Biomedical Engineering Reference
In-Depth Information
4.1
Introduction
Hospital associated infections (HAI) continue to be a common and significant
complication of hospitalization, leading to increased morbidity and mortality.
It was estimated that in 2002, there were approximately 1.7 million healthcare-
associated infections, which resulted in approximately 99,000 deaths [
41
]. A more
recent meta-analysis of the costs and financial impact of HAI on the US healthcare
system reported that the total annual costs for the five major infections (central
line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia
(VAP), surgical site infections (SSI),
Clostridium difficile
infection (CDI), and
catheter-associated urinary tract infections (CAUTI)) were $9.8 billion (95 %
confidence interval (CI) $8.3 to $11.5 billion) [
106
]. There has been an unprece-
dented movement for healthcare facilities to improve patient safety and certainly
prevention of HAI represents a major portion of that effort.
The process by which a patient acquires an infection while hospitalized is com-
plex. This has been elegantly illustrated and described by Dr. Weinstein (Fig.
4.1
),
highlighting the role of the patient's endogenous flora, exposure to exogenous flora,
as well as the influence of devices and pressure from antibiotic use [
101
]. Recent
development and implementation of strategies to prevent HAI have included such
efforts as antimicrobial stewardship, interrupting transmission of epidemiologically
important organisms, and infection specific prevention bundles; however, there is
renewed interest in defining the role of environmental contamination in transmission
of nosocomial pathogens and development of HAI.
Fig. 4.1 Hazards in the hospital (Adapted from the figure by Weinstein [
101
]). The complexity
and dynamic nature of the microbial pressure being introduced into the built clinical environment
is dependent on stochastic nature inherent to healthcare
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