Skin and Infection FAQs

The following are frequently asked questions (FAQs) about skin and infections. The content is designed to act as a resource, giving you more information about skin, infections, and more specifically, healthcare-associated infections and surgical site infections and how they may potentially affect you.

Contents

 

What is a healthcare-associated infection (HAI)?

A nosocomial infection, otherwise known as a healthcare-associated infection (HAI), is an infection that a patient acquires after 48 hours of admittance but that he/she does not have at the time of admittance.6 A major source of HAIs is the introduction of naturally-occurring bacteria and other microorganisms on the skin into a patients bloodstream or surgical incision.3

 

What is a bloodstream infection (BSI)?

  • Bloodstream infections (BSIs) are the third leading cause of HAIs.
  • BSIs represent 19%4 of HAIs and have a mean cost for treatment of $36,441 (range $1,822 to $107,156).7
  • These infections have an attributable mortality rate of 12 to 25%.4 Because of how often these infections occur, BSIs have an attributable mortality rate of 12% to 25%.
  • Individuals contract 250,000 BSIs each year in the U.S., according to the Centers for Disease Control and Prevention. The majority of BSIs are catheter-related bloodstream infections (CRBSIs).
  • 60 percent of CRBSIs are caused by microorganisms from the patient’s skin.8 CRBSIs often originate in emergency rooms and intensive-care units, where 5.3 bloodstream infections occur per 1,000 days of central venous catheter insertion.9
  • CRBSI patients, on average, stay in the ICU for 20 days and in the hospital for 22 extra days with more than $56,000 increased hospital cost and more than $70,000 increased ICU cost.10
  • IV catheters are the devices most frequently used for providing fluids directly into the bloodstream. Although the incidence of local or BSIs associated with these devices is usually low, serious infectious complications produce a considerable number of deaths annually because of the frequency with which such catheters are used.
 

What are surgical site infections (SSIs)?

  • Surgical site infections (SSIs) are one of the leading causes of HAIs. In fact, individuals contract 500,000 to 780,000 SSIs in the U.S. annually.11,12
  • SSIs represent 22% of HAIs1 and have a mean treatment cost of $25,546 (range $1,783 to $134,602).7
  • SSIs result in at least 3.7 million additional days of hospitalization and cost $1.6 billion in hospital charges annually in the U.S.11
  • Certain surgical sites are more prone to infection13
  • SSIs not only impact a hospital’s bottom line, they can also have lasting effects on patients. When compared to patients without an infection, patients with SSIs are14:
    • Twice as likely to die.
    • Sixty percent more likely to be admitted to an Intensive Care Unit.
    • More than five times more likely to be readmitted after discharge.
    • More likely to experience a disability lasting longer than 60 months (an effect in almost 20 percent of all SSIs.)
 

Are they really that prevalent?

According to the Centers for Disease Control and Prevention (CDC), 1.7 million people per year acquire an HAI, which results in 99,000 deaths — the equivalent of one airline crash (or 271 people) each day.1

These infections not only have a personal impact on patients and their families, they also add to the nation’s rising healthcare costs. HAIs in the U.S. were estimated to cost $4.5 billion in 1995.4 A more recent estimate puts HAI economic impact at more than $17 billion a year.5

 

How could I acquire an HAI?

Nearly half of all HAIs are attributable to bloodstream infections (BSIs) and SSIs. The source of the pathogens leading to the infection may be the naturally-occurring bacteria on the patient’s skin. These microorganisms can enter the patient’s body or bloodstream in several ways8:

  • Surgery or a medical procedure that cuts or punctures the skin allowing bacteria on the skin’s surface to enter the bloodstream
  • Skin-to-skin contact with other individuals such as healthcare workers, other patients, or visitors who may transfer microorganisms
  • Medical equipment that may become contaminated during use, such as catheters, needles, or dressings, may allow bacteria to enter the body.
 

What are "staph" infections?

Staphylococcus aureus and Staphylococcus epidermis, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25-30 percent of the population is colonized (when bacteria are present, but not causing an infection) in the nose with staph bacteria. Staph infections, including MRSA, occur most frequently among people in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. Healthcare-associated staph infections can include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.

 

How can I avoid or prevent acquiring an HAI?

Hospitals and other healthcare facilities have developed extensive infection prevention and control programs to prevent HAIs. While hand washing is one of the most common preventive measures, it is not enough on its own. Medical experts also recommend the following action steps to help prevent an HAI:

  • Shower or bathe with antibacterial soap the night before and the morning of your surgery or procedure. Be sure to primarily focus on the location of surgery site.
  • Talk with your physician about what steps the hospital will take to prevent HAIs.
    • Those steps may include cleaning skin with an antiseptic prior to the surgery or procedure and applying the skin prep solution using an applicator that avoids skin contact between the patient and healthcare professional. The skin prep solution should be one that remains active in the presence of blood, serum, and other protein-rich biomaterials to resist recontamination of the patient’s skin and offer persistent antibacterial activity for at least 48 hours.
    • Observe hand washing and glove use of the healthcare professionals taking care of you. Don't be afraid to ask them to wash their hands again or to get a new set of gloves.

     

    With what surgeries am I more at risk to acquire an infection?

    Generally, patients undergoing longer surgeries have a higher risk of infection. However, patients undergoing any type of surgery or procedure where the skin is cut, punctured, or an abrasion exists, are also susceptible.

     

    What are the signs of an infection?

    Acquiring a fever is often the first sign of infection. Other symptoms and signs of infection include sore throat, rapid breathing, mental confusion, low blood pressure, reduced urine output, and a high white blood cell count.

    Furthermore, swelling, redness, and tenderness on the skin or around a surgical wound or other open wound are also a sign of a surgical site infection.

     

    Should I be concerned if I acquire an infection?

    If you notice any signs listed above or anything out of the ordinary, please contact your doctor immediately. Infections can progress rapidly to the destruction of deeper layers of muscle tissue. Read about a personal experience with an HAI.

    REFERENCES
    1 www.cdc.gov/ncidod/dhqp/hai.html Accessed October 10 2007
    2 www.cdc.gov/ncidod/dhqp/healthDis.html Accessed October 16 2007
         a. www.cdc.gov/hiv/topics/surveillance/basic.htm#ddaids Accessed October 16 2007
         b. www.cancer.org/downloads/STT/CAFF2005BrF.pdf Accessed October 16 2007
         c. www.car-accidents.com/pages/fatal-accident-statistics.html Accessed October 16 2007
    3 Mangram AJ, Moran TC, Pearson ML, Silver LC, Jarvis WR and The Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Surgical Site Infection, 1999; Infect Control Hosp Epidemiology. 20:250-278.
    4 Weinstein RA. Nosocomial infection update. Emerg Infect Dis. 4 1998:416-420.
    5 Bhutta A, Gilliam C, Honeycutt M, et al. Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ. 334 2007:362-365.
    6 State of Connecticut, Department of Public Health. An Act Concerning Hospital Acquired Infections. Issued April 1, 2007. www.ct.gov/dph/lib/dph/hisr/hcqsar/healthcare/pdf/healthcare_acquired_infections_2007.pdf
    7 Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control. 33 2005:501-509.
    8 Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Int Care Med. 2004;30:62-67.
    9 National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 32 2004:470-485.
    10 Dimick JB, Pelz RK, Consunji R, et al. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg. 136 2001:229-234.
    11 Martone WJ, Nichols RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis. 33 Suppl 2 2001:S67-68.
    12 Fletcher N, Sofianos D, Berkes MB, Obremskey WT. Prevention of perioperative infection. J Bone Joint Surg Am. 89 2007:1605-1618.
    13 Ostrander RV, Botte MJ, Brage ME. Efficacy of surgical preparation solutions in foot and ankle surgery. J Bone Joint Surg Am. 87 2005:980-985.
    14 Kirkland, K.B., Briggs, J.P., Trivette, S.L., Wilkinson, W.E., Sexton, D.J. (1999), "The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs", Infection Control and Hospital Epidemiology, Vol. 20 No.11, pp.725-30