Healthcare-associated infections pose a threat to patient safety, and the ever-escalating problem of antibiotic resistance in bacteria further complicates the prevention and treatment of these infections.
Understanding healthcare-associated infections
Healthcare-associated infections are infections that patients acquire within a healthcare setting. These infections can occur during treatment for another condition. They can also arise from outpatient care, where treatment is provided at a healthcare facility without staying overnight. Common and significant examples of bacterial healthcare-associated infections include catheter-related urinary tract infections, bloodstream infections related to intravenous cannulas and other devices, post-operative wound infections, and ventilator-associated pneumonia. Healthcare-associated infections include viral infections, such as influenza or norovirus gastroenteritis, that patients contract during a hospital stay.
In bacterial healthcare-associated infections, the bacteria can originate from various sources within the healthcare setting, such as the hands of a healthcare worker, the patient’s own hands, or skin flora. Either way, healthcare professionals classify the infection as healthcare-associated and treat it accordingly. Both susceptible and resistant bacteria can cause these infections, but resistant bacteria may complicate treatment and prolong recovery time. Multidrug-resistant bacteria are especially difficult to treat.
Multidrug-resistant bacteria and health care-associated infections
Patients in hospitals are often exposed to multiple risk factors for acquiring multidrug-resistant bacteria, including underlying chronic diseases, surgery, indwelling catheters, and antibiotic use. The spread of multidrug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), occurs when someone colonized with resistant bacteria, without being ill, transmits them to another person, who then also becomes colonized. The bacteria may, for example, be carried on the person’s skin (as is most common with MRSA) or in the bowel (as is most common with various ESBL-producing bacteria or vancomycin-resistant enterococci). Colonization by multidrug-resistant bacteria does not necessarily coincide with infection; bacteria may remain present without causing harm. However, if a healthcare-associated infection arises from a multidrug-resistant bacterium, patient care becomes more challenging due to limited treatment options.
An example to clarify
A patient comes to the hospital. On the second day, a multidrug-resistant bacterium is transferred to the patient via the healthcare worker’s hands. On the fifth day, the patient undergoes surgery, and the multidrug-resistant bacterium enters the wound. The prophylactic antibiotic dose administered prior to the operation has killed other skin bacteria but not the multidrug-resistant bacterium. Now, it multiplies, and within a few days, the bacterium causes a healthcare-associated infection, leading to pus and fever.
Some patients, such as premature babies and those with malignancies treated with cytotoxic agents, are especially vulnerable to infections and are more likely to develop healthcare-associated infections. If the infection is caused by a multidrug-resistant bacterium, the patient’s chances of receiving effective antibiotic treatment decrease, and consequently, the risk of dying from the infection increases.
Thus, it is crucial to implement measures to prevent and control:
- The occurrence of healthcare-associated infections
- The transmission and colonization of bacteria, including resistant bacteria, in healthcare settings.
Read more about how to do this under Prevent infection.
Selected Resources
| Resource | Description |
| Global report on infection prevention and control | WHO global report that provides a situation analysis on infection prevention and control implementation worldwide. Chapter 2 describes the problems and consequences of healthcare-associated infections and AMR on patients and healthcare workers globally. |
| The ISID Guide to Infection Control in the Healthcare setting | Guide that summarizes principles, interventions, and strategies to reduce healthcare associated infections. Contains more than 60 short chapters on a variety of topics. The guide is also available in Spanish. |