ATrain Education


Continuing Education for Health Professionals

Infection Control and Prevention

Module 1

Healthcare-Associated Infections (HAIs)

Healthcare-associated infections (HAIs) are among the most common adverse events in healthcare. In addition to the personal consequences for patients, families, and professionals, HAIs add to the skyrocketing costs of the nation’s healthcare system. A recent CDC report estimated the annual medical costs of HAIs in U.S. hospitals to be between $28 and $45 billion (Scott, 2009).

Healthcare-associated infections are infections that people acquire in a healthcare setting while they are receiving treatment for another condition. HAIs can be acquired anywhere healthcare is delivered, including inpatient acute care hospitals, outpatient settings such as ambulatory surgical centers and end-stage renal disease centers, as well as long-term care facilities such as nursing homes and rehabilitation centers. HAIs may be caused by any infectious agent, including bacteria, fungi, and viruses, as well as other less common types of pathogens (HHS, 2011).

HAIs are associated with a variety of risk factors, including:

  • The use of indwelling medical devices such as bloodstream, endotracheal, and urinary catheters
  • Surgical procedures
  • Injections
  • Contamination of the healthcare environment
  • Transmission of communicable diseases between patients and healthcare workers
  • Overuse or improper use of antibiotics (HHS, 2011).

HAIs are a significant cause of morbidity and mortality. At any given time, 1 in 20 hospital patients have an HAI. More than a quarter of all hospital-acquired HAIs are of the following four types:

  • Urinary tract infections
  • Surgical site infections
  • Bloodstream infections
  • Pneumonia (HHS, 2011).

In 2002 the CDC estimated that more than 1.7 million HAIs occur in U.S. hospitals each year, and they are associated with approximately 99,000 deaths (Klevens, 2007).

Using even the most conservative data, the number of HAIs far exceeds the number of cases of any currently notifiable disease. Deaths associated with HAIs in hospitals exceeded the number of deaths attributed to several of the ten leading causes of death reported in U.S. vital statistics (Klevens, 2007).

New attention to HAIs, seen as both patient safety and public health problems, has underscored the need for systematic surveillance as part of a broad-based prevention and control strategy. To address this need, the American Recovery and Reinvestment Act of 2009 provided $50 million to support states in the prevention and reduction of HAIs. These funds have supported surveillance and research, improved quality, encouraged collaboration, and trained healthcare workers in HAI prevention and in measurement of outcomes. Data from these programs may be accessed here.

Nearly 5000 hospitals, in all 50 states use CDC’s NHSN (National Healthcare Safety Network) to track HAI’s. As of April 2012 27 states and the District of Columbia require reporting of HAIs using NHSN. Links and information about CDC and state-based HAI prevention activities can be found on the CDC website here.

The Centers for Medicare and Medicaid Services (CMS) have increased scrutiny of practices and implemented financial incentives for prevention of HAIs. In 2011 the CMS implemented a new requirement that all hospitals nationwide receiving payment from CMS provide information on specific HAIs, using standardized reporting.

In April 2011 the Obama administration launched a public/private program called Partnership for Patients: Better Care, Lower Costs, designed to make hospital care safer, more reliable, and less costly by:

  • Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010, which would mean approximately 1.8 million fewer injuries and 60,000 lives saved.
  • Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010 (, 2011).
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