Risk Factors for HAIs Unique to Special Populations

Michael Calderwood, MD, MPH, previously assistant hospital epidemiologist and associate director of antimicrobial stewardship at Brigham and Women’s Hospital, explains healthcare associated infection risk factors for individuals who are immunocompromised, and prevention methods.

Interview Transcript (slightly modified for readability)

“Some of the things we think about [when considering healthcare associated infections in special populations] are devices. Patients that are coming into the hospital [for example] to get chemotherapy are going to need to have a long-term device put in place, [such as] a central venous catheter. That now serves as a conduit for bacteria that often colonize skin or, coming down from the oropharynx, [can enter] into the blood-stream. Patients that are hospitalized and unable to get out of bed for a long period of time may have a Foley catheter put in place, which is a similar highway for bacteria to then invade and cause either a urinary tract infection or upper disease, such as pyelonephritis, and then invasive [bacteremia].

We want to be thoughtful. Oftentimes we need these devices, but we want to be thoughtful particularly for the urinary catheters and thinking, ‘Is the indication appropriate? Might we be able to use a noninvasive means of achieving the same end?’

For men, we oftentimes will think about things like condom-catheters, rather than an insertion of a Foley catheter. We can sometimes put commodes at the bedside so the patient doesn’t necessarily have to walk all the way to the bathroom, [and we can come] up with means of providing less-risky solutions. The other [option is to have the patient] just wear a diaper, and that’s okay. We obviously want to be thoughtful that that’s being changed, we don’t want to have the skin break down.

The other thing that does put patients at risk if [they are] immunocompromised, is the impairment of mucosal barriers. If [a patient has] breakdown of skin, that’s [the body’s] first line of defense. Some of this is the invasion of the portals of entry, like devices we’ve seen. Some of this is the mucocutaneous areas in the mouth, and what might invade via that pathway. At the same time, we have breakdown in the lining of the [gastrointestinal] system, so we can have translocation of certain bacteria. [For] people [who] have a normal immune system, when [some of these barriers of defense are] no longer there, we now have risk factors for invasive disease."