Healthcare-Associated Infections _ ______________________________________________________________
procedures has contributed to higher rates of infection; more than 80% of HAIs are caused by four types of infection: cath- eter-related urinary tract infection, intravascular device-related bloodstream infection, surgical site infection, and ventilator- associated pneumonia [1]. These HAIs, along with infections caused by C. difficile and drug-resistant micro-organisms (especially methicillin-resistant Staphylococcus aureus [MRSA]), have garnered the most attention and research because of their impact in terms of morbidity, mortality, economic costs, and potential for prevention. Based on CDC-sponsored hospital surveillance data from 2018, about 3% to 4% of inpatients are infected and an estimated 633,000 hospitalized patients develop an HAI each year [4]. These infections lead to excess mortality and add billions of dollars in total direct medical costs annually [1; 5]. Prior to 2020, the prevalence of HAIs had been declining, the result of an ongoing national collaborative effort. However, an analysis of National Healthcare Safety Network (NHSN) data from acute care hospitals in 12 U.S. states found that rates of central-line-associated bloodstream infections, catheter-related urinary tract infections, and ventilator-associated events increased significantly compared with 2019, largely as a result of the COVID-19 pandemic [6]. The analysis showed that national standard infection ratios for central-line-associated bloodstream infections initially declined in the first quarter of 2020 compared with the first quarter of 2019, but then rose by 27.9%, 46.4%, and 47.0% in the second, third, and fourth quarters of the year, respectively. Ventilator-associated events rose by 44.8% in the fourth quarter of 2020 compared with the same period for 2019 [6]. While acknowledging that 2020 was an unprecedented time for hospitals, the authors of the analysis emphasized the continued need for regular review of HAI surveillance data to identify gaps in prevention [6]. The increased focus on healthcare quality over the past decade has highlighted the need to prevent HAIs as part of overall efforts to enhance patient safety as well as reduce costs, and national initiatives have been developed by healthcare quality agencies, advocacy organizations, healthcare regulating bodies, and policymakers ( Table 1 ) [7; 8; 9; 10; 11; 12; 13; 14; 15]. In 2009, with updates made in 2013 and 2018, the U.S. Department of Health and Human Services (HHS) developed the national Action Plan to Prevent Healthcare-Associated Infections, an initiative with a steering committee that repre- sents a host of government health-related agencies. The plan includes 5-year goals for nine specific measures of improve- ment in HAI prevention [2]. The HHS is currently working to update the plan with new indicator targets and data, new research and intervention efforts, and a review of the impact of the COVID-19 public health emergency on HAIs [2].
OVERVIEW This course is structured to provide essential education regard- ing the epidemiology, prevention, diagnosis, and treatment of healthcare-associated infections (HAIs). The course begins with background information on the pathogenesis of bacterial infections, transmission of infection in the healthcare setting, and the development of drug resistance. The primary sources of HAIs related to the environment, patient factors, and iatrogenic factors are also discussed. The core of the course is a comprehensive description of the most common and costly HAIs: catheter-related urinary tract infections, surgical site infections, hospital-acquired pneumonia, intravascular device-related bloodstream infections, and Clostridioides difficile infections. The overall incidences, related costs, risk factors, common pathogens, prevention, diagnosis, and treatment are presented for each of these infections, with the implica- tions of drug-resistant infections also noted. An overview of the responsibilities of an infection control program in the healthcare setting is provided, with a discussion of surveil- lance, adherence to infection control guidelines, management of drug-resistant micro-organisms, precautions and isolation techniques, preparedness for outbreaks and epidemics, and education targeted to both healthcare workers and patients and families. The course content is limited to infections in adults in acute care hospitals, although many measures for preven- tion are applicable in all settings for all patient populations.
EPIDEMIOLOGY AND BACKGROUND
HAI is one of the leading causes of death and increased morbidity for hospitalized patients. About 1 in 31 patients hospitalized has at least one healthcare-associated infection, a complication estimated to affect more than 1 million patients each year who reside in hospitals or other inpatient care facili- ties [1; 2; 3]. Historically, these infections have been known as nosocomial infections or hospital-acquired infections because they develop during hospitalization. As health care has increasingly expanded beyond hospitals into outpatient settings, nursing homes, long-term care facilities, and even home care settings, the more appropriate term has become healthcare-acquired or healthcare-associated infection. Many factors have contributed to an increase in HAIs. Advances in medical treatments have led to more patients with decreased immune function or chronic disease. The increase in the number of these patients, coupled with a shift in health care to the outpatient setting, yields a hospital population that is both more susceptible to infection and more vulnerable once infected. In addition, the increased use of invasive devices and
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