What every patient should know about HAIs

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From the HealthyPeople2020.gov website

Hospital Acquired Infections (HAIs) are just one of the “medical mistakes” that can happen in a hospital when staffing levels are low.  Nurses who are caring for too many patients at one time don’t have the time to check on patients and assess them properly.  Instead, a patient can develop an infection under a dressing or from a pressure ulcer that can lead to a longer hospital stays or readmissions to the hospital after discharge.

Overview

HAIs are infections that patients get while receiving treatment for medical or surgical conditions. They are among the leading causes of preventable deaths in the United States and are associated with a substantial increase in health care costs each year.1

HAIs occur in all types of care settings, including:

  • Acute care within hospitals
  • Same-day surgical centers
  • Ambulatory outpatient care in health care clinics
  • Long-term care facilities (e.g., nursing homes and rehabilitation facilities)

In hospitals, HAIs lead to extended hospital stays, contribute to increased medical costs, and are a significant cause of morbidity and mortality.

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 and reducing HAIs. These high-priority objectives address central line-associated bloodstream infections (CLABSI) and methicillin-resistant Staphylococcus aureus (MRSA) 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. Nearly 3 out of every 4 HAIs in the acute care hospital setting are a result of 1 of the following 4 categories of infection, listed in order of prevalence:

  1. Catheter-associated urinary tract infections
  2. Surgical site infections
  3. Bloodstream infections
  4. Pneumonia

Why Are Healthcare-Associated Infections Important?

HAIs are the most common complication of hospital care.2 However, recent studies suggest that implementing existing prevention practices can lead to up to a 70 percent reduction in certain HAIs. The financial benefit of using these prevention practices is estimated to be $25.0 billion to $31.5 billion in medical cost savings.3

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Understanding Healthcare-Associated Infections

Risk factors for HAIs can be grouped into three general categories:

  • Medical procedures and antibiotic use
  • Organizational factors
  • Patient characteristics4

The behaviors of health care providers and their interactions with the health care system also influence the rate of HAIs.

Physical Determinants of Healthcare-Associated Infections

Factors that lead to HAIs include:

  • Use and maintenance of medical devices, such as catheters and ventilators
  • Complications following surgical procedures
  • Transmission between patients and health care workers

Other issues that increase the risk of HAIs are:

  • Contaminated air conditioning systems
  • Disproportionate nurse-to-patient ratio
  • Physical layout of the health care facility (for example, open beds close together)4

Determinants of Healthcare-Associated Infections

Studies have shown that proper education and training of health care workers increases compliance with and adoption of best practices to prevent HAIs.5 An example of a best practice by a health care provider is the careful use of antibiotics or antimicrobial drugs, as some can increase the patient’s risk of HAIs.

Emerging Issues in Healthcare-Associated Infections

Healthy People 2020 objectives measure progress toward reducing the incidence of CLABSI and MRSA infections. However, progress must be made in addressing other major types of HAIs, particularly:

  • Catheter-associated urinary tract infections
  • Surgical site infections
  • Ventilator-associated pneumonia
  • Clostridium difficile infections

Research suggests that many of these infections are preventable. Efforts are under way to expand surveillance and to identify and implement effective prevention programs.

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. Many HAIs in these settings are the result of poor basic infection-control practices. HAIs in outpatient settings happen because of:

  • Improper sterilization and disinfection practices
  • Reuse of syringes and needles
  • Using single-use medication vials for multiple patients.

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. The knowledge gained from these research and demonstration projects is expected to lead to additional national objectives for HAIs in future versions of Healthy People.

References

1Klevens RM, Edwards JR, Richards CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep. 2007 Mar–Apr;122(2):160-6.

2Agency for Healthcare Research and Quality (AHRQ). AHRQ’s efforts to prevent and reduce health care-associated infections [fact sheet]. AHRQ Publication No. 09-P013, Rockville,MD: AHRQ; 2009 Sept. Available from: http://www.ahrq.gov/qual/haiflyer.htm

3Scott 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.

4Agency 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://www.ahrq.gov/qual/nurseshdbk

5Safdar N, Abad C. Educational interventions for prevention of healthcare-associated infection: A systematic review. Crit Care Med. 2008 Mar;36(3):933-40.

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