What are healthcare-associated infections
Medical advances have brought lifesaving care to patients in need, yet many of these advances come with a risk of a healthcare-associated conditions, including infections. Healthcare-associated infections (HAIs) refer to infections associated with the delivery of healthcare in hospitals, long-term care facilities, ambulatory settings, home care and other settings. These unanticipated infections that develop during the course of medical or surgical treatment may result in significant patient illnesses and deaths (morbidity and mortality); prolong the duration of hospital stays; and necessitate additional diagnostic and therapeutic interventions, which generate added costs. The Centers for Disease Control and Prevention (CDC) provides national leadership in surveillance, outbreak investigation, lab research and prevention of HAIs. The prevention and reduction of HAIs is also a top priority for the U.S. Department of Health and Human Services (HHS) and they have developed the HHS Action Plan to Prevent Healthcare-Associated Infections to provide a roadmap for HAI prevention.
Risk factors for HAIs
Preventing HAIs is critical to patient safety. Any patient is at risk for developing an HAI, although there are certain factors that increase the risk of infection. These include, for example, patient characteristics, such as, age or underlying diseases or conditions that may compromise the immune system; presence of indwelling or invasive medical devices, such as catheters or breathing tubes; complications from surgical procedures; and antibiotic use. The risk of infection related to invasive devices increases the longer the device is left in place. Patients in the healthcare setting are also at increased risk of HAIs from exposure to organisms that are transmitted between patients and healthcare workers.
Overuse of antibiotics also contributes to the problem of HAIs by promoting the emergence of antibiotic resistant organisms that cause HAIs and are difficult to treat, limit treatment options and may prolong a patient’s length of stay. Up to 50 percent of antimicrobial use in hospitals is unnecessary and inappropriate and also contributes to the growing problem of Clostridium difficile infections which are at historically high levels. A commitment to the responsible use of antibiotics is often called antimicrobial stewardship. For more information, visit the Safety Institute website on antimicrobial stewardship.
HAIs – extent, costs of the problem
HAIs are infections that patients acquire during the course of receiving healthcare treatment for other conditions. A recent CDC healthcare-associated infection (HAI) prevalence survey provides an updated national estimate of the overall problem of HAIs in U.S. hospitals. Based on a large sample of U.S. acute care hospitals, the survey found that on any given day, about 1 in 25 hospital patients has at least one healthcare-associated infection. There were an estimated 722,000 HAIs in U.S acute care hospitals in 2011. About 75,000 hospital patients with HAIs died during their hospitalizations. More than half of all HAIs occurred outside of the intensive care unit. The direct and indirect costs of HAIs are estimated to total $97-147 billion annually.
For the full prevalence study report, please visit: CDC HAI Prevalence Survey
Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med 2014;370:1198-208.
Major types of HAIs
The four most common types of HAIs are related to invasive devices or surgical procedures and include:
- Catheter-associated urinary tract infection (CAUTI)
- Central line-associated bloodstream infection (CLABSI)
- Surgical site infection (SSI)
- Ventilator-associated events (VAE)
A variety of organisms are responsible for many different types of HAIs. Details about these organisms and specific prevention efforts can be found on the CDC website. These organisms causing HAIs include:
Prevention of HAIs
CDC and other healthcare and public health partners use knowledge gained from HAI surveillance, outbreak investigations, research and expert advice and guidance to improve clinical practice, medical and surgical diagnostic and therapeutic procedures, and for the ongoing development of evidence-based infection control guidance and HAI prevention successes.
The CDC maintains a robust website for prevention of HAIs that has specific guidelines, prevention toolkits, infection prevention plans, checklists, and audiovisual materials. These materials are targeted for specific types of infections, organisms, as well as being directed to a variety of health care settings and audiences, including the public.
- CDC Healthcare Infection Control Practices Advisory Committee (HICPAC)
The Healthcare Infection Control Practices Advisory Committee (HICPAC), a federal advisory body, provides guidance to both CDC and the Secretary of the Department of Health and Human Services (HHS) on all matters related to surveillance, infection prevention and control. The primary activity of the Committee is to provide advice on periodic updating of existing CDC guidelines and development of new CDC guidelines. In addition to CDC-HICPAC . A number of healthcare and professional organizations offer guidelines for the prevention of HAIs. Many of these organizations are liaisons to the CDC’s HICPAC. ( List of infection prevention-related liaison organizations to HICPAC. For a listing of key infection prevention guidelines visit:
Tracking HAIs and success of prevention
- CDC NHSN
More than 13,000 healthcare facilities currently track HAIs through the CDC’s National Healthcare Safety Network (NHSN), the most widely used tracking system in the U.S. NHSN allows facilities to track, benchmark HAIs, identify infection prevention problems, and measure and track progress on prevention efforts, to ultimately eliminate HAIs
- CDC HAI progress report
The CDC’s National and State Healthcare-Associated Infections Progress Report provides a closer look at the healthcare-associated infections (HAIs) most commonly reported to CDC using the National Healthcare Safety Network (NHSN). This annual report describes national and state progress in preventing central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections after colon surgery and surgical site infections after abdominal hysterectomy. The report is based on 2012 data.
- CDC Healthy People 2020
The CDC’s Healthy People 2020 initiative, the nation’s report card, also sets goals and measures progress towards elimination of HAIs.
- HHS – National Action Plan to prevent HAIs
The National Action Plan to Prevent Health Care-Associated Infections provides a roadmap to the elimination of preventable HAIs, an important public health and patient safety issue. A federal Steering Committee was convened by the Secretary of HHS and is charged is to coordinate and maximize the efficiency of prevention efforts across the federal government. Members of the Steering Committee include clinicians, scientists and public health leaders.
Partnership for Patients (PFP)
The Centers for Medicare and Medicaid Services’ (CMS’s) Innovation Center initiated “The Partnership for Patients” in April 2011 as a public-private partnership that offers support to physicians, nurses and other clinicians working in and out of hospitals to make patient care safer and to support effective transitions of patients from hospitals to other settings. The two goals of this partnership were to:
- Reduce harm caused to patients in hospitals. By the end of 2014, preventable hospital-acquired conditions would decrease by 40% compared to 2010.
- Improve care transitions. By the end of 2014, preventable complications during a transition from one care setting to another would be decreased such that all hospital readmissions would be reduced by 20% compared to 2010.
Achieving the Partnership’s two goals had the potential to both save lives and costs for CMS programs. On December 2, 2014, HHS Secretary Sylvia Burwell announced a new report that showed an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in healthcare costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. According to the report, preliminary estimates show that hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013. This translates to a 17% decline in hospital-acquired conditions over the 3-year period. The PFP program ended December 9, 2014.
The areas of focus included several HAIs:
- Catheter-associated urinary tract infections (CAUTI)
- Central line associated blood stream infections (CLABSI)
- Surgical site infections (SSIs)
- Ventilator-Associated Events (VAE)
See Premier Safety Institute’s Partnership for Patients website for resources for each area of focus.