ATrain Education

 

Continuing Education for Health Professionals

NY: Infection Control and Prevention, including Sepsis

Module 1

Healthcare-Associated Infections (HAIs)

A healthcare-associated infection (HAI) is an infection acquired as a result of treatment for another condition while in a healthcare setting. In accordance with Public Health Law 2819, New York State has been tracking HAIs since 2007 and reporting them each year. This law was created to provide the public with fair, accurate, and reliable HAI data to compare hospital infection rates and to support quality improvement and infection prevention activities in hospitals (NYSDOH, 2013). Reports from 2007 through 2012 may be found at this source.

In addition to the personal consequences for patients, families, and professionals, HAIs add to the skyrocketing costs of the nation’s healthcare system. A 2009 report from the Centers for Disease Control and Prevention (CDC) estimated the annual medical costs of HAIs in U.S. hospitals to be between $28 and $45 billion (CDC, 2009).

The CDC healthcare-associated infection (HAI) Prevalence Survey provides an updated national estimate of the overall problem of HAIs in U.S. hospitals. Based on a large sample of acute care hospitals, the survey found that on any given day about 1 in 25 hospital patients has at least one healthcare-associated infection. There were an estimated 722,000 HAIs in U.S acute care hospitals in 2011. About 75,000 hospital patients with HAIs died during their hospitalizations (CDC, 2014).

More than half of all HAIs occurred outside the intensive care unit. According to the Centers for Disease Control and Prevention (CDC), healthcare-associated infections are one of the top ten leading causes of death in the United States. The CDC estimates that there are 1.7 million healthcare-associated infections in American hospitals each year, with 99,000 associated deaths (CDC, 2014).

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 (USDHHS, 2014).

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 (USDHHS, 2014)

HAIs are a significant cause of morbidity and mortality. Most HAIs are of the following four types:

  • Urinary tract infections
  • Surgical site infections
  • Bloodstream infections
  • Pneumonia (USDHHS, 2014)

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 (P.L. 111-5) of 2009 provided $50 million to support states in the prevention and reduction of HAIs (ARRA, 2009). These funds have supported surveillance and research, improved quality, encouraged collaboration, and trained healthcare workers in HAI prevention and in measurement of outcomes.

The Centers for Medicare and Medicaid Services (CMS) have increased scrutiny of practices and implemented financial incentives for prevention of HAIs. Media and public attention are also increasing. In 2011 the CMS implemented a new requirement that all hospitals nationwide receiving payment from CMS provide information on specific HAIs, using standardized reporting. Then in April 2011 the Obama administration launched a public/private program called Partnership for Patients, designed to make hospital care safer, more reliable, and less costly by:

  • Keeping hospital patients from getting injured, or sicker. The goal is, by the end of 2013, to decrease instances of patients acquiring preventable conditions while in hospitals by 40% compared to 2010.
  • Helping patients heal without complication. By the end of 2013, to decrease preventable complications during a transition from one care setting to another, so that the number of patients who must be re-admitted to the hospital is reduced by 20% compared to 2010. (CMS, 2011)

Reports are not yet available. More than 300 hospitals, consumer and patient organizations, employers, unions, and health plans in New York are participating in the Partnership for Patients program.

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