Healthcare associated infections (HAIs) are complications that occur while patients undergo treatment and are often associated with invasive procedures and devices. According to Magill et al. (2014), about 721,800 HAIs occurred in acute care settings in 2011 with the top five types of infections being pneumonia, gastrointestinal infection, urinary tract infection (UTI), bloodstream infection, and surgical site infection (SSI). However, most HAIs are preventable through adherence to prevention standards and the implementation of related programs. The purpose of this paper is to explore current HAI standards and HAI prevention programs.
Standards
The “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” is a document that outlines current HAI prevention standards in hospital settings. The Compendium is the product of a collaborative guideline development initiative of 10 organizations in the areas of epidemiology, infectious disease, infection control, hospitals, healthcare and quality improvement, public health, and critical and hospital medicine (Yokoe et al., 2014). These organizations include the American Hospital Association, CDC, and Joint Commission. The document has helped make HAI prevention a national priority. It outlines evidence-based recommendations in the prevention of catheter-associated UTI, SSI, central line associated bloodstream infection (CLABSI), and ventilator associated pneumonia (VAP).
The Compendium has prompted many changes in practice . For instance, recommendations to prevent CAUTI include the insertion of indwelling catheters only when medically necessary and the decision to continue with it based on appropriate medical indications (Yokoe et al., 2014). In preventing SSI, the Compendium strongly recommends antimicrobial prophylaxis, strict postoperative blood sugar control, perioperative normothermia, using alcohol-based agents for preoperative skin preparations, adequate peri- and post-operative oxygenation, and using a checklist to ensure all recommendations are followed (Yokoe et al., 2014). Meanwhile, preventing CLABSI entails adherence to recommendations before, during, and after insertion including bathing the patient with chlorhexidine and using alcohol-based chlorhexidine for skin preparation (Yokoe et al., 2014). Finally, VAP prevention entails minimizing sedation and performing trials for spontaneous breathing for the purpose of early extubation (Yokoe et al., 2014).
Furthermore, the Compendium recognized the key role of good hand hygiene in HAI prevention and for this reason included standards for hand hygiene. These include using alcohol-based hand sanitizers for routine hand hygiene and using soap and water if the hands are noticeably soiled (Yokoe et al., 2014). The Compendium recommendations are consistent with World Health Organization’s Five Moments for Hand Hygiene standards which represent a multifaceted approach (Higgins & Hannan, 2013). The standards include educating and training staff on correct hand hygiene techniques and when or where to perform them, providing adequate sinks and hand hygiene supplies, installing reminders in the workplace, and monitoring staff adherence (Higgins & Hannan, 2013).
Programs
Hospitals have also implemented HAI prevention programs that incorporate current standards as well as quality improvement (QI) principles. The Comprehensive Unit-Based Safety Program (CUSP) is one example of a framework which was originally employed in ICUs in Michigan hospitals for the prevention of CLABSI and VAP but was integrated in the national effort to reduce CLABSI known as “On the CUSP: Stop BSI” (Hong et al., 2013). However, because of its effectiveness, the CUSP has also been applied to other settings and types of HAIs such as SSI (Wick et al., 2012). The CUSP consists of patient safety education, assessing threats to patients, identifying evidence-based preventive strategies, senior leadership participation and support (Hong et al., 2013; Wick et al., 2012). The CUSP also requires the identification of system defects which contribute to HAIs and fostering teamwork and communication among the staff to implement QI for prevention (Hong et al., 2013; Wick et al., 2012).
Also at the national level, the U.S. Department of Health and Human Services (US DHHS) developed a program to comprehensively address HAIs and is known as the “National Action Plan to Prevent HAIs: Roadmap to Elimination” (Kahn et al., 2014). This program fostered the prioritization of HAI prevention by health care organizations and coordination among different stakeholders, such as regulatory agencies, in order to prevent fragmented and redundant prevention efforts (Kahn et al., 2014). The Action Plan also sought to identify the responsibilities of healthcare organizations and to give incentives to those who exert effort to lower their HAI rates (Kahn et al., 2014). Furthermore, the program aimed to engage stakeholders and thereby elicit strong support for preventing HAIs. Finally, the Action Plan provides funding, tools, and other resources to enable prevention in organizations (Kahn et al., 2014).
Conclusion
HAIs are a primary concern in all hospitals. Given that the top types of HAIs are generally preventable, adopting standards and programs for prevention are paramount. The “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” is a comprehensive standard outlining recommendations for preventing the top 4 types of HAI. Meanwhile, the WHO Five Moments of Hand Hygiene outlines the systems and processes needed to promote and sustain good hand hygiene. Two effective HAI prevention programs include the U.S. DHHS “National Action Plan to Prevent HAIs: Roadmap to Elimination” which promotes coordination, prioritization, and support for HAI prevention, and “On the CUSP: Stop BSI” which is specific to only one type of HAI.
References
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Hong, A. L., Sawyer, M. D., Shore, A., Winters, B. D., Masuga, M., Lee, H., Lubomski, L. H. (2008). Decreasing central-line-associated bloodstream infections in Connecticut intensive care units. Journal for Healthcare Quality, 35(5), 78–87. doi: http://doi.org/10.1111/j.1945-1474.2012.00210.x
Kahn, K. L., Mendel, P., Weinberg, D. A, Leuschner, K. J., Gall, E. M., & Siegel, S. (2014). Approach for conducting the longitudinal program evaluation of the US Department of Health and Human Services National Action Plan to prevent healthcare-associated infections: Roadmap to elimination. Medical Care, 52(2 Suppl 1), S9–S16. doi: http://doi.org/10.1097/MLR.0000000000000030
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