Reducing Your Risk of Infections

---

Finding statistics specific to all infections is a bit difficult because there are so many types of infections. As a clinician, I know from experience that an infection can be a reason for a person to need medical care, including hospital or long-term care facility-based services. 

The consequences of an infection for a person whose state of health makes them more vulnerable than others can be serious. A vulnerable person could be a person 

• who is recovering from another concern and whose immune system is compromised
• who has congestion in their lungs from COPD or similar
• whose skin has an open wound
• who cannot adequately perform personal hygiene when toileting or bathing
• whose nutritional requirements are not being met
• who cannot manage their medications correctly
• and more. 

As I cannot realistically address every kind of infection on this webpage, I will focus on the big ones I usually encounter.

Cellulitis is an infection of the skin caused by a bacteria. It tends to occur in people who have an opening in their skin such as a wound from surgery, pressure ulcer, cut, or similar. It can cause the skin to become red, warm, swollen, and tender. It most often occurs in legs and feet. 

Why do I focus on cellulitis? Because it can be an all too common complication in people with wounds and underlying medical vulnerabilities. If left untreated, it can result in a need for hospital and/or long-term care facility services. Plus, it can make a wound much more difficult to heal.

Antibiotics are needed to treat cellulitis. If you think you have this condition, seek care from a doctor or nurse practitioner. 

At the bottom of this page is a handout on Cellulitis from HealthLink BC. 

Urinary Tract Infections (UTI) are more common among women, especially during younger adult years. Research has shown that up to 70% of women report at least one UTI in their lifetime.* UTIs are not exclusive to women, though, and, as we age, the proportion of men who get a UTI increases. By the age of 85, it is a much more even playing field.* 

We do not want to promote overuse of antibiotics, so when a person who has a normal immune system shows signs and symptoms of a UTI, a doctor or nurse practitioner may prescribe non-antibiotic approaches to combat the UTI while waiting and watching in case these are not effective. For many, these non-antibiotic approaches are enough.

For others, especially those who with underlying health conditions and other vulnerabilities, an antibiotic may be needed more quickly as the consequences can be more severe and even unexpected. This is a decision for your doctor or nurse practitioner to make. 

If you have, or suspect, a UTI, DO reach out to a doctor or nurse practitioner so that your condition can be monitored and your symptoms treated appropriately.

Some costs associated with UTIs:*

• "Between 2009 and 2013, there were 325,385 hospitalizations related to UTIs in Canada (excluding Quebec, Manitoba and the Territories). 
• In 108,777 of those cases, UTI was the most responsible diagnosis for the hospitalization.  
• Of the larger number (where UTI was present but not the primary diagnosis), the average patient age was 75. 
• The authors calculated the average cost per case to be $12,407. 
• 15% of people had a dementia diagnosis and 8.1% died.
• In the US, total costs of UTIs, including lost labor due to sick days and healthcare costs, has been estimated to be 3.5 billion US dollars."

*Source: CanAge: Urinary Tract Infections 101

At the bottom of this page are two UTI-related handouts. One from Healthlink BC provides good general information about UTIs and how to prevent and treat them. One from CanAge provides excellent research related to UTIs and older adults. 

Similar to UTIs, yeast infections are not exclusive to women. They tend to be associated more with women because of the prevalence of one type: vulvovaginal yeast infection. Other common types are oral which occurs inside the mouth and is also called "thrush," and invasive type which can affect the blood, heart, brain, eyes, bone, and more. 

A yeast infection is a fungal infection associated with the fungus candida and more formally called candidiasis. It is normal to have some candida on your skin and inside your body. The problems come when the growth is out of control. 

I had some difficulty finding statistics specific to Canada so the ones below come from the US. Here are the numbers*:

Vaginal:

• It is the second most common type of vaginal infection after bacterial vaginal infections in the US. 
• About 1.4 million people seek outpatient care for vaginal candidiasis per year. 

Invasive:

• 2013-2017 cases were approximately 9 per 100,000 people with an estimated 25,000 cases across the US per year.
• Infants and elderly are more vulnerable as are minority populations possibly due to socioeconomic status, access to healthcare, and similar.
• Death related to candidiasis is estimated between 19 and 25% when looking at all deaths in hospitals from any cause. However, candidiasis often occurred with other medical conditions in this research so it is difficult to be certain of these numbers at this time. 
• "Candida is a  leading cause of healthcare-associated bloodstream infections in U.S. hospitals." 
• Hospital and healthcare facility stays are longer, between 3-13 days.
• The related cost for each stay is increased above the norm by US$6,000 to US$29,000.

Oral:

• There is no current "surveillance system" in the US for oral candida. This means they have not been tracking it. 
• What they do know is that most healthy adults will not develop this condition. People who have a health vulnerability, though, can develop this condition. 

*Source: CDC: Candidiasis

At the bottom of this page are three Candida-related handouts addressing the three types described above. They are from the Centers for Disease Control and Prevention in the US. 

A cold is an infection caused by a virus. It tends to affect the nose, throats, and/or sinuses. It is spread through coughing, sneezing, and close contact with an infected person. There is no cure, only medicine to make you feel more comfortable while your body fights it off. 

The numbers*:

• Estimated Canadian information indicates an adult experiences 2 to 5 colds per year.
• Colds appear to be a primary reason why people call off from work.

*Source: Canadian Centre for Occupational Health and Safety: Disease, Disorders and Injuries - Common Cold.

At the bottom of this page is a handout from HealthLink BC on colds. 

Flu is a nickname for influenza. It is also a viral infection and spreads similarly to how a cold spreads. There are anti-viral medications that, if started early enough, can shorten the duration of the illness. However, most people do not realize they're infected until a couple of days afterwards when their symptoms start so recognizing it early enough can be a bit of a trick. More often, 'watchful waiting' and comfort care are the approaches taken. 

Watchful waiting means that your doctor or nurse practitioner will wait to see how you are progressing before taking a more aggressive approach. Comfort care refers to the over-the-counter and at-home ways you can make your experience more tolerable, such as being more restful and using acetaminophen (Brand name: Tylenol) for aches, pains, and fever.

The numbers*: 

• From 2020-2021, lab-confirmed influenza rates were 0.1% or less. 
• From 2021 to 2022, lab-confirmed influenza did increase from 69 the previous year to 16,126 cases, still far lower than pre-COVID years. 

Why are we still concerned about influenza if these numbers are so low? Because by wearing masks and staying home due to COVID precautions we reduced the ability for us to spread the flu, too. Now that we are not masking or staying home, it is expected that the cases of flu will once again increase. 

*Source: Government of Canada Annual Influenza Reports

At the bottom of this page are handouts from HealthLink BC on influenza. 

RSV stands for Respiratory Syncytial Virus. As it indicates, it is a viral infection and is spread similarly to a cold. The symptoms are also similar to a cold, but people might say it feels like a "bad cold." Most people will recover through home-based comfort-care, such as the rest and the use of over-the-counter medicines to manage symptoms. Infants and people with underlying health concerns, though, are more vulnerable to poor outcomes from RSV. In these people RSV can lead to pneumonia and other respiratory complications. 

The numbers*:

• Data specific to British Columbia showed only 11 cases of RSV from 2020 to 2021, when people were still under masking precautions, working more often from home, and restricting travel.
• As masking and stay-at-home restrictions lifted, the cases of RSV increased in BC during the 2021 to 2022 reporting year to 9,529.
• During the partially reported 2022-2023 year cases were already at 8,215 in BC.

*Source: The Lancet: Respiratory syncytial virus epidemiology and clinical severity before and during the COVID-19 pandemic in British Columbia, Canada: a retrospective observational study.

At the bottom of this page are handouts from HealthLink BC on RSV. 

Pneumonia is an infection in your lungs that can be caused by bacteria or viruses. Like RSV, most people can be treated at home with rest and over-the-counter medicines to ease symptoms. If the pneumonia is due to a bacterial infection, your doctor or nurse practitioner may prescribe an antibiotic depending upon the severity of your symptoms and medical vulnerabilities. Also like RSV, infants and those with underlying healthcare vulnerabilities are more at risk for medical complications and may need hospital or medical facility based services. 

The numbers*:

• In 2017, pneumonia, alongside influenza, was the 6th leading cause of death in Canada.
• Pneumonia as the cause for hospitalizations in Canada was 611 per 100,000 children under age 5 years and 3,002 per 100,000 adults over age 80 years. 
• In Ontario from 2012 to 2014, community-acquired pneumonia occurred in 50.1 of every 1,000 adults aged 65 years or older. 
• The rate was 12.9 people for every 1,000 adults aged 18 to 64 years.
• The rate was 24.7 for every 1,000 children aged 0-17 years. 
• 92.6% of people were treated in an outpatient setting and most with only one doctor or nurse practitioner visit. The related cost was $1,595.
• For the remaining population treated in an inpatient setting (hospital and/or healthcare facility), the average cost was $12,576. 

*Source: The Journal of Medical Economics: The epidemiology and healthcare costs of community-acquired pneumonia in Ontario, Canada-a population-based cohort study. 

At the bottom of this page are handouts from HealthLink BC on pneumonia. 

COVID, also called COVID-19, refers to the coronavirus disease. This is a viral infection caused by the SARS-CoV-2 virus and it's variants. It causes an infection of your lungs and overall respiratory system but can go further to affect other parts of your body as well. It is very contagious and spreads similarly to colds and flus. When someone exhales, the virus spreads to those nearby and onto surfaces touched by others. Particles of the virus can land on, or be transferred by touch to, your eyes, nose or mouth causing infection.

Any person can become very ill from COVID. Those who have underlying medical conditions are especially vulnerable. Some people are able to recover at home, others require hospital-based care. COVID symptoms can be quite severe and long-lasting compared to a cold or flu. This can take a toll on a person's ability to engage in normal activities, disrupt the care of others who rely on the ill person, and disrupt income from employment. Long COVID is another complication that we are still learning about. My experience with patients who have this diagnosis is that long COVID symptoms continue to disrupt all previously described facets of their life for months. We do not currently have a length of time that long COVID 'typically' lasts. 

If you suspect you may have COVID, please work with your doctor or nurse practitioner to manage your care. 

The numbers:

From the World Health Organization

• Between January 3, 2020 and October 25, 2023, there have been 4,716,205 confirmed cases of COVID in Canada with 53,297 associated deaths.
• As of June 2, 2023, 97,596,974 doses of vaccine have been administered in Canada.

From the Canadian Medical Association Open Journal (CMAJ Open) article: Initial health care costs for COVID-19 in British Columbia and Ontario, Canada: an interprovincial population-based cohort study:

• In BC, net costs for the first 30 days of in-hospital care were $22,010 per person and $65,828 per person for those who were admitted to the Intensive Care Unit. The timeframe examined was mid-year 2020.

From the Canadian Institutes for Health Information: National Health Expenditure Trends:

• "Spending related to the COVID-19 pandemic has continued in 2022. COVID-19 Response Funding makes up 4.4% of total health spending, compared with 9.9% in 2021."
• "Federal, provincial and territorial governments (combined) spent $770 per person in 2020 for health-specific funding to deal with COVID-19. Pandemic response funding is projected to decline to $376 per person in 2022."

You can see COVID tracking statistics from the Government of Canada here.

At the bottom of this page is a handout from HealthLink BC on COVID.