The responsibility to adhere to scientifically accepted principles and practices of infection control and to monitor the performance of those for whom the professional is responsible.
Scientific evidence is the primary source of guidance for infection control practice and, as the science has evolved, practices have been updated to reflect new findings. A number of factors contribute to this changing landscape; for example, germs evolve and mutate, and new diseases emerge. The recent H1N1 influenza outbreak is an example of a potentially deadly virus that emerged as a mix of human, swine, and bird viruses. Human immunodeficiency virus (HIV) is a well-known example of a disease that emerged in the late 1970s, prompting widespread and rapid changes in infection control practices.
The transition of healthcare delivery from acute care hospitals to other healthcare settings (home care, ambulatory care, free-standing specialty care sites, and long-term care) has created a need for infection control guidelines that can be applied in all settings. These guidelines must follow common principles of practice, yet be modified to reflect setting-specific needs. The emergence of new pathogens, concern for evolving pathogens, development of new therapies, and increasing concern for the threat of biological weapons attacks has led to broader guidelines for infection control and prevention.
Until recently, infections were an expected consequence of hospitalization, and reliance on scientifically accepted information for infection prevention had not penetrated all corners of the healthcare system. However, as healthcare moves rapidly toward practices and procedures based on scientifically accepted, evidence-based principles, we are seeing a cultural shift in the management of HAIs.
In the past it was accepted practice for hospitals to compare the success of their infection control activities to national averages called benchmarks—if the hospital’s infection rates were comparable to these benchmarks their performance was acceptable. Zero tolerance has now emerged as a guiding concept in the management of HAIs. The goal for all healthcare organizations—from hospitals to home care—is to reduce the number of HAIs to zero.
The CDC’s National Healthcare Safety Network (NHSN) is a useful tool for monitoring HAI rates and evaluating the effectiveness of prevention strategies, and it supports state-based collaborative efforts to reduce HAIs. Hospitals have continuous access to their own data and can compare their rates to national levels and monitor trends over time. HAIs monitored include central-line associated infections, catheter-associated urinary tract infections, surgical site infections, ventilator-associated pneumonia, blood transfusion infections and more. In March 2012 the CDC released information on successful collaborative efforts to reduce Clostridium difficile (C. difficile) infection rates in three states: Illinois, Massachusetts, and New York (CDC, 2011; 2012a; 2012b).