One in twenty hospitalized patients has at least one nosocomial infection, according to Public Health France (survey May-June 2017). We speak of nosocomial infection when a patient enters a hospital or a clinic without infection, and he “catches” one during his stay. 

From when do we consider the infection to be nosocomial?

More specifically, the infection is considered nosocomial if it appears after 48 hours of hospitalization. Because if it declares itself before this time, we will suspect that the infection was in incubation. For infections relating to the surgical site, they will be considered nosocomial if they appear within 30 days of the operation. This period can even be extended to one year when placing a prosthesis or an implant. Public Health France carries out a survey every 5 years.

Figures

Since 2012, the number of infected patients has not increased. But it did not decrease either, unlike the period 2006-2012, which had experienced a drop of 10%. “The most frequent infections are urinary tract infections (more than one infection in 4), infections of the surgical site, ie related to surgery (1/6), pneumonia (1/6) and bacteremia (more than one infection in 10) ”, indicates the public establishment.

The most frequent nosocomial infections

Urinary tract infections, the most common, are also often the most benign, even if they are uncomfortable. “Conversely, infections occurring for example during orthopedic surgery are more serious. “

They are eclectic. Here are the most common: 

• Prescribing too many antibiotics – again – is one reason;
• Poor hygiene, on the part of the staff and the patients themselves, is another;
• Age is a risk factor. “Patients aged 65 to 84 are 2,5 times more likely to be infected than others”, indicates Public Health France;
• Other populations at risk: immunocompromised people, newborns, in particular premature babies, and severe burns.
• Some services are also more at risk. In particular, intensive care units, where nearly one in 4 patients is a carrier of a nosocomial infection. “Patients with an invasive device (catheter, urinary catheter, respiratory assistance) have a risk of being infected 4,6 times greater than that of patients without an invasive device,” recalls Public Health France.
• Finally, on the podium of the bacteria most frequently responsible for a nosocomial infection, we find Escherichia coli (culprit in nearly a quarter of cases), which naturally lives in the intestines of each, staphylococcus aureus (13%), Enterococcus faecalis (6,5%).

The responsible germs most often come from the patient himself, especially if he has a particular vulnerability. It can also be contaminated by other patients in the hospital, by staff or by the equipment used.

At best, nosocomial infections cause discomfort. At worst, they can lead to serious complications, such as amputation, or even death. Some infections are extremely serious, such as lung infections and sepsis.

They would be more than 4000 to die of it each year in France. Between the two extremes, the whole range of possible and imaginable symptoms, including the most common:

• fever,
• chills,
• pain,
• cough,
• shortness of breath
• vomiting,
• headache,
• chest pain.

These symptoms vary depending on the location of the infection in the body.

The physical examination can sometimes be sufficient to make a diagnosis, when the symptoms “sign” the infection. But doctors often need additional tools to confirm their doubts, and identify the responsible bacteria (when there are any): urine dipstick and / or cyto-bacteriological examination of the urine (ECBU) for a urinary tract infection, radiography (for lung infection), etc.

The management varies enormously from one patient to another. Since a large part of nosocomial infections are caused by bacteria, antibiotics are often prescribed to stop these infections. In other cases, surgery will be necessary to treat the infectious focus.

Can these infections be avoided, or are they inevitable? Hospital pharmacist, president of the Committee for the Fight against Nosocomial Infections (CLIN) at the Côte Fleurie Hospital Center, Bénédicte Gosselin leads a daily fight to lower the numbers of nosocomial infections. “We train staff every day to improve practices and reduce infections,” she says.

All public and private health establishments are required to have a CLIN. They were created in 1988. To assess the situation, and implement corrective and preventive actions. “We pay particular attention to hand hygiene, with the use of hydro-alcoholic gel when entering and leaving the room. We also insist on the importance of not wearing varnish, or jewelry. This is also the case for thoroughly cleaning equipment, such as urinary catheters, or using antibiotics properly. “

Instructions may also be to wear gloves in case of contact with blood, or to disinfect equipment and surfaces between each patient. Before each invasive or surgical procedure, the nursing staff are required to follow strict protocols to limit the risks. With her team, Bénédicte Gosselin repeats the same instructions. Tirelessly. So that no one leaves the hospital sicker than they entered.