Felis ISSN 2398-2950

Hospital-associated infections

Synonym(s): Hposital-acquired infections; Nosocomial infections

Contributor(s): Sarah Binns, Karen Coyne, J Scott Weese

Introduction

  • Hospital-associated, or nosocomial, infections are infections that occur in response to hospitalization.
  • Hospital-associated infections (HAIs) may be endogenous or exogenous.
  • They may develop from the endogenous flora of the patients or from exogenous microorganisms acquired from the environment or other animals or personnel during hospitalization.
  • Veterinary personnel are considered the most common mode of transport for hospital-associated infections.
  • Infections are considered as hospital-associated if they first appear 48 hours or more after hospital admission or within 30 days after discharge. This cutoff is somewhat subjective, but it is widely used in human and veterinary medicine to determine the source of infections once hospitalized.
  • Not all infections that develop during hospitalization are hospital-associated. Some cats maybe incubating community-associated infections, which are expressed after admission.
  • Generally, infections that occur within 48 h of admission to a hospital are considered community-associated, however it is possible that some hospital-associated infections could develop within this timeframe and that some community-associated infections could take longer to develop.
  • Similarly, not all hospital-associated infections are noticed during hospitalization. Cats can be infected while in hospital but not develop clinical signs of infection until after discharge. Typically, infections that occur within a certain period of time (~30days) of discharge from hospital are considered hospital-associated/community-onset infections. 
  • Hospital associated infections are of particular concern because the patients immunity may be compromised by underlying disease, drugs, surgery, invasive supportive care, malnutrition or stress.
  • Cats can be exposed to a variety of infectious agents in veterinary hospitals including those from contaminated environments, veterinary personnel or other infected animals.
  • Hospital-associated infections are an inherent risk of hospitalization. Development of a hospital-associated infection does not necessarily indicate a poor quality veterinary clinic. A certain percentage of hospital-associated infections are considered non-preventable and would occur despite the best infection control program. Infection control programs are designed to reduce the preventable fraction of hospital-associated infections. 
  • Organisms endemic to the hospital environment often show multiple drug resistances Resistant bacterial infections and may lead to outbreaks of infection. Examples include multi drug resistant E.coli  Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA) Methicillin-resistant Staphylococcus aureus.
  • Hospitals for all species contain individuals of varying levels of susceptibility and animals are often crowded together in a situation in which they are likely to encounter agents of infectious disease.
  • For details of biosecurity and infection control procedures used in small animal hospitals, see Biosecurity and Infection control Biosecurity and infection control.
  • Hospital-based human epidemics of staphylococcal infections, including multi-resistant strains, have been reported since the 1950s and encouraged the development of hospital infection control policies.
  • Hospital-associated infections are an important cause of morbidity and mortality in humans. As medical advances in human medicine lead to increased survival from serious diseases, there still remains those that are immunocompromised and with increasing numbers of hospital visits, hospital-associated infections become a greater risk.
  • Similarly, advances in small animal medicine have resulted in more invasive procedures, such as intravenous and urinary catheters, advanced surgical procedures, an increase in duration of hospitalization, an increase in intensive care practices, and the increased use of antimicrobial drugs Therapeutics: antimicrobial drug, all of which inherently increase the risk of hospital-associated infection. 
  • Many different organisms have been implicated in hospital associated infections of cats. Some are thought to be intrinsically pathogenic, such that a certain number of animals exposed to the pathogen will develop clinical signs. Eg feline herpesvirus Feline herpesvirus disease or feline calicivirus Feline calicivirus disease, which can exist in a small number of carrier animals but can cause clinical illness in a proportion of the population, particularly in stressed animals.
  • Other organisms that might be considered normal resident flora on the skin, in the upper respiratory tract, or in the gastrointestinal tract can become pathogens that is if they gain access to normally sterile parts of the body, if they become a dominant organism (as in bacterial overgrowth), or if they are resistant to antimicrobial drugs Feline herpesvirus disease.
  • Common nosocomial infections in cats in the veterinary hospital include surgical wound infections, infectious upper respiratory tract disease (URTD), and urinary tract infections
  • Although the control of infectious diseases in small animal hospitals focusses on contagious infectious diseases, such as URTD Viral-induced upper respiratory tract disease, more recently the control of zoonotic infectious diseases such as MRSA have taken precedent.
  • Some hospital-associated infections are highly contagious, often brought in by infected cats, and appear as epidemics, for example URTD, caused by feline herpesvirus (FHV) and/or feline calicivirus (FCV) or virulent systemic disease caused by FCV (FCV-VSD) Feline calicivirus (new strains).
  • Others are caused by agents already present in cats and veterinary personnel and which can contaminate the hospital environment, eg MRSA.
  • Many of the problems found in small animal hospitals are similar to, and have similar risk factors to those widely reported in human hospitals, such as hospital-associated infections involving MRSA.

Surveillance and monitoring of hospital-associated infections

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Hospital-associated infections in small animal practice

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Hospital-associated post-operative wound infections

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Hospital-acquired urinary tract infections

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Hospital associated blood-stream infections

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • Gibson J S, Cobbold R N, Trott D J (2010) Characterization of multidrug-resistant Escherichia coliisolated from extraintestinal clinical infections in animals. J Med Microbiol 59(Pt 5), 592-598 PubMed.
  • Gow A G, Gow D J, Hall E J, Langton D, Clarke C, Papasouliotis K (2009) Prevalence of potentially pathogenic enteric organisms in clinically healthy kittens in the UK. J Feline Med Surg 11(8), 655-662 PubMed.
  • Philbey A W, Brown F M, Mather H A, Coia J E, Taylor D J (2009) Salmonellosis in cats in the United Kingdom: 1955 to 2007. Vet Rec 164(4), 120-122 PubMed.
  • Reynolds B S, Poulet H, Pingret J L, Jas D, Brunet S, Lemeter C, Etievant M, Boucraut-Baralon C (2009) A nosocomial outbreak of feline calicivirus associated virulent systemic disease in France. J Feline Med Surg 11(8), 633-644 PubMed.
  • Weese J S, Finley R, Reid-Smith R R, Janecko N, Rousseau J (2009) Evaluation of Clostridium difficilein dogs and the household environment. Epidemiol Infect 2,1-5 PubMed.
  • Benedict K M,  Morley P S, Van Metre D C (2008) Characteristics of biosecurity and infection control programs at veterinary teaching hospitals. JAVMA 233, 767-773 PubMed.
  • Clooten J, Kruth S, Arroyo L, Weese J S (2008) Prevalence and risk factors for Clostridium difficile colonization in dogs and cats hospitalized in an intensive care unit. Vet Microbiol 129(1-2), 209-214 PubMed.
  • McLean C L, Ness M G (2008) Meticillin-resistant Staphylococcus aureus in a veterinary orthopaedic referral hospital: staff nasal colonisation and incidence of clinical cases. J Small Anim Pract 49(4), 170-177 PubMed.
  • Middleton J R, Fales W H, Luby C D, Oaks J L, Sanchez S, Kinyon J M, Wu C C, Maddox C W, Welsh R D, Hartmann F (2005) Surveillance of Staphylococcus aureus in veterinary teaching hospitals. J Clin Microbiol 43(6), 2916-2919 PubMed.
  • Wright J G, Tengelsen L A, Smith K E, Bender J B, Frank R K, Grendon J H, Rice D H, Thiessen A M, Gilbertson C J, Sivapalasingam S, Barrett T J, Besser T E, Hancock D D, Angulo F J (2005) Multidrug-resistant Salmonella Typhimurium in four animal facilities. Emerg Infect Dis 11(8), 1235-1241 PubMed.
  • Cherry B, Burns A, Johnson G S, Pfeiffer H, Dumas N, Barrett D, McDonough PL, Eidson M (2004) Salmonella Typhimurium outbreak associated with veterinary clinic. Emerg Infect Dis 10(12), 2249-2251 PubMed.
  • Duquette R A, Nuttall T J (2004) Methicillin-resistant Staphylococcus aureus in dogs and cats: an emerging problem? J Small Anim Pract45(12), 591-597 Review PubMed.
  • Eugster S, Schawalder P, Gaschen F, Boerlin P (2004) A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg 33(5), 542-550 PubMed.
  • Johnson J A (2002) Nosocomial infections. Vet Clin North Am Small Anim Pract 32(5), 1101-1126 PubMed.
  • Boerlin P, Eugster S, Gaschen F, Straub R & Schawalder P (2001) Transmission of opportunistic pathogens in a veterinary teaching hospital. Vet Microbiol 82(4), 347-359 PubMed.
  • Weese J S, Staempfli H R, Prescott J F (2000) Isolation of environmental Clostridium difficile from a veterinary teaching hospital. J Vet Diagn Invest 12(5), 449-452 PubMed.
  • Brown D C, Conzemius M G, Shofer F &  Swann H (1997) Epidemiologic evaluation of postoperative wound infections in dogs and cats. JAVMA 210, 1302-1306 PubMed.
  • Murtaugh R J & Mason G D (1989) Antibiotic pressure and nosocomial disease. Vet Clin North Am Small Anim Pract 19,1259-1274.
  • Romatowski (1989) Prevention and control of surgical wound infection. JAVMA 194, 107-114.
  • Vasseur P B, Levy J, Dowd E & Eliot J (1988) Surgical wound infection rates in dogs and cats. Vet Surg 17, 6064. 
  • Bodey G P, Bolivar R, Fainstein V, Jadeja L (1983)  Infections caused by Pseudomonas aeruginosa. Rev Infect Dis 5(2), 279-313.
  • Glickman L T (1981) Veterinary nosocomial (hospital-acquired) Klebsiellainfections. J Am Vet Med Assoc 179(12), 1389-1392 PubMed.

Other sources of information


ADDED