Jordan Ellis
Hospital-acquired infections (HAIs) are illnesses that patients can contract while receiving treatment for other conditions in healthcare facilities. HAIs are a leading cause of morbidity and mortality, with about 72,000 deaths in the US in 2015 and an average of 1 in 10 affected patients dying from HAIs globally. While good hand hygiene and other cost-effective practices can prevent up to 70% of infections, the COVID-19 pandemic has exposed gaps in infection prevention and control (IPC) worldwide. However, there is encouraging progress, with significant decreases in specific types of HAIs between 2022 and 2023, and a 16% lower likelihood of HAIs in 2015 compared to 2011. This paragraph introduces the topic of HAIs, their impact, prevention strategies, challenges, and recent trends, highlighting the importance of addressing these infections to improve patient safety in healthcare settings.
| Characteristics | Values |
|---|---|
| Date of latest data | 2025-03-25 |
| Number of hospital patients with at least one healthcare-associated infection on a given day | 1 in 31 |
| Percentage of patients in the 2015 HAI Hospital Prevalence survey with an HAI | 3% |
| Number of HAIs in U.S. acute care hospitals in 2015 | 687,000 |
| Number of hospital patients with HAIs who died during their hospitalizations in 2015 | 72,000 |
| Types of HAIs | Central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), hospital-onset C. difficile infections (CDI), ventilator-associated events (VAE), methicillin-resistant Staphylococcus aureus (MRSA), and more |
| Changes in HAIs between 2022 and 2023 | Decreases observed in CLABSI (13%), CAUTI (11%), VAE (5%), and MRSA (16%); no significant change in SSI following colon surgery; 8% increase in SSI following abdominal hysterectomy |
| Geographic location of data | National and state level in the U.S. |
| Types of data | HAI data, AR data, Antibiotic Stewardship data, Standardized Utilization Ratios for Acute Care Hospitals, Critical Access Hospitals, and Inpatient Rehabilitation |
| Laboratory resources | Reference Antimicrobial Susceptibility Testing (AST) Data, minimum inhibitory concentration (MIC) distributions for bacteria and fungi |
| Standardized Infection Ratio (SIR) | Compares the number of infections in a facility or state to the number of "predicted" infections based on previous years' data |
| Standardized Utilization Ratio (SUR) | Compares the number of device days in a facility or state to the number of "predicted" device days based on previous years' data |
| Global perspective | The COVID-19 pandemic highlighted the role of healthcare settings in spreading infections if IPC practices are lacking; good hand hygiene and cost-effective practices can prevent 70% of infections |
| Infection rates | On average, 1 in 10 patients with HAI will die from it; in high-income countries, 7 in 100 patients acquire an HAI, while in low- and middle-income countries, 15 in 100 patients acquire an HAI |
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What You'll Learn
Hand hygiene and cost-effective practices
Hand hygiene is a simple yet powerful tool in the fight against healthcare-associated infections (HAIs). The COVID-19 pandemic highlighted the role of healthcare settings in contributing to the spread of infections if adequate attention is not paid to infection prevention and control (IPC). The World Health Organization (WHO) has released a report showing that good hand hygiene and other cost-effective practices can prevent up to 70% of these infections.
HAIs are a significant issue in healthcare, with about one in 31 hospital patients affected on any given day. The CDC's National and State Healthcare-Associated Infections Progress Report tracks HAIs commonly reported to their National Healthcare Safety Network (NHSN). Between 2022 and 2023, there were significant decreases observed for several types of HAIs, including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated events (VAE).
Hand hygiene is a critical component of IPC, a clinical and public health specialty that aims to protect patients, health workers, and visitors from avoidable infections. Appropriate hand hygiene can prevent up to 50% of infections acquired during healthcare delivery, including those affecting healthcare workers. It is particularly important in reducing the risk of SARS-CoV-2 infection among healthcare personnel and in preventing the spread of antimicrobial-resistant organisms.
To improve hand hygiene compliance, healthcare leaders should ensure that healthcare personnel (HCP) have the knowledge and resources to follow evidence-based practices. This includes access to alcohol-based hand sanitizers, promoting hand skin health, and selecting appropriate hand hygiene products. High-quality evidence also emphasizes the importance of healthy skin and fingernails, with some practices prohibiting fingernail polish and gel shellac for those involved in surgical procedures.
Implementing hand hygiene policies can generate significant economic savings, with returns averaging 16 times the cost of implementation. Hand hygiene is a cost-effective practice that saves lives and plays a key role in preventing HAIs and reducing the burden of healthcare-associated infections.
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HAIs in intensive care units
Hospital-acquired infections (HAIs) are a serious issue in intensive care units (ICUs), with very high rates of infection and increased mortality among patients. HAIs are nosocomial infections that are absent or incubating upon hospital admission and typically manifest after 48 hours. The risk factors for HAIs include immunosuppression, older age, extended hospital stays, multiple underlying comorbidities, frequent healthcare visits, mechanical ventilation, invasive procedures, and the use of indwelling devices.
The development of HAIs in ICUs is influenced by the patient's underlying health conditions, the ICU environment, and the medical procedures performed. The use of invasive devices, such as central vascular lines (CVCs), intubation tubes, and urethral catheters, increases the risk of HAIs in ICU patients. Additionally, long-term antibiotic treatment can lead to the selection of antibiotic-resistant microorganisms, further complicating the treatment of infections.
The World Health Organization (WHO) has reported that HAIs are the most common adverse event among hospitalized patients, with over 2.5 million HAI episodes occurring annually in Europe. The six most common types of HAIs in Europe are healthcare-associated pneumonia, urinary tract infections, surgical site infections (SSIs), Clostridium difficile infections, neonatal sepsis, and bloodstream infections. In the United States, there were approximately 687,000 HAIs in acute care hospitals in 2015, resulting in 72,000 deaths.
To address the high rates of HAIs in ICUs, various preventive strategies have been implemented. These strategies include improving hand hygiene, contact precautions, antibiotic stewardship, appropriate antimicrobial prophylaxis, patient positioning, subglottic suction, strict asepsis when placing central lines, limiting the use of external devices, and early removal of catheters. Surveillance and monitoring of HAIs are also crucial, with organizations such as the National Healthcare Safety Network (NHSN) of the Center for Disease Control and Prevention (CDC) playing a vital role in tracking and preventing HAIs.
Recent reports from the CDC indicate progress in reducing HAIs in ICUs. Between 2022 and 2023, significant decreases were observed in central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), methicillin-resistant Staphylococcus aureus (MRSA) infections, C. difficile infections, and ventilator-associated events (VAE). However, surgical site infections (SSIs) following abdominal hysterectomy showed an increase during this period. Overall, the implementation of preventive measures and improvements in infection control policies have contributed to a downward trend in HAIs in intensive care units.
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HAIs in newborn nurseries
Healthcare-associated infections (HAIs) are a significant concern in hospitals, and newborn nurseries are no exception. Newborns are particularly vulnerable to infections, and the risk is heightened in neonatal intensive care units (NICUs).
In the newborn nursery, the risk of HAIs is influenced by various factors. One key factor is the immature gastrointestinal tract of newborns, which provides a potential entry point for pathogens. The acquisition of normal colonizing flora is disrupted in hospitalized newborns due to exposure to pathogenic bacteria, antimicrobial agents, and invasive procedures. This disruption can increase the risk of invasive infections. Additionally, the frequent use of antimicrobial agents in the hospital setting can impact the development of the newborn's microflora.
The environment and hygiene practices also play a crucial role in HAI prevention. Studies have shown a relationship between overcrowding, understaffing, and infection rates in newborn nurseries and NICUs. Adequate staffing levels of registered nurses have been found to significantly reduce the risk of bloodstream infections (BSI). Maintaining good hand hygiene is essential, as mothers can transmit infections to their newborns postpartum, and healthcare workers can inadvertently spread bacteria through their hands. Toys in NICU beds have also been found to be contaminated with pathogenic bacteria, although their role in infection transmission is not yet fully understood.
To address the challenges posed by HAIs in newborn nurseries, infection control measures are crucial. These include hand hygiene, contact precautions, cohorting of infants and staff, and restricting healthcare workers (HCWs) with signs of gastrointestinal illness from patient contact. Encouraging good hand hygiene practices among mothers and visitors can also help minimize the risk of postpartum transmission. Additionally, consistent definitions and risk stratification are necessary for meaningful analysis of HAI rates in newborn nurseries due to the heterogeneity of the population.
While HAIs in newborn nurseries are a concern, the implementation of infection prevention and control (IPC) practices can significantly reduce the risk of infections. The World Health Organization (WHO) has reported that adhering to good hand hygiene and other cost-effective practices can prevent up to 70% of these infections.
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HAIs in surgical centres
Healthcare-acquired infections (HAIs), also known as nosocomial infections, are infections that patients acquire while receiving treatment for medical or surgical conditions. HAIs occur in all care settings, including hospitals, surgical centres, ambulatory clinics, and long-term care facilities such as nursing homes and rehabilitation centres. According to the CDC, about one in 31 hospital patients has at least one healthcare-associated infection on any given day. HAIs pose a significant threat to patient safety, and the CDC is actively working to prevent and control these infections.
Surgical site infections (SSIs) are a common type of HAI, with rates ranging from 12.9% to 32.6% in different studies. Patients who develop infections following surgery face prolonged hospital stays, an increased risk of readmission, and higher mortality rates. They are also more likely to require intensive care unit admission, resulting in substantial healthcare costs.
Recent reports emphasize the importance of adhering to evidence-based best practices to prevent HAIs. Recommendations include stringent hand hygiene for healthcare providers, judicious use of catheters, and proper cleaning of surgical sites. The World Health Organization's (WHO) report on infection prevention and control highlights that 70% of infections can be prevented through good hand hygiene and other cost-effective practices.
The CDC's National and State Healthcare-Associated Infections Progress Report provides valuable insights into HAI prevention efforts. It tracks infections such as central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), select surgical site infections (SSI), and hospital-onset C. difficile infections. The report utilizes standardized infection ratios (SIRs) and utilization ratios (SURs) to monitor progress and compare infection rates across facilities and states.
While there has been progress in reducing HAIs in surgical centres and other healthcare settings, ongoing challenges remain. The COVID-19 pandemic has exposed gaps in infection prevention and control programmes, underscoring the need for continued vigilance and improvement in these areas.
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HAIs in long-term care facilities
Healthcare-acquired infections (HAIs), also known as nosocomial infections, are infections that patients acquire while receiving treatment for medical or surgical conditions. HAIs occur in all care settings, including hospitals, surgical centres, ambulatory clinics, and long-term care facilities such as nursing homes and rehabilitation facilities. According to the Centers for Disease Control (CDC), HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year in American hospitals alone.
Long-term care facilities, which provide treatment for patients who are generally very sick and have long hospital stays, are particularly vulnerable to HAIs. The COVID-19 pandemic has exposed challenges and gaps in infection prevention and control (IPC) in these settings. The World Health Organization (WHO) has reported that good hand hygiene and other cost-effective practices can prevent up to 70% of infections. However, inadequate implementation of IPC practices has been observed, with only 15.2% of healthcare facilities meeting all IPC minimum requirements in a 2019 WHO survey.
To address HAIs in long-term care facilities, the Agency for Healthcare Research and Quality (AHRQ) has developed the 'Toolkit To Reduce CAUTI and Other HAIs in Long-Term Care Facilities'. This toolkit is based on the Comprehensive Unit-based Safety Program (CUSP) and provides resources to enhance leadership and staff engagement, teamwork, and safety culture. It includes instructional materials and resources on foundational infection prevention strategies, CAUTI prevention, and antibiotic stewardship. The toolkit has been used by LTC facilities participating in the AHRQ Safety Program for Long-Term Care: HAIs/CAUTI, involving approximately 500 long-term care facilities across the country.
In addition to the AHRQ toolkit, the CDC's National and State Healthcare-Associated Infections Progress Report provides valuable information on HAIs in long-term care facilities. This report includes data on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), and hospital-onset C. difficile infections, among other HAI types. The CDC also recommends that all hospitals implement an Antibiotic Stewardship Program to optimise antibiotic prescribing and limit overuse and misuse.
Overall, while there have been challenges in reducing HAIs, particularly during the COVID-19 pandemic, progress has been made. Standardized Infection Ratios (SIRs) and Standardized Utilization Ratios (SURs) are useful tools for tracking HAI prevention progress and device utilization over time, respectively. With continued efforts to improve infection prevention and control practices, it is hoped that the incidence of HAIs in long-term care facilities will decrease.
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Frequently asked questions
Hospital-acquired infections, also known as healthcare-associated infections (HAIs) or nosocomial infections, are illnesses that patients can contract while receiving treatment in a healthcare facility. These infections can occur in hospitals, surgical centres, dialysis clinics, and long-term care facilities. HAIs are a leading cause of morbidity and mortality, particularly in intensive care and newborns.
Common types of HAIs include urinary tract infections, surgical site infections, bloodstream infections, skin infections, and various pneumonias. Antibiotic-resistant pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), can complicate the treatment of HAIs.
Good hand hygiene practices and other cost-effective measures, such as proper disinfection of equipment, can prevent up to 70% of HAIs. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) emphasize the importance of infection prevention and control (IPC) to reduce the spread of infections in healthcare settings.
