Disease from hospital. Hospital-Acquired Infections: 5 Most Common HAIs and Their Impact on Patient Health

04.07.202327.06.2023 by alexxlab

What are the 5 most common hospital-acquired infections. How do HAIs affect patient outcomes and healthcare costs. What measures can be taken to prevent the spread of nosocomial infections.

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Understanding Hospital-Acquired Infections (HAIs): A Growing Concern in Healthcare

Hospital-acquired infections (HAIs), also known as healthcare-associated infections, pose a significant threat to patient safety and healthcare quality. These infections are typically not present or incubating at the time of admission and usually manifest 48 hours after hospitalization. The impact of HAIs on healthcare systems is substantial, with agencies like the National Healthcare Safety Network (NHSN), National Institute of Health and Care Excellence (NICE), and the Centre for Disease Control and Prevention (CDC) closely monitoring their prevalence.

In England alone, NICE reports that approximately 300,000 people are diagnosed with HAIs annually, resulting in an estimated cost of Â£1 billion to the NHS. These infections often arise from contaminated equipment, materials, or cross-contamination within hospital settings. As we delve deeper into this critical issue, we’ll explore the five most common types of HAIs and their causative pathogens.

Respiratory Tract Infections: The Leading Cause of HAI-Related Deaths

Respiratory tract infections, particularly pneumonia, stand out as one of the most prevalent and dangerous hospital-acquired infections. Hospital-acquired pneumonia affects 0.5% to 1.0% of hospitalized patients and is the most common healthcare-associated infection contributing to death.

Key Facts About Hospital-Acquired Pneumonia:

Increases hospital stay by approximately 8 days
Mortality rate ranges from 30% to 70%
Common causative agents include Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and other non-pseudomonal Gram-negative bacteria
Early-onset pneumonia (less than 5 days after admission) is often caused by Streptococcus pneumoniae
Late-onset pneumonia (more than 5 days after admission) is typically caused by hospital-acquired microorganisms

Are certain patients more susceptible to hospital-acquired pneumonia? Elderly patients and those with compromised immune systems are at higher risk of developing severe complications from hospital-acquired pneumonia. Additionally, patients on ventilators in intensive care units face an increased risk of ventilator-associated pneumonia (VAP), a clinically distinct form of hospital-acquired pneumonia.

Surgical Site Infections: A Prevalent Post-Operative Complication

Surgical site infections (SSIs) account for up to 20% of all healthcare-associated infections, affecting at least 5% of patients undergoing surgical procedures. These infections can range from minor wound discharges to life-threatening postoperative complications.

Common Causative Organisms of SSIs:

Enterobacterales (including Escherichia coli, Klebsiella, Salmonella, and Shigella)
Staphylococcus aureus
Pseudomonas aeruginosa

How does the prevalence of causative organisms vary across different surgical categories? In 2019/20, Enterobacterales were responsible for 29.8% of superficial SSIs and 26.2% of deep or organ/space SSIs across all surgical categories. However, the proportion varied significantly depending on the type of surgery, ranging from 10.6% for knee replacements to 48.5% for large bowel surgeries in superficial SSIs.

Sepsis and Bacteremia: Life-Threatening Systemic Infections

Sepsis is a clinical syndrome triggered by the body’s immune and coagulation systems in response to an infection. It is one of the most common causes of death among hospitalized patients in intensive care units (ICUs). Septic shock, a severe form of sepsis, is characterized by low blood pressure despite adequate fluid replacement, along with organ dysfunction.

Understanding Sepsis and Bacteremia:

Sepsis can be caused by bacteria, viruses, or fungi
Bacteremia refers to the presence of bacteria in the bloodstream
Septic shock has a high mortality rate, especially in critically ill patients
Early detection and prompt treatment are crucial for improving patient outcomes

How can healthcare providers improve the early detection of sepsis? Implementing standardized screening protocols, utilizing rapid diagnostic tests, and employing electronic health record-based alert systems can help healthcare providers identify sepsis in its early stages, enabling timely intervention and potentially reducing mortality rates.

Urinary Tract Infections: A Common yet Preventable HAI

Urinary tract infections (UTIs) are among the most frequent hospital-acquired infections, often associated with the use of urinary catheters. These infections can lead to significant discomfort, prolonged hospital stays, and increased healthcare costs.

Key Points About Hospital-Acquired UTIs:

Catheter-associated UTIs (CAUTIs) account for a large proportion of hospital-acquired UTIs
Common causative organisms include Escherichia coli, Klebsiella pneumoniae, and Enterococcus species
Proper catheter care and timely removal are essential in preventing CAUTIs
Antibiotic-resistant strains pose a significant challenge in treating hospital-acquired UTIs

Can the implementation of evidence-based protocols reduce the incidence of CAUTIs? Yes, adopting standardized protocols for catheter insertion, maintenance, and removal can significantly reduce the risk of CAUTIs. These protocols may include proper hand hygiene, aseptic technique during insertion, regular assessment of catheter necessity, and prompt removal when no longer medically indicated.

Clostridium difficile Infections: A Growing Concern in Healthcare Settings

Clostridium difficile (C. difficile) infections have emerged as a significant healthcare-associated infection in recent years. These infections often occur following antibiotic use, which disrupts the normal gut microbiota, allowing C. difficile to proliferate and cause symptoms ranging from mild diarrhea to life-threatening pseudomembranous colitis.

Important Aspects of C. difficile Infections:

Primarily affects hospitalized patients and those in long-term care facilities
Can lead to severe complications, including toxic megacolon and bowel perforation
Highly resistant spores can persist in the environment for extended periods
Proper hand hygiene and environmental cleaning are crucial in preventing transmission

How has the epidemiology of C. difficile infections changed in recent years? The emergence of hypervirulent strains, such as NAP1/BI/027, has led to more severe disease presentations and increased mortality rates. Additionally, community-acquired C. difficile infections have become more prevalent, highlighting the need for improved antibiotic stewardship and infection control measures both in healthcare settings and the community.

Preventing Hospital-Acquired Infections: Strategies for Improved Patient Safety

Preventing hospital-acquired infections requires a multifaceted approach involving healthcare providers, administrators, and patients. Implementing evidence-based practices and fostering a culture of safety are essential in reducing the incidence of HAIs.

Key Prevention Strategies:

Hand hygiene compliance
Proper use of personal protective equipment (PPE)
Environmental cleaning and disinfection
Antibiotic stewardship programs
Device-associated infection prevention bundles
Staff education and training
Patient empowerment and education

How can healthcare facilities effectively implement and sustain infection prevention practices? Successful implementation of infection prevention strategies requires a combination of leadership commitment, ongoing staff education, regular monitoring and feedback, and the use of quality improvement methodologies. Engaging frontline staff in the development and implementation of prevention initiatives can enhance buy-in and sustainability.

The Impact of COVID-19 on Hospital-Acquired Infections

The COVID-19 pandemic has significantly impacted the landscape of hospital-acquired infections. While the focus on infection control practices may have led to improvements in some areas, the strain on healthcare systems and resources has created new challenges in preventing and managing HAIs.

COVID-19 and HAIs: A Complex Relationship

Increased awareness and adherence to hand hygiene and PPE use
Potential reduction in some types of HAIs due to enhanced infection control measures
Emergence of COVID-19 as a new hospital-acquired infection
Challenges in maintaining routine infection prevention practices during surges
Increased use of broad-spectrum antibiotics potentially leading to antimicrobial resistance

Has the COVID-19 pandemic led to any lasting improvements in infection control practices? The pandemic has undoubtedly heightened awareness of infection prevention and control measures. Many healthcare facilities have implemented more rigorous hand hygiene protocols, improved environmental cleaning practices, and enhanced surveillance systems. These improvements, if sustained, could have long-term benefits in reducing the incidence of various HAIs beyond COVID-19.

As we continue to navigate the challenges posed by hospital-acquired infections, it is crucial to remain vigilant and adapt our strategies to address emerging threats. By combining evidence-based practices, innovative technologies, and a commitment to patient safety, healthcare systems can work towards reducing the burden of HAIs and improving overall patient outcomes.

5 Most Common Hospital Acquired Infections (HAIs)

Despite the complications of the current pandemic caused by severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2), other infections and outbreaks caused by different microorganisms still exist. These may even pose a higher risk than previously reported, as all the medical attention and research efforts are being focused on fighting coronavirus disease-19 (COVID-19), providing opportunities for other pathogens to thrive and evolve. However, the persistent and continuous efforts that have been employed into improving infection control practices as a result of this pandemic, may actually reduce the rates of other nosocomial infections.

Hospital-acquired infections, also known as healthcare-associated infections (HAI or HCAI), are nosocomially acquired infections that are typically not present or might be incubating at the time of admission. These infections are usually acquired after hospitalisation and manifest 48 hours after admission to the hospital. The infections are monitored closely by agencies such as the National Healthcare Safety Network (NHSN), National Institute of Health and Care Excellence (NICE), and the Centre for Disease Control and Prevention (CDC). According to NICE, 300,000 people are diagnosed with HCAI in England only every year, costing the NHS an estimate of £1 billion yearly. This could be due to contamination of equipment and other materials or cross-contamination within the hospital. In this article, we will shed light on the different infections acquired in the hospital setting, and their corresponding pathogenic microorganisms.

Respiratory tract infections (Pneumonia)

Pneumonia is an infection of the lung tissue. It affects the air sacs (alveoli) of the lungs, which fill with microorganisms, fluid and inflammatory cells, impacting their normal function. Pneumonia is a common condition, affecting 8 in 1,000 people each year in the UK. It can affect people of any age but can be more serious for the very young or the elderly. Hospital-acquired pneumonia affects 0.5% to 1.0% of hospitalised patients and is the most common healthcare-associated infection contributing to death.

Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and other non-pseudomonal Gram-negative bacteria are the most common causes. Hospital-acquired pneumonia is estimated to increase hospital stay by about 8 days and has a reported morality rate that ranges from 30 to 70%. These figures include hospital-acquired pneumonia that develops in people who are intubated in an intensive care unit, known as ventilator-associated pneumonia (VAP) and is clinically distinct from hospital-acquired pneumonia in non-intubated people.

Early-onset hospital-acquired pneumonia (less than 5 days after admission to hospital) is usually caused by Streptococcus pneumoniae and late-onset (more than 5 days after admission to hospital) is usually caused by microorganisms that are acquired in hospital, most commonly MRSA, P. aeruginosa and other non-pseudomonal gram-negative bacteria. In 2012, 345 people for every 100,000 had one or more episodes of pneumonia, down from 307 per 100,000 in 2004. In 2009, this rose to 409 people for every 100,000 due to a global flu pandemic. Around 220,000 people receive a diagnosis of pneumonia each year.

Surgical site infections

Surgical site infections (SSIs) have been shown to compose up to 20% of all healthcare-associated infections. At least 5% of patients undergoing a surgical procedure develop a surgical site infection. A surgical site infection may range from a spontaneously limited wound discharge within 7 to 10 days of an operation to a life-threatening postoperative complication, such as a sternal infection after open heart surgery.

Enterobacterales including Escherichia coli, Klebseilla, Salmonella and shigella continued to make up the largest proportion of causative organisms across all surgical categories in 2019/20 for both superficial SSIs (29. 8%) and deep or organ/space (26.2%), however S. aureus still contributes to a large proportion of deep or organ space SSIs (24.2%). The proportion of superficial SSIs due to Enterobacterales varied from 10.6% for knee replacement to 48.5% for large bowel surgery. Among deep and organ/space SSI, the range is from 10.0% for knee replacement to 55.7% for large bowel surgery.

Sepsis/Bacteraemia

Sepsis is a clinical syndrome caused by the body’s immune and coagulation systems being switched on by the presence of an infection (bacteria, viruses or fungi). Sepsis is one of the most common causes of death among hospitalised patients in the intensive care unit (ICU). Septic shock is a life-threatening condition that is characterised by low blood pressure despite adequate fluid replacement in addition to organ dysfunction and sepsis. The UK Sepsis Trust estimates that 37,000 people die from sepsis in the UK every year. The most common causes of sepsis in adults are pneumonia, bowel perforation, urinary tract infection and severe skin infection.

The UK Sepsis Trust cites Hospital Episode Statistics (HES) data suggesting the recorded incidence of sepsis is rising by about 11.5% each year, with 141,772 cases per year recorded in 2014–15. It notes this is likely to be an underestimate of true incidence, with an estimate of at least 250,000 cases of sepsis each year in the UK being more representative.

Globally, the largest contributors to sepsis cases and sepsis-related mortality across all ages were diarrhoeal diseases (9.2 to 15 million annual cases) and lower respiratory infections (1.8-2.8 million annually) reported in 2017. However, non-communicable diseases are on the rise; one-third of sepsis cases and nearly half of all sepsis-related deaths in 2017 were due to an underlying injury or chronic disease. Maternal disorders were the most common non-communicable disease complicated by sepsis. the most common causes of sepsis-related deaths were neonatal disorders, lower respiratory infections, and diarrhoeal diseases. Group B streptococcus is the leading cause of both neonatal and maternal sepsis, though E.coli is an emerging threat. Both of these pathogens have displayed considerable resistance to treatment and are considered priority pathogens for research and development of new antibiotics.

Clostridium difficile infections (CDIs)

Clostridium difficile (C.diff) is now recognised as the leading cause of health-care-associated infective diarrhoea and is increasingly being linked to community-acquired cases of colitis. C. diff can be found in the intestinal tracts of both humans and animals, but its spores are also ubiquitous in the environment and can be remain infective on contaminated surfaces for a long period of time, as well as being the most resistant to disinfection. C. diff bacteria are found in the digestive system of about 1 in every 30 healthy adults. The first European Centre for Disease Prevention and Control (ECDC) point-prevalence survey in 2011 and 2012 estimated that ~124,000 patients developed health-care-associated CDI within the European Union each year including the UK. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis — the major symptoms of CDI.

Urinary tract infections

Urinary tract infections (UTIs) are caused by the presence and multiplication of microorganisms in the urinary tract. UTIs can result in several clinical syndromes, including acute and chronic pyelonephritis (infection of the kidney and renal pelvis), cystitis (infection of the bladder), urethritis (infection of the urethra), epididymitis (infection of the epididymis) and prostatitis (infection of the prostate gland). Infection may spread to surrounding tissues (for example, perinephric abscess) or to the bloodstream. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections.

Uncomplicated UTIs typically affect women, children and elderly patients who are otherwise healthy. Complicated UTIs are usually associated with indwelling catheters, urinary tract abnormalities, immunosuppression, or exposure to antibiotics. The most common causative agent for both uncomplicated and complicated UTIs is uropathogenic E.coli (UPEC), accounting for almost 75% and 65% off all UTI cases respectively. For uncomplicated UTIs, other causative agents are (in order of prevalence) Klebsiella pneumoniae, Staphylococcus saprophyticus, Enterococcus faecalis, group B Streptococcus (GBS), Proteus mirabilis, P.aeruginosa, S.aureus and Candida spp. For complicated UTIs, the other causative agents are (in order of prevalence) Enterococcus spp., K. pneumoniae, Candida spp., S. aureus, P. mirabilis, and P.aeruginosa. Acute UTI occurs in up to 50% of women and estimates suggest that by the age of 24 years nearly one third of females will have had at least one episode of cystitis.

A retrospective observational study using linked health records (Clinical Practice Research Datalink [CPRD]) from almost one million patients aged ≥65 years old in England found that of 931,945 older adults, 196,358 (21%) had at least one clinically diagnosed UTI over the 10-year study period. Incidence was found to increase from 9.03 to 10.96 in women aged 65–74 years, 11.35 to 14.34 in those aged 75–84 years, and 14.65 to 19.80 in those aged over 85 years.

Conclusion

As a final thought, these harmful infections could arise as a result of poor adherence to cleaning protocols, hand hygiene or not implementing alternative interventions such as automated disinfection technologies. As it was shown numerous times in the literature and peer-reviewed papers, manual cleaning only is not sufficient to eliminate contamination at a safe level for patients and staff. Implementing infection control and prevention measures that include the use of automated no-touch technologies such as UV-C light and hydrogen peroxide vapour alongside manual cleaning will improve outcomes and reduce rates of infection. One of the proposed solutions in combining manual cleaning and hydrogen peroxide vapour technology, is the use of Patient Equipment Cleaning Centres (PECC) to contain and significantly clean patient equipment. Here, my colleague Enrico Allegra discusses in detail patient equipment contamination and how we can solve this issue with PEC centres.

Hospital-Acquired Infection: Definition and Patient Education

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Medically reviewed by Graham Rogers, M. D. — By Heaven Stubblefield — Updated on June 7, 2017

Infections caught in the hospital

A nosocomial infection is contracted because of an infection or toxin that exists in a certain location, such as a hospital. People now use nosocomial infections interchangeably with the terms health-care associated infections (HAIs) and hospital-acquired infections. For a HAI, the infection must not be present before someone has been under medical care.

One of the most common wards where HAIs occur is the intensive care unit (ICU), where doctors treat serious diseases. About 1 in 10 of the people admitted to a hospital will contract a HAI. They’re also associated with significant morbidity, mortality, and hospital costs.

As medical care becomes more complex and antibiotic resistance increases, the cases of HAIs will grow. The good news is that HAIs can be prevented in a lot of healthcare situations. Read on to learn more about HAIs and what they may mean for you.

For a HAI, the infection must occur:

up to 48 hours after hospital admission
up to 3 days after discharge
up to 30 days after an operation
in a healthcare facility when someone was admitted for reasons other than the infection

Symptoms of HAIs will vary by type. The most common types of HAIs are:

urinary tract infections (UTIs)
surgical site infections
gastroenteritis
meningitis
pneumonia

The symptoms for these infections may include:

discharge from a wound
fever
cough, shortness of breathing
burning with urination or difficulty urinating
headache
nausea, vomiting, diarrhea

People who develop new symptoms during their stay may also experience pain and irritation at the infection site. Many will experience visible symptoms.

Bacteria, fungus, and viruses can cause HAIs. Bacteria alone cause about 90 percent of these cases. Many people have compromised immune systems during their hospital stay, so they’re more likely to contract an infection. Some of the common bacteria that are responsible for HAIs are:

Anyone admitted to a healthcare facility is at risk for contracting a HAI. For some bacteria, your risks may also depend on:

your hospital roommate
age, especially if you’re more than 70 years old
how long you’ve been using antibiotics
whether or not you have a urinary catheter
prolonged ICU stay
if you’ve been in a coma
if you’ve experienced shock
any trauma you’ve experienced
your compromised immune system

Your risk also increases if you’re admitted to the ICU. The chance of contracting a HAI in pediatric ICUs is 6.1 to 29.6 percent. A study found that nearly 11 percent of roughly 300 people who underwent operations contracted a HAI. Contaminated areas can increase your risk for HAIs by almost 10 percent.

HAIs are also more common in developing countries. Studies show that five to 10 percent of hospitalizations in Europe and North America result in HAIs. In areas such as Latin America, Sub-Saharan Africa, and Asia, it’s more than 40 percent.

Many doctors can diagnose a HAI by sight and symptoms alone. Inflammation and/or a rash at the site of infection can also be an indication. Infections prior to your stay that become complicated don’t count as HAIs. But you should still tell your doctor if any new symptoms appear during your stay.

You also may be required to talk a blood and urine test as to identify the infection.

Early detection and treatment are vital for HAIs. Many people are able to make a full recovery with treatment. But people who get HAIs usually spend 2.5 times longer in the hospital.

In some cases, a HAI can seriously increase your risk for life-threatening situations. The Centers for Disease Control and Prevention (CDC) estimate that around 2 million people contract HAIs. About 100,000 of those cases result in death.

The responsibility of HAI prevention is with the healthcare facility. Hospitals and healthcare staff should follow the recommended guidelines for sterilization and disinfection. Taking steps to prevent HAIs can decrease your risk of contracting them by 70 percent or more. However, due to the nature of healthcare facilities, it’s impossible to eliminate 100 percent of nosocomial infections.

Some general measures for infection control include:

Screening the ICU to see if people with HIAs need to be isolated.
Identifying the type of isolation needed, which can help to protect others or reduce chances of further infection.
Observing hand hygiene, which involves washing hands before and after touching people in the hospital.
Wearing appropriate gear, including gloves, gowns, and face protection.
Cleaning surfaces properly, with recommended frequency.
Making sure rooms are well ventilated.

To reduce the risk of UTIs, your healthcare provider can:

Follow the aseptic insertion technique to minimize infection.
Insert catheters only when needed and remove when no longer needed.
Change catheters or bags only when medically indicated.
Make sure the urinary catheter is secured above the thigh and hanging below the bladder for unobstructed urine flow.
Keep a closed drainage system.

Talk to your doctor about any concerns you have during a procedure.

Nosocomial infections, or healthcare associated infections occur when a person develops an infection during their time at a healthcare facility. Infections that appear after your hospital stay must meet certain criteria in order for it to qualify as a HAI.

If new symptoms appear within 48 hours of admission, three days after discharge, or 30 days after an operation, talk to your doctor. New inflammation, discharge, or diarrhea could be a symptom of a HAI. Visit the CDC website to see what your state’s healthcare facilities do to prevent HAIs.

Last medically reviewed on October 24, 2016

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Medically reviewed by Graham Rogers, M.D. — By Heaven Stubblefield — Updated on June 7, 2017

Doctors of the Kirov Regional Hospital have diagnosed a Kirov resident with a disease that occurs in one in several million people

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Article published on September 06, 2022 at 21:56.
Updated on September 06, 2022 at 21:56.

In the practice of every doctor there are diagnostically difficult patients. It is often difficult even for experienced specialists to understand the symptoms and the results of laboratory and instrumental research methods. The Kirov doctors had to go through a long path of diagnostic search in order to find the only correct solution to the most difficult clinical problem.

The first symptoms of an unknown disease in a 58-year-old resident of Kirov appeared in 2019year, the man’s joints hurt. In the summer of last year, he felt weakness and malaise, joint pains again made themselves felt, and in the fall of 2021, diarrhea appeared.

A characteristic feature of the disease that developed in a citizen of Kirov is that it masquerades as various pathologies. According to statistics, it takes up to 7 years to identify the cause of the disease. Often time is lost, and the disease passes into the next stage. The man was examined in several medical institutions: as a result, experts ruled out he had oncopathology, blood disease, sarcoidosis, tuberculosis, and rheumatic diseases. The man also underwent outpatient treatment twice at the place of residence: for clostridial infection and antibiotic-associated diarrhea. However, the improvement was short-lived.

In the summer of 2021, a citizen of Kirov went to the Kirov Regional Clinical Hospital, where he was admitted to the gastroenterology department. Here he underwent all types of examinations: laboratory, endoscopic, in particular FGDS and colonoscopy, computed and magnetic resonance imaging. Specialists of the Regional Clinical Clinical Hospital repeated laparoscopy for histological examination of the lymph node.

According to the head of the gastroenterology department of the Kirov Regional Clinical Hospital Vladimir Rayanov, even then it was suggested that it could be Whipple’s disease – one of the rarest diseases.

– During the histological examination, which was carried out by our colleagues, cells typical of Whipple’s disease were detected in the lymph nodes and biopsy of the patient’s small intestine mucosa. After consultations with narrow specialists from the federal center, our diagnosis was confirmed. The patient was prescribed etiotropic therapy. During the treatment, the man immediately felt better, his stool and metabolic processes returned to normal. The patient was discharged from the clinic the other day,” said Vladimir Rayanov.

According to the specialist, Whipple’s disease is an extremely rare systemic disease, suffice it to say that it is not in the international classification of diseases. The annual prevalence is 1 in 3-4 million people. The bacterium itself in Russia is determined only on the basis of an extended histological examination. In more than 50 years of Vladimir Rayanov’s practice, this is the only case.

According to Vadim Ralnikov, chief physician of the Kirov Regional Clinical Hospital, the danger of Whipple’s disease lies in the development of a severe syndrome of malabsorption and irreversible damage to the nervous system. The disease can be fatal.

Escape from the hospital increases the risk of readmission and even death

For escaping from the hospital – illness and death – Gazeta. Ru

August 27, 2013, 10:02 am
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Patients who leave the hospital untreated, contrary to the doctor’s recommendations, will soon be rehospitalized or even die.

Patients are different: some try to get to the hospital at all costs, others strive to be discharged from there as soon as possible. In each hospital, the proportion of undertreated patients is 1–2%. The tendency to leave the hospital undertreated worries doctors. They cannot keep the sick by force, although, of course, they recommend that they stay. Now they have a weighty argument at their disposal: as experts from the University of Manitoba (Canada) have established, patients who leave the hospital without permission have a several times higher risk of disease exacerbation and even death within six months after discharge.

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The problem of unauthorized discharge is not new – it has been discussed in the medical literature for more than 50 years. Canadian scientists published in the Canadian Medical Association Journal the most representative study on this topic in recent years. They analyzed 1,916,104 discharge cases from 610,187 adult patients admitted to hospitals in Manitoba from 1 April 1990 to February 28, 2009 (population of the province of Manitoba – 1.2 million people). They were interested in cases of rehospitalization within 30 days after discharge and death within 90 days.

Researchers identified 234,809 readmissions.

Factors that increase the likelihood of hospital readmission include advanced age, male gender, low social and economic status, multiple hospitalizations in the previous five years, late referral to a physician, certain comorbidities, and too short a hospital stay.

Scientists recorded 21,417 cases (1.1% of the total number of hospitalizations) when patients insisted on early discharge against the doctor’s recommendation. Among these patients, the need for re-hospitalization within 30 days occurs three times more often than among other categories of patients. At the same time, a quarter of the “runaway” patients became worse on the very first day, and 60% within two weeks. The risk of dying within 90 days after discharge is 2.5 times higher for people who left the hospital early.

The likelihood of rehospitalization and death among “fugitives” is especially high in the first days after discharge, then it decreases, but remains elevated for at least 180 days.

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Researchers believe that this situation is connected not only with the course of the patient’s illness, but also with his attitude towards his health. People who do not want to take additional treatment, once at home, behave like healthy people: they do not take medicines and do not follow the doctor’s recommendations.