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A Summary of the Reasons for Healthcare Associated Infections

Healthcare Associated Infections (HCAIs) are infections acquired in hospitals or as a result of healthcare interventions

They can affect both patients and healthcare workers. They are caused by a wide variety of micro-organisms, often by bacteria that normally live harmlessly in or on the body. The majority of HCAIs cause minimal harm and can be treated like any infection, but meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C.difficile) create particular challenges. For people infected with MRSA or C.difficile, the consequences can be severe.

A range of measures is needed to tackle HCAIs effectively, though not all can always be prevented. The Department of Health has a wide-ranging programme in place to reduce the number of HCAIs to the avoidable minimum and much success has already been reported. The Design Bugs Out challenge complements the Department’s other programmes.

What is MRSA?

MRSA is a strain of the Staphylococcus aureus family of bacteria, which is resistant to commonly used antibiotics. It is no more infectious than other strains of S.aureus but can be more difficult to treat and therefore infections may become more severe.

The Staphylococcus aureus family of bacteria, to which MRSA belongs, is a very common cause of bacterial infections such as boils, carbuncles, infected wounds, deep abscesses and bloodstream infections (or bacteraemia).

MRSA was relatively uncommon through the 1960s and 1970s, and only a few more cases appeared in the 1980s. In the mid-1990s, however, ‘epidemic’ strains of MRSA became established in hospitals throughout the UK. These strains are easily transmissible and have the capacity to cause serious disease.

What does MRSA cause in patients?

There is no specific ‘MRSA disease’, as there is with tuberculosis or typhoid. Instead, MRSA can infect a range of tissues and body systems, depending on how it entered the body. As a result, patients may have general and ambiguous symptoms that are common to many different infections caused by other bacteria – including other strains of S.aureus bacteria. These can range from potentially fatal infections such as septicaemia to infections of wounds and ulcers.

How do patients become infected?

S.aureus is just one of a family of staphylococcal bacteria. Their normal home is on human skin and in the nose, and some of them – such as S.epidermidis – are seen as part of the normal ‘commensal flora’ of the human body. About 30% of the general population are colonised by S.aureus – in other words, they have it on their skin and/or in their nose – and are known as carriers. In about one tenth of these carriers (3% of the population overall), the S.aureus is MRSA.

MRSA infection occurs when the bacteria enter the body through a wound or when they enter the bloodstream. A carrier can be a source of infection for themselves (e.g. they can infect themselves if they have a wound), but they can also infect others when the bacteria are passed on either on someone’s hands (normally a healthcare worker’s) or on infected equipment such as catheters. Carriage sites are most commonly the nose and the skin, especially in folds such as axilla (armpit) or groin.

What can be done to prevent infection?

• To reduce the likelihood of spreading infection, healthcare professionals should always wash their hands or use an antibacterial hand rub after physical contact with a patient whether the patient has a wound or not. Healthcare workers can be carriers of the bacteria even if they are not infected themselves.

• Patients should be encouraged to wash their hands after using the toilet and before and after eating.

• Healthcare professionals should use gloves when treating infected patients where there is contact with body fluids and handling of contaminated dressings or linen and infected patients should be isolated from patients who are not infected to help prevent the bacteria spreading.