Preventing healthcare-associated infection

Healthcare-associated infections (HAIs) are infections you might get while receiving treatment for medical or surgical conditions in settings such as hospitals, rehabilitation facilities and rest homes. 

HAIs are caused by micro-organisms (bugs or germs), most often bacteria, getting into your body. They can be associated with the devices used to provide your care, such as catheters or ventilators, or with having surgery. Examples of HAIs include wound infections, chest infections, urinary tract infections and bloodstream infections.

Anyone receiving treatment for medical or surgical conditions is at risk of HAIs, but some people are at greater risk, eg, young children, older adults and people with weakened immune systems.

Across Aotearoa New Zealand, healthcare providers follow best practices to reduce HAIs. Proper hand washing by everyone, including your healthcare providers and visitors, is the best way to prevent the spread of infection.

The following are examples of healthcare-associated infections.

Wound infections

These are also called surgical site infections. A surgical site infection is an infection that occurs after surgery in the part of your body where you've had the operation. Surgical site infections can sometimes be superficial, that is, they only involve your skin. Other surgical site infections are more serious and can involve tissues under your skin, your organs or things that have been implanted into your body during surgery, such as a joint replacement. Read more about surgical site infections(external link) and caring for surgical wounds at home.

Urinary tract infections

A urinary tract infection (UTI) can involve any part of your urinary tract, including your kidneys, ureters, bladder and urethra. UTIs are the most common hospital-associated infection. They're more common in older adults and in people who have a urinary catheter. A urinary catheter is a thin tube used to empty your bladder if you can't pass urine (pee, mimi) naturally. Read more about urinary catheters.

Chest infections 

Infections that affect 1 or both lungs can occur – this is called pneumonia. Anyone can get pneumonia, but some factors may increase your risk, such as having chronic lung disease, being fed through a tube or being on a ventilator. Read more about pneumonia.

Bloodstream infections

Bloodstream infections, also known as septicaemia, are rare but can be associated with infections anywhere in your body. They can also happen when germs enter your bloodstream through an intravenous (IV) line. There are 2 main types of IV lines: peripheral and central.

• A peripheral line is a catheter (a very thin, flexible tube) that's inserted into a small vein in your arm, hand, leg or foot. This is done to give fluids or medicines directly into your bloodstream. The IV is held in place with tape or a type of bandage.
• A central line is a catheter that doctors often place in a large vein in your neck, chest or groin to give medicines or fluids or to collect blood for medical tests. Central lines are commonly used in intensive care units and can remain in place for weeks or months.

If any of these infections spread throughout your body they can cause an immune response and widespread inflammation that can result in organ damage or failure and sometimes death. This is known as sepsis and it’s a medical emergency.

Anyone admitted to hospital is at some risk of getting an HAI. If you’re very sick or you’ve had surgery you have an increased risk of getting an HAI, and some other groups are also more at risk than others, including:

• premature babies or very sick children
• older adults or frail people
• people with certain medical conditions, such as diabetes
• people with a weakened immune system, such as those receiving treatment with chemotherapy or steroids.

Other factors that may increase your risk of getting an HAI

• A long hospital stay, eg, if you're admitted to hospital for complex or multiple illnesses.
• The type of surgery you have – some surgeries have a higher risk of HAI than others.
• Poor hand hygiene practices by hospital staff and patients.
• Having an invasive procedure that bypasses your skin, which is your body's normal protective layer. Examples are insertion of urinary catheters, IV cannulas, respiratory equipment and drainage tubes
• Having some sort of damage to your skin, such as wounds, incisions (surgical cuts), burns and ulcers. Broken skin is more open to infection than intact skin.

HAIs are treated with antibiotics which are usually effective. Sometimes the infection can be serious and life threatening. Some bacteria are hard to treat because they don't respond to to regular antibiotics. These bacteria are said to be resistant to these antibiotics and are sometimes called 'super bugs’. Read more about antibiotic resistance.

HAIs can have a significant impact on patients and their families. People who get HAIs are:

• likely to spend longer in hospital
• more likely to be admitted to a hospital's intensive care unit
• more likely to be admitted to hospital again.

Across Aotearoa New Zealand, healthcare providers are following best practice guidelines to help prevent HAIs. These include:

• staff cleaning their hands with soap and water or an alcohol-based hand rub before and after caring for every patient
• catheters being used only when necessary and removed as soon as possible
• cleaning the surgical site or the skin where a catheter is being inserted 
• wearing hair covers, masks, gowns and gloves when appropriate.  

However, the risk of infection can never be completely removed and some people have a higher risk of acquiring an infection than others. For examples of national initiatives follow the links below:

• Health Quality & Safety Commission New Zealand(external link)
• Health New Zealand | Te Whatu Ora(external link)

You and your whānau can help by making sure you're doing as much as possible to avoid HAIs. Here are some suggestions.

Before you go to hospital

• Tell your healthcare provider about other medical problems you may have. Health problems such as diabetes could affect your surgery and your treatment. Also tell them if you've been unwell recently, such as with a cold or the flu, which could lead to a chest infection.
• If you have diabetes, try and manage it so that your blood glucose levels are under control.
• Quit smoking. People who smoke get more infections. Talk to your healthcare provider about how you can quit before your surgery or contact Quitline(external link) (call 0800 778 778 or text 4006).
• Try to stay at a healthy weight. People who are overweight are more prone to infection.
• Get the flu vaccine before surgery to reduce your risk of getting the flu. 
• Don’t shave the area near where you’ll have your surgery. Shaving with a razor can irritate your skin and make it easier for an infection to develop. If necessary, healthcare staff should remove any hair using electric clippers instead.

While you're in hospital

• Proper hand washing is the best way to prevent the spread of infection. Everyone visiting a patient must wash their hands or use an alcohol-based hand rub before and after every visit. Read more about hygiene and hand washing. Don’t be afraid to ask nursing and medical staff whether they've cleaned their hands before they touch you. You should also clean your own hands often, especially after using the toilet and before and after touching any wounds you may have.
• Recognise the signs any symptoms of infection such as a fever or chills, shivering, muscle pain, diarrhoea (runny poo) and feeling unwell. Tell your doctor or nurse immediately if you get these symptoms. Tell them also if you develop signs of infection – redness, pain or swelling at the site of an IV catheter or surgical wound, or cloudy fluid in a drainage tube.
• If you have loose or dirty dressings, or feel like a tube or catheter is out of place tell your nurse.  
• Allow people to clean your room.
• If you've been prescribed antibiotics, take than as directed and report any side effects to your healthcare provider. Don't stop taking them by yourself.
• Prevent the spread of illness by asking friends and family not to visit if they're feeling unwell, and covering your mouth and nose if you cough or sneeze. Read more about how to cough and sneeze properly.
• Read more about preventing infection after surgery(external link).

Apps reviewed by Healthify

You may find it useful to look at some diabetes apps, quit smoking apps and nutrition, exercise and weight management apps.

Video: 5 tips for patients

(CDC, US, 2014)

If you do get an infection in hospital, you’ll be given appropriate antibiotic treatment. You may also be moved to a single room with your own bathroom and/or nursed by staff wearing gloves and gowns. This is to stop the spread of infection to other patients.