What are iatrogenic infections?
Iatrogenic infections are those infections transmitted during medical treatment and care. A study published by the Journal of the American Medical Association reported that iatrogenic infection contributes to about 225,000 deaths in the United States each year. After heart disease and cancer, iatrogenic illness is the third leading cause of death in the United States.
Iatrogenic infection is complex because it has so many causes, including chance, negligence, medical error, and interactions of prescription drugs. Nosocomial infections, another leading cause of iatrogenic illness, are those that occur during hospitalization or through treatment in another health care setting. Vectors for infection in these facilities include vomit, blood, urine, and feces. Some microorganisms can be spread through the air. Postsurgical patients are particularly vulnerable to hospital-acquired infection. Illnesses can be transmitted by health care providers who neglect proper methods of sanitation.
The risks associated with adverse drug reactions typically occur when health care providers lack understanding and education about the prescribed drug. One of the most significant issues in drug-drug interactions resulting in iatrogenic illness is a change in the gastrointestinal tract and liver that leads to metabolic problems. Alcohol intake and smoking can also affect the way drugs are metabolized.
One study of hospitalized patients showed that up to one-half of drug-related problems occur because of errors in prescribing, administering, dispensing, and transcribing records of drugs. Inadequate monitoring of patients was cited in another study, meaning that the appropriate laboratory tests were either not ordered or were incorrectly interpreted.
Also, a lack of sanitation frequently leads to iatrogenic illness. This could happen in a wide range of settings, from food waste and dirty restrooms to devices, such as surgical equipment, catheters, and wound dressings, that are supposed to be sterile.
Rare diseases can be transmitted during corneal transplants, by contaminated dura matter (the layers surrounding the brain and spinal cord), through blood transfusion, and by dental pulp, which has been implicated in the spread of the incurable Creutzfeldt-Jakob disease.
Affected persons experience a wide range of symptoms, illnesses, disorders, and conditions. Some of the most frequently studied include ovarian hyperstimulation syndrome, fat intolerance after cholecystectomy, rupture of the tracheobronchial tree, colitis, hypoglycemia, back pain, neuropathy after hysterectomy, rectourethral fistula, acute estrogen deficiency, temporomandibular joint symptoms, and small perforations of the colon during colonoscopy.
By applying rigorous methodology, researchers can study, for example, the epidemiology of drug-induced illnesses. Such research includes a consideration of the frequency of a drug-induced disease, nonmedical contributing factors, the dose and route of administration of all drugs taken by the patient, the time and place of drug-induced diseases, and the specific characteristics of each patient. Other kinds of iatrogenic illness, such as nosocomial infections, are often monitored by the medical provider’s risk-management or quality-assurance departments.
Measures for the treatment of iatrogenic illness include antiseptics, antibiotics, and better surgical techniques. Anesthesia may be used to control pain.
Because there are hundreds of varieties of iatrogenic illness, each requiring individualized treatment, this section will outline the therapeutic course for a patient who is at high risk for developing a common type of iatrogenic, adverse drug reaction: dyspepsia caused by treatment with ibuprofen.
Patients with dyspepsia, or indigestion, have symptoms such as upper abdominal pain, belching, nausea, vomiting, abdominal bloating, and satiety. For patients taking ibuprofen, there is also a risk of internal bleeding, and the medical team will have to screen for this. The patient may also experience warning signs such as weight loss, blood in the stool, fever, and vomiting. The medical team also needs to check on the patient’s diet, and it needs to screen for depression and anxiety. Other factors under consideration should include the patient’s age, medical history, concurrent drug use, use of herbal medicines, and use of food supplements. Treatment cannot safely begin until all differential diagnoses have been excluded.
If the dyspepsia is caused by abnormal function of the gastrointestinal muscles, a smooth muscle relaxant will increase motility and improve symptoms. Dyspepsia with the production of stomach acid may be treated with a proton pump inhibitor or misoprostol. After weighing the risks and benefits, the physician may ask the patient to reduce or stop the ibuprofen.
Nosocomial infection can be addressed by decontamination measures such as cleaning, disinfection, sterilization, and ventilation. Vulnerable patients with wounds can be protected with sterile dressings and isolation precautions. Adequate air flow and moisture control help to keep microorganisms such as bacteria and fungi in check. Health care providers can limit the risk of iatrogenic illness by containing or removing infectious materials, instituting single-use devices, and standardizing drug equipment. Some hospitals are experimenting with financial incentives for handwashing, as studies have shown that medical staff fail to wash their hands more than half of the time.
Many quality improvement approaches to iatrogenic illness focus on the design of systems for control of hospital infections and adverse drug reactions. Targeting people has been less effective. In a system-focused environment, mechanisms such as medical audit, peer review, and risk management offer valuable feedback to every member of the health care team, making it easier to implement evidence-based preventive measures. The evidence-based environment also fosters meta-analysis to improve clinical practice.
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