Infection Special Book: Control, Prevention, BBP, SARS, FluPage 4 of 46

1. Healthcare-Associated Infections (HAIs)

[Material in Module 1 is from USHHS, ODPHP, 2020, unless otherwise noted.]

In 2020 CDC is responding to a pandemic of respiratory disease spreading from person-to-person caused by a novel [new] coronavirus. . . This situation poses a serious public health risk. The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this situation. COVID-19 can cause mild to severe illness; most severe illness occurs in older adults.

CDC, March 18, 2020

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. Given the current COVID-19 pandemic, it makes sense to review the tried and true rules for infection control. For specific information about the pandemic, please see ATrain Education, “COVID-19: The Novel Coronavirus” on this website.

Health care-associated infections (HAIs) are infections people get while they're receiving healthcare for another condition. HAIs can happen in any healthcare facility, including hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities. Bacteria, fungi, viruses, or other, less common pathogens can cause HAIs.

HAIs are a significant cause of illness and death — and they can have serious emotional, financial, and medical consequences. In normal circumstances, at any given time about 1 in 25 inpatients have an infection related to hospital care. These infections lead to tens of thousands of deaths and cost the U.S. health care system billions of dollars each year.

The U.S. Department of Health and Human Services (HHS) has identified the reduction of HAIs as an Agency Priority Goal. HHS is committed to reducing the national rate of HAIs.

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

HAIs are a significant cause of morbidity and mortality. At any given time, 1 in 25 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
  • The COVID-19 pandemic presents another urgent source of HAIs.

Risk Factors and Common HAIs

Factors that raise the risk of HAIs include: 

  • Catheters (bloodstream, endotracheal, and urinary)
  • Surgery
  • Injections
  • Health care settings that aren’t properly cleaned and disinfected
  • Communicable diseases passing between patients and healthcare workers
  • Overuse or improper use of antibiotics

Common HAIs that patients get in hospitals include:

  • Central-line associated bloodstream infections (CLABSI)
  • Clostridium difficile infections
  • Pneumonia
  • Methicillin-resistant Staphylococcus aureus (MRSA) infections
  • Surgical site infections
  • Urinary tract infections

National HAI Targets and Metrics

The U.S. Department of Health and Human Services (HHS) announced new targets for the national acute care hospital metrics for the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan) in October 2016. The targets use data from calendar year 2015 as a baseline — and are in effect for a 5-year period from 2015 to 2020. These targets replaced the previous targets that expired in December 2013. These target goals for reduction of health care-associated infections (HAIs) are ambitious, but achievable. No doubt they will be revised again in light of the COVID-19 pandemic.

The measures track population-based harm from HAIs at the national level. These measures address the following goals from the HAI Action Plan:

  • Reduce central line-associated bloodstream infections (CLABSI) in intensive care units and ward-located patients.
  • Reduce catheter-associated urinary tracts infections (CAUTI) in intensive care units and ward-located patients.
  • Reduce the incidence of invasive health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections.
  • Reduce hospital-onset MRSA bloodstream infections.
  • Reduce hospital-onset Clostridium difficile infections (CDI).
  • Reduce the rate of Clostridium difficile hospitalizations.
  • Reduce surgical site infections (SSI).

Note: The initial set of acute care hospital targets and metrics included a measure on Surgical Care Improvement Project (SCIP) processes. That measure is no longer part of the HAI Action Plan because these processes are now widely accepted as standards of practice.

*Because 2020 saw the beginning of the COVID-19 pandemic, this table contains no data on it.
1NHSN: The National Healthcare Safety Network, of the Centers for Disease Control and Prevention (CDC), is the nation’s most widely used health care-associated infection tracking system. Since 2009, infection data has been reported to the NHSN to track the national progress of the reduction of HAIs.
2EIP: CDC’s Healthcare-Associated Infections—Community Interface (HAIC), a component of the Emerging Infections Program, is an active population-based surveillance system for HAIs caused by pathogens such as MRSA. These EIP sites also use the NHSN to perform time-limited evaluations of HAIC data among NHSN facilities participating in the EIP NHSN network.
3HCUP: AHRQ’s Healthcare Cost and Utilization Project is the nation’s most comprehensive source of hospital data. HCUP data is used to track hospitalizations due to Clostridium difficile.
Source: HHS, 2020. Public domain.

2020 National Acute Care Hospital HAI Metrics*

Measure (and data source)

Progress made by 2016

2020 Target (from 2015 baseline)

CLABSI (NHSN)1

10% reduction

50% reduction

CAUTI (NHSN)1

6% relative reduction

25% reduction

Invasive MRSA (NHSN/EIP2)

8% reduction

50% reduction

Hospital-onset MRSA (NHSN)

6% reduction

50% reduction

Hospital-onset CDI (NHSN)

7% reduction

30% reduction

SSI (NHSN)

Data to be released in 2018

30% reduction

Clostridium difficilehospitalizations (HCUP)3

Data pending release

30% reduction

CDC is committed to protecting patients and healthcare personnel from adverse healthcare events and promoting safety, quality, and value in healthcare delivery.  Preventing HAIs is a top priority for CDC and its partners in public health and healthcare. The 2018 National and State Healthcare-Associated Infections (HAI) Progress Report provides a summary of select HAIs across four healthcare settings; acute care hospitals (ACHs), critical access hospitals (CAHs), inpatient rehabilitation facilities (IRFs) and long-term acute care hospitals (LTACHs) (CDC, 2019).

Nearly 5000 hospitals in all fifty states use CDC’s NHSN (National Healthcare Safety Network) to track HAIs. Links and information about CDC and state-based HAI prevention activities can be found on the CDC website: CDC.gov.

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 (CMS.gov, 2020).

In 2011 the Obama administration launched a public/private initiative called Partnership for Patients: Better Care, Lower Costs, designed to make hospital care safer, more reliable, and less costly. Current Initiative goals are:

  • Making Care Safer. Keep patients from getting injured or sicker. Decrease preventable hospital-acquired conditions by 40 percent compared to 2010.
  • Improving Care Transitions. Help patients heal without complication. Decrease preventable complications during a transition from one care setting to another so that hospital readmissions would be reduced by 20 percent compared to 2010 (CMS.gov, 2011).