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Medical Devices Associated Nosocomial Infections

Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections associated with their peculiar microorganisms along with conventional and novel therapies.

  • nosocomial infection
  • medical devices
  • catheter
  • ventilation
  • microorganisms
  • biofilm
  • treatment

1. Definition

Healthcare-associated infections (HAIs) are nosocomial-acquired infections (hospital-acquired infections) that are not present in the patient before their hospitalization [1][2]. HAIs can occur in various wards during treatment; they are most often associated with hospitalization in intensive care units (ICUs). In ICUs, patients have a 5 to 10 times higher risk of acquiring an HAI due to both intrinsic (immunodeficiency) and extrinsic factors (the administration of medical devices). In addition, an ICU is often an epicenter of microorganisms with multi-drug resistance (MDR) [3].HAIs typically occur from 48 h to 30 days post-treatment [4][5]

2. Introduction

HAIs typically occur from 48 h to 30 days post-treatment [4][5]. In Europe, the European Centre for Disease Prevention and Control (ECDC) created in 2005 “The Healthcare-Associated Infections Surveillance Network”, and in the USA, the World Health Organization (WHO)’s section on prevention of hospital-acquired infections published their practical guide (second edition) in 2012. The WHO have stated that HAIs are a global phenomenon responsible for a high amount of morbidity and mortality all over the world [6]; they are a major problem not only in developing countries but also in the highly developed countries in Europe [4][7][8]. The ECDC reported that around 3.2 million patients acquired HAIs in European Union (EU) countries, and among them, 37,000 mortalities have been registered every year [9]. These infections also cause economic losses in the hospital sector, which have been increasing every year. A survey performed by Duszynska et al. (2020) revealed that one in five patients are diagnosed with a device-associated HAI, which leads to an additional financial burden of over 10,000 euros per patient [10]. Hopmans et al. (2020) conducted a biannual point-prevalence surveillance on HAIs from 2007 to 2016 and identified a decrease in the incidence of HAIs in hospitals in the Netherlands, specifically in surgical site infections (SSIs) and urinary tract infections (UTIs). This survey showed a reduction in the mean length of hospital stay by 3 days, but the usage of antibiotics increased from 31% to 36%. In this way, they demonstrated the importance of surveys to know the impact of ongoing treatment procedures to help and modify those procedures to provide a high standard of healthcare [11].

3. Content

3.1 Medical devices associated infections

Several studies have identified that the kind of microorganisms causing an HAI depends on the type of medical implant inserted into the patient [12][13]. Additionally, it is necessary to determine precisely whether the patient got the infection before admission to the hospital or became infected during hospitalization. HAIs only include infections that do not appear in patients until 48 h after hospitalization. Evidence that the patient is infected are symptoms such as fever, chills, lethargy, cough, difficulty breathing, abdominal pain, and stool problems. Sepsis and inflammation may also be included among the common symptoms [14][15]. CVCs are considered to be a major source of bloodstream infections (BSIs) in hospitals, especially in patients with permanently impaired immunity. Their insertion is an invasive method and is used in both adult and pediatric patients [16]. Additionally, long-term intestinal problems in children also require the insertion of a CVC to provide parenteral nutrition, but this is frequently accompanied by infections resulting in an increased rate of morbidity and mortality [17]. Another type of common nosocomial infection caused by catheters in hospitals is CAUTI. Removal of the urinary catheter in the shortest time possible is a basic step to prevent infections. However, adhering to this rule in hospitals is very difficult. Long-term catheterization should only be recommended in very justified cases. From this perspective, identifying the risk factors for CAUTI is critical [18][19]. Letica-Kriegel et al. (2019), similarly to other authors, observed that when the duration of catheterization increased, the risk of infection also increased. Furthermore, they confirmed that approximately 12% of patients with an indwelling catheter developed CAUTI within 30 days. Some risk factors are predominantly associated with CAUTI [20][21]. The above-mentioned study defined two main hazards, i.e., sex (female) and those associated with mobility issues [20]. Medina-Polo et al. (2021) determined in their study that a catheter in the upper urinary tract and immunosuppression are the other critical factors contributing to CAUTI caused by MDR bacteria [22]. VAPs as part of intensive care are also particularly dangerous. Li et al. (2018) documented that bacterial contamination was largely observed on devices that were used repeatedly. Therefore, emphasis should be placed on the constant sterilization of intubation equipment used [23]. Patient monitoring can help physicians to detect changes in lung function in a timely manner to reduce the risk of VAP and mortality [24]. The predominant microorganisms isolated from the above-mentioned medical devices are Gram-positive bacteria of S. aureus and S. epidermidis, then enterococci and streptococci. The Gram-negative bacteria include E. coliEnterobacter spp., Acinetobacter baumaniiP. aeruginosaK. pneumoniae, and Proteus mirabilis, as well as representatives of the yeast from the genus Candida [25][12][13].The detail list of microorganisms associated with medical devices are described in Table 1. Microorganisms can survive not only in planktonic form, but also they frequently colonize medical devices and form mono- or inter-species communities. Biofilms have subsequently become more resistant to conventional drugs, often resulting in chronic infections in patients [12][26][27][28]. Svensson et al. (2021) noted that a strong biofilm production was significantly associated with recurrent infection [28]. According to a meta-analysis of PubMed and Web of Sciences databases from January 2005 to May 2020 published by Pinto et al. (2021), strong biofilm producers tested in vitro and associated with BSI were strongly represented among the resistant strains. Methicillin-resistant S. aureus (MRSA) was mainly mentioned. Moreover, biofilm producers were also highly linked to BSI persistence. It is of interest that this association was the highest for Candida spp. As for UTIs, multi-resistant E. coli was observed to be the predominant strong biofilm producer. The above-mentioned study clearly proved that biofilms must be assumed to be a BSI and UTI resistance factor [27]. The medical implants are summarized in Figure 1.Device associated infection
Figure 1. Medical implants associated HAI
Table 1. Device associated microorganisms
Device associated microorganisms

4. Conclusions

This review concisely summarizes relevant and up-to-date information on HAIs themselves and HAI-associated microorganisms while also providing a description of several useful approaches for the treatment and eradication of HAIs. It is focused on device-associated infections such as CLABSIs including CVCBSIs, CAUTIs, VAPs, and SSIs associated with orthopedic implants and CVDs. Updated information is summarized along with some documents elaborated by the ECDC and CDC. The most relevant microorganisms are mentioned in terms of their frequency of infection associated with medical devices, and they are categorized based on their colonization.Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. An update of information on HAIs could not only be beneficial for medical professionals but also for researchers to have an idea of the available clinical data and research results, and it could be helpful for improving strategies tackling HAIs.

5. Funding

This paper was supported by EU Grant number 952398—CEMBO, Call: H2020-WIDESPREAD-05-2020—Twinning and by the grants of VEGA 1/0537/19 from the Ministry of Education, Science, Research, and the Sport of the Slovak Republic.


  1. Kollef, M.H.; Torres, A.; Shorr, A.F.; Martin-Loeches, I.; Micek, S.T. Nosocomial Infection. Crit. Care Med. 2021, 49, 169–187.
  2. Monegro, A.F.; Muppidi, V.; Regunath, H. Hospital Acquired Infections; StatPearls Publishing: Treasure Island, FL, USA; Las Vegas, NV, USA, 2021.
  3. European Centre for Disease Prevention and Control. Surveillance of Healthcare-Associated Infections and Prevention Indicators in European Intensive Care Units Year: Hai-Net Icu Protocol; Version 2.2; ECDC: Stockholm, Sweden, 2017; Available online: (accessed on 23 September 2021).
  4. Walter, J.; Haller, S.; Quinten, C.; Kärki, T.; Zacher, B.; Eckmanns, T.; Abu Sin, M.; Plachouras, D.; Kinross, P.; Suetens, C. Healthcare-Associated Pneumonia in Acute Care Hospitals in European Union/European Economic Area Countries: An Analysis of Data from a Point Prevalence Survey, 2011 to 2012. Eurosurveillance 2012, 32, 1700843.
  5. Suetens, C.; Latour, K.; Kärki, T.; Ricchizzi, E.; Kinross, P.; Moro, M.L.; Jans, B.; Hopkins, S.; Hansen, S.; Lyytikäinen, O.; et al. Prevalence of Healthcare-Associated Infections, Estimated Incidence and Composite Antimicrobial Resistance Index in Acute Care Hospitals and Long-Term Care Facilities: Results from Two European Point Prevalence Surveys, 2016 to 2017. Eurosurveillance 2018, 23, 1800516.
  6. World Health Organization. Prevention of Hospital-Acquired Infections: A Practical Guide, 2nd ed.; World Health Organization: Geneva, Switzerland, 2002; Available online: (accessed on 30 March 2020).
  7. Badia, J.M.; Casey, A.L.; Petrosillo, N.; Hudson, P.M.; Mitchell, S.A.; Crosby, C. Impact of Surgical Site Infection on Healthcare Costs and Patient Outcomes: A Systematic Review in Six European Countries. J. Hosp. Infect. 2017, 96, 1–15.
  8. Zingg, W.; Hopkins, S.; Gayet-Ageron, A.; Holmes, A.; Sharland, M.; Suetens, C.; Almeida, M.; Asembergiene, J.; Borg, M.A.; Budimir, A.; et al. Health-Care-Associated Infections in Neonates, Children, and Adolescents: An Analysis of Paediatric Data from the European Centre for Disease Prevention and Control Point-Prevalence Survey. Lancet Infect. Dis. 2017, 17, 381–389.
  9. European Centre for Disease Prevention and Control. Economic Evaluations of Interventions to Prevent Healthcare-Associated Infections: Literature Review; Publications Office: Stockholm, Sweden, 2017.
  10. Duszynska, W.; Rosenthal, V.D.; Szczesny, A.; Zajaczkowska, K.; Fulek, M.; Tomaszewski, J. Device Associated –Health Care Associated Infections Monitoring, Prevention and Cost Assessment at Intensive Care Unit of University Hospital in Poland (2015–2017). BMC Infect. Dis. 2020, 20, 761.
  11. Hopmans, T.E.M.; Smid, E.A.; Wille, J.C.; Kooi, T.I.I.; van der Koek, M.B.G.; Vos, M.C.; Geerlings, S.E.; Greeff, S.C. De Trends in Prevalence of Healthcare-Associated Infections and Antimicrobial Use in Hospitals in the Netherlands: 10 Years of National Point-Prevalence Surveys.2020. J. Hosp. Infect. 2020, 104, 181–187.
  12. Vandecandelaere, I.; Matthijs, N.; van Nieuwerburgh, F.; Deforce, D.; Vosters, P.; de Bus, L.; Nelis, H.J.; Depuydt, P.; Coenye, T. Assessment of Microbial Diversity in Biofilms Recovered from Endotracheal Tubes Using Culture Dependent and Independent Approaches. PLoS ONE 2012, 7, e38401.
  13. Holá, V.; Ruzicka, F.; Horka, M. Microbial Diversity in Biofilm Infections of the Urinary Tract with the Use of Sonication Techniques. FEMS Immunol. Med. Microbiol. 2010, 59, 525–528.
  14. Boev, C.; Kiss, E. Hospital-Acquired Infections: Current Trends and Prevention. Crit. Care Nurs. Clin. N. Am. 2017, 29, 51–65.
  15. Gentili, A.; Di Pumpo, M.; La Milia, D.I.; Vallone, D.; Vangi, G.; Corbo, M.I.; Berloco, F.; Cambieri, A.; Damiani, G.; Ricciardi, W.; et al. A Six-Year Point Prevalence Survey of Healthcare-Associated Infections in an Italian Teaching Acute Care Hospital. Int. J. Environ. Res. Public Health 2020, 17, 7724.
  16. Böll, B.; Schalk, E.; Buchheidt, D.; Hasenkamp, J.; Kiehl, M.; Kiderlen, T.R.; Kochanek, M.; Koldehoff, M.; Kostrewa, P.; Claßen, A.Y.; et al. Central Venous Catheter-Related Infections in Hematology and Oncology: 2020 Updated Guidelines on Diagnosis, Management, and Prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann. Hematol. 2021, 100, 239–259.
  17. Wendel, D.; Mezoff, E.A.; Raghu, V.K.; Kinberg, S.; Soden, J.; Avitzur, Y.; Rudolph, J.A.; Gniadek, M.; Cohran, V.C.; Venick, R.S.; et al. Management of Central Venous Access in Children With Intestinal Failure: A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group. J. Pediatr. Gastroenterol. Nutr. 2021, 72, 474–486.
  18. Menegueti, M.G.; Ciol, M.A.; Bellissimo-Rodrigues, F.; Auxiliadora-Martins, M.; Gaspar, G.G.; Canini, S.R.M.; da Silva Canini, S.R.M.; Basile-Filho, A.; Laus, A.M. Long-Term Prevention of Catheter-Associated Urinary Tract Infections among Critically Ill Patients through the Implementation of an Educational Program and a Daily Checklist for Maintenance of Indwelling Urinary Catheters: A Quasi-Experimental Study. Medicine 2019, 98, e14417.
  19. Gad, M.H.; AbdelAziz, H.H. Catheter-Associated Urinary Tract Infections in the Adult Patient Group: A Qualitative Systematic Review on the Adopted Preventative and Interventional Protocols From the Literature. Cureus 2021, 13, e16284.
  20. Letica-Kriegel, A.S.; Salmasian, H.; Vawdrey, D.K.; Youngerman, B.E.; Green, R.A.; Furuya, E.Y.; Calfee, D.P.; Perotte, R. Identifying the Risk Factors for Catheter-Associated Urinary Tract Infections: A Large Cross-Sectional Study of Six Hospitals. BMJ Open 2019, 9, e022137.
  21. Vincitorio, D.; Barbadoro, P.; Pennacchietti, L.; Pellegrini, I.; David, S.; Ponzio, E.; Prospero, E. Risk Factors for Catheter-Associated Urinary Tract Infection in Italian Elderly. Am. J. Infect. Control 2014, 42, 898–901.
  22. Medina-Polo, J.; Gil-Moradillo, J.; González-Díaz, A.; Abad-López, P.; Santos-Pérez de la Blanca, R.; Hernández-Arroyo, M.; Peña-Vallejo, H.; Téigell-Tobar, J.; Calzas-Montalvo, C.; Caro-González, P.; et al. Observational Study over 8-Year Period Evaluating Microbiological Characteristics and Risk Factor for Isolation of Multidrug-Resistant Organisms (MDRO) in Patients with Healthcare-Associated Infections (HAIs) Hospitalized in a Urology Ward. GMS Infect. Dis. 2021, 9, Doc04.
  23. Li, Y.-C.; Lin, H.-L.; Liao, F.-C.; Wang, S.-S.; Chang, H.-C.; Hsu, H.-F.; Chen, S.-H.; Wan, G.-H. Potential Risk for Bacterial Contamination in Conventional Reused Ventilator Systems and Disposable Closed Ventilator-Suction Systems. PLoS ONE 2018, 13, e0194246.
  24. de Souza Kock, K.; Maurici, R. Respiratory Mechanics, Ventilator-Associated Pneumonia and Outcomes in Intensive Care Unit. World J. Crit. Care Med. 2018, 7, 24–30.
  25. Percival, S.L.; Suleman, L.; Vuotto, C.; Donelli, G. Healthcare-Associated Infections, Medical Devices and Biofilms: Risk, Tolerance and Control. J. Med. Microbiol. 2015, 64, 323–334.
  26. Ling, M.L.; Apisarnthanarak, A.; Jaggi, N.; Harrington, G.; Morikane, K.; Thu, L.T.A.; Ching, P.; Villanueva, V.; Zong, Z.; Jeong, J.S.; et al. APSIC Guide for Prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob. Resist. Infect. Control 2016, 5, 16.
  27. Pinto, H.; Simões, M.; Borges, A. Prevalence and Impact of Biofilms on Bloodstream and Urinary Tract Infections: A Systematic Review and Meta-Analysis. Antibiotics 2021, 10, 825.
  28. Svensson Malchau, K.; Tillander, J.; Zaborowska, M.; Hoffman, M.; Lasa, I.; Thomsen, P.; Malchau, H.; Rolfson, O.; Trobos, M. Biofilm Properties in Relation to Treatment Outcome in Patients with First-Time Periprosthetic Hip or Knee Joint Infection. J. Orthop. Transl. 2021, 30, 31–40.
Subjects: Microbiology
View Times: 43
Revisions: 3 times (View History)
Update Time: 29 Mar 2022
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    Dadi, N.C.T. Medical Devices Associated Nosocomial Infections. Encyclopedia. Available online: (accessed on 28 May 2022).
    Dadi NCT. Medical Devices Associated Nosocomial Infections. Encyclopedia. Available at: Accessed May 28, 2022.
    Dadi, Nitin Chandra Teja. "Medical Devices Associated Nosocomial Infections," Encyclopedia, (accessed May 28, 2022).
    Dadi, N.C.T. (2021, November 26). Medical Devices Associated Nosocomial Infections. In Encyclopedia.
    Dadi, Nitin Chandra Teja. ''Medical Devices Associated Nosocomial Infections.'' Encyclopedia. Web. 26 November, 2021.