Wash your hands! Cover your mouth when you cough or sneeze! Don’t recap that needle! Be sure to gown and glove when you take care of infectious patients! Every clinician has heard these words from their first day of training. They are essential instructions and prevent the spread of disease to patients as well as healthcare providers.
Every year, lives are lost because of the spread of infections in hospitals. Healthcare professionals are a key element of prevention and can take important steps to prevent the spread of infectious diseases. These steps are part of a standard infection control process for all healthcare providers (U. S. National Library of Medicine, 2017). The promotion of a safe climate is the cornerstone of the prevention of pathogen transmission in every healthcare setting (World Health Organization [WHO], 2007).
Healthcare-associated infection (HCAI) is a major problem for patient safety and its surveillance and prevention must be a first priority in all healthcare settings. HCAIs can lead to the following (Centers for Disease Control and Prevention [CDC], 2017b; WHO, 2009):
- Prolonged hospital stays
- Long-term disability
- Increased resistance of microorganisms to antimicrobials
- Massive additional financial burdens to healthcare organizations, patients, and communities
- High costs for health care for patients and their families
- Excessive (unnecessary) deaths
The five most common, costly, preventable, and well-tracked healthcareassociated infections are (Burns, 2014; CDC, 2015; Office of Disease Prevention and Health Promotion, 2017):
- Surgical site infections (SSI)
- Central-line-associated bloodstream infection (CLABSI)
- Catheter-associated urinary tract infection (CAUTI)
- Ventilator-associated pneumonia (VAP)
- Clostridium difficile infection (CDI)
In developed countries, HCAI affects 5% to 15% of patients and can affect between 9% and 37% of those admitted to intensive care units (ICUs). In the United States, the HCAI incidence is approximately 4.5% of patients annually with approximately 99,000 deaths attributable to them. The economic impact of HCAIs is more than $6.5 billion in the United States. In Europe, approximately 5 million HCAIs occur annually, costing more than $13 to $24 billion euros and contributing to approximately 50,000 deaths per year (WHO, 2009).
International and national guidelines have been established to prevent and control the spread of infection and address a broader scope of issues than in previous isolation guidelines. These updated guidelines have been created because of the following (CDC, 2017a):
- The emergence of new pathogens (such as severe acute respiratory syndrome [SARS], coronavirus [CoV] associated with SARS, avian influenza in humans, etc.)
- Renewed concerns for evolving pathogens (such as Clostridium difficile, noroviruses, community-associated multidrug-resistant Staphylococcus aureus [MRSA])
- The development of new therapeutic regimens (such as gene therapy)
- Increasing concern for the threat of bioweapons attacks
Many factors impact the incidence of HCAIs, including the education and knowledge of staff about infection control and prevention measures. However, there is also powerful evidence that medical procedures, antibiotic use, patient characteristics, and organizational characteristics (such as nurse staffing levels and composition as well as the establishment of a safety culture) greatly impact the adherence to recommended infection control practices by healthcare personnel. These characteristics are considered vital factors in preventing the transmission of infectious agents (CDC, 2017a; Office of Disease Prevention and Health Promotion, 2017).