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The importance of hospital infection control

By Ana Paula Ferreira

Nurse

 

“First of all, do no harm.” This fundamental principle serves as a constant reminder to doctors, nurses and other health professionals, urging them to consider the possible harm that an intervention can cause. Since 1860, this phrase has been an expression of hope, intention, humility and the recognition that well-intentioned acts can have undesirable consequences.

The vast majority of patients who access medical services today are cured. However, some suffer the unintended consequences of care, such as healthcare-related infections (HAIs). Since 1847, when Ignaz Semmelweis discovered the importance of hand washing, and in 1860, when Joseph Lister, a pioneer of infection control, developed antisepsis to prevent wound infections, health care has become increasingly complex and sophisticated.

In Brazil, it is estimated that the hospital infection rate ranges from 5% to 14% of all hospitalizations, representing a significant challenge for public health and directly impacting on the quality of care provided. Data from the National Biosafety Association (Anbio) indicates that 100,000 people die every year from hospital-acquired infections, highlighting the prevalence of this problem in health institutions across the country. With a diverse population and varied health systems, the Brazilian scenario intensifies the challenges related to infections acquired during hospitalization.

Healthcare-Related Infections (HAIs), also known as Hospital-Acquired Infections, represent a serious public health problem, with a high economic impact and an increase in morbidity and mortality, especially in patients admitted to intensive care units (ICUs). According to the National Health Surveillance Agency (Anvisa), a hospital-acquired infection is one that is acquired after a patient has been hospitalized, whether it manifests itself during hospitalization or even after discharge, when it is related to hospitalization or hospital procedures.

 

The most frequently encountered HAIs in hospitals include:

  • Surgical Site Infection (SSI),
  • Pneumonias (especially VAP – ventilator-associated pneumonia),
  • Urinary Tract Infection (UTI)
  • Bloodstream Infection (BSI).

 

Although Brazilian evidence regarding the economic burden of HAIs is still limited, data from the United States of America (USA) and Europe suggest costs estimated at several billion per year. According to the US Centers for Disease Control and Prevention, the direct medical costs of HAIs for hospitals range from $35.7 to 45 billion annually, while the annual economic impact in Europe reaches €7 billion. A Brazilian study estimated that the daily cost of a patient with an HAI is 55% higher than that of a patient without an HAI, representing 18.0% of the total daily occupancy cost, mainly due to the use of hospital accommodation.

All over the world, the prevention of hospital-acquired infections depends mainly on the healthcare institution and its workers. Training and adherence to preventive measures by healthcare professionals reduces the risk of acquiring hospital-acquired infections related to the care provided. This work is coordinated by the Hospital Infection Control Commission (Comissão de Controle de Infecção Hospitalar – CCIH), which is responsible for management, and put into practice by the Hospital Infection Control Service (Serviço de Controle de Infecção Hospitalar – SCIH). Both are responsible for developing the Hospital Infection Control Program (PCIH), which is mandatory in all hospitals in the country.

The prevention of HAIs is at the heart of patient safety, receiving the full attention of experts at regional and national level, as well as consumers, payers, legislators and the media. Since 1999, the National Health Surveillance Agency (Anvisa) has led national actions to prevent and control HAIs in Brazil, following the guidelines of the World Health Organization (WHO). Anvisa has developed a number of strategic actions to reduce the risk of acquiring HAIs, including the publication of the Healthcare-Related Infection Prevention Measures manual.

Evidence-based measures for the prevention of HAIs should be adopted in all health services, covering the hospital environment, primary health care, establishments that provide care for chronically ill patients and home care. Research indicates that when health services and their teams are aware of the magnitude of the infection problem and adhere to HAI prevention and control programs, they can achieve a reduction of more than 70% in some infections, such as bloodstream infections.

According to the NATIONAL PROGRAM FOR THE PREVENTION AND CONTROL OF HEALTH CARE-RELATED INFECTIONS (PNPCIRAS) 2021 to 2025, published in 2021 by Anvisa, and in the 2017 Manual of Health Care-Related Infection Prevention Measures (Anvisa), six (6) basic effective measures are at the heart of HAI prevention strategies:

 

Hand hygiene:

Hand washing is considered the most important single measure in the control of Healthcare-Related Infections (HAIs). The WHO and Anvisa recommend hand washing in five situations in health services to prevent HAIs: before contact with the patient, before aseptic procedures, after exposure to body fluids, after contact with the patient and after contact with the environment close to the patient.

 

Respect standard and contact precautions, as well as isolation, using the appropriate PPE:

Precautions are adopted to prevent the spread of communicable diseases, of which there are four types: standard, contact, droplets and aerosols. The use of Personal Protective Equipment (PPE), such as gloves, masks and goggles, is crucial in preventing the transmission of infections to patients and staff.

 

Use of disposables:

Disposable medical devices provide greater safety, reducing the risk of infection and cross-contamination. In addition, they eliminate ongoing reprocessing costs, saving water, electricity and optimizing staff time. Standardizing disposables avoids waste and allows procedures to be carried out correctly, reducing HAIs, especially in invasive procedures.

 

Attention to and compliance with cleaning protocols:

Cleaning staff play a crucial role in preventing hospital-acquired infections. Respect for technical and ethical standards is essential to ensure the effectiveness of prevention.

 

Education and constant reinforcement of all staff:

The challenge for prevention lies not in the lack of protocols, but in the efficient and continuous implementation of recommended practices. Guidelines must be rigorously developed, reviewed and trained on an ongoing basis to ensure the prevention of hospital-acquired infections.

 

These five fundamental measures form the basis for the effective prevention of Healthcare-Related Infections (HAIs), highlighting the importance of the collaboration of the entire healthcare team in implementing these practices.

 

Bibliographical references

NATIONAL PROGRAM FOR THE PREVENTION AND CONTROL OF HEALTH CARE RELATED INFECTIONS (PNPCIRAS) 2021 to 2025. Anvisa, 2021

Patient Safety and Quality in Health Services Series. Measures to Prevent Healthcare-Related Infection. Anvisa, 2017

A Compendium of Strategies for the Prevention of Healthcare-Related Infections in Acute Care Hospitals. APECIH. 2008

Global report on infection prevention and control. WHO

Guidelines on the essential components of infection prevention and control programs at national and health service level. WHO

 

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The importance of hospital infection control

In Brazil, it is estimated that the hospital infection rate ranges from 5% to 14% of all hospitalizations, representing a significant challenge for public health and directly impacting on the quality of care provided.