Hospital infections are on the rise – here’s how to protect yourself in healthcare facilities

A new study from the National Institutes of Health shows a rise in hospital-acquired infections and resistance to the antibiotics used to treat them. The findings are based on data collected at 120 U.S. hospitals from January 2018 to December 2022, a five-year period that includes the COVID-19 pandemic. Dr. Nasia Safdar, a professor of infectious disease medicine at the University of Wisconsin-Madison, discusses why infection rates have risen and how you can protect yourself as a hospital patient or family visitor.

Nasia Safdar discusses the dangers of hospital infections.

The Conversation has partnered with SciLine to bring you highlights from the discussion, edited for brevity and clarity.

What are healthcare-associated infections?

Nasia Safdar: These are infections that occur as a result of exposure to the healthcare system. People who come for treatment are usually very ill, so there is a risk of being infected with bacteria that can cause an infection during their hospital stay or shortly after being discharged from hospital.

Why do infections, especially antibiotic-resistant ones, spread so easily in hospitals and other healthcare facilities?

Nasia Safdar: There is a certain profile of bacteria and germs that thrive in healthcare settings. And that profile is usually bacteria that are resistant to many commonly used antibiotics.

Patients are already susceptible and may have weakened immune systems. Add to that the risks associated with heavy antibiotic use, surgeries, procedures, and medical devices such as urinary and intravascular catheters that enter the bloodstream. The result is a population at risk for infection with these bacteria circulating in the environment.

What does it mean if an infection is resistant to antibiotics?

Nasia Safdar: For any common infection, there are a number of treatment options. There’s what’s called a first-line treatment, which is the first antibiotic you’re going to reach for. These are usually antibiotics that can treat the infection really well, but they don’t harm the good bacteria that live in your gut.

However, when bacteria become resistant to antibiotics, we need to switch to broader-spectrum antibiotics, which may still be effective in treating the disease but may have more side effects or destroy some of the good bacteria in the gut.

What can hospitals and clinics do to prevent or limit the spread of infection?

Nasia Safdar: One is infection prevention, and the other is antibiotic stewardship, which is the judicious use of antibiotics. They both work synergistically with each other.

In the category of infection prevention, we are dealing with hand hygiene, which is extremely important not only for medical personnel, but also for the patients themselves.

Gowns and gloves are also used where necessary to ensure that if one patient has a transmissible disease, that pathway is interrupted by healthcare workers wearing appropriate personal protective equipment. I also believe that using devices such as urinary catheters or intravascular catheters only when they are really needed is another way to prevent infections in patients.

Next, antibiotic stewardship should include preventing the overuse of antibiotics.

What has changed in recent years in healthcare-associated infection rates?

Nasia Safdar: Before the pandemic, I was quite optimistic because we were seeing fewer antibiotic-resistant and device-related infections.

Many of those gains were reversed when the pandemic hit. During that time, there was a lot of unnecessary use of antibiotics. And so now we’re seeing a dramatic increase in many of these antibiotic-resistant bacteria. That’s led to concerns that whatever success we had was fragile and short-lived. Now we want to make sure that we’re not as vulnerable as we became during the pandemic.

Can you give us some information about Candida auris?

Nasia Safdar: Candida auris is a new pathogen. Unlike some of the other antibiotic-resistant bugs in healthcare systems, this one is a fungus – or a yeast, as it’s called. And it’s spreading pretty quickly in healthcare systems.

Candida auris persists in the environment and on the skin and can cause serious bloodstream infections in susceptible patients. It is responsible for a number of epidemics, and treatment options are much more limited compared with other infectious germs.

With the advent of the pandemic, there was a sharp increase Candida auris infections. They have increased by several hundred percent nationwide after a period of simmering. This rapid increase worries us.

Can the spread of these infections be reduced by changing the gut microbiome?

Nasia Safdar: Many of these germs live in the gut. They are usually kept at bay by the good bacteria that we all have in our gut. But sometimes when we use antibiotics, or we use devices, or we have surgery, those good bacteria get wiped out. And then those germs can find a hospitable niche and multiply, causing infections.

Diet plays a major role in maintaining a healthy gut microbiome. Most Americans don’t get enough fiber. However, a diet high in fiber keeps your gut bacteria healthy and helps fight off germs when they try to get in.

What can patients or their families do to reduce the risk of infection in a healthcare facility?

Nasia Safdar: Make sure both the patient and the healthcare workers are practicing good hand hygiene. Use hand sanitizer. It works. It’s convenient. It’s readily available. It’s a great way to prevent infections in healthcare systems.

But there are some cases where it would be better to use soap and water. Soap and water are a better option when the hands are dirty with blood, feces, diarrhea, or other body secretions.

Also ask about infection rates in the healthcare system. These are things that healthcare systems usually track closely, and the information is often publicly available. Ask your healthcare team about the medications you are receiving for treatment, especially if they are antibiotics. Then ask how long you should be taking them for, what side effects to expect, and what effect they will have on your gut bacteria.

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