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The hygiene of dependent patient involves multiple contacts between the patient, the healthcare professionalhealthcare professional and   the environment: whether it is during simple tasks of accompanying the patient (to the toilet or on the   commode) or for the maintenance or cleaning of the environment (toilets, sheets…). More specifically, the major acts of hygiene of the dependent patient concern the management of excreta, bed bath   and medical bedding.

These procedures performed on fragile and often immunocompromised people can easily be the source of various, potentially dangerous contaminations for the patient.

What are HAIs?

An healthcare-associated infection occurs at the beginning or at the end of a patient’s care (diagnostic, therapeutic, palliative, preventive, educational, operative) by a health professional, whether in a health care institution, a medico-social institution or at home.

These infections may be directly related to care (during an invasive procedure, for example) or occur during hospitalization, independently of any medical procedure (due to an epidemic episode, for example). When the patient’s infectious state on admission is unknown, the infection is classically considered nosocomial if it appears after 48 hours of hospitalisation.1

D’où proviennent les IAS ?

HAIs have multiple origins. There are several types of infections that are related to different transmissions:

  • Infections of “endogenous” origin for 40 – 60%2 of cases: the patient is infected with his own germs because of an invasive act and/or because of a particular
  • Infections of “exogenous” origin: cross-infections for 20 – 40%3 of cases, transmitted from one patient to another, and/or transmitted by healthcare professionalthe healthcare professional and/or infections linked to contamination of the environment in which the patient is located for 20% of cases.

These infections can be caused by several types of microbes:

  • 31,2% are multi-resistant bacteria (MRB)
  • 25% are highly resistant emerging bacteria (HBRE)
  • 15,3% are Clostridium difficile4.

 

The resistance of these bacteria to antibiotics has become a major public health issue since it is responsible for 700,000 deaths per year5

Healthcare associated infections vary according to four main criteria6 :

  • Type of establishment
  • Type of stay
  • Length of stay
  • The patient’s profile

 

Fragile patients are the most affected, such as the very old or very young, immunocompromised, exposed to invasive devices or who underwent surgery. In addition, the lack of mobility in the dependent patient can lead to decubitus-related risks, including pressure sores7 as well as incontinence due to restricted   mobility7 .

With significant social, economic and individual impacts, HAIs management is now a priority.

HAIs, which sources of propagation?

In order to reduce and control these HAIs, it is key to trace their origins.

And the excreta (i.e. faeces, urine, vomit) are recognized as the major source of the spread of healthcare-associated infections in dependent and/or bedridden patients. In order to control this risk of infection, it is essential to optimize the management of excreta in healthcare institutions, in nursing   homes and at home.

Excreta management

Body hygiene

Medical bedding

 

Sources :

[1] Santé.gouv : https://solidarites-sante.gouv.fr/soins-et-maladies/qualite-des-soins-et-pratiques/securite/infections-associees-aux-soins-ias/article/les-infections-nosocomiales-318585

[2] Widmer et al. Antimicrob Resist Infect Control (2021) 10:120 https://doi.org/10.1186/s13756-021-00956-1

[3] WHO, Health care-associated infections FACT SHEET

[4]  Sylvie Maugat et all., « Bilan 2001-2017 des signalements externes d’infections nosocomiales. Part des signalements impliquant une bactérie multi résistante, hautement résistante-émergente ou un clostridium difficile », article soumis le 30.11.2017

[5] https://www.pasteur-lille.fr/actualites/dossier-du-mois/les-medicaments/les-medicamentscontrer-resistance-antibiotiques-defi-scientifique/

[6] Infections nosocomiales : ces microbes qu’on  « attrape » à l’hôpital INSERM, URL au 04.02.2021 : https://www.inserm.fr/information-en-sante/dossiers-information/infections-nosocomiales.

[7] Syndrome d’immobilisation Corpus de Gériatrie – Janvier 2000

[8] Prévenir la dépendance iatrogène liée à l’hospitalisation chez les personnes âgées – HAS : Haute Autorité de santé, France 2 CNPG : Collège national professionnel de gériatrie, France.