Nosocomial infections create an extra burden to the health care system because the costs of treating infections are added to those of the original medical problem, or surgical procedure that resulted in the initial hospitalization.

 Nosocomial infections needlessly prolong hospitals stays and substantially increase the number of medical exams. Their treatment is very expensive. Moreover, when hospital stays are prolonged by infection, the number of hospital beds available is reduced. The net result is that health care resources are wasted treating problems that could easily be avoided. This is particularly serious when one considers that health care costs in Quebec and elsewhere are exploding, and health care budgets are being stretched to the breaking point.

The cost of N.I’s to Quebec is difficult to establish for the following reasons:

Lack of reliable data on the actual number of nosocomial infections. Only cases of C. difficile have been reported, and this has been done only since August 2000.

The structure of hospital budgets does not take specifically include costs related to the prevention and treatment of N.I.’s

A Canadian study carried out in 2001 for the medical journal “Infection Control and Hospital Epidemiology” listed the additional costs related to the treatment of each SARM infected patient:

Colonized patient - $1,369

 Infected Patient - $14,360

 Blood infection - $28,000

There are approximately 4,200 to 7,200 new cases per year.

 In the August 4^th, 2004 issue of the Canadian Medical Association Journal, it was estimated that a single case of C.difficile cost the health care system between $10,000 and $12,000. This means that between 140 million dollars and 168 million dollars was required to treat the 14,000 cases reported from 2003 to 2005.

Recent studies clearly demonstrate that 50% to 80% of nosocomial infections are avoidable if adequate preventative measures are introduced. Moreover, it costs the health care system 30% to 50% less to implement preventative measures than it does to treat nosocomial infections.

I. The World Health Organization (WHO) released some revealing statistics in October 2005:

The cost of treating four or five infected patients is the equivalent of the annual budgetary allotment for antiseptic hand cleaning products.

The cost of treating serious surgical infections, blood poisoning, and respiratory infections combined is much greater than a hospital's annual budget for antiseptic hand cleaning products.

In Russia, the cost of treating a single nosocomial infection in an intensive care unit is the equivalent of using a hand antiseptic for 3,265 days.

In Geneva, Switzerland's CHU Hospitals, the total cost of antiseptic hand care products is less that one percent of the cost of treating nosocomial infections. Proper hand hygiene alone reduces infections by 50%.

Nosocomial infections are contracted in hospitals or during surgical procedures.

Nosocomial infections are not complications related to the illness or surgical procedure that resulted in the initial hospitalisation.

 In the vast majority of cases, nosocomial infections are not the result of medical or professional errors.

 Nosocomial infections are simply medical accidents that occur during treatment, and are an ever-present risk associated with hospitalisation. Such infections have existed as long as hospitals.

 The origin of the word «nosocomial» can be traced to the Latin word «Nosocomium», which means hospital, and the Greek word «Nosokomeion».

 During the middle ages, hospital infections were considered to be divine wrath. In the 12^th Century for example, the Church persecuted Theodore of Bologna as a heretic for suggesting that medical procedures were the cause of diseases and infections. In the 17^th Century, nosocomial infections were attributed to particles circulating in hospital air. Improving hospital ventilation systems was thought to be the solution. Late in the 19^th Century, Louis Pasteur discovered that germs or bacteria, were the cause of nosocomial infections and demonstrated the importance of ensuring that conditions were aseptic, or free of disease causing micro-organisms.

They are the key to controlling nosocomial infections:

As with all human activities, running a hospital and treating patients can be very risky. Nosocomial Infections constitute 30% of the sixteen major risks, or “undesirable occurrences”, that affect patient safety.

Controlling N.I.`s (Nosocomial Infections) is a question of risk management. Obviously, it is impossible to eliminate all risk because residual risk will always be a problem. Effective risk management is therefore critical to ensuring quality health care.

Surveillance and protection are the keys to controlling N.I.`s. At least 50% of Nosocomial Infections are avoidable, and with proper measures more than 80% of them could be prevented. This is especially true of blood and respiratory infections, which are the most serious and the most deadly.

 Surveillance

 Vigilant surveillance must become an integral part of hospital routine, and practiced on a regular basis in order to detect anything that could adversely affect patient safety. This requires a thorough epidemiological investigation to determine the causes of N.I.’s, and to implement the following preventative measures:

 Close supervision of the clinical environment

·  Surveillance of high-risk personnel, for example, colonized or infection-carrying health care workers.

·   Stringent inspection of potential sources of infection: examination rooms, medical instruments, the ventilation and heating systems.

·   Thorough assessment of the results obtained by preventative measures.

 
Prevention

 Prevention protocol tends to vary according to risk level of hospitals, clinics and patients. Intensive care units and operating rooms carry a much higher risk that psychiatric units or a general practitioner’s office. Effective surveillance and stringent preventative measures are required. Consequently, the following preventative measures should be standardized and implemented everywhere:

·   Proper hygiene: washing one’s hands is the basic preventative measure and reduces infection by at least 50%. Researchers have known for 150 years that medical personnel can save lives simply by washing their hands prior to treating a patient.

·     Isolating colonized and infected patients is essential. Ideally, each patient should be in a single room, but if space does not allow for this, only patients infected by the same bacteria should be kept together. Patients infected by different bacteria must be separated.

·         Barrier measures such as wearing sterile clothing, latex gloves and masks reduces the spread of bacteria and protects immune-deficient and other high risk patients from contamination. This applies to all personnel, patients and visitors.

·       Limiting the use of antibiotics in order to prevent the development of antibiotic resistant bacteria.

·     Both inside and outside the hospital, clothing worn by health care workers constitutes a serious hazard. Hospital personnel should no longer be allowed to wear their hospital garments outside the establishment. Furthermore, surgical staff should not be permitted to wear their garb outside the operating room. When arriving for their shift, all hospital personnel must remove their street clothing and put on the appropriate hospital garb. The British Medical Association recently recommended (July, 2005) that all hospital clothing be cleaned and disinfected on a daily basis.

·   Good hygiene and regular disinfection are standard preventative measures. Hospital rooms, beds, linen, doorknobs, toilets, and sinks etc. must all be disinfected.  Hospital maintenance workers require specific training in the techniques of disinfection. One simply does not clean a hospital room in the same manner as a hotel room.

·       The World Alliance for Patient Safety recommends that patients and the general public get involved. This organization was founded in 2004 and includes hospital administrators, university professors and researchers, and patient associations. In the USA, many patients associations, consumer protection groups, as well as public and private insurance companies have requested that infection rates for all hospitals be rendered public. They also insist that patients themselves personally intervene in order to ensure their safety. For example, patients should ask health care workers to wash their hands prior to treating them. In June 2005, the Mayo Clinic Medical Association published a document on nosocomial infections in which they informed patients and their families of preventive measures that should be taken.

·      In France, patient’s associations are actively involved in the fight against N.I.’s. Upon admission, all hospital patients receive a booklet that indicates the establishment’s infection rate, and lists all preventative measures undertaken by the hospital. The booklet also contains the Charter of Hospital Patient’s Rights.