Risk Factors:

As with all human activities, providing health care entails certain risks. Unfortunately the hospital - the prime provider of health care services – has become a high risk environment.  For instance, 25% to 30% of intensive care patients contract nosocomial infections. Hospital administrators must therefore learn methods of effective risk management in order to ensure safe, efficient, quality health care.

The performance of any given hospital is not determined by its ability to provide the most up-to-date medical procedures. Rather, it is determined by the safety of the care it provides. There is no point, for example, in giving a patient the latest, most efficient artificial hip if that patient later dies as the result on an infection contracted because the hospital failed to respect basic hygienic standards.

Infection risk falls into two categories: risk related to the patient and those related to the institution, in this case the hospital itself.

Colonized Patients

            Colonized patients already carry potentially disease-causing bacteria - such as SARM (staphylococcus resistant to bacteria) - without actually exhibiting any symptoms of the disease. They are known as healthy carriers.

            Bacteria, viruses, and mold are all part of the ecosystem in which we live. We all carry bacteria on our skin, in our intestines, or in our respiratory system. Currently in the USA, 60% of staphylococcus found in the populace are resistant to antibiotics, and 30% to 50% of healthy people are carriers at any given time.

            In the case of colonized patients, infections are caused by invasive medical procedures such as surgery, endoscopy, or the insertion of a catheter, performed during the patients stay at the hospital, after day surgery or any other ambulatory treatment.

            Colonized patients are also a source of infection for other patients and health care workers. The latter’s hands are the main vehicle for passing on infections. In Israel for example, a study conducted in December 2005 revealed that 55% of health care workers and 46% of patients were colonized by bacteria known to cause nosocomial infections.

Institutional Risks

            Due to the high concentration of antibiotic resistant bacteria in hospitals, the risk of infection has become higher with the evolution of medical practices. Although antibiotics are an absolute necessity in the treatment of infections, their use has also resulted in bacterial strains that are highly resistant to such drugs. Currently, the majority of germs found in hospitals are resistant to one or several antibiotics. These germs are found on virtually all surfaces, in the ventilation system, in the plumbing, on cell phones, computer keyboards, and even on doctor’s ties.

Several factors aggravate the risk of nosocomial infections:

-         Medical diagnosis and treatment has become increasingly invasive over the years. Consequently, any penetration of a patient’s skin or natural orifice can result in an infection.

-         Frequent transfers of patients from one hospital to another for diagnostic or treatment purposes favors the spread of germs.

-         Putting too many patients in the same hospital room is one facilitates the spread of infection.

-         The lack of facilities to quarantine infected patients. Moreover, many examination rooms are in poor condition and not properly adapted to ensure adequate hygiene.

-         Insufficient numbers of hospital staff and heavy workloads further undermine patient safety standards.

-         Hospital workers are often inadequately trained in infection detection and prevention. This includes not only infection control personnel, but all categories of hospital workers: administrators, technical staff, nursed, orderlies, maintenance workers etc. Consequently, hygiene standard are simply no respected.

The solution to this problem is to bolster detection and prevention techniques. The risk factor for each establishment and health care unit must be carefully evaluated, and measures implemented in order to minimize the risk of infection.