Challenge 2

Healthcare-associated Infections (HAIs)

Healthcare-associated infections (HAIs) are infections patients acquire while being treated in a healthcare facility. HAIs are serious and, often times, preventable if an actionable prevention plan is in place and best practices to safely manage these infections are implemented across the organization. PSMF currently focuses on the following topics related to HAIs: Hand Hygiene, Catheter-associated Urinary Tract Infections (CAUTI), Surgical Site Infections (SSI), Ventilator-associated Pneumonia (VAP), Clostridium Difficile Infection (CDI), and Central Line-associated Blood Stream Infections (CLABSI).

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Sub-Challenges

Statistics

There has been a 50% decrease in CLABSIs between 2008 and 2014.1
1.

Centers for Disease Control and Prevention. (2014). National and state healthcare associated infections progress report. Atlanta, GA: Centers for Disease Control and Prevention.

CLABSIs result annually in: 84,551 to 203,916 preventable infections, 10,426 to 25,145 preventable deaths, and $1.7 to $21.4 billion avoidable costs2
2.

Agency for Health Research and Quality. Appendix 2. Central line-associated bloodstream infections fact sheet. (2014). Retrieved from http://www.ahrq.gov/professionals/education.curriculum-tools/clabsitools/clabsitoolsap2.html

An estimated 250,000-500,000 CLABSIs occur in U.S. hospitals each year.3
3.

Medscape. Advances in Central Line Insertion and Care: Skin Antisepsis for Prevention and Control of Catheter-Related and Surgical Site Infections.

Increased cost (the non-inflation-adjusted attributable cost) of CLABSIs have been found to vary from $3,700 to $39,000 per episode.4
4.

Marschall, J., Mermel, L., Fakih, M., Hadaway, L., Kallen, A., O’Grady, N., . . . Yokoe, D. (2014). Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 35(7), 753-771. doi:10.1086/676533.

In the United States, approximately 250,000 CLABSIs are estimated to occur each year, associated with a death rate of 12-25% and extended hospital stays, at a cost of up to $56,000 per infection.5
5.

Centers for Disease Control and Prevention. (2011). Guidelines for the Prevention of Intravascular Catheter-Related Infections.

29,000 people who were initially diagnosed with CDI died within 30 days.6
6.

Lessa, F. C., Mu, Y., Bamberg, W. M., Beldavs, Z. G., Dumyati, G. K., Dunn, J. R. … McDonald, L. C. (2015). Burden of Clostridium difficile Infection in the United States. The New England Journal of Medicine,372, 825-834. doi:10.1056/NEJMoa1408913.

In 2011, CDI was estimated to cause almost half a million infections in the United States.7
7.

Lessa, F. C., Mu, Y., Bamberg, W. M., Beldavs, Z. G., Dumyati, G. K., Dunn, J. R. … McDonald, L. C. (2015). Burden of Clostridium difficile Infection in the United States. The New England Journal of Medicine,372, 825-834. doi:10.1056/NEJMoa1408913.

Clostridum difficile infection accounts for 15-25% of antibiotic-associated diarrhea.8
8.

DePestel, D. D., & Aronoff, D. M. (2013). Epidemiology of Clostridium difficile Infection. Journal of Pharmacy Practice26(5), 464–475. http://doi.org/10.1177/0897190013499521

VAP increases patient time in the ICU by 4 to 6 days.9
9.

Halyard Health. Ventilator Associated Pneumonia. Retrieved from: http://www.halyardhealth.com/hai-watch/hai-threats-solutions/ventilator-associated-pneumonia.aspx

VAP is the most common and deadly healthcare-associated infection, affecting up to 28% of ventilated patients.10
10.

Kalanuria, A. A., Zai, W., & Mirski, M. (2014). Ventilator-associated pneumonia in the ICU. Critical Care18(2), 208. http://doi.org/10.1186/cc13775

Costs due to SSIs can reach up to $10 billion annually.11
11.

Perencevich, E. N., Sands, K. E., Cosgrove, S. E., Guadagnoli, E., Meara, E., & Platt, R. (2003). Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge. Emerging Infectious Diseases9(2), 196–203. http://doi.org/10.3201/eid0902.020232

Length of hospital stay can result in 7-10 additional postoperative hospital days due to an SSI.12
12.

Kaye, K. S., Anderson, D. J., Sloane, R., Chen, L. F., Choi, Y., Link, K., … Schmader, K. E. (2009). The Impact of Surgical Site Infection on Older Operative Patients. Journal of the American Geriatrics Society57(1), 46–54. http://doi.org/10.1111/j.1532-5415.2008.02053.x

Continuous monitoring in post-surgical patients was shown to reduce ICU transfers by 48% and rapid response activations by 65% – with no deaths or brain damage over a five year period.13
13.

Through Movement (Rep.). (2017). Retrieved http://www.masimo.com/globalassets/image/homepage/masimo_annual_report_2016_international.pdf

Surgical site infections occur in 2-5% of patients undergoing inpatient surgery.14
14.

Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., … & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(06), 605-627.

Patients hospitalized for MRSA have longer hospital stays and are more likely to die than patients who do not have MRSA.15
15.

Agency for Healthcare Research and Quality (AHRQ). (2011). Healthcare-Associated Infections. Retrieved from www.ahrq.gov/qual/hais.htm.

Several studies have demonstrated that handwashing virtually eradicates the carriage of MRSA which invariably occurs on the hands of Health Care Practitioners working in ICUs.16
16.

Mathur, P. (2011). Hand hygiene: Back to the basics of infection control. The Indian Journal of Medical Research134(5), 611–620. http://doi.org/10.4103/0971-5916.90985.

Proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of HAIs and the spread of antimicrobial resistance.17
17.

Mathur, P. (2011). Hand hygiene: Back to the basics of infection control. The Indian Journal of Medical Research134(5), 611–620. http://doi.org/10.4103/0971-5916.90985

HAIs declined 17% from 2010 to 2013.18
18.

Efforts To Improve Patient Safety Result in 1.3 Million Fewer Patient Harms. Content last reviewed November 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2013.html

Infections associated with health care affect an estimated 1 in 20 hospital patients on average every year (estimated at 4.1 million patients).19
19.

World Health Organization. Data and statistics. Retrieved from: http://www.euro.who.int/en/health-topics/Health-systems/patient-safety/data-and-statistics

1 out of every 25 hospitalized patients in the U.S. contracts an HAI during their stay.20
20.

Healthcare-associated Infections. (2016). Retrieved June 08, 2017, from https://www.cdc.gov/hai/surveillance/

Approximately 1 to 3 out of every 100 patients who have surgery develop infections.21
21.

Center for Disease Control and Prevention. (2010). Healthcare-associated Infections. Retrieved from https://www.cdc.gov/hai/ssi/faq_ssi.html

HAIs cost hospitals approximately $9.8 billion every year.22
22.

Gregory, A., Chami, E., & Pietsch, J. (2016). Emotional motivators: Using visual triggers as an infection control intervention to increase hand hygiene compliance throughout the hospital. American Journal of Infection Control, 44(6), S3.

More than 700,000 HAIs occur annually in the United States.23
23.

Center for Disease Control and Prevention. (n.d.). Preventing Healthcare-Associated Infections. Retrieved https://www.cdc.gov/washington/~cdcatWork/pdf/infections.pdf

An estimated 1.7 million healthcare-associated infections occur each year leading to 99,000 deaths.24
24.

Center for Disease Control and Prevention. (n.d.). Preventing Healthcare-Associated Infections. Retrieved https://www.cdc.gov/washington/~cdcatWork/pdf/infections.pdf