Preventing healthcare-associated infection

Healthcare-associated infections (HAIs) are infections you can get while receiving treatment for medical or surgical conditions. HAIs can occur in settings such as in hospitals, rehabilitation facilities and rest homes. Infections are caused by germs getting into your body. They can be associated with the devices used to provide care, such as catheters or ventilators, or with having surgery.

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 infections involving your skin only. Other surgical site infections are more serious and can involve tissues under your skin, organs or implanted material. 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 are more common in older adults and in people with a urinary catheter. A catheter is a thin tube used to empty your bladder if you are unable to pass urine (pee, mimi) naturally. Read more about urinary catheters.

Chest infections 

Infections that affect one or both lungs can occur (called pneumonia). Anyone can get pneumonia but some factors may increase your risk, such as having chronic lung disease, receiving food through a tube or being on a ventilator. Read more about pneumonia.

Bloodstream infections

Bloodstream infections (also called 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 two main types of IV lines: peripheral and central.

• A peripheral line is a catheter (a very thin, flexible tube) that is 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 secured 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 medication 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.

Read more about septicaemia.

All people admitted to hospital are at some risk of contracting an HAI. If you are very sick or have had surgery, you have an increased risk. Some people are more vulnerable 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.

There are other risk factors that may increase your risk of acquiring an HAI. These include:

• increased length of stay – a long hospital stay can increase your risk of HAI, eg, if you are admitted to hospital for complex or multiple illnesses
• type of surgery – some surgeries pose a higher risk than others
• hand hygiene techniques – poor hand hygiene practices by hospital staff and patients may increase your risk
• invasive procedures – some procedures that bypass your body’s normal protective layer, the skin, can introduce infection into your body, eg, insertion of urinary catheters, IV cannulas, respiratory equipment and drain tubes
• non-intact skin – wounds, incisions (surgical cuts), burns and ulcers are more prone to infection than intact skin.

HAIs are treated with antibiotics and usually respond well. Sometimes the infection can be serious and life threatening. Some bacteria are hard to treat because they are resistant to regular antibiotics. These bacteria 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 a longer time in hospital and they are more likely to need admission to a hospital's intensive care unit and be readmitted after discharge. 

Across New Zealand, healthcare providers are adhering to best practices to reduce HAIs. This includes:

• 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 skin where the catheter is being inserted or the surgical site
• wearing hair covers, masks, gowns and gloves when appropriate.  

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

• Health Quality & Safety Commission New Zealand(external link)
• Important information for heart surgery patients(external link) Auckland Hospital

You and your family can help make sure you are doing as much as possible to keep you safe from HAIs. Here are some suggestions.

Before admission to hospital

• Tell your doctor about other medical problems you may have. Health problems such as diabetes could affect your surgery and your treatment. Also tell your doctor if you have been unwell recently, eg, with a cold or the flu, which can lead to a chest infection.
• If you have diabetes, try and manage it so that your blood sugar levels are under control.
• Quit smoking. People who smoke get more infections. Talk to your doctor about how you can quit before your surgery.
• Maintain a healthy weight. People who are overweight are more prone to infection.
• Get the flu vaccine before surgery to reduce the risk of getting the flu. 
• Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection.

While in hospital

• Hand washing: proper hand washing is the best way to prevent the spread of infection. Everyone visiting the 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 have cleaned their hands before they touch you.
• Recognise the signs of infection:  such as a fever or chills, shivering, muscle pain, runny poos (diarrhoea) and feeling unwell. Tell your doctor immediately if you get these symptoms or if you develop signs of infection (such as redness, pain, swelling) at an IV catheter or surgical site.  
• Read more about preventing infection after surgery(external link).

Also see staying safe before and after surgery.

Video: 5 tips for patients

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(CDC, US, 2014)

If you do get an infection in hospital, measures (apart from antibiotic treatment) may be put in place to stop the spread of the infection to other patients. Depending on the type of infection, this might include:

• being moved to a single room with your own bathroom
• being nursed by staff wearing gloves and gowns.