Darline Dupree
PhD Student
Walden University
PUBH 8165-2
Instructor: Dr. Robert Marino
Winter 2012
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Hospital Board of Directors
OSHA
County Public Health Departments
Center for Disease Control (CDC)
Environmental Health Department
Healthcare Practitioners
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Generate awareness concerning Hospital-Associated
Infections (HAIs)
Generate awareness regarding the varying types of HAIs
Generate awareness regarding the financial burden that
HAI’s pose on hospitals
Promote practitioners adherence to infection prevention
guidelines
Promote the enhancement of Infection Surveillance
Systems
Improve hospital infectious control policies
Promote quality of care practices that minimize HAI risk
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Define Hospital Associated Infections
Explain HAI impact on public health
Identify four of the most common infections occurring
in hospitals
Name preventative measures used to prevent/control
HAIs
Explain the impact of HAI on low-income developing
countries
Explain HAI surveillance systems
Identify states with laws requiring HAI reporting
Understand the importance of activating infection
control requirements
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“Hospital-Associated Infections (HAI) are infections
caused by a wide variety of common and unusual bacteria,
fungi, and viruses during the course of receiving medical
care” (CDC, 2011)
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Infections that develop during hospitalization that are not
present nor incubating upon the patient’s admission to the
hospital (Collins, 2008)
Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 19, 2012 from: http://www.cdc.gov/hai/
Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/
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Traditional hospital
Outpatient surgery centers
Long-term care facilities
Rehabilitation centers
Community clinics
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Health
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Financial
◦ 1 out of every 20 patients contract some form of hospital
related infections
◦ HAI is responsible for approximately 90, 000 deaths
annually
◦ Responsible for approximately $28.4 billion to $33.8
billion dollars in direct healthcare cost
◦ Responsible for approximately $8.5 billion in overall
hospital net cost
Center for Disease Control and Prevention. Healthcare associated infections: Burden. Retrieved on January 19, 2012 from: http://www.cdc.gov/HAI/burden.html
Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from:
http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf
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Device related infections
◦ Central Line-Associated Bloodstream Infection
(CLABSI)
◦ Catheter-Associated Urinary Tract Infection (CAUTI)
◦ Ventilator-Associated Pneumonia (VAP)
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Procedure related infections
◦ Surgical Site Infection (SSI)
Center for Disease Control and Prevention. Healthcare associated infections: Infection Types.
Retrieved on January 1, 2012 from http://www.cdc.gov/HAI/infectionTypes.html
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UTI accounts for 36%
SSI accounts for 20%
Bloodstream infection (BSI) accounts for 11%
Pneumonia accounts for 11%
World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide:
Clean Care is Safer Care (ISBN 978 92 4 150150 7))
◦ Most common type of hospital-associated infections
◦ Responsible for between approximately 75%-97% of
urinary tract infections in the hospital
◦ Accounts for approximately > 30% of HAIs infections
◦ Responsible for an Estimated 13,000 HAI deaths
annually
◦ Occurs when bacteria enters the urinary tract through
the urinary catheter
◦ Prolonged use of urinary catheter increase the risk for
infections
World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide:
Clean Care is Safer Care (ISBN 978 92 4 150150 7).
Center for Disease Control and Prevention. Healthcare associated infections:
Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf
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Perform proper hand hygiene practices in
accordance to CDC recommended standard
precautions
Insert catheters only when needed
Remove catheters immediately when the need
for it no longer exist
Use aseptic techniques for insertions
Maintain a closed drainage system
Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections.
Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html
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Infection occurring after surgery in the part of
the body that was operated on
Accounts for approximately 300,000 of all
HAI cases
Responsible for 75% of SSI associated deaths
Infections range from superficial to serious
Approximately 12% to 84 % of surgical site
infections are discovered after patients are
released from the hospital
◦ most infections discovered within 21 days after surgical operation
Center for Disease Control and Prevention. Healthcare associated infections: FAQs about SSI. Retrieved January 15, 2012 from:
http://www.cdc.gov/HAI/ssi/faq_ssi.html
Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/
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Administer antimicrobial prophylaxis
Prepare surgical site of skin with an antiseptic
agent
Treat remote infections prior to performing
operations
Use sterilized instruments to perform surgery
Maintain a sterile environment by limiting
traffic in the operating room
Use sterile dressings to protect incisions
Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012
from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.htm
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◦ Occurs when bacteria or viruses enters the
bloodstream through the catheter
◦ Marked by fever and soreness around the
area where the catheter was inserted
◦ Responsible for up to 35% of HAI related
mortalities
◦ Responsible for approximately 87% of BSI
World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4
150150 7).
Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012retrieved from
:http://www.cdc.gov/HAI/pdfs/toolkits/CLABSItoolkit_white020910_final.pdf
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Perform proper hand hygiene practices in
accordance to CDC recommended standard
precautions
Select an insertion site least vulnerable to
infections
Wear sterile surgical protective gear
Properly insert central lines
Use appropriate agent for skin antisepsis
Remove central line when no longer needed
Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare
Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html
◦ Lung infection that develop in a person who
is on a ventilator
◦ Infection occurs when germs enter the tube
and accumulate in the patient’s lungs
◦ Accounts for 83% of hospital associated
pneumonia
World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4
150150 7
)
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Perform proper hand hygiene practices in
accordance to CDC recommended standard
precautions
Elevate the bed of patients( varies based upon
age in pediatrics)
Remove the ventilator as soon as the patient
is able to breathe without it.
Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012
from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html
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Antibiotic associated
◦ Clostridium difficile infection (CDAD)
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Antibiotic resistant infections
◦ Methicillin-resistant Staphylococcus aureus (MRSA)
Infection
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Spore-forming, gram-positive anaerobic bacillus
bacterium
Accounts for 15%-25% of all episodes of antibioticassociated diarrhea
Responsible for 9,000 deaths annually
Occurs most often in elderly people and people with
certain medical problems
Causes diarrhea and other serious intestinal conditions
Transmission
◦ Contaminated bed linens, bed rails, bathroom fixtures and
medical equipment
◦ Person to person on the hands of hospital personnel and
visitors
Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 14, 2012 from:
http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html
Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from:
http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf
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Perform proper hand hygiene practices in
accordance to CDC recommended standard
precautions
Clean and disinfect equipment and overall
environment
Utilize contact precautions during the
duration of diarrhea
Isolate symptomatic patients
Implement universal glove use
Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012
from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html
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Staph bacteria resistant to certain antibiotics
Occurs more often among patients who undergo invasive
medical procedures or who have weakened immune systems
Causes severe and potentially life-threatening infections
25% of MRSA cases occur in the hospital
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Transmission
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◦ Spread from patient to patient on unclean hands of
healthcare personnel or through the improper use or reuse
of equipment
◦ Hands may become contaminated with MRSA by contact
with: colonized or infected patients; devices, surfaces
contaminated with body fluids, infected hospital personnel
Center for Disease Control and Prevention. Hospital associated infections: Methicillin-resistant Staphylococcus aureus (MRSA) Infection. Retrieved on January
14, 2012 from: http://www.cdc.gov/HAI/organisms/mrsa-infection.html
Center for Disease Control and Prevention. Symptoms of MRSA. Retrieved on January 14,2012 from: http://www.cdc.gov/mrsa/symptoms/index.html
Center for Disease Control and Prevention. Protect Yourself from MRSA . Retrieved on January 14, 2012 from: http://www.cdc.gov/Features/MRSAinHealthcare/
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Perform proper hand hygiene practices in
accordance to CDC recommended standard
precautions
Implement contact precautions for colonized
and infected MRSA patients
Immediately report MRSA lab results
Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012
from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html
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Endogenous
◦ Body sites that house microorganisms as part of the
normal microbial flora
 Ex. skin, nose, mouth gastrointestinal tract, vagina
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Exogenous
◦ Sources external to the patient
 Ex. medical devices, health-care workers, healthcare
environment, visitors, patient care equipment
WHO (2011) Report on the burden of Endemic Health Care- Associated Infection Worldwide. Retrieved on January, 14, 2012 from
http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf
◦ Compromised immune systems
◦ Primary immunodeficiency (e.g., anemia or
autoimmune disease)
◦ Secondary immunodeficiency’s (e.g., chemotherapy,
corticosteroids, diabetes, leukemia)
Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved on January 14, 2012 from:
http://www.ncbi.nlm.nih.gov/books/NBK2683/
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Patients admitted to ICUs
Burn patients
Transplant patients
Neonates
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HAI is an issue that extends past our US
borders
HAIs are more frequent in resource-limited
settings than in developed countries
WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 12, 2012 from
http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
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15 out of every 100 patients hospitalized in low-income
developing countries acquire HAI
SSI is the leading infection within the general patient
population
Central vascular lines, ventilators, and urinary catheters are
approximately 19 times higher in low- income countries
Newborn HAI rates are 3- 20 times higher in low-income
developing countries then in high income countries
◦ Responsible for 4% to 56% of all causes of death with the numbers
increasing to 75% in countries such as South-East Asia and Sub-Saharan
Africa.
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HAI is more frequent in critically-ill patients admitted to ICUs.
◦ Account for 42.7 episodes per 1000 patient-days in developing countries
WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 14,201 from
http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
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Insufficient environmental sanitary conditions and
waste disposal
Meager infrastructure
Inadequate equipment
Understaffing
Overcrowding
Poor knowledge and application of basic infection
control measures
Nonexistent local and national guidelines
Insufficient hospital policies
Unawareness of injection and blood transfusion
safety
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“Primary prevention offers the hopes of eliminating
unnecessary illness, injury, and even death” (Cohen
et al, 2010)
Improves health
Reduces Cost
Requires concerted efforts by all healthcare
practitioners, public health officials, governmental
officials and the general public
Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA: Josey-Bass
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Implement policies for the development of HAI
prevention programs
◦ Action Plan to Prevent Healthcare Associated Infections
◦ 29 states and the District of Columbia passed laws related
to HAI prevention
◦ 3 States developed reporting procedures that don’t require
legislations
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Activate infection control requirements.
◦ Appropriate training, accreditation and licensure to
encourage adherence to infection control requirements
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Encourage continued research to acclimatize
surveillance protocols and preventive strategies.
Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections
Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf
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Establish minimum reporting requirements
for all healthcare facilities
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Status of current Surveillance System
 National Healthcare Safety Network (NHSN)
 Secure web-based system that facilitates reporting from
healthcare facilities
 Mandated by 23 states and the District of Columbia
 Intended use in approximately 5,000 hospitals within the
U.S.
23 developing countries (23/147) reported a functioning
national surveillance system
Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections.
Retrieved from: http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf
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Alabama
California
Colorado
Connecticut
Delaware
Washington D.C. District of
Columbia
Florida
Hawaii
Illinois
Maine
Maryland
Massachusetts
Minnesota
Missouri
New Hampshire
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New Jersey
New Mexico
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee-limited
Texas
Virginia
Vermont
Washington
West Virginia
The committee to reduce infectious disease (2011). Retrieved on January 12, 2012 from :
http://www.hospitalinfection.org/legislation.shtml
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Minimize environmental exposure
◦ Implement standard precautions to include best hand hygiene
practices
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Develop hospital policies and procedures geared toward
protecting health and safety
◦ Include appropriate preventive measures for hospital related infection
risks
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Train staff on the principles of infection control
◦ comply with requirements for staff education and training as
established through existing federal, state, and local regulations
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Coordinate efforts with the infection control department
in monitoring and investigating potentially harmful
infectious exposures and outbreaks among personnel
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American Recovery and Reinvestment Act
◦ Signed into law on February 17, 2009
◦ Designed to stimulate economic recovery in various
ways including strengthening the nation's
healthcare infrastructure and reducing healthcare
costs
◦ Authorize $50 million to support states in the
prevention and reduction of Healthcare Associated
Infections
Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/
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Patient Protection and Affordable Care Act
of 2010
◦ Health Reform
◦ Reimbursement of Medicare/Medicaid funding
contingent upon HAI prevention
◦ CMS Hospital Inpatient Quality Reporting Program
 de facto national mandate
 95% of hospitals participates in this program
◦ Requires hospitals to report select infections
 CLABSI’s in ICUs
 Certain SSI
Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections.
Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf
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Be proactive
◦ Partner with other agencies to enhance prevention
strategies
◦ Familiarize yourself with the statues and
regulations surrounding HAI prevention
◦ Foster relationships with and engage stakeholders
in HAI programs
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Educate the public on HAI
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Hospital Associated Infections poses a serious
threat to the health and financial viability of the
healthcare system in general.
The elimination of HAI is going to take a concerted
effort from all healthcare practitioners
In order to improve infectious control policies and
enhance infection surveillance systems, there must
be collaboration and involvement from
policymakers, and governing/regulatory entities
Focus must be placed on better educating service
providers on infection control techniques
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Center for Disease Control and Prevention. Healthcare associated infections:
Burden Retrieved on January 19, 2012 from:
http://www.cdc.gov/HAI/burden.html
Center for Disease Control and Prevention. Healthcare associated infections:
Infection Types. Retrieved on January 1, 2012 from
http://www.cdc.gov/HAI/infectionTypes.html
Center for Disease Control and Prevention and Association of State and
Territorial Health Officials (2011) Eliminating Healthcare Associated Infections
World Health Organization (2011). Report on the Burden of Endemic Health
Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4
150150 7).
Center for Disease Control and Prevention. Healthcare associated infections:
Retrieved January 15, 2012 from:
http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf
Center for Disease Control and Prevention. Healthcare associated infections:
FAQs about SSI. Retrieved on January 15, 2012 from:
http://www.cdc.gov/HAI/ssi/faq_ssi.html
Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved
from http://www.ncbi.nlm.nih.gov/books/NBK2683/
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Center for Disease Control and Prevention. Healthcare associated infections.
Retrieved on January 14, 2012 from:
http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html
Center for Disease Control and Prevention. Healthcare associated infections:
Retrieved on January 15, 2012 from:
http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf
WHO(2011)Health care-associated infections :FACT SHEET. Retrieved from
http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
Center for Disease Control and Prevention. Healthcare associated infections:
Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/
Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA:
Josey-Bass
Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in
U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from:
http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf
Center for Disease Control and Prevention and Association of State and Territorial
Health Officials (2011) Eliminating Healthcare Associated Infections Retrieved from
http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf
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Infection Control Policies and Hospital-Associated
Infections Among Surgical Patients: Variability and
Associations in a Multicenter Pediatric Setting.
(www.pediatrics.org/cgi/doi/10.1542/peds.2004-2014)
Diseases and Organisms in Healthcare Settings.
(www.cdc.gov/HAI/organisms/organisms.html)
National healthcare Safety Network (NHSN) Report, data
summary for 2010, device associated module
(www.cdc.gov/nhsn/PDFs/dataStat/2009NHSNReport.p
df)