Healthcare-associated infections (HAIs) and sepsis in hospitals are a common and unfortunate complication. Every year, around one out of every 25 hospital patients develops an HAI, with many of these infections developing into sepsis or other complications. The consistent rate of HAIs occurring in hospitals across the United States has the Centers for Disease Control and Prevention (CDC) and other organizations taking an aggressive approach to prevent infections and ensure that hospitals adhere to standards.
Read on to learn more about HAIs and sepsis in hospitals, and what these often preventable infections could mean for your health. If you have questions about HAIs and your legal rights, contact our Houston medical malpractice attorney to discuss your case.
HAIs are More Dangerous than Viral Infections
Unlike the more common viral infection, HAIs are caused by bacteria, which is aggressive and often resistant to antibiotics. This makes HAIs a tremendous concern for patients and the healthcare community at large. Without immediate and appropriate treatment, HAIs can quickly develop into complicated infections, such as sepsis or septic shock. In fact, a large portion of HAIs reported in hospitals are related to sepsis.
Sepsis is a type of HAI that occurs most commonly after surgery, among patients with compromised immune systems, patients with chronic health conditions, and the elderly. The National Institute of General Medical Sciences estimates that over one million Americans develop sepsis in hospitals each year. Of those, 15 to 30 percent die. Furthermore, these rates have continued to rise in recent years. The continued increase in the rate of sepsis in hospitals is attributed to:
- Increased tracking and data collection.
- Average age of Americans increasing, making the population of individuals living with chronic conditions also increasing.
- Many infections are resistant to antibiotics, which can increase the risk of developing sepsis.
- Organ transplants continue to be more common. Patients receiving an organ transplant are at a much higher risk of developing an HAI or sepsis.
Why is Sepsis So Common in Hospitals?
Sepsis is the body’s immune response to infection, most commonly caused by bacteria. The chemicals released into the bloodstream to combat infection restrict blood flow and cause inflammation. Rather than fighting the infection, the overwhelming response leads to oxygen deprivation in the organs, a drop in blood pressure, and can lead to multiple organ failures.
In hospitals, sepsis is often caused by an underlying infection or bacteria that has been introduced into the body during the course of medical care. Some of the most common causes of sepsis in hospitals include:
Also called central venous catheters or intravenous catheters (IV), central lines are one of the most common causes for HAIs and sepsis in hospitals. Central lines are inserted into large veins in the neck, chest, or groin areas, and depending on the condition being treated, the line may remain in place for several days or weeks, or even months. Because central lines are inserted into major veins and are kept in place for longer durations, the risk of infection and serious complications are higher.
Urinary Tract Infections
Many hospital patients require the use of a urinary catheter. This catheter is inserted into the urethra, and serves as a drain for urine during hospitalization. Urinary catheters are a common cause of infections, including the common catheter-associated urinary tract infection, or CAUTI. These are the most common HAI occurring in hospitals, with at least 75 percent of all UTIs occurring in hospitals being classified as a CAUTI.
Surgical Site Infections
Surgical site infections are a common risk factor in hospitals. Any time surgery is performed, there is a chance of bacteria entering the body. During recovery, there are also further opportunities for bacteria to move into the wound if it is not properly cleaned, covered, and taken care of. Surgical site infections are called SSIs, and can easily develop into sepsis or septic shock. Bloodstream infections, including sepsis, following surgery occur at a rate of 5.23 percent, meaning that more than five percent of all surgical patients will develop an infection.
Patients who need help breathing may be placed on a ventilator. Ventilators have tubes that run down the throat and into the airway. The machine helps expand and retract the lungs and helps the patient breathe easier. Unfortunately, ventilators have been known to increase the risk of pneumonia. Ventilator tubes may provide an avenue for bacteria to travel into the lungs. Pneumonia, as a bacterial infection, is a common cause of sepsis in hospitals.
Strategies to Prevent HAIs and Sepsis in Hospitals
Due to some of the concerning rates of HAIs in U.S. hospitals, the CDC has initiated a series of prevention strategies. These strategies use surveillance, laboratory research, and outbreak investigations to develop improved prevention techniques. The CDC offers healthcare providers with toolkits and other information about how to prevent HAIs and protect providers and patients from infection. The CDC has specific guidelines for infection control and prevention, including:
- Disinfection and sterilization
- Hand hygiene
- Proper handling of laundry
- Environmental infection control
- Isolation precautions
- Multidrug-resistant organisms (MDRO)
- Catheter-associated urinary tract infections (CAUTI)
- Organ transplantation
- Surgical site infection (SSI)
- Dialysis infection control
- Disease/organism-specific infection control guidelines:
- Tuberculosis (TB)
The U.S. Department of Health and Human Services (HHS) has also developed a committee dedicated to the prevention of HAIs and sepsis in hospitals. The HHS Steering Committee for the Prevention of Healthcare-Associated Infections began in 2008 and continues offer support for prevention strategies and healthcare education. The Committee developed a National Action Plan to Prevent Healthcare-Associated Infections: Road Map to Elimination, which includes the following:
- Phase One: Focuses on the top six high priority HAIs:
- Surgical site infections
- Central line-associated bloodstream infections
- Ventilator-associated events
- Catheter-associated urinary tract infections
- Clostridium difficile (C. diff) infections
- Methicillin-resistant staphylococcus aureus (MRSA) infections
- Phase Two: Expands infection control efforts outside hospitals to outpatient settings including end-stage renal disease facilities and ambulatory surgical centers. Phase two also promotes better influenza vaccination rates among healthcare providers.
- Phase Three: Further expands efforts to include long-term care facilities like nursing homes, rehabilitation facilities, and skilled-nursing facilities.
- Phase Four: Reviews federal antibiotic stewardship efforts in various healthcare settings, and highlights the importance of stewardship in the prevention of HAIs.
Most healthcare facilities also have their own policies and procedures for infection control. It is up to those working in these environments, however, to follow policies and procedures that will prevent HAIs and sepsis.
Sepsis Specific Guidelines
Several organizations also have specific guidelines for preventing and treating sepsis in hospitals. Many of these guidelines are similar to that of HAIs, but they address more specific factors associated with sepsis in hospitals, including factors related to the environment, patient condition, and prevention policies.
CMS guidelines are titled “Severe Sepsis and Septic Shock Early Management Bundle”. These guidelines were established in 2015 with the goal of preventing sepsis, identifying infections earlier, and ensuring that treatment is initiated as soon as possible.
The Centers for Disease Control and Prevention (CDC) also has guidelines for managing sepsis in healthcare settings. The Surviving Sepsis Campaign is one of the most widely-accepted sets of guidelines. Created in collaboration between the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, the guidelines include guidance from the Institute for Healthcare Improvement (IHI).
The guideline bundles available for hospitals include critical care, intensive care, clinical practice guidelines, and severe sepsis guidelines. All of the guidelines are based on evidence-based practices and are intended to improve outcomes for patients. The essential guidelines include:
- Hospitals must measure serum lactate levels in patients with severe sepsis within three hours of a diagnosis being made.
- Hospitals must obtain blood cultures within three hours of diagnosis.
- Broad-spectrum antibiotics must be initiated within three hours of diagnosis.
- Healthcare providers should being rapid administration of crystalloid if hypotension (low blood pressure) is diagnosed, or if serum lactate levels are below a certain level.
- If, during or after fluid resuscitation, the patient’s blood pressure is still low, vasopressors should be applied.
- If the patient is diagnosed as being in septic shock, a further series of steps must be followed within six hours.
It is important that healthcare providers and staff adhere to infection control policies in order to preserve patient safety and health.
Infection In Hospitals Could be a Sign of Negligence
Healthcare facilities have a tremendous responsibility to care for patients and maintain an environment that is safe and healthy. Often, hospitals are kept clean and safe, and infection control policies are followed. Sadly, as the data discussed above shows, there are plenty of reports of noncompliance to raise concern.
Sepsis in hospitals could be the result of unavoidable complications, or it could be a sign of negligence. If hospital staff do not follow infection control guidelines, then patients may be at risk for developing preventable illnesses or complications.