Prevent, reduce, and ultimately eliminate healthcare-associated infections (HAIs).
HAIs are infections that patients get while receiving treatment for medical or surgical conditions, and many HAIs are preventable. Modern healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Infections can be associated with procedures (like surgery) and the devices used in medical procedures, such as catheters or ventilators. HAIs are important causes of morbidity and mortality in the United States and are associated with a substantial increase in health care costs each year. At any one time in the United States, 1 out of every 25 hospitalized patients are affected by an HAI.1
HAIs occur in all types of care settings, including:
- Acute care hospitals
- Ambulatory surgical centers
- Dialysis facilities
- Outpatient care (e.g., physicians' offices and health care clinics)
- Long-term care facilities (e.g., nursing homes and rehabilitation facilities)
The establishment of the Healthcare-Associated Infections objectives for Healthy People 2020 reflects the commitment of the U.S. Department of Health and Human Services (HHS) to preventing HAIs. These high-priority objectives address central line-associated bloodstream infections (CLABSI) and methicillin-resistant Staphylococcus aureus (MRSA) infections.
A central line-associated bloodstream infection (CLABSI) is a serious HAI that occurs when germs (e.g., bacteria) enter the bloodstream through the central line (a long flexible tube placed in a large vein that empties out near the heart). These infections result in thousands of deaths each year and several million dollars in added costs to the U.S. health care system.
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to many antibiotics. In medical facilities, MRSA causes life-threatening bloodstream infections, pneumonia, and surgical site infections.
Besides these sources of HAIs, several other sources have been identified as major contributors to HAI-related illness and deaths in the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination.
Common types of HAIs include:
- Catheter-associated urinary tract infections
- Surgical site infections
- Bloodstream infections
- Clostridium difficile
Why Are Healthcare-Associated Infections Important?
HAIs are a significant source of complications across the continuum of care and can be transmitted between different health care facilities. However, recent studies suggest that implementing existing prevention practices can lead to up to a 70 percent reduction in certain HAIs.2 Likewise, recent modeling data suggests that substantial reductions in resistant bacteria, like MRSA, can be achieved through coordinated activities between health care facilities in a given region.3 The financial benefit of using these prevention practices is estimated to be $25 billion to $31.5 billion in medical cost savings.4
Risk factors for HAIs can be grouped into three general categories: medical procedures and antibiotic use, organizational factors, and patient characteristics.5 The behaviors of health care providers and their interactions with the health care system also influence the rate of HAIs.
Studies have shown that proper education and training of health care workers increases compliance with and adoption of best practices (e.g., infection control, hand hygiene, attention to safety culture, and antibiotic stewardship) to prevent HAIs.5,6 Examples of best practices by a health care provider include careful insertion, maintenance, and prompt removal of catheters, as well as the careful use of antibiotics. Another example of a best practice is decolonization of patients with an evidence-based method to reduce transmission of MRSA in hospitals.7
Emerging Issues in Healthcare-Associated Infections
Healthy People 2020 objectives measure progress toward reducing the incidence of CLABSI and invasive MRSA infections. However, more work needs to be done. In addition, there are other major types of HAIs that HHS is working to prevent, including those caused by antibiotic-resistant pathologens:
- Catheter-associated urinary tract infections
- Surgical site infections
- Ventilator-associated events/ventilator-associated pneumonia
- Clostridium difficile infections
Research suggests that many of these infections are preventable. Efforts are under way to expand implementation of strategies known to prevent HAIs, advance development of effective prevention tools, and explore new prevention approaches.8 Many efforts to prevent HAIs have focused on acute care settings. Increasingly, health care delivery, including complex procedures, is being shifted to outpatient settings, such as ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities. These settings often have limited capacity for oversight and infection control compared to hospital-based settings. Because patients with HAIs, including HAIs caused by antibiotic resistance organisms, often move between various types of health care facilities, prevention efforts must also expand across the continuum of care. Moreover, the challenges posed by antibiotic-resistant organisms and C. difficile are best addressed through coordinated action among health care facilities in a given region.
The National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination contains strategies on preventing HAIs in non-acute care hospital settings and supports further research on how to identify and control HAIs in these settings and apply evidence-based approaches for reducing HAIs.
1Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. New England Journal of Medicine 2014; 370:1198-208.
2Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725-32.
3Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States; MMWR August 4, 2015; 64; 1-7 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0804a1.htm?s_cid=mm64e0804a1_w).
4Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Atlanta: Centers for Disease Control and Prevention; 2009.
5Agency for Healthcare Research and Quality (AHRQ). Patient safety and quality: An evidence-based handbook for nurses. AHRQ Publication No. 08-0043. Rockville, MD: AHRQ; 2008 Apr. Available from: http://archive.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/index.html
6Safdar N, Abad C. Educational interventions for prevention of healthcare-associated infection: A systematic review. Crit Care Med. 2008 Mar;36(3):933-40.
7Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
8Agency for Healthcare Research and Quality. AHRQ’s Healthcare-Associated Infections Program: Tools & Resources to Prevent HAIs. Available from: http://www.ahrq.gov/professionals/quality-patient-safety/hais/index.html