A Patient & Physician's Guide to Healthcare Associated Infections

Patients visit hospitals and other medical care facilities to address health issues and receive treatment. Unfortunately, the exact environment designed to support their health can sometimes expose them to infections that make them more ill. Healthcare associated infections are a known risk of being in a healthcare setting and can pose serious problems for both patients and their care teams.

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Read on to learn about healthcare associated infections (HAIs), including their causes, symptoms, prevention, and when an HAI is grounds for medical malpractice claims.

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What Are Healthcare Associated Infections?

Healthcare associated infections (HAIs) are infections that develop during — or soon after — a patient gets treatment in a medical setting. These infections can range from mild to life threatening.

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According to the Centers for Disease Control and Prevention (CDC), on any given day, one out of every 31 hospital patients contracts an HAI. For residents of nursing homes, the rate is one in 43. Patients in surgical centers, dialysis facilities, and other settings are also at risk of HAIs.

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HAIs have a major impact on both affected patients and the healthcare system as a whole. Patients may suffer serious health complications, resulting in longer hospital stays and additional medical treatments. Hospitals bear an overall direct cost from HAIs that ranges from US$28 to $45 billion.

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Examples of Healthcare Associated Infections

Many types of healthcare associated infections exist, though some are more common than others. Some key HAIs for patients and healthcare providers to be aware of include the following:

• Bloodstream infections: When bacteria, viruses, or fungi enter the blood, they can cause septicemia (blood poisoning).
• Urinary tract infections: Urinary tract infections caused by catheter use are common HAIs. They can occur when a catheter, a tube that drains urine from the body, is contaminated.
• Surgical procedures: After surgery, the incision wound may become infected. Surgical site infections can also affect the area around an implant, like a replacement joint or a metal rod in a bone.
• Pneumonia: Hospital-acquired pneumonia is a lung infection that develops during a hospital stay, often after treatment with a ventilator (breathing machine).
• Gastrointestinal infections: Digestive tract infections may spread through healthcare settings, resulting in symptoms like diarrhea.

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What Is the Most Common Cause of Healthcare Associated Infections?

Healthcare associated infections are caused by a variety of bacteria, viruses, and fungi that spread in a healthcare setting. Methicillin-resistant Staphylococcus aureus (MRSA), a type of staph bacteria that can be resistant to many antibiotics, is one of the most common causes of HAIs. Another bacteria of note is Clostridioides difficile (C. diff), which causes about half a million HAIs yearly.

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How Are Healthcare Associated Infections Spread?

The pathogens that cause HAIs can spread through the air, through droplets released by coughs or sneezes, or through contact with a person or object. Some of the factors that may put patients at higher risk of contracting an HAI include:

• Contaminated equipment: Blood pressure cuffs, thermometers, wheelchairs, and other equipment shared among patients may transmit HAIs if they are not disinfected between uses.
• Contaminated environment: Frequently touched parts of hospital rooms, like tray tables, light switches, and bed rails, may harbor bacteria and viruses.
• Improper hand hygiene: Research shows that contamination of healthcare workers’ hands causes nearly one-third of HAIs (30%).
• Antibiotic resistance: Antibiotics are medicines that kill bacteria, but some bacteria have evolved to survive them. The resistant bacteria may cause outbreaks of HAIs.
• Prolonged hospital stays: Research shows that people who have more extended hospital stays are more likely to contract an HAI.
• Invasive procedures: Procedures that involve breaking the skin (like surgery) or inserting something in the body (like a catheter) may introduce pathogens that could lead to an infection.
• Weakened immune systems: People with weakened immune systems are less able to fight off viruses and bacteria.

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Symptoms & Diagnosis

A wide variety of healthcare associated infections exist, so the signs and symptoms of HAIs can vary depending on the specific infection a patient develops.

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Some common symptoms of HAIs include:

• Fever: A body temperature of 100°F or higher, measured by mouth, is considered a fever.
• Pain: Infections can cause pain in various areas, including the abdomen (stomach area) or flank (side of the body).
• Urinary changes: Pain with urination or urinating more often than normal can be a sign of an HAI.
• Skin changes: Rashes or areas of the skin that are red, swollen, and painful are cause for concern.
• Diarrhea: Diarrhea with HAIs can be watery, frequent, and may contain blood or pus.
• Breathing problems: Shortness of breath or a cough that produces phlegm can be a sign of HAIs.

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Doctors may suspect a patient has a healthcare associated infection if the patient presents with symptoms like those listed above. They will likely ask detailed questions about the patient’s symptoms and perform a comprehensive physical exam to confirm the diagnosis.

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Laboratory testing plays a vital role in diagnosing infections. Depending on the type of HAI the physician suspects, they may order blood tests, urine tests, stool tests, or sputum (phlegm) tests. Laboratory analysis of samples can determine which pathogens are present, if any.

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Preventing Healthcare Associated Infections

Research shows that as many as 70% of HAIs could be prevented with evidence-based control methods. Some of the standard methods that hospitals and other healthcare facilities use to protect patients from infections include:

• Strict hand hygiene protocols: The CDC recommends healthcare workers clean their hands with hand sanitizer or soap and water both before and after touching a patient. They may need to clean their hands as many as 100 times per shift.
• Sterilization of medical equipment: All equipment that has come in contact with body tissues or fluids, like surgical tools, must be sterilized to kill infection-causing viruses and bacteria.
• Environmental cleaning: Regular cleaning and disinfecting of patient areas may lower the rates of HAIs, studies have shown. That includes cleaning floors, beds, doorknobs, and other surfaces.
• Improving antibiotic practices: About 30% of the antibiotics prescribed in U.S. hospitals are unnecessary or suboptimal. Since the misuse of antibiotics allows bacteria to become resistant to the drugs, hospitals may create programs to improve prescribing.
• Patient and family education: Healthcare facilities can educate patients and their families about the importance of good hand hygiene while receiving treatment and the warning signs of an infection.
• Isolation procedures: To reduce the risk of spread, keeping patients with suspected or confirmed HAIs separate from other patients is key. Reusable equipment (like blood pressure cuffs) should be dedicated to a single isolation patient.

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Role of Healthcare Providers

Healthcare providers can improve patient safety and reduce the spread of infections by adhering to their employer’s infection prevention and control requirements.

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Since contamination of healthcare workers' hands is a significant cause of HAI spread, one of their most important responsibilities is practicing good hand hygiene. Many healthcare workers are already prioritizing hand hygiene, but there is room for improvement with hand washing compliance hovering around 50% at U.S. hospitals.

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Another critical responsibility for healthcare workers is pursuing continuing education to stay up-to-date on HAI prevention best practices. Many organizations offer infection prevention courses for healthcare providers, including the CDC.

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Legal Aspects: Can You Sue for HAIs?

Suing a physician or healthcare provider for a healthcare associated infection is an option. However, merely contracting an HAI in the hospital doesn’t mean a patient has been a victim of medical negligence or errors, and can thus sue their physician. Bad outcomes sometimes happen, without anyone being at fault. For an HAI to be grounds for a medical malpractice case, four elements must be present:

1. Duty of care: If a doctor-patient relationship exists, the doctor owes a duty of care to the patient. That includes the duty to provide at least the accepted medical standard of care, meaning the type of care a prudent, similarly skilled doctor would offer in similar circumstances.
2. Breach of duty of care: Doctors may breach the duty of care if they provide treatment that falls below the accepted medical standard. For example, neglecting to follow infection control protocols or failing to diagnose an HAI could be a breach.
3. Causation: Proving causation means showing that the doctor’s breach of the duty of care directly caused or worsened the HAI. That involves proving that the infection or its complications wouldn’t have happened without the doctor’s negligence.
4. Damages: Finally, the physician's negligence must have caused the patient actual harm. Examples of harm include financial costs like medical expenses and lost wages, or non-economic costs like pain and suffering.

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Patients have successfully filed HAI medical malpractice suits in the past, and some have been awarded significant judgments. For example, in 2023, a New York jury awarded a man $250,000 after finding he was mistakenly prescribed an antibiotic that caused him to develop a C. diff infection. The same year, a Michigan jury awarded almost $10 million to the estate of a woman who developed a surgical wound infection and later passed away.

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Finally, please note, while laws vary from place to place, keep in mind it is likely any lawsuit for an HAI will need to be filed before the local statute of limitations expires.

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The Role of Malpractice Insurance in HAI Cases

Insurance helps protect physicians and other medical professionals if a patient files an HAI-related medical malpractice lawsuit. It helps cover the legal costs of defending a medical malpractice claim, including attorney, court, and expert witness fees.

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Medical malpractice insurance also helps cover the costs of settling a lawsuit. That could include the cost of an out-of-court settlement or the cost of court-awarded damages following a trial. This crucial coverage helps protect physicians’ personal finances and the finances of their practice.

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Addressing HAI Concerns With Patients

When communicating with patients about HAIs, it’s essential to be clear and transparent. Start by explaining what HAIs are in layman’s terms, and encourage the patient to ask questions if there’s anything they don’t understand.

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Be honest about the potential risks of HAIs in healthcare settings to ensure the patient can make an informed decision about their treatment. However, be sure to reassure the patient about the infection control procedures that are in place to help reduce the risk.

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Patients have a role to play in preventing HAIs. Empower your patients with the knowledge to perform proper hand hygiene while in the hospital, and to recognize common signs of HAIs so they can seek prompt treatment.

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Patient education materials, such as brochures or fact sheets, may help address HAI concerns with patients. Physicians can also suggest reputable online resources, such as government websites like CDC.gov and MedlinePlus.gov.

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Ultimately, it’s important to remember that HAIs are often preventable but present a potentially serious risk of harm to patients. By focusing on awareness and prevention, healthcare facilities can promote a culture of patient safety and reduce the threat of HAIs. Physicians should consider taking advantage of the risk management resources offered by their medical malpractice provider.

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How Indigo Can Help

Indigo is a revolutionary medical malpractice insurance provider that helps physicians get the coverage they need, at the price they deserve. With the power of AI, physicians receive pricing tailored to their practice and easy access to coverage. Physicians also enjoy access to a third-party risk management helpline to receive confidential advice about managing the risk of HAI lawsuits.

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Get a quote today.

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