Sunday, March 1, 2015

On Hospital (Nosocomial) Infections

By Tereza Hubkova, M.D.

A major problem virtually all hospitals face is nosocomial infections—microbes you become infected with while or because of being in a hospital. Infections acquired in hospitals due to dangerous pathogens are more rampant than you might imagine. According to the federal Centers for Disease Control and Prevention, almost 100,000 patients in the United States die each year from hospital-acquired infections—more deaths than those from motor vehicle accidents, suicides, and homicides combined. Perhaps an even more staggering figure, more than two million patients per year develop infections during their hospital stay. That's approximately ten percent of all hospital admissions. Surgical site infections alone account for nearly 500,000 infections annually.

If you’ve visited a hospital recently, you likely noticed patient rooms with a red STOP sign at the door. You’re required to don all sorts of protective gear before entering these rooms. Such measures are taken to prevent the spread of infectious diseases from one patient to another. Unfortunately, these measures aren’t nearly effective enough. Hospital administrators recognize this, which is one of the reasons so many procedures are now being done on an outpatient basis. Inpatients (i.e., those admitted into a health care facility for an extended stay) are twice as likely to acquire an infection following a medical procedure versus their outpatient counterparts.

When I first entered residency training, isolation rooms were rarely used. We simply didn’t have the prevalence of antibiotic-resistant bacteria we do today. The problem lies with bacteria learning to outsmart our most modern antibiotics faster than the pharmaceutical industry can develop new ones. These bacteria trade resistance genes between each other as easily as kids trade the contents of their lunchboxes.

Bacterial antibiotic resistance can occur in animals as well. In fact, 90% of all antibiotics used in the U.S. are administered to livestock. Most commercially-raised animals are heavily dosed with antibiotics to treat or prevent infections caused by overcrowding of feedlots, poor nutrition (e.g., cows being fed corn instead of its natural food, grass), and unhealthy or inhumane methods of production and processing. Perhaps worse still, it is not far-fetched to believe that our ingestion and exposure to animal antibiotics may contribute to the disruption of our own healthy and protective intestinal microflora.

Since more and more procedures are being done on an outpatient basis, people in the hospital (i.e., inpatients) tend to be overall sicker these days—thus with weaker immune systems. Moreover, any invasive device inserted into any part of the body (e.g., intravenous catheter, urinary catheter, surgical drains, endotracheal tubes, etc.) serves as an invasion entrance route for bacteria as they bypass our body’s natural defense barriers. Use of immunosuppressive medications as well as various medications used to limit stomach acid (e.g., antacids) also contribute to the risk.

The two most worrisome bacteria in the world of hospital-acquired infections are: Methicillin-resistant Staphylococcus aureus (generally known as MRSA—pronounced MER-sa) and Clostridium difficile (also known as C. diff). Though it has garnered significant media attention over the years, the so-called flesh-eating disease (i.e., necrotizing fasciitis caused by Streptococcus pyogenes) is extremely rare.

Many bacteria coexist with humans without causing us harm and, in fact, are beneficial to our health (i.e., symbiotic). An example of such bacteria are the beneficial bacteria residing in our intestines—such as Lactobacilli and Bifidobacteria, plus as many as a thousand other species of intestinal microflora—most of which we have yet to even name. These good, probiotic bacteria are extremely beneficial for our digestive and immune systems. If you think you have mostly human cells in your body, you are very wrong. Surprisingly, we have about ten times more bacterial cells on or in our bodies than we have of our own cells—mostly in our intestines and on our skin. Like it or not, we are all a collection of human cells, bacteria, viruses (e.g., oncogenes in our DNA), and sometimes even parasites.

As opportunistic bacteria, we can perpetually host bad bacteria without ever succumbing to any disease caused by them. We refer to that state as being colonized. Colonization is not the same as infection, but under the right conditions (e.g., weakened immune system, poor nutrition, advanced aging, etc.) these colonizers will take advantage of a hobbled immune system, becoming more aggressive, multiplying, and, if left unchecked, eventually causing disease.

The invention of antibiotics was one of the biggest achievements of modern medicine, saving millions of lives every year. As collateral damage, however, antibiotics also destroy the helpful bacteria in our intestines. Taking an antibiotic is analogous to dropping a bomb on your intestinal friends. And often, we pay the price. Clostridium difficile, yeast overgrowth, and antibiotic-associated diarrhea are a few commonly known complications of antibiotic use. By killing good bacteria, antibiotics also trigger so called leaky gut syndrome, and increase the risk of breast cancer by up to 40%.

To minimize the collateral damage of antibiotics, I highly recommend taking oral probiotics whenever you take antibiotics. Start taking them as soon as possible, and continue for at least two weeks following your completed course of antibiotics. Sometimes including yogurt in your diet may suffice, especially if you only need one to three days of antibiotics for something relatively simple like a urinary tract infection, however, if you take a longer course of antibiotics, or antibiotics with a wider spectrum—meaning they kill a wider range of bacteria—, you will need something stronger than simple yogurt. As with any over-the-counter supplements, since they are not regulated by the FDA, choose one from a reputable company. Check out for the latest reviews and information on such supplements.

Because the number of beneficial intestinal bacteria can be suppressed by simple stress, whenever you must be admitted to a hospital, it may be a good idea to take probiotics preventively. There are plenty of studies demonstrating the beneficial effects and safety of probiotics. For instance, taking probiotics during pregnancy seems to lower the risk of allergic disorders (e.g., allergic dermatitis) in your baby. Women suffering from recurrent urinary tract infections have 40% less infections if they use vaginal probiotics. Breastfeeding women with mastitis (i.e., painful inflammation of the breast) see greater improvement with probiotics than with administered antibiotics. Plus, I firmly believe the probiotic to be better than an antibiotic when it comes to its effect on a nursing baby. Children receiving probiotics suffer less infectious diarrhea. Travelers taking probiotics are less likely to be afflicted with traveler’s diarrhea. Probiotics seem to have a beneficial effect on inflammatory bowel diseases such as ulcerative colitis and irritable bowel syndrome. And the list goes on….

I suspect that doctors, nurses, and visitors will continue to spread bacteria regardless of the precautions enacted. Washing your hands frequently and asking everyone to wash their hands before touching you is very important.

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