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Healthcare-associated infections (HAIs)


What are healthcare-associated infections (HAIs)

Terms and definitions The term healthcare-associated infection (HAI) refers to infections associated with healthcare delivery in any setting (e.g., hospitals, long-term care facilities, ambulatory settings, home care). This term reflects the uncertainty in always being able to determine where the pathogen is acquired. Patients may be colonized with, or exposed to, potential pathogens outside of the healthcare setting before receiving healthcare, or may develop infections caused by those pathogens when exposed to the conditions associated with delivery of healthcare. Additionally, patients frequently move among the various settings within a healthcare system.

Risk factors  Many factors promote HAIs in healthcare settings, including decreased immunity among patients, as well as diagnostic and therapeutic procedures, invasive techniques, and medical devices that increase the risk of infections. For example, patients are at increased risk of infection from invasive devices such as intravenous needles or cannulae that are inserted through a person's skin, bypassing the body's first line of defense. Other invasive devices include artificial airways and tubes to assist breathing, and urinary devices – all providing a pathway for bacteria and other organisms to enter the blood stream, lungs and bladder, and increasing the risk of infection and other medical complications. 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 from other patients, generally from lack of staff compliance with basic infection prevention measures, like handwashing or use of alcohol-based hand cleaners.

Major types of infection The four major types of HAIs are related to invasive or surgical procedures and include:

CDC has developed definitions, tracking methods, and prevention guidelines to assist with the elimination of HAIs.

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HAIs – Extent of the problem

The CDC estimated the burden of U.S. HAIs in 2002 as 1.7 million infections in hospitals (9.3 infections per 1000 patient days or 4.5 per 100 admissions) noting that more than 98,000 of these patients die (1). It is also estimated that the U.S. spends $4.5 billion to $5.7 billion annually on the treatment of HAIs. (1, 2)  

Data sources:
(1)  Klevens, R.M. "Estimating health care-associated infections and deaths in U.S. hospitals, 2002." Public Health Reports March-April 2007:22; 160-66.

(2)  Stone PW. "A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000."  Am J Infect Control 2002; 30:145-52. (doc) (31kb)

These data highlight the enormous personal financial burden of HAIs and provide a baseline for tracking the success of improvement efforts to prevent HAIs as we move forward.

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HAI - Elimination

Combine elimination goal with prevention practices The CDC encourages hospitals and healthcare organizations to set a goal to eliminate preventable HAIs. This means healthcare organizations should aim for 100 percent adherence to prevention recommendations – that is, evidence-based practices that have been shown to prevent some infections. The CDC and other healthcare partners continue to work together to further identify improvements in clinical practice, medical procedures, and evidence-based practices and guidelines with the goal of elimination of preventable HAIs.

Framework for HAI elimination program There are several key issues to consider for a successful "HAI Elimination Program." One is the healthcare organization's assessment of key elements using local data to determine priorities in targeting HAIs for elimination. The assessment is conducted by hospital leaders including at minimum, patient safety, infection prevention and control, and quality/risk management staff.

A framework of an overall HAI elimination program is available here and begins with assessing past and current experience (e.g., measurement of prior HAIs), development of a safety culture, interventions to reduce or eliminate preventable infections, and adherence to known proven evidence-based practices to prevent transmission (e.g., hand hygiene).

Among new resources available to use during this assessment is the Compendium of Strategies to Prevent HAIS. See Guidelines and HAI Compendium

Safety culture The HAI Elimination Program is part of the overall safety and quality improvement program. A culture of safety that empowers and supports staff in their efforts to reduce risks and improve patient care is the key to success. A number of tools and resources are available to assess the safety culture of an organization.

Hand hygiene  Hand hygiene by healthcare personnel is considered one of the most important strategies to prevent patient-to-patient transmission of organisms causing HAIs in the healthcare setting.  Healthcare settings should set a goal of 100 percent compliance with CDC’s hand-hygiene guideline.

Bundling – evidence-based practices There has been dramatic success in improving the quality of patient care by focusing on the implementation of an entire group or bundle of evidenced-based practices to achieve a better outcome than when implemented individually. This process is referred to as "bundling" of evidence-based practices. The science behind each element of the bundle is so well established that its implementation is considered a generally accepted practice. Separate elements of a bundle can be easily measured as completed or not completed. But the entire bundle – all of the elements taken together – can be similarly measured as a whole. The effect of all the right processes occurring together should have a positive impact on the disease process and improve patient outcomes; the outcome being measured may be reported using a variety of rates. Unprecedented reductions in rates of VAP and CLA-BSI, for example, have been reported by hospitals participating in local, regional, state and national bundling initiatives.

Surgical site infection (SSI) prevention Preventing SSIs is part of the national Surgical Care Improvement Project (SCIP) that promotes the adoption of a specific set of evidence-based practices aimed at reducing SSIs. The overall goal of the SCIP project is to reduce surgical complications by 25 percent by the year 2010. SCIP is sponsored by the Centers for Medicare and Medicaid Services (CMS) in collaboration with a number of other national partners serving on the steering committee, including the American Hospital Association (AHA), CDC, the Institute for Healthcare Improvement (IHI), and The Joint Commission and other supporting partners, including Premier. SCIP is an extension of a previous CMS initiative called the Surgical Infection Prevention Project (SIPP) that focused on appropriate antimicrobial prophylaxis to reduce the risk of SSIs.

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