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Healthcare Associated Infections

Healthcare-associated infections (HAIs) are infections that patients acquire after being admitted into a healthcare setting for other conditions.1 The onset of the infection usually occurs more than 48 hours upon admission.2 HAIs are caused by a variety of infectious agents, including bacteria, fungi, and viruses; however, they are largely preventable.3
HAIs are one of the top ten leading causes of death in the United States and are one of the leading causes of death and increased morbidity among hospitalized patients worldwide.1,2 HAIs affect 5-10% of patients in US acute care hospitals and one death every six minutes is attributed to an HAI.4 The financial burden of HAIs is substantial, incurring an estimated $28 to $33 billion in excess healthcare costs each year.3
There are four categories of infections which account for about three quarters of HAIs in the acute care hospital setting:3

  • Surgical site infections (SSIs)
  • Central line-associated bloodstream infections (CLABSIs)*
  • Ventilator-associated pneumonia (VAPs)
  • Catheter-associated urinary tract infections (CAUTIs)

In addition, infections associated with Clostridium difficile (C.diff) and Methicillin-Resistant Staphylococcus Aureus (MRSA)* also contribute considerably to the overall problem.3
HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year in American hospitals alone in 2002.1,3 Of these infections:1

  • 32% of all healthcare-associated infection are urinary tract infections
  • 22% are surgical site infections
  • 15% are pneumonia (lung infections)
  • 14% are bloodstream infections

CLABSIs

An estimated 248,000 bloodstream infections occur in US hospitals each year.5 Most bloodstream infections are associated with the insertion of a central line or umbilical catheter, resulting in an  increased cost due to prolonged hospital stay and higher risk of mortality.6

MRSA

Methicillin-Resistant Staphylococcus Aureus is a staph bacterium that is resistant to specific antibiotics. Some of the antibiotics include methicillin, oxacillin, penicillin, and amoxicillin.7 MRSA can be acquired in the community, usually resulting in skin infections, while more severe MRSA occurs in hospital settings.7

American Reinvestment and Recovery Act

In 2009, Congress passed the American Reinvestment and Recovery Act to assist in stimulating the economy. $50 million was appropriated to support states in efforts to prevent and reduce HAIs. $40 million was allocated by CDC to enable states in creating action plans that would assist in expanding their HAI prevention programs. The District of Columbia was awarded $250,792 for purposes of monitoring and reducing HAIs in the District. The grant has allowed the District to hire a HAI Plan Coordinator, who manages the newly established HAI Prevention Program.

As part of the grant, the DOH will host a series of half-day meetings with key stakeholders representing the provider community, local healthcare systems, and healthcare consumers in the District as well as the local Medicare Quality Improvement Organization. The meetings will allow key stakeholders to provide feedback on the Medical Malpractice Amendment Act of 2006 and its mandatory adverse events reporting requirements and to establish the District of Columbia State Plan to Reduce and Prevent Healthcare Associated Infections.

In June 2010, the DOH hosted a National Healthcare Safety Network workshop opened to infection control practitioners, local healthcare systems, and key stakeholders in order to provide an avenue to ask questions and discuss the use and implementation of the surveillance system within facilities.

Surveillance Method

In order to monitor and reduce HAIs in the District, facilities are now required to report HAIs through the National Healthcare Safety Network (NHSN), “a voluntary, secure, internet-based surveillance system that integrates and expands legacy patient and healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion (DHQP) at CDC.”8 NHSN enables state and local health departments to collect HAI data from healthcare facilities in their jurisdiction.8 NHSN will allow the DOH to analyze data collected in the system to improve upon patient safety and will provide the DOH with the ability to compare healthcare facility’s rates in the District with the national aggregate measures.

Central line-associated bloodstream infections and Methicillin-Resistant Staphylococcus Aureus are reportable diseases mandated by the District of Columbia Department of Health, Center for Policy, Planning and Evaluation through the NHSN system.

Physicians

To report Healthcare Associated Infections to the Department of Health, please complete the Communicable Disease Case Report Form [PDF].

View a complete list of disease factsheets offered by the Division of Epidemiology- Disease Surveillance and Investigation.

Reportable Diseases in the District of Columbia [PDF]

Health Care Infectious Report January 2013 - December 2013 Final Report at the bottom of the page 

1Centers for Disease Control and Prevention. “Estimates of Healthcare-Associated Infections.” 12 Mar 2010. http://www.cdc.gov/ncidod/dhqp/hai.html.

2World Health Organization. Dec 2002. Prevention of Hospital Acquired Infections. Geneva, Switzerland. 2nd Edition. http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

3Department of Health and Human Services. 22 Jun 2009. Action Plan to Prevent Healthcare-Associated Infections. http://www.hhs.gov/ash/initiatives/hai/actionplan/hhs_hai_action_plan_final_06222009.pdf

4Muto, Carlene A. 6 Dec 2006. Controlling Methicillin Resistant Staphylococcus aureus.
http://www.apic.org/Content/NavigationMenu/Education/OnlineLearning/Webinars/061206_muto.pdf

5Centers for Disease Control and Prevention. Jun 2010. Central Line-Associated Bloodstream Infection (CLABSI) Event. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

6Allen-Bridson, Kathy. Aug 2010. Central Line-Associated Bloodstream Infection Surveillance Using the National Healthcare Safety Network. Centers for Disease Control and Prevention, Division of Healthcare Quality and Promotion.

7Centers for Disease Control and Prevention. “MRSA Infections.” 9 Aug 2010. http://www.cdc.gov/mrsa/definition/index.html

8Centers for Disease Control and Prevention. “National Healthcare Safety Network.” 25 Oct 2010. http://www.cdc.gov/nhsn/about.html

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