Every year, the treatment and care provided to hundreds of millions of patients all around the world are complicated by hospital-acquired infections.
It may worsen the patient’s condition and result in prolonged hospitalizations, disabilities or premature death. Despite the human cost, Healthcare systems bear a financial burden.
An infection is called ‘nosocomial’ if it did not exist when the patient was admitted to the hospital and if it developed in the 48 hours after admission. This period allows to distinguish a community-acquired infection from a nosocomial infection. In case of surgical site infection, it increases the period to 30 days, and the period could be extended to 1 year, in case of implantation of prosthetic material.
In other word, it is considered as infection nosocomial, any infection occurring on a surgical scar over the year following the operation, even if the patient has left the hospital.
Nosocomial infections are identified as a major public health issues due to their frequency, cost, and seriousness.
- More than 1.4 million people in the world has a sever infection acquired in the hospital.
- Between 5 and 10 % of patients admitted to modern hospitals in the developed countries contract one or more infections.
- The infection risk during health care in developing countries is 2 to 20 times higher than that of developed countries. In some developing countries, the proportion of patients infected by healthcare increases up to more than 25%.
- Each year, nosocomial infections affect between 700,000 and one million people in France. It affects 5 to 10% of admissions in general hospitals and until 30% of patients in intensive care. These infections prolong hospital stays for 4 to 5 days on average. 9 000 persons are estimated to have been died by nosocomial infections in France.
- In the United States of America, one in 136 patients is seriously ill as a result of nosocomial infection, which means 2millions cases and 80,000 deaths over one year.
- In England, more than 100,000 health care infections cause over 5,000 deaths a year.
- In Mexico, 450,000 cases of care-related infections are estimated to cause 32 deaths per 100,000 population each year.
- The annual cost of nosocomial infections is estimated at £ 1 billion in England. In the United States of America, this cost is estimated every year between $ 4.5 and $ 5.7 billion. In Mexico, the annual cost is around 1.5 billion USD.
Nosocomial infections are of two types:
- Endogenous infections when the patient is infected by his/her own pathogens. These appear when the health status of a patient is fragilized due to age, disease, treatments, quality of care, and the presence of pathogens. Endogenous infections account for at least 50% of nosocomial infections.
- Exogenous infections, whether they are cross-infections from other patients, infections caused by germs carried by members of the staff, or infections related the hospital environment contamination.
At the source of these infections:
- Poor hygiene practices. It was recently shown that the major cause for the transmission of bacteria was the lack of hygiene (no hand wash, no disinfection…).
- Advancements in medical and surgical care with, for instance, increasingly more aggressive procedures and treatments which may be potential sources of infection.
- The proportion of multiresistant bacteria strains among those causing infections in French hospitals, is one of the highest in Europe: 35% of all staphylococci identified in hospitals are methicilline-resistant, and the resistance of Klebsiellas to beta-lactamins is quite common…
Nosocomial infections result in a major financial extra cost, mostly due to a longer hospital stay (4 days on average), anti-infectious therapy and laboratory exams required for the diagnosis and monitoring of the infection. It is estimated that a new infection increases by nearly 2 weeks the stay in an orthopaedic surgery unit, and by 300% the patient care costs.
The various available studies indicate a very wide cost scale ranging from an average 340 Euros for a urinary infection to 40 000 Euros for a severe bacteraemia in ICU. Thus, the estimates vary substantially depending on the anatomical site of the infection, the type of germ, the underlying disease, and also the type of hospital unit. If we apply an extra cost mean value ranging from 3500 to 8000 Euros per infection to the annual 750 000 nosocomial infections, we reach a total expense of 2.4 to 6 billion Euros.
Lowering the number of infections by 10% would result in savings worth 240 to 600 million Euros, i.e. up to 6 times the prevention effort of hospitals which is about one hundred million Euros.
This quick calculation shows how much the non-quality cost is higher than that of prevention.
The risks of infection are higher in some parts of the world.
Many projects, in both developed and developing countries, show that the implementation of interventions and strategies can considerably reduce the morbidity burden attributed to infections in health care.
Hospitals, clinics, medical offices, laboratories
These care facilities welcome patients infected with pathogens and immunodeficient. To reduce or eliminate the risk of infection, surfaces in contact with the patient must be subjected to strict procedures of cleaning and disinfection. So, it’s necessary to have a system allowing to disinfect/sterilize efficiently 100% of the surfaces (rooms, operating theaters,…).
Retirement Homes, Rehabilitation centre, thalassotherapy centre
These facilities welcome people for long-terme care. These patients are most often immunodeficient or even immunosuppressive. Even if, the risk of nosocomial infections is less in these facilities, it’s necessary to remain vigilant with a risk management for all the surfaces.
Ambulances, fire fighters
Ambulances and firefighter vehicles are used for transporting ill or injured persons. The patients may be contaminated or contaminate the ambulance staff/firefighters. Therefore, ambulance staff and firefighters must follow strict cleaning and disinfection protocols between patients.