Nosocomial Infections (Healthcare-Associated Infections)

What is nosocomial infection?

Nosocomial (naa-suh-KOW-mee-uhl) infections (also called healthcare-associated infections, hospital-acquired infections or HAIs) are illnesses you can get at a medical facility while you’re getting treatment for another condition. These infections can cause serious and sometimes life-threatening conditions. HAIs can occur in a variety of settings like hospitals, surgical centers, dialysis clinics and long-term care facilities.

By definition, HAIs are infections that happen within:

• Forty-eight hours of arrival or hospital admission.
• Three days after discharge from a hospital or surgical center.
• Thirty days of a surgical procedure.

Anyone receiving care at a healthcare facility can get nosocomial infections. But they’re most common in people with compromised immune systems. You can get HAIs from these pathogens (germs):

• Bacteria.
• Viruses.
• Funguses.

Most HAIs are avoidable. Yet every year in the United States, more than a half-million patients and healthcare providers get them. To stay safe, it’s important for medical teams and families to work together.

Types of healthcare-associated infections (HAIs)

There are several types of nosocomial infections and many reasons why they occur:

• C. diff (Clostridioides difficile) infection: C. diff is one of the most common HAIs, causing nearly half a million infections in the U.S. each year. It causes diarrhea and colitis (inflammation of the colon). Over 16% of people who get a C. diff infection will get another one within two to eight weeks.
• Catheter-associated urinary tract infection (CAUTI): CAUTIs make up 32% of all HAIs. These urinary tract infections can develop due to long-term catheter use. A catheter is a tube that goes from your bladder through your urethra to allow urine to drain from your body into a collection bag.
• Central line-associated bloodstream infection (CLABSI): Bloodstream infections make up 14% of all HAIs. They can happen in people who need a central line (central venous catheter). A provider places the central venous catheter into a vein near your heart so they can give medications and take blood without multiple injections.
• MRSA (methicillin-resistant Staphylococcus aureus): MRSA is one of the most common HAIs. It’s a staph infection that’s resistant to certain antibiotics like penicillin, amoxicillin and methicillin.
• Surgical site infection (SSI): About 22% of all HAIs are surgical site infections. SSIs can affect incision wounds. They can also affect deeper tissues, organs and even surgical implants (like pacemakers or artificial joints).
• Ventilator-associated pneumonia (VAP): Ventilator-associated pneumonia accounts for 15% of all HAIs. This condition can develop in people who need mechanical ventilation — a type of treatment that breathes for you when you can’t breathe on your own. Infection happens if germs enter the lungs through a breathing tube.

What are the symptoms of nosocomial infections?

People with HAIs can develop different symptoms depending on the type of infection. Some of the most common nosocomial infection symptoms include:

• Fever.
• Chills.
• Shortness of breath (dyspnea).
• Cough.
• Abdominal pain.
• Heart palpitations.
• Diarrhea.
• Peeing more than usual (polyuria).
• Painful urination (dysuria).
• Change in mental state, like confusion or irritability.

What causes nosocomial infections?

A variety of pathogens (germs) can cause nosocomial infections. Common examples include:

• Gram-negative bacteria, which can cause blood infections, pneumonia or meningitis.
• Clostridioides difficile (C. diff), a bacterium (singular form of bacteria) that can cause colon inflammation and a very contagious form of diarrhea.
• Methicillin-resistant Staphylococcus aureus(MRSA), a type of bacterial infection resistant to common antibiotics like penicillin, amoxicillin and methicillin.
• Hepatitis, a group of easily transmittable viral infections that affect the liver.

How do nosocomial infections spread?

Nosocomial infections can spread through respiratory droplets when a person sneezes or coughs. They can also occur when healthcare providers don’t follow proper infection control procedures (like sterilization).

What are the risk factors for nosocomial infections?

A risk factor is something that increases your chance of getting an illness. You’re more likely to get a nosocomial infection if your treatment involves:

• Catheters (drainage tubes).
• Ventilation (mechanical breathing).
• Injections.
• Surgery.

What are the complications of nosocomial infections?

Complications depend on the type and severity of the nosocomial infection. Listed below are the types of HAIs and some of the possible complications:

Central line-associated bloodstream infection (CLABSI)

• Endocarditis.
• Thrombophlebitis.
• Osteomyelitis.
• Abscess.
• Sepsis.

Surgical site infection (SSI)

• Slow wound healing.
• Repeat surgery.
• Rejection of implanted medical devices.
• Body cavity infections.
• Sepsis.

Catheter-associated urinary tract infection (CAUTI)

• Urinary tract infections.
• Sepsis.

Ventilator-associated pneumonia (VAP)

• Respiratory failure.
• Empyema.
• Sepsis.

How are nosocomial infections diagnosed?

Most of the time, healthcare providers can tell a person has an HAI when they develop symptoms like the ones mentioned above. Early signs may include a skin rash or redness around an incision. Your provider might need to order urinalyses (pee tests) or blood tests to confirm or rule out a diagnosis.

How are nosocomial infections treated?

Treatment for HAIs depends on the type of infection. Healthcare providers may use:

• Antibiotics.
• Antivirals.
• Antifungals.

Challenges like antibiotic resistance, antiviral resistance and antifungal resistance can sometimes make HAI treatment less effective. Resistance is when pathogens evolve (change) so much that the drugs designed to treat them no longer work. This is one reason HAIs are so difficult to treat.

Though it’s not always possible, the best treatment for nosocomial infections is prevention.

Can nosocomial infections be prevented?

You can’t prevent every single instance of hospital-acquired infections. But you and your family can take the following steps to significantly reduce your risk:

• Keep your hands clean. Regular handwashing is one of the best ways to prevent spreading germs and avoid getting sick.
• Ask your healthcare providers about their infection control procedures. Don’t be afraid to speak up if you have concerns.
• If you have a catheter, ask each day if it’s necessary.
• Take antibiotics exactly as prescribed and only when your provider says you need them.
• Ask your healthcare provider to run tests to ensure they prescribe the appropriate antibiotic.
• Ask your healthcare provider how they prevent infection during and after surgery. Ask how you can prepare for surgery to help reduce your risk.
• Recognize the signs of skin infection. Redness, draining, or pain around incisions or catheter insertion sites could indicate infection.
• Stay up to date on your flu shot and other recommended vaccinations.

What’s the outlook for someone with a nosocomial infection?

Many people with HAIs make a full recovery with early diagnosis and treatment. But they also have longer hospital stays and additional obstacles to overcome.

In some cases, nosocomial infections can cause serious health complications or death. According to the Centers for Disease Control and Prevention (CDC), about 99,000 people die from healthcare-associated infections each year in American hospitals alone.

When should I see my healthcare provider?

You should tell your healthcare provider any time you develop concerning or worsening symptoms — especially if you’re currently under medical care or had recent surgery. If something doesn’t seem right, let your provider know right away so they can recommend appropriate treatment.

A note from Cleveland Clinic

We go to hospitals, surgery centers and healthcare clinics to feel better when we’re sick. But when you get even sicker while under medical care, it can be frustrating, uncertain — maybe a little scary.

Nosocomial infections cause serious complications, yet most HAIs are totally avoidable. We all play an important role in healthcare safety. If you see something that could put you or someone else at risk for an infection, tell your healthcare team.