infection recognized?
The most common symptom is fever, especially if it occurs a few days after admission. Other signs depend on the site of infection.
- Urinary infections may cause: frequent urination, pain, and cloudy urine.
- Lung infections may cause: cough, difficulty breathing, and fever.
- Wound infections may cause redness, swelling, and purulent discharge.
- Sepsis can cause: rapid pulse, drop in blood pressure, confusion, and fever.
It is important to emphasize that a fever can have other causes, so a medical evaluation is always necessary.
Are all infections in the hospital nosocomial infections?
No. A hospital-acquired infection is only considered such if:
- occurs at least 48 hours after admission,
- appears up to 30 days after the surgical intervention, or up to 90 days if an implant is inserted,
- occurs in newborns after birth,
- was not present at the reception.
Colonization with microorganisms without symptoms is not considered an infection.
How are hospital infections treated?
Treatment depends on the cause and location of the infection.
Most often includes:
- antibiotic, antiviral or antifungal therapy, if necessary targeted after an antibiogram,
- removal or replacement of a medical device if it is a source of infection, for example a catheter,
- symptomatic treatment and support, such as infusions and oxygen,
- intensive care in severe cases.
Can hospital infections be prevented?
Yes. Although it is not possible to completely eliminate them, it is possible to significantly reduce them.
Prevention measures include:
- regular and proper hand washing of staff, patients and visitors,
- disinfection of instruments and surfaces,
- use of sterile equipment,
- control and rational use of antibiotics,
- staff education and infection monitoring,
- limiting visits to high-risk wards.
Good organization and systematic monitoring can reduce the number of infections by up to 30 percent.
What are the basic principles of prevention in hospitals?
Some of the most important measures are:
- hand hygiene, including hand washing at five key moments according to the recommendations of the World Health Organization,
- antisepsis and asepsis, i.e. skin disinfection and the use of sterile material,
- limiting the use of catheters and other invasive procedures when they are not necessary,
- microbiological surveillance, including sample analysis and monitoring of antibiotic resistance,
- mandatory reporting of each case to the hospital infection control team.
What can patients and visitors do?
Patients and visitors also play an important role in prevention.
It is recommended that:
- wash their hands before arriving and after leaving the hospital,
- respect visit restrictions and dress codes, including wearing protective masks and gowns when necessary,
- do not touch medical equipment without permission,
- notify staff if they notice signs of infection,
- they avoid coming to visit if they are sick.
Can a hospital be completely free of infections?
Unfortunately, no. The hospital environment is where the most seriously ill patients reside, often particularly vulnerable to infections. However, a well-organized system, education, supervision and responsible behavior can make a big difference and ensure maximum safety for each patient.
Together against hospital infections
Healthcare workers, patients and visitors can all contribute to reducing the risk of infections.
Proper hygiene, education, and adherence to protective measures are key to safe treatment and successful recovery.
