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What are healthcare-associated infections (HCAIs)?

HCAIs are a range of infections acquired in hospitals or as a result of healthcare interventions. They occur in hospitals and in the community; and affect both patients and healthcare workers. The focus has been on infections in hospitals: it is estimated that 9% of all inpatients have an infection associated with their care in hospital. But, healthcare, especially if it involves puncturing the skin (for an injection) or inserting a device (like a catheter) in any setting can risk HCAI. Many patients come into hospital with an infection, which is why screening is so important.

What sort of infections are HCAIs? Information on the most common ones is listed below. Methicillin resistant Staphylococcus aureus (MRSA) is a common bacteria carried by around one in three healthy people, usually on their skin or in the nose. In most cases, it is not harmful for healthy people to carry MRSA. But hospital patients are sick and, therefore, liable to infection. MRSA is dangerous if it enters the bloodstream.

Clostridium difficile is a bacteria that can survive and multiply without oxygen. It is present as one of the ‘normal’ bacteria in the gut in up to 3% of healthy adults. Clostridium difficile, known as C diff, can cause diarrhoea when certain antibiotics disturb the balance of ‘friendly’ bacteria in the gut. In most cases, the result is mild, but in some cases it may lead to complications. This bacteria forms spores that can survive for long periods of time in the environment and therefore it can be easily transmitted to susceptible people.

Noroviruses are the most common cause of gastroenteritis (stomach upsets). They are easily spread by coming into contact with an infected person, or can be passed on through food, water, or by touching contaminated objects. Symptoms may last between 12 and 60 hours, and these are most commonly nausea, sickness and diarrhoea, though some people could have a raised temperature, headaches and aching limbs. It is important for an infected person to drink plenty of fluids to prevent dehydration. They may be seasonal, such as the ‘winter vomiting’ bug.

Glycopeptide-resistant Enterococci (GRE) are bacteria commonly found in the bowels of most people. There are many different species of enterococci, but only a few have the potential to cause infections in humans. GRE is resistant to certain antibiotics and are therefore more difficult to cure. GRE may cause wound infections, blood poisoning or infections of the abdomen and pelvis, and occasionally cause infections in the bile duct, heart valves or the urinary tract. Infections caused by GRE mainly occur in patients that are immuno-compromised, those who have had previous treatment with certain other antibiotics, those who are on a prolonged hospital stay, or those in specialist units such as intensive care or renal units.

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