Prevention and Management of Hospital Acquired Infection

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In 2002 there were 1.7 million hospital acquired infection, or 4.5 per 100 admissions, resulting in some 99,000 deaths. The cost of this is estimated to be between 5-10 billion dollars a year. One third or more of hospital acquired infections are preventable.

Being in a hospital poses an infection risk caused by close contact with sick people, germs, and health care providers who touch sick patients. Frequent hand washing, use of gloves, surgical masks, HEPA filters, and isolation of infected patients have proven to reduce infection. Surgery also poses a risk of in fection even when precautions are taken.

It is important to recognize the signs of infection early, before it reaches the blood stream and the patient becomes septic. These signs may include fever, weakness, high white blood cell count, redness of the skin, breathing difficulty. Fever and a high white blood cell count are signs that the immune systems is working to fight the infection. However, patients who are immunosuppressed may not be able to fight the infection and therefore may not have fever or a high white blood cell count. Doctors should not be fooled into believing such absence means there is no infection. Although over use of antibiotics could reduce their effectiveness, it is important that the appropriate antibiotic in appropriate dosage be given without delay when a patient shows signs of infection. Cultures are done to identify the organism causing the infection. Cultures can be taken from the sputum, wound, surgical site, blood. Broad spectrum antibiotics are used for most organisms, and are often started to protect the patient who presents with signs of infection even before the culture results come in. There are some organisms which do not respond to broad spectrum antibiotics, but do respond to certain powerful antibiotics. MRSA is a particularly virulent hospital acquired infection which needs to be treated with vancomycin. Delay in or inadequate treatment can result in the infection entering the blood stream leading to sepsis. This is a very dangerous condition which can cause organ failure and may require that the patient be placed on a ventilator, which places the patient at additional risk of infection. It is important that the doctor stay ahead of the infection before it leads to sepsis. An infectious disease specialist should be consulted.

Infection may develop into an abscess. An abscess is a way the body protects itself my walling off infection. The problem is that antibiotics may not penetrate through the wall of the abscess to attack the infection. If antibiotics are not working the prudent doctor would do a sonogram or CT scan to look for the presence of an abscess, which can be surgically removed.

Infection can be caused by a breakdown of the tissue at the operative site. The surgeon needs to operate to remove dead tissue and drain the infected area. Sometimes a temporary colostomy is required so the colon is not contaminated by fecal material.

Weisfuse & Weisfuse LLP represents families of patients who have died of infection and sepsis due to the negligence of doctors and hospitals. Call us for a free consultation at 212 983 3000 or visit us at our website:

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