Other healthcare associated infections

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This information is written for patients, carers and members of the public affected by healthcare associated infections. It answers some of the questions we are frequently asked and signposts other trusted resources offering information on the diagnosis, treatment and what can be done to help reduce the spread of healthcare associated infections.

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What are healthcare associated infections?

Healthcare associated infections, often abbreviated as HCAI, occur as a result of treatment in a hospital or anywhere you receive healthcare, which could be in a surgery, at home or in a nursing home or care home.

Anyone in need of healthcare may be vulnerable to getting an infection, and many healthcare associated infections can be avoided. This can include keeping the number and duration of invasive procedures to a minimum, and paying attention to good hand-hygiene and thorough aseptic techniques. A clean environment can also help in the prevention and control of any outbreaks of healthcare associated infections.

If you have a healthcare associated infection, the bacteria (or germs) that gave you symptoms are often used to describe the infection, such as MRSA or C.diff. Sometimes there may be more than one germ involved. This page acts as a signpost for more detailed descriptions of the bacteria that can cause invasive infections - these are regularly updated by Public Health England, who monitor healthcare associated infections.

What parts of the body are affected by healthcare associated infections?

Healthcare associated infections can affect any part of the body including the bloodstream. This is known as invasive infection.

Signs that you may have an invasive infection include:
-fever, which is a high temperature of 38C or 100.4F or above
-chills
-a general sense of feeling unwell
-dizziness
-confusion
-muscular aches and pains
-pain, swelling and tenderness in the affected body part

Types of infection that you may have heard of are described here, but this is not an exhaustive list.

What is a bloodstream infection?

If you have a bloodstream infection this means you have bacteria (or germs) in the blood with signs of infection. If this is described as a 'primary' bloodstream infection this means it has been transmitted directly into the bloodstream, perhaps by a catheter or an IV line. If it is described as a 'secondary' bloodstream infection this means it has spread to the bloodstream from somewhere in the body, perhaps from the urinary tract, or a surgical wound. Bacteraemia is a term used to describe the presence of bacteria in the blood.

Bloodstream infection is also known as sepsis.

What is sepsis?

Sepsis is a common and potentially life-threatening condition triggered by an infection. In sepsis, the body’s immune system goes into overdrive, setting off a series of reactions including widespread inflammation, swelling and blood clotting. This can lead to a lowering of the blood pressure, which can mean the blood supply to vital organs such as the brain, heart and kidneys is reduced. If not treated quickly, sepsis can eventually lead to multiple organ failure and death.

Each year in the UK, it is estimated that more than 100,000 people are admitted to hospital with sepsis and around 37,000 people will die as a result of the condition.

Early symptoms of sepsis usually develop quickly and can include:
-a high temperature (fever)
-chills and shivering
-a fast heartbeat
-fast breathing

In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop soon after. These can include:
-feeling dizzy or faint
-confusion or disorientation
-nausea and vomiting
-diarrhoea
-cold, clammy and pale or mottled skin

When to seek medical advice:
See your GP immediately if you have recently had an infection or injury and you have possible early signs of sepsis. Severe sepsis and septic shock are medical emergencies. If you think that you or someone in your care has one of these conditions, call 999 and ask for an ambulance.

Sources of information about sepsis can be found on NHS Choices website (Page last reviewed: 21/03/2014, Next review due: 21/03/2016)

What is a surgical site infection?

Surgical site infection, also often abbreviated as SSI, can be defined as being present when germs multiply in a wound causing local signs and symptoms, for example heat, redness, pain and swelling, and, in more serious cases, signs of fever or a raised white blood cell count. The infection may prevent healing taking place so that the wound edges separate or it may cause an abscess to form in the deeper tissues. More serious deep infections of the body's organs and surrounding tissue can also be described as surgical site infections.

More information is available in the NICE guide Prevention and treatment of surgical site infection, published in 2008 and referenced at the bottom of this page.

What is a urinary tract infection?

A urinary tract infection occurs when bacteria or germs have invaded the urinary tract, the name given for the organs involved in the production and excretion of urine, and symptoms of infection are present. It is quite normal for elderly persons to have bacteria in the urine and the presence of bacteria does not mean that there is an infection if there are no symptoms. If there are no symptoms a person does not need antibiotics. Urinary tract infections are most often caused by bacteria from the stomach or intestines, most commonly E.coli. It can also be caused by germs that have been introduced to the bladder or urine by a catheter. This is known as a catheter-associated urinary tract infection, often abbreviated to read CAUTI.

Pain and frequency of urination, feeling unwell or blood in the urine can be some of the symptoms. Some people are more vulnerable to complications if they have a urinary tract infection, so it is always advisable to seek medical advice if there are signs of infection.

More information on symptoms and the treatment your doctor is likely to prescribe are published in the NICE guidelines:

Urinary tract infection: diagnosis, treatment and long-term management of urinary tract infection in children - Clinical guidelines, CG54 - Issued: August 2007

The management of lower urinary tract symptoms in men - Clinical guidelines, CG97 - Issued: May 2010

Urinary tract infection (lower) in women - Last revised in November 2014

What are respiratory infections?

Respiratory infections describe the presence of symptoms or signs caused by germs that have invaded the respiratory tract, a term to describe the lungs, wind pipe, nose and throat. Symptoms include cough, sputum and sneezing, and are more likely to be caused by a virus rather than bacteria. The common cold and influenza are respiratory infections and in people that are normally fit and well, should not cause any serious risk to health.

Respiratory infections associated with healthcare are often related to the lungs and chest and can include pneumonia. Patients who are on a ventilator and have a tube placed into their mouth, nose or through the neck and down into their windpipe can be vulnerable to pneumonia, this is known as ventilator-associated pneumonia, often abbreviated as VAP. Healthcare professionals should make sure these patients are sitting up or leaning back supported for as much of the time as possible. This will not be appropriate for all patients, for example, those with injuries to the spine. Making sure an antiseptic is included as part of the mouth care routine for patients on ventilators can also help to prevent infection.

More information on symptoms and the treatment your doctor is likely to prescribe are published in the NICE guidelines:

Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care - Clinical guidelines, CG69 - Issued: July 2008

Technical patient safety solutions for ventilator-associated pneumonia in adults - Patient safety solutions pilot, PSG002 - Issued: August 2008

What are skin and soft tissue infections?

Skin and soft tissue infections occur as a result of germs entering the tissues of the skin and related body tissues, often at the site of damage such as a sore, ulcer or cut to cause symptoms such as redness, swelling and /or pus. Skin infections can cause symptoms such as boils or abscesses - painful, pus-filled lumps on the surface or just under the skin. This can lead to impetigo, which forms a crust on the skin, or cellulitis, which causes redness, swelling and pain in the skin and underlying tissue. In some cases an invasive infection can develop as a complication of a skin infection.

Minor skin and soft tissue infections, such as smaller boils or abscesses, may only require a treatment called incision and drainage. Incision and drainage involves piercing the tip of the boil or abscess with a sterile needle or scalpel. This encourages the pus to drain out, which should help relieve pain and stimulate the recovery process. Before having the procedure, you are likely to be given a local an anesthetic to numb the affected area.

More extensive skin infections, such as cellulitis (an infection of the underlying layers of skin), will usually require a 5 to 10-day course of antibiotic tablets. It is hard to predict what antibiotic you will be given. The choice depends on the result of testing and, in some cases, what part of the country you live in.

Further information

Further information on the bacteria that cause healthcare associated infections can be found on Public Health England's website using the A to Z index

Details of monitoring reports for healthcare associated infections are also available on Public Health England's website

Further guidance for healthcare practitioners and patients is available on the NHS Choices website and

Infection: prevention and control of healthcare-associated infections in primary and community care - NICE Clinical guidelines, CG139 - Issued: March 2012

National Institute for Health and Care Excellence (NICE) quality standard [QS113]: Healthcare-associated infections - Published date: February 2016

National Institute for Health and Care Excellence (NICE) quality standard [QS110]: Pneumonia in adults - Published date: January 2016

References

English National Point Prevalence Survey on Healthcare-Associated Infections and Antimicrobial Use, 2011

Antimicrobial resistance and healthcare-associated infections 2010 - European Centre for Disease Prevention and Control

National Institute for Health and Care Excellence (NICE): Surgical site infection: Prevention and treatment of surgical site infection - clinical guidelines [CG74] - Published date: October 2008

National Institute for Health and Clinical Excellence: Prevention and control of healthcare-associated infections quality improvement guide [PH36]:- Published date: November 2011

National Institute for Health and Care Excellence (NICE): Infection Control Quality Standard [QS61]: - Published date: April 2014

National Institute for Health and Care Excellence (NICE): Urinary tract infections in adults Quality standard [QS90] Published date: June 2015

Content written 18/02/16
Review due 18/02/19

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