RARE BUT REAL
The spread of infection inside hospitals, while not inevitable, is always a possibility
Later the hospital workers realized it had been smallpox. But how could it have spread that easily to a different floor? The team tried to look into the air flow pattern within the building, and it turned out that the ventilation of the floor on which the patient had been confined allowed the air coming from it to move up the side of the building and then enter the upper floors via the windows. Even worse, the patient had been situated next to a stairwell, which allowed the air to move to the upper floors, and infect unwitting patients.
"This is to point out the fact that this is a highly infectious virus and this is transmitted via infectious aerosol," Opal said. "And if we're not careful and if we're delayed in making the diagnosis, [we] could expose a large number of patients to this potentially lethal infection before we realize the trouble we got ourselves into."
These kinds of incidents happen very rarely, but the spread of infection inside hospitals, while not inevitable, is always a possibility. After all, given the number of people in various states of sickness and degrees of vulnerability, different pathogens may easily jump from one bed to another. Also, the use of different devices in managing different patients may invite certain pathogens to thrive and eventually cause infection. But with the institution of stringent but commonsensical practices on hygiene and sanitation, this possibility of nosocomial infections has been significantly diminished.
Pinning Down Rates
In the United States it has been reported that one out of every 20 patients in acute care acquires an infection in the hospital, and these incidents incur expenses of up to US$2 billion every year. However, a lot of specifics need to be identified to understand its full meaning. For example, an older, immunocompromised patient may be at a higher risk of contracting an infection than a younger, relatively less immunosuppressed patient. Also, the length of time patients spend with a urinary catheter, a central IV line, or on mechanical ventilation increases their risk of developing a device-associated infection. Such factors as the environment the patients are placed in or the people moving around the patient may also have a bearing on the development of infections.
Among the most common nosocomial infections are urinary tract infections (UTIs), pneumonia, blood-stream infections (BSI), and surgical site infections (SSI). Other diseases such as chickenpox and antimicrobial-resistant tuberculosis among HIV patients have also been reported abroad. But is the nosocomial infection situation abroad similar to the Philippine situation?
Dr. Abelardo Alera, head of the infection-control committee of the San Lazaro Hospital, said that although there might be some similarities, different countries will have different rates, in the same way these same rates may differ from institution to institution.
There are as yet no definitive national data on the prevalence of nosocomial infections. There was an initial study, though, conducted in 2000, that may give doctors and hospital administrators an idea on hospital infection rates. Dr. Jodor Lim, president of the Philippine Hospital Infection-Control Society and one of the lead researchers, provided MEDICAL OBSERVER with the results of the pilot phase of the study. Called SHIP (Surveillance of Hospital-acquired Infections in the Philippines), the project examined nosocomial infection trends in five government and six private hospitals in Metro Manila.
Between April and May 2000, a total of 972 patients were observed in 20 ICUs (adult, pediatric, surgical, and burn) and high-risk nurseries. In that one-month period, 127 patients or 13.06 percent developed some form of nosocomial infection. More than half of the patients (72) developed pneumonia, while more than a third (22) experienced UTIs. The overall rate is nearly twice as high as the overall US rate, but Lim explained that the number of hospitals involved in the study (in other words, the limited sample population) does not make the results of the project representative of the national picture.
While coming up with a national registry on nosocomial infections is important-in fact, it is one of the long-range projects of the PHICS-there are several things that first need to be resolved. For instance, Lim said that a follow-up to the pilot phase of the SHIP project was not done because of "so many problems." He explained: "[Infection]-control nurses [are] leaving for abroad with no one to take care of the collection of data. Another problem is, of course, logistics and finally the need to revise the protocol."
Alera agreed, saying that although hospitals regularly monitor nosocomial infection rates, it remains a challenge to come up with national data since different hospitals follow different guidelines, and the infection rates each hospital reports "depend on which guidelines are being used." In addition, logistical concerns have to be ironed out, such as who will be responsible, who will participate, and where and how to get funding for the project.
Sharing Infections
The possibility of hospital outbreaks like the one Opal described has been significantly diminished over the years, but one moment of neglect on the part of medical professionals may have dramatic implications. In addition, the growing resistance of many microorganisms to antimicrobials could significantly affect a patient's susceptibility to acquiring a disease as well as his chances of recovering from it.
Alera said that although outbreaks "seldom happen," rigorous surveillance carried out by the hospital infection-control committee helps identify certain trends and come up with containment measures. Also, it is under the guidance of the infection-control committee that strict rules on keeping infection carriers away are imposed and observed. It's kind of like keeping one's own home clean and safe, only stricter: hygienic and safety practices, from appropriate handwashing to the isolation of certain types of patients, from the rational use of certain medications to the proper disposal of waste, not only keep possible infections at bay, but help improve a patient's chances at recovery.
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