STEM & TECHNOLOGY
Hospital Associated Infections:Why are They Still a Problem? Ana Rosu A B S T R A C T
There have been both government and hospital-led policy-based initiatives to
prevent HAIs, with limited success due to lack of consistency when implementing proper sanitary procedures. Since most HAIs are caused by transmission of pathogens on the surface of a medical device, several large-scale companies and startups have attempted to create medical devices with antimicrobial surfaces. However, these technological solutions have had their challenges in clinical trials and implementation. HAIs are an issue in any country and, to properly address them, there should be an increased push and support for technological solutions from both the financial and political perspectives.
INTRODUCTION
Hospital-associated infections (HAIs) were first reported in 1846 by Hungarian doctor Ignaz Semmelweis. Semmelweis realized that doctors in his hospital were spreading puerperal fever to women giving birth because they were not washing their hands after dissecting infected cadavers (Cavaillon et al.). Since then, HAIs continue to be associated with a variety of unsanitary practices in hospitals: improper sterilization in surgeries, catheter insertions, and ventilators are just a few examples. One in thirty-one patients will be infected by pathogens in hospitals after being admitted for treatment of another disease (Magill et al.). Most often, these HAIs will be transmitted when patients are catheterized with central lines or urinary catheters. Central line-associated bloodstream infections (CLABSI) have the highest mortality rate and monetary cost: the average CLABSI case has an 18 percent chance of death and costs 46,000 dollars. Other common HAIs include ventilator-associated pneumonia (VAP) and surgical site infections (SSI) (Zimlichman et al.). In 2013, it was estimated that the total annual costs 8
for HAIs was 9.8 billion dollars, with SSIs contributing most to overall costs, then VAPs and catheter-associated HAIs. Unfortunately, today, a patient’s likelihood of getting infected during their hospital stay is highly dependent upon how well their nurse or doctor follows proper sanitary procedure (“2018 National and State HealthcareAssociated Infections Progress Report”).
HOSPITAL ASSOCIATED I N F E C T I O N S (H A I S) CAUSES HAIs are commonly caused by C. difficile, S. aureus MRSA (multidrug resistant staphylococcus aureus), E. Coli., and norovirus. MRSA is best known for its high mortality rate and resistance to drugs like penicillin, oxacillin, methicillin, and amoxicillin. In extreme cases, HAIs can lead to severe sepsis, causing organs to dysfunction. In those cases, one in four patients will die (Mayr et al.). While some HAIs are deadly, many other HAI-causing pathogens do not necessarily cause death but increase hospital stay and inhibit patient recovery from the original disease.
Hopkins Undergraduate Research Journal
Catheter-associated HAIs are caused when pathogens crawl from the catheter’s insertion site to the tip of the catheter inside of the patient’s body. Once inside the body, these pathogens begin to colonize and form a biofilm, a layer of bacteria that covers itself in extracellular polymeric substances (EPS), which help pathogens adhere to the catheter and each other (Safdar et al.). Research has found that the EPS of biofilms protects bacteria from many common drugs, making the infection harder to treat (Costerton et al.; Drenkard et al.). Surgical site infections (SSI) are caused when pathogens infect a surgical wound through contact with a contaminated surgical instrument or caregiver or spread from the air into a newly made surgical wound. Because surgeries are invasive, infections can occur at different levels within the body: superficial (skin and subcutaneous tissue), deep incisional (fascia and muscular layers), and organ or space (any part of the body opened or manipulated during the procedure that is not skin, subcutaneous tissue, fascia, or muscular layers). Although more than half of SSIs are preventable by evidence-based guidelines,