Frequently asked questions (FAQ) about HCAI's
Healthcare-associated infection (HCAI) refers to infections that occur as a result of contact with the healthcare system in its widest sense - from care provided in your own home, to general practice, nursing home care and care in acute hospitals. The term has recently been coined in recognition that increasingly complex procedures are undertaken outside hospitals. Previously, when most complex healthcare was hospital based, the term hospital acquired infection was used.
Hospital-acquired infection (HAI) (also known as nosocomial infection) has a strict definition. It refers to an infection that develops in a patient 48 hours or more after admission to a hospital. Infections that occur within the first 48 hours are considered to have been picked up in the community and were incubating prior to admission. These are then referred to as community-acquired infections.
Community-acquired infection (CAI) is any infection that a patient has when they come into hospital or occurs within the first 48 hours of admission. In this latter case, it is assumed that the patient was already incubating the infection, which they picked up in the community prior to admission.
The 48 hour cut-off is somewhat arbitrary as infections have variable incubation periods. Nevertheless, some standard definition is useful when considering likely sources of infection and 48 hours has remained the standard for many years.
No, although most of the news headlines are about MRSA healthcare associated infection can be due to a variety of organisms that happen to be picked up from a healthcare setting. MRSA can also sometimes be acquired in the community. Further information on specific topics related to healthcare associated infection (HCAI) is available on this website.
The Top Ten Blood Stream Infection Surveillance (bacteraemia) surveillance provides some insight into the burden of infections dealt with by NHS Trusts/Health Boards in Wales and reflects both community and healthcare associated infections. It can be seen from the tables of blood stream infections that other organisms can cause healthcare associated infections and that MRSA is not the most common infection encountered in our hospitals.
From the earliest days of healthcare, organisms have found opportunities to cause infection at sites of wounds and in weakened patients fighting other diseases. As the health service has modernised with increasing knowledge, technology and innovation you might have expected infections to disappear. However the increasing numbers of invasive treatments and powerful drugs that are now available to us not only improve the survival rates for many cancer and trauma patients for example, but also carry an increased risk of associated infections.
HCAI is a problem because the development of infections in association with healthcare increases the time a patient takes to get better from the surgery or other treatment that was first given and they can lead to severe disability or death in some cases. From the healthcare service point of view patients who remain in hospital longer due to HCAI means that other patients cannot be treated as quickly and outbreaks of infection can cause severe disruption to a hospital or community healthcare service.
On the basis of a survey carried out in 2006, it is estimated that about 6% of patients in hospital, at any given time, have an infection that they picked up in hospital. Currently a further survey is being carried out in Wales and other parts of the UK to bring this data up to date. It is also thought that up to 5000 patients die of hospital acquired infection every year in England & Wales combined (source: The management and control of hospital acquired infection in acute trusts in England (NAO, 2004))
The impact of healthcare associated infections is felt by patients, their families and carers, and the health service itself. Patients may endure severe and /or chronic illness, pain, anxiety, longer stays in hospital, a reduced quality of life, loss of earnings and sometimes even death.
The health service has to bear the cost of diagnosis and treatment of these infections, the extended length of stay, which often results, and the use of more expensive treatment that may be needed. Infection Control services must also be paid for and bed / ward closures and cancellation of operations / admissions that can result from these infections, are also a hidden burden for the health service.
There are several reasons why HCAI occur:
The urinary tract is the commonest site for a HCAI to develop, closely followed by infections of the chest (lower respiratory tract):
The main sites of healthcare associated infections
Source: The management and control of hospital acquired infection in acute trusts in England (NAO, 2004)
It is probably impossible to eradicate healthcare associated infections completely. It has however been estimated that a proportion of healthcare associated infection can be prevented. It is thought that about 15% - 30% could be avoided by improved practices and better application of existing knowledge.
To support the reduction of HCAI in Wales the Welsh Government launched the "Healthcare Associated Infections – A Strategy for Hospitals in Wales" in September 2004, the first document in a series of guidance documents aimed at the health service in Wales. The strategy for reducing healthcare associated infections in the community will follow and through these strategies the health service in Wales will be guided to reduce the burden of healthcare associated infections.
Other initiatives related to healthcare associated infections that are currently in place in Health Boards in Wales are the Clean Your Hands Campaign, and from June 2006 an e-learning package will be launched in Wales to provide education in Infection Control for all members of staff in the NHS in Wales.
Individual Health Boards in Wales are implementing the recommendations of the strategy and all have specialised infection control staff who advise the Health Boards on the management and prevention of infections and also develop various other Infection Control programmes and initiatives, details of which can be found via the individual Trusts.
There is a comprehensive Surveillance Programme for infections in Wales, which provides Health Boards with information about rates of various infections in their Health Board, highlighting for them potential areas for investigation and action.
Last updated: 08/02/2012