Hospital-acquired infections (HAIs), also called healthcare-associated infections, affect millions of patients every year. Most of these infections are linked to medical devices, surgical procedures, or prolonged hospital stays, and they affect men and women alike. However, a few HAIs occur more frequently in women due to biological differences, anatomical factors, or procedures unique to female patients. Understanding these infections can help healthcare providers design better prevention strategies and help patients advocate for safer care. In today's post, we'll look at several healthcare-associated infections that disproportionately affect women and the factors that contribute to their increased risk.
Catheter-associated urinary tract infections are among the most common healthcare-associated infections in hospitals. Approximately 30-40% of hospital infections are CAUTIs, a occurring in patients with indwelling urinary catheters. Women face a higher risk of developing urinary tract infections for anatomical reasons. The female urethra is significantly shorter than the male urethra, which allows bacteria to reach the bladder more easily. When a catheter is introduced, it can serve as a pathway for bacteria to enter the urinary tract.
Because urinary catheters are used in 12-25% (depending on hospital unit) of hospital stays, reducing catheter use and shortening catheter duration remain some of the most effective ways to prevent these infections.
Cesarean delivery is one of the most common surgical procedures performed in hospitals. Like any surgery, it carries a risk of surgical site infection (SSI). Post-cesarean infections can affect the incision, surrounding tissue, or deeper layers of the abdomen and uterus. These infections may occur during the hospital stay or shortly after discharge. Typical symptoms include: Redness or swelling at the incision site, fever, drainage from the wound, and increased pain around the surgical area. Risk factors include emergency Cesarean procedures, prolonged labor before surgery, obesity or diabetes, and, of course, inadequate infection control practices. Cesarean surgical site infections affect 3.8% of procedures in the United States according to the National Institutes of Health. With 1.2 million Cesarean section surgeries per year in the US, that results in 45,600 Cesarean surgical site infections per year.
Hysterectomy, the surgical removal of the uterus, is another common hospital procedure that carries a risk of postoperative infection. These infections may develop in the abdominal incision, pelvic tissues, and the vaginal cuff (the top of the vagina after uterine removal). Symptoms may include: Fever, pelvic pain, abnormal discharge, and wound inflammation.
The incidence of infection after hysterectomy varies depending on the surgical approach (abdominal, laparoscopic, or vaginal), but rates typically fall around 9.8% according to the American Congress of Obstetricians and Gynecologists, but with over 433,000 procedures per year, that means over 40,000 infections per year. Hospitals track hysterectomy infections as part of surgical quality metrics, and improvements in antibiotic prophylaxis and sterile technique have helped reduce their frequency over time, as have the newer methods such as laparoscopy.
Childbirth is one of the most common reasons for hospitalization, and postpartum infections remain an important patient safety issue. Healthcare-associated postpartum infections can include: Endometritis (infection of the uterine lining), episiotomy infections, urinary infections after catheter use during labor, and as mentioned separately above, post-Cesarean incision infections. These infections can occur within days of delivery and may lead to complications if not treated promptly. Risk factors include: Cesarean delivery, prolonged rupture of membranes, multiple vaginal examinations during labor, and retained placental tissue. Postpartum infections occur in approximately 5-7% of deliveries according to the National Center for Biotechnical Information.
When healthcare providers design infection prevention programs, they often focus on device management, antibiotic stewardship, and environmental sanitation. However, recognizing sex-specific risk factors can improve prevention strategies.
For example:
Understanding these differences helps healthcare systems tailor prevention strategies to the patients most at risk.
Healthcare-associated infections remain a major challenge for hospitals worldwide, affecting 1 in 31 US hospital patients each year according to the Centers for Disease Control and Prevention.
While many HAIs affect men and women equally, infections related to urinary catheters, obstetric care, and gynecologic surgery disproportionately impact women.
Improving infection control in these areas will require continued attention to: Device management protocols, surgical infection prevention, maternal care safety initiatives, and innovative biocidal materials and technologies.
Reducing these infections does more than improve patient outcomes, it also reduces healthcare costs and protects the most vulnerable patients during some of the most important moments of their lives.