Gabriel Alvarado, Spokesperson for the Centers for Disease Control and Prevention, presents the facts and figures surrounding the state of healthcare-associated infections in the US today.
Healthcare-associated infections (HAIs), which are infections contracted by patients during or soon after health treatment, are a serious threat to healthcare safety. The impacts of HAIs are detrimental and include sickness, death and billions of dollars in healthcare costs each year.
In the US alone, around one in 31 hospital patients has at least one healthcare-associated infection on any given day. Whilst progress has been made in reducing the number of HAIs, it is still a major public health issue, and it is, therefore, crucial that everyone works collaboratively to help address the problem.
The Centers for Disease Control and Prevention (CDC) is committed to protecting patients and healthcare personnel from adverse healthcare events and promoting safety, quality, and value in healthcare delivery. Preventing HAIs is a top priority for CDC and its partners in public health and healthcare.
The Innovation Platform spoke to CDC Spokesperson Gabriel Alvarado to learn the current picture of HAIs in the US and to find out what is being done to help reduce the threat.
What is the current state of healthcare-associated infections in the US? Has this changed in recent years?
Healthcare-associated infections (HAIs) continue to be a major threat to patient safety in the United States, exacerbated by the COVID-19 pandemic.
CDC tracks selected HAIs through the National Healthcare Safety Network (NHSN), which receives data from more than 38,000 healthcare facilities across the country, including hospitals and long-term care facilities. Before the COVID-19 pandemic, data from NHSN showed significant progress in reducing HAIs, such as hospital-onset Clostridioides difficile infection (CDI), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI). During the COVID-19 pandemic, we saw a reversal in prevention progress and significant increases in multiple HAI types, including CLABSI, CAUTI, ventilator-associated events, and bloodstream infections due to methicillin-resistant Staphylococcus aureus. These increases continued into 2021; fortunately, in 2022, we started to see some improvements, and by 2023, some infections had returned to, or were even below, pre-pandemic levels.
To complement data reported to NHSN, CDC partners with the Emerging Infections Program Healthcare-Associated Infections – Community Interface Activity (EIP HAIC) to conduct periodic point prevalence surveys of HAIs in hospitals. These surveys, conducted in 2011, 2015, and 2023, provide snapshots of the complete picture of all HAI types occurring in hospital patients. Survey data showed a significant decrease in the prevalence of HAIs in 2015 compared with 2011. In 2015, we found that approximately 1 in 31 hospital patients, or about 3.2%, had an HAI on any given day. That is still more than 680,000 infections over the course of a year. In 2023, preliminary results show that the prevalence of HAIs was 2.6%.
It’s important to note that HAIs are not only a safety problem for patients in hospitals. HAIs affect people who receive care in all different types of healthcare facilities, including nursing homes. The EIP HAIC program conducted a point prevalence survey in nursing homes in ten states in 2017 and found that about 1 in 43 residents had an HAI. NHSN tracks respiratory virus infections and vaccination in nursing home residents and staff, who were severely impacted by the COVID-19 pandemic, and who continue to be at high risk for COVID-19, as well as infections due to other respiratory viruses such as influenza and respiratory syncytial virus.
How much of a threat do HAIs pose to society, the economy, and the healthcare system?
HAIs are one of the most common causes of harm to patients in healthcare facilities. CDC has estimated that there are more than 680,000 HAIs annually among hospitalised patients in the United States. These infections can lead to longer lengths of hospital stays, increased severity of illness, and increased rates of death.
HAIs are also extremely costly. A recent analysis estimated that, in 2016, the national direct medical cost for all HAIs was $12.1bn.
HAIs are also potentially an indicator of healthcare facility or system resilience. During times of stress, it may be harder for facilities and staff to have the resources and capacity to adhere to recommended infection prevention and control (IPC) practices that are critical for preventing HAIs. When gaps in IPC occur, this can lead to increases in HAIs. As healthcare and public health systems prepare for new threats, ensuring that facilities can maintain IPC best practices, regardless of the threats they face, is essential.
Is awareness of HAIs sufficient?
Awareness of the importance of HAIs has increased substantially over the past couple of decades, and preventing HAIs is a priority for governmental public health agencies as well as for healthcare facilities, providers, and patients. Years ago, HAIs were viewed as a largely unavoidable consequence of healthcare, especially healthcare for complex medical or surgical conditions.
Today, there is widespread recognition and acceptance in the healthcare community that HAIs are preventable, and measures to prevent HAIs are an integral component of routine healthcare practices in the United States. Increases in HAIs during the COVID-19 pandemic served to shine a light on areas of vulnerability within the US healthcare and public health systems and showed us that we have more work to do to make sure that, even in times of extreme stress, we can continue to protect patients from the everyday threat of HAIs.
What is the CDC doing in order to help prevent HAIs? Can you provide any examples of key projects the CDC is involved with?
CDC works in many ways to help prevent HAIs. We must monitor infections to know if we are preventing them. The CDC’s NHSN is the nation’s HAI tracking system, providing data for action to show whether progress is being made at the local, state, and national levels in the United States. NHSN provides medical facilities, states, regions, and the nation with data collection and reporting capabilities needed to: identify infection prevention problems by facility, state, or specific quality improvement project; benchmark progress of infection prevention efforts; comply with state and federal public reporting mandates, and ultimately, drive national progress toward elimination of HAIs.
CDC also provides numerous infection prevention guidelines for healthcare facilities to use in keeping patients and healthcare workers safe – from environmental infection control and disinfection and sterilisation, to isolation precautions and healthcare worker occupational exposure management. These are developed and updated in collaboration with the Healthcare Infection Control Practices Advisory Committee. In addition to guidance, CDC supports health departments, healthcare facilities and providers, and patients by providing training and tools, outbreak investigation assistance, and technical expertise.
CDC also partners with academic centers of excellence, through networks such as the CDC Prevention Epicenters and Modeling Infectious Diseases in Healthcare (MInD-Healthcare), to conduct applied public health research and other activities that advance healthcare epidemiology and infection prevention science.
What support is needed from government and other bodies to help reduce the prevalence of HAIs?
United States government agencies and state, tribal, local, and territorial health departments have critical roles to play in protecting patient safety by preventing HAIs. In addition to the direct support and technical assistance that federal, state, and local public health professionals provide to healthcare facilities, they also facilitate communication and build partnerships among healthcare systems and facilities in their regions to encourage learning and sharing of best practices.
Collaboration among multiple US government departments and agencies, including CDC, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, and others, health departments, academic investigators, healthcare systems and providers, and patient groups, is essential to continued progress in eliminating HAIs and improving the safety and quality of healthcare in the United States.
Please note, this article will also appear in the 21st edition of our quarterly publication.
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