Examining Social and Emotional Outcomes for Patients with Hospital-Acquired Infections

A new review examines previous studies and concludes that healthcare professionals could benefit from sensitivity training when dealing with patients who have HAIs.

Although not the norm, it’s not uncommon for patients who endure a hospital stay to contract a hospital-acquired infection (HAI), such as methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile. Recent studies report that roughly 6% of hospital patients in Europe contract a HAI each year, while 4% of American patients do. In affluent nations, the total rate of HAIs is 7.6% annually.

While research has typically focused on the financial and physical costs of these infections, there has been scant attention paid to emotional and social outcomes for patients and their families. To that end, a team of scientists at Glasgow Caledonian University in Scotland conducted a meta-analysis of the research in this area published between 2000 and 2017. The studies included patients in 5 different countries and were generally small, with no more than 24 participants in the biggest study. The researchers looked at patients’ responses to their infections as well as how health care professionals responded to the patients’ infections. They examined how well patients coped with their diagnoses and if they felt any stigma about their condition.

The study team discovered that patients’ responses to their HAIs often differed based on whether they knew they had an infection because they saw it or felt ill versus whether they felt fine but were told by staff that they had acquired an infection.

“At the lower end of the physical response continuum, the experience of physical symptoms was frequently absent for patients colonized with MRSA,” the authors wrote in their report. “This made it difficult for some patients to accept there was anything wrong or to understand the need for measures to manage MRSA colonization, particularly after discharge from the hospital.” In contrast, the scientists wrote, patients who developed an infection at a surgical site were often taken aback by sudden pain and leakage in the absence of any immediate explanation of what was going on.

The most highly emotional responses seemed to be elicited in patients who had MRSA. They worried about being seen as dirty and as carriers of a plague, according to the study authors, especially if the individual giving the diagnosis acted as though it were a big deal. In patients with surgery-site infections, women tended to express feelings of fear, anxiety, and guilt whereas men were angry that they weren’t being given more information. Patients with C. difficile experienced a lot of embarrassment about the more unpleasant gastrointestinal symptoms of their infection, which led to depression in some of them. When it came to all forms of HAIs, patients frequently worried that their concerns weren’t being taken seriously by staff, and they said they were sometimes disrespected by being shut out of clinics or classes because of transmission fears. Those patients who were able to communicate directly with infectious disease physicians felt they got more accurate information and much-needed reassurance.

What can health care providers do to ease the worries of patients who contract an HAI? “[O]ur primary recommendation would be that health care practitioners require training to better equip them to answer patients’ questions accurately and to respond more sensitively to patients’ concerns,” Kay Currie, PhD, professor of nursing & applied health care research at Glasgow Caledonian University and the author of the meta-analysis, told Contagion®. “In addition, patients require specific advice on how to manage their infection/ colonization once discharged home, as often their response is disproportionate to the risks of transmission in a community setting.”

Elaborating on this, Dr. Currie explained that hospital patients are naturally more vulnerable to infection than those outside the hospital setting, who may be at little or no risk of contracting a resistant organism carried by someone who was just discharged. However, individuals may go overboard in their actions due to misplaced worry. “In our article, you will see examples of where, [for instance,] a patient's wife soaked his underwear in disinfectant before washing, where patients didn't visit family or attend social events, [and] didn't go to the hairdresser or gym, etc.,” she said.

Understanding what patients are going through when diagnosed with an HAI will help caregivers and clinicians relate to them and improve their experiences. Dr. Currie’s team intends to continue studying the challenges of HAI and how hospital staff can have a more positive impact. “We are currently undertaking primary research into the contemporary patient experience of HAI in the UK context,” she said.

Ms. Saloman is a health writer with more than 20 years of experience working for both consumer-and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.