The Hidden Threat in Hospitals: Antibiotic-Resistant Bacteria

Hospitals are a breeding ground for antibiotic-resistant bacteria, according to a confidential report by the Ministry of Health, recently revealed in Yediot. It is estimated that around 100,000 people are infected annually, approximately 8,000 per month. The National Center for Infection Control at the Ministry estimates that 6,000 patients die each year from such infections, nearly 20 times the annual number of traffic fatalities.

The risk looms over patients, especially those with higher susceptibility: transplant recipients, newborn preemies, chronically ill patients, newborns, burn victims, cancer patients undergoing chemotherapy, ventilated patients, and the elderly. No hospitalized individual in Israel is immune to these aggressive, antibiotic-resistant bacteria lurking in the wards. It is estimated that 5%-10% of the hospitalized are infected.

The report indicates that among the thousands of infections occurring within hospitals each month, hundreds are severe, often deadly, blood infections. A significant portion of the bacteria causing these infections, prevalent in hospitals across Israel, are resistant to all forms of antibiotics and can no longer be eradicated with medication, leading to very high mortality.

This is a national crisis: violent bacteria are the main cause of acquired infections—those contracted by patients during hospitalization. These infections are now considered the primary complication of hospitalization worldwide.

The resistant bacteria are transmitted from patient to patient through direct hand contact, often by the medical staff, or indirectly, via contaminated equipment or environment. They are especially common in intensive care units, surgical, and orthopedic wards, but also occur in general wards.

The mortality rate from infections is based solely on estimates, as it is practically impossible to know with certainty what caused the death of a patient who acquired an infection: the underlying illness, the resistant bacteria, or a combination of both. However, the State Comptroller noted four years ago that more than half of deaths from acquired infections could have been prevented if medical institutions strictly adhered to safety rules and adequate hospitalization conditions.

The cocktail of bacteria residing in our hospitals is aggressive and resistant. One of the most dangerous bacteria in hospitals today is CPE, a highly lethal gut bacteria known to break down the most advanced antibiotics. Though infections are relatively few, its outbreak potential is vast. Recently, doctors in England warned it is almost untreatable.

Another violent bacterium is Clostridium difficile, causing intestinal inflammation after antibiotic exposure. The third on the list is Acinetobacter, a highly infectious and lethal bacterium that primarily affects ventilated patients. Acinetobacter tops the list of superbugs, having developed resistance to all types of antibiotics. It causes outbreaks of severe pneumonia and blood infections in ventilated patients in intensive care units and internal wards. Its mortality rate is exceedingly high: medical literature reports between 30%-80%. In some instances, death occurs swiftly: doctors receive test results in the morning indicating a patient is infected, and by evening, the patient has succumbed. It is considered the biggest nightmare of hospitals.

What contributes to the spread of acquired infections? According to the World Health Organization, overcrowding and a shortage of staff are key factors. Recent studies show a direct link between overcrowded hospitals and the spread of antibiotic-resistant bacteria. These factors, combined with the extensive use of antibiotics within hospitals, contribute to the development of resistant strains, some of which cannot be eradicated. Faulty procedures and failure to adhere to infection prevention protocols are also to blame.

How can infections be prevented? It is crucial to rigorously wash hands with disinfectant before each patient contact. Additionally, cleaning, disinfecting, and sterilizing devices used for internal examination is vital.

Medical literature suggests a distance of 1.5 meters between beds, yet burdened Israeli hospitals cannot provide this. For instance, during flu season, patients often lie only 70 centimeters apart.

The shortage of staff further fuels the spread of resistant bacteria. "If we placed every patient in a separate room with a door and assigned them a private nurse, infection rates would likely plummet. An adequate patient-to-nurse ratio is critical, especially when caring for ventilated patients," says Prof. Weinberger.

The Ministry of Health stated: "Infection prevention is a complex issue which the Ministry pays significant attention to. Key measures include establishing the National Center for Infection Control and founding the national infection prevention program with dedicated funding from the treasury in 2016, which operates successfully. The Ministry has identified reducing Acinetobacter infections as a primary goal in this program. In the first year, 82% of hospitals met this target, with a decrease of at least ten percent in infections within a year. A national 15% reduction in bloodstream infections caused by the bacteria was observed.

"More single hospitalization rooms are indeed needed. The Ministry has set standards for the number of isolation rooms in all new constructions. For existing buildings, this change is hard to implement. The Ministry incentivizes hospitals to install partitions between critically ill patients in multi-patient rooms to enhance isolation. Cleanliness is part of the overall required activities, funded by daily hospitalization rates. The campaign for infection prevention is planned, funded, and we hope to launch it soon."