The Covid pandemic provides a stark reminder of the impact of hospital acquired infection, with the proportion of hospital patients becoming infected by the virus after admission reaching 24%1. 

A national survey conducted in 2023 estimated that approximately 6.4% of patients in acute care settings acquire an Healthcare Associated Infections (HCAI) during their hospital stay.  These infections not only contribute to increased morbidity and healthcare costs but can also prolong hospital stays and complicate treatments. 

The most common types of HCAIs in the UK include: 

• Urinary tract infections (UTIs), often associated with the use of urinary catheters. 

• Surgical site infections (SSIs), which can occur after surgery. 

• Respiratory infections, particularly pneumonia, often linked to mechanical ventilation in intensive care units (ICUs). 

• Bloodstream infections (BSIs), such as those caused by methicillin-resistant Staphylococcus aureus (MRSA). 

• Clostridioides difficile (C. difficile) infections, often linked to antibiotic use. 

The prevalence of these infections varies, but they commonly affect between 5% and 10% of hospitalized patients, with intensive care units seeing even higher rates.  For example, in ICUs, the prevalence of HCAIs can be as high as 7.4%, with pneumonia and bloodstream infections being particularly prevalent​   

Put simply, there is significantly less risk of infection at-home.  

There is strong evidence from UK and US research that patients experience significantly poorer sleep in hospital settings compared to at home, primarily due to noise disturbances and environmental factors. ​  A study3 focused on adult patients in a UK Medical Admissions Unit found that noise levels in hospital wards caused sleep disturbances for 30-50% of patients.  Patients reported average sleep durations of 5.3 hours in hospital compared to 7.1 hours at home.   

The link between sleep and recovery rates is well documented, impacting patient mental and physical well-being.  Sleep quality directly impacts the rate of recovery from illness or surgery in the following ways: 

• Immune Function: Sleep plays a critical role in immune system function. Research shows that during sleep, the body produces cytokines, proteins essential for fighting infections and reducing inflammation. Lack of sleep can impair immune responses, making the body more susceptible to infections and slowing down recovery from illness or surgery​. 

• Tissue Repair and Growth: During deep sleep, the body releases growth hormone, which is crucial for tissue repair and muscle regeneration. This phase of sleep promotes healing and recovery after surgeries or injuries. Disrupted or insufficient sleep can lead to slower tissue repair and delayed recovery​. 

• Pain Tolerance: Studies indicate that poor sleep can decrease pain tolerance, leading to heightened sensitivity to pain and discomfort. Patients who get adequate sleep after surgery or injury tend to have a higher pain threshold, which can lead to a smoother recovery process​. 

• Cognitive Function and Mental Health: Adequate sleep helps maintain cognitive functions like memory, focus, and emotional regulation, which are essential for adhering to treatment plans and rehabilitation exercises. Lack of sleep, on the other hand, can increase stress and anxiety, which may hinder recovery. 

Our Virtual Nursing Hub perform the following duties for patients receiving our Elective Remote Monitoring services: 

• Remote monitoring of patient vital signs  

• Collection of Patient Reported Outcome Measures (PROMS) and questionnaires  

• Rapid escalation management, leveraging advice & guidance from specialist doctors, with oversight by the named Consultant Specialist

Nutrition plays a crucial role in recovery by providing the essential building blocks (proteins, vitamins, and minerals) needed for tissue repair, immune support, and energy production, all of which are critical to healing after hospitalisation or illness.   

Many hospital patients, especially the elderly, are at risk of malnutrition.  Recent studies by the National Institute for Health and Care Research6 and NHS England found that a significant proportion of hospital patients are either malnourished or at risk of becoming so, due to various factors including lack of personal preferences, meal timing, patients being asleep when food is served, logistical constraints and hospital budget constraints.   

Studies have indicated that home-based care allows for better nutrition management, where patients can have more personalised meals, greater control over the quality and nutritional value, as well as the time that is served.  This is particularly evident where patients receive support from carers or family members.   

The link between nutrition and recovery from hospital illness or surgery is well evidenced and understood.  Good nutrition is scientifically linked to better recovery rates from hospital care due to its direct influence on multiple physiological processes vital to healing and recovery. Here's how specific nutrients impact recovery: 

• Protein and Tissue Repair: Protein is essential for the repair and regeneration of body tissues. It provides the amino acids required for synthesizing new tissues, especially after surgery or injury. A lack of protein can slow wound healing, weaken immune responses, and increase the risk of complications like infections​.  Studies4 show that patients with higher protein intake have faster recovery rates because protein helps rebuild muscle mass lost during illness or bed rest​. 

• Vitamins and Immune Function: 

Vitamin C: This vitamin plays a key role in collagen production, which is critical for wound healing. It also supports the immune system by enhancing the function of white blood cells, helping to ward off infections that can prolong recovery​. 

Vitamin A: Essential for cellular growth and immune response, vitamin A is particularly important in the recovery from infections and wounds​( 

Vitamin D: This nutrient is linked to immune function and muscle health. Adequate levels of vitamin D reduce the risk of infections and support musculoskeletal recovery, especially in patients with chronic conditions​( 

Minerals and Cellular Functions: 

Zinc: Zinc is crucial for wound healing as it supports cell division and immune function. Deficiency in zinc can impair the healing process and increase susceptibility to infections​ 

Iron7: Iron is important for the production of hemoglobin, which carries oxygen to tissues. Ensuring adequate iron levels can help prevent fatigue and enhance energy levels during recovery​. 

Energy and Caloric Intake: Recovery requires significant energy, especially after surgery, infections, or trauma. Carbohydrates and fats provide the necessary calories to fuel the body's healing processes. Malnutrition or inadequate caloric intake can lead to weight loss, muscle wasting, and longer recovery times​.

Hydration and Detoxification: Proper hydration supports kidney function, which is essential for eliminating waste products and toxins from the body. Dehydration can lead to complications such as electrolyte imbalances, which can delay recovery​.

In summary, good nutrition accelerates recovery by providing the essential building blocks (proteins, vitamins, and minerals) needed for tissue repair, immune support, and energy production, all of which are critical to healing after hospitalisation or illness. 

Research indicates that hospital patients spend over 96% of their time confined to a bed or chair and that such inactivity, particularly for elderly patients, results in significant decline in functional mobility, which can lead to long-term consequences such as nursing home admission and increased mortality risk8.  This is commonly referred to as ‘hospital related de-conditioning’. 

A Cambridge based study demonstrates a significant reduction in muscle strength and functional movement range associated with hospital admission.  The study assessed capability to perform basic Activities of Daily Living such as eating, bathing, grooming, dressing, toilet use, mobility, stair climbing (etc) before and after hospital admission.  Findings evidence an average 50% reduction in patient ability to perform such Activities of Daily Living after hospital admission, with such loss of function still being present 6 weeks post discharge.  

 Other US based studies have demonstrated that a 10 days hospital stay for older adults caused an average 65% reduction in ambulatory function during hospitalisation, caused by loss of lower extremity strength, power, and aerobic capacity.   

Not infrequently, hospital related deconditioning results in nursing home placement.  The unfortunate reality is that once admitted to a nursing home, patients incur further functional loss owing to lack of structured rehabilitation and ongoing reduced physical activity.   

Conversely, patients who are treated at home in our Acute Virtual Ward are benefited from the freedom mobilise in their home, garden and community, as well as maintain or more quickly return to routines of self-care and hobbies during their treatment.  This enables patients to preserve and where necessary rebuild their independence and functional mobility.    

Hospital stays can be a very lonely and isolating experience, restricting patients with access to their family, friends, pets, familiar comforts and hobbies - at a time they are ill, often low and vulnerable.   

For patients with dementia, a hospital admission can be particularly stressful, with research indicating high vulnerability to cognitive decline during hospital stays, leading to onset of delirium in nearly 46% of patients.  The change in environment, routine and care team, which notably commonly excludes mental health practitioners, are common contributors to such deterioration:  

• Changes to routine & stress can trigger Delirium: Dementia patients often rely heavily on routines for maintaining cognitive function. A hospital stay disrupts these routines with unfamiliar surroundings and people.  The chaotic nature of hospitals - constant noise, frequent medical interventions, and a sterile atmosphere – add to the impact on the patient.  Such changes create disorientation and stress, which studies have shown to cause onset of Delirium in nearly 46% of dementia patients during hospitalisation.  The onset of delirium in such circumstances significantly exacerbates cognitive decline, leading to further mental confusion.  This rapid cognitive deterioration often makes it harder for these patients to return to their pre-hospitalisation functional state. 

• Absence of mental health care in acute hospital – whilst in an acute hospital, patients do not have access to, or support from their mental health practitioners; nor do they have the same support from their regular care team and family - who understand their unique needs, preferences, and tendencies.  This impact is heightened for dementia patients.  Put simply, whilst patients are being treated for an acute physical condition in hospital (e.g. Pneumonia, heart failure, etc.), their mental health needs are not provided for, leading to neglect and decline of these conditions.  One condition suffers at the expense of the other, in an unfortunate vicious circle.    

Overall, hospital admissions pose a stress on the mental health of patients, exacerbating cognitive decline and contributing to worse outcomes post-discharge.    

Treatment in our Acute Virtual Ward enables patients to be treated in their same familiar environment, in which they can continue with their daily routines in their home and garden.  If lucky, they might even enjoy some sunshine.  Our patients receive uninterrupted support from their normal day-to-day care team and mental health practitioners, and most importantly, they will not suffer the isolation from their family, friends and pets when they are most vulnerable.