Exploring the prevalence, risk factors, and prevention strategies for infections acquired outside intensive care units
When we think of infections caught in hospitals, our minds often jump to the Intensive Care Unit (ICU). It's easy to imagine critically ill patients surrounded by complex machinery being vulnerable to complicated infections. But this perception overlooks a significant and often underappreciated reality: hospital-acquired infections (HAIs) are a formidable challenge throughout healthcare facilities, including general medical and surgical wards. Imagine a patient recovering from pneumonia in a general ward, a new mother in a maternity unit, or an elderly person in a long-term care facility—all can be susceptible to these unintended consequences of medical care.
HAIs affect patients across all hospital departments, not just ICUs, with significant impacts on general wards, maternity units, and long-term care facilities.
The World Health Organization recognizes HAIs as a global priority, affecting millions of patients annually worldwide 9 .
Hospital-acquired infections, also known as nosocomial infections, are defined as infections that patients develop 48 hours or more after admission to a healthcare facility, which were not present or incubating at the time of their arrival 9 . These infections represent one of the most common preventable adverse events across healthcare settings worldwide.
Most common route, via direct person-to-person contact or contaminated surfaces.
Spread through respiratory droplets or smaller particles suspended in air.
Via contaminated water, medications, or medical devices 9 .
Infections related to catheters, ventilators, and other medical devices.
Most common infection sites across hospital settings 9
Understanding the true scale of HAIs in non-ICU settings requires looking at comprehensive surveillance data from around the world. The evidence reveals that while the risk is generally lower than in ICUs, the absolute number of patients affected in general wards is substantial due to the larger patient volumes.
A systematic review of 44 studies found that the pooled prevalence of HAIs in ICUs was 28.22%, significantly higher than in other wards 7 .
A five-year surveillance study reported that the incidence density of HAIs in ICUs was 10.31 per 1000 patient-days compared to just 1.70 per 1000 patient-days in general clinics 4 .
European data showing HAI prevalence across different care settings 9
| Care Setting | Prevalence of HAIs | Notable Characteristics |
|---|---|---|
| Intensive Care Units | 19.2% 9 | Highest risk due to critical illness and invasive devices |
| Tertiary Hospitals | 7.1% 9 | Complex patient populations with severe conditions |
| Primary Care Hospitals | 4.4% 9 | Lower complexity but still significant risk |
| Long-term Care Facilities | 3.7% 9 | Vulnerable elderly population with prolonged exposure |
To understand the specific patterns and risk factors for HAIs outside ICUs, let's examine a detailed investigation conducted at a specialized infectious disease hospital in Chongqing, China, from 2017 to 2023 5 . This comprehensive study exemplifies the rigorous surveillance needed to capture the complete picture of hospital-acquired infections.
Distribution of HAIs across departments in a specialized hospital 5
Studying hospital-acquired infections in non-ICU settings requires specific methodological approaches and tools. Researchers and infection preventionists utilize a sophisticated arsenal to track, understand, and prevent these infections:
The ultimate goal of studying HAIs is preventing them. Research conducted in diverse healthcare settings has identified several effective strategies for reducing infections outside the ICU:
Structured sets of evidence-based practices implemented together. A national project in Brazil achieved reductions of 43.5% in bloodstream infections, 52.1% in pneumonia, and 65.8% in urinary tract infections 2 .
Simple yet remarkably effective. Improved hand hygiene practices among healthcare workers remain the cornerstone of HAI prevention, potentially reducing transmission by up to 50% 3 .
Judicious antibiotic use is crucial since antimicrobial exposure increases HAI risk 7.46-fold 5 . Effective programs promote appropriate antibiotic selection, dosing, and duration.
Enhanced cleaning protocols for frequently touched surfaces and shared medical equipment can reduce the bioburden of pathogens in the patient care environment 3 .
Reduction in HAIs through implementation of infection control bundles in a national project 2
Hospital-acquired infections beyond the ICU represent a significant yet often underestimated threat to patient safety. While the intense focus on critical care settings is justified by their high infection rates, the findings from general wards, specialized units, and long-term care facilities reveal that nowhere in the healthcare system is completely safe from this risk.
Combating hospital-acquired infections requires vigilance beyond the ICU doors. Through continued surveillance, adherence to evidence-based practices, and a commitment to safety at all levels of healthcare, we can work toward a future where patients receive the care they need without the added risk of preventable harm.