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Health Topics – Healthcare-associated Infections (HAI)
Overview
HAIs are infections resulting from complications of healthcare. They are linked with high morbidity and mortality. On any given day, 1 in 31 hospital patients has an HAI (an infection while being treated in a medical facility). Additional infections occur in other healthcare settings. Many HAIs are caused by the most serious antibiotic-resistant bacteria and can lead to sepsis or death.
Economic Burden
HAIs in U.S. hospitals have direct medical costs of at least $28.4 billion each year. They also account for an additional $12.4 billion in costs to society from early deaths and lost productivity.
Risk Factors
Certain factors raise the risk of contracting HAIs:
Invasive procedures
Severity of illness
Not adhering to best practices for prevention
Overuse or improper use of antibiotics
Public Reporting and Validation
Transparency and accountability are critical to the prevention of HAIs. Mandatory reporting to the state health department with public disclosure of data ensures reliable data for HAI tracking and increases accountability. As of November 2019, 36 states and the District of Columbia (DC) have passed laws pertaining to HAI prevention and reporting. HAI data from CDC’s National Healthcare Safety Network is also used by the Centers for Medicare and Medicaid Services (CMS) for quality improvement and public reporting programs. A series of high-profile outbreaks following breaches in infection control procedures (particularly in outpatient settings) has led to regulatory and other policy actions in states. Many states also have HAI-related regulations, indicative of the growing role of states in addressing this issue.
Incentives
States have employed innovative incentives to encourage providers to make the investments necessary to sustain prevention efforts. These incentives have included instituting subsidies to offset costs for updating electronic data systems and increasing the reimbursement rates for meeting HAI reduction targets. The Hospital- Acquired Condition Reduction Program (HACRP) is a Medicare pay-for-performance program that supports the CMS’s long-standing effort to link Medicare payments to healthcare quality in the inpatient hospital setting.
Oversight
States can adopt policies establishing regulatory oversight authority for the state health agency or commissioner of health.
State-based HAI Prevention: State Policy Resources
Many of the most impactful and sustained examples of public health success have been driven and supported by effective public policies. Recent experiences with emerging and highly infectious diseases further highlight the need for clarity and consistency in public health and health policy. CDC has been working with health departments and other partners to identify policy options and best practices to support HAI prevention and improve healthcare outcomes. CDC’s state policy resources provide policy options for sepsis prevention and early recognition, improving outpatient settings, and other policy toolkits.
10 ways Health Department leaders can support HAI-AR prevention, detection and response
Health department leaders and their partners can take evidence-based actions to reduce preventable infections, lower healthcare costs, and improve public health.
Featured Resources
2019 National and State Healthcare-Associated Infection Progress Report
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).
Antibiotic Resistance (AR) Investment Map
CDC’s strategic investments empower the nation to combat AR, the global threat jeopardizing modern medicine. The Fiscal Year 2019 investments shown on the investment map support comprehensive, coordinated, and ambitious public health action to meet national goals to prevent drug-resistant infections.
Antibiotic Resistance Laboratory Network (AR Lab Network)
Established in 2016, the CDC’s AR Lab Network includes labs in 50 states, several cities, and Puerto Rico, including seven regional labs and the National Tuberculosis Molecular Surveillance Center (National TB Center). AR Lab Network supports nationwide lab capacity to rapidly detect antibiotic resistance and inform local responses to prevent spread and protect people.
Antibiotic Stewardship Programs (ASP) Core Element Documents
These resources summarize core elements of successful hospital ASP. They complement existing guidelines on ASPs from organizations including the Infectious Diseases Society of America in conjunction with the Society for Healthcare Epidemiology of America, American Society of Health System Pharmacists, and The Joint Commission.
CDC’s Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report)
Report includes the latest national death and infection estimates that underscore the continued threat of antibiotic resistance in the U.S.
Discussion on topics including improving inpatient antibiotic prescribing, preventing central line-associated bloodstream infection (CLABSI), and preventing clostridium difficile infections.
Overview of information on CDC’s research on HAIs.
CDC’s Project Firstline is a collaborative of diverse healthcare and public health partners that have come together to make that happen. The right practices can stop pathogens from spreading in healthcare facilities.
This collaborative provides millions of frontline healthcare workers and members of the public health workforce the infection control training they need to protect the nation from infectious disease threats.
Featured Tools
Antibiotic Resistance and Patient Safety Portal
An interactive web-based application created to provide enhanced data visualizations on Antibiotic Resistance, Use, and Stewardship datasets as well as healthcare-associated infection (HAI) data.
More information on healthcare-associated infections can be found here.
Antibiotic Resistance Patient Safety Atlas
View and filter data about HAIs caused by antibiotic resistant bacteria.
Basic Infection Control and Prevention Plan for Outpatient Oncology Settings
Review a model for a basic infection control and prevention plan. It contains policies and procedure tailored to these settings to meet minimal expectations of patient protections as described in the CDC Guide to Infection Prevention in Outpatient Settings.
Presents prevention strategies for a variety of settings as well as different pathogens.
Infection Control Assessment Tools
Access information to assist health departments in assessing infection prevention practices and guide quality improvement activities (e.g., by addressing identified gaps). These tools may also be used by healthcare facilities to conduct internal quality improvement audits.
CDC developed this guidance for state and local health departments and healthcare facilities as a resource during the initial response for the containment of novel or targeted multidrug-resistant organisms (MDROs) or resistance mechanisms. The site also includes example scripts for requesting patient assent for MDRO screening and answers to patients’ frequently asked questions.
Targeted Assessment for Prevention (TAP) Strategy
Review the TAP Strategy framework for quality improvement. Developed by CDC to use data for action to prevent HAIs, the TAP Strategy consists of three components:
- Running TAP Reports in the National Healthcare Safety Network to target healthcare facilities and specific units with an excess burden of HAIs
- Administering TAP Facility Assessment Tools to identify gaps in infection prevention in the targeted locations
- Accessing prevention resources within the TAP Implementation guide to address those gaps