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Healthcare-Associated Infections (HAIs)

What are HAIs?

Healthcare-associated infections (HAIs) are infections that are acquired by patients within a healthcare setting while they are receiving care. These infections may occur in all types of healthcare facilities, including hospitals, outpatient surgery centers, nursing homes, or rehabilitation facilities. HAIs are largely preventable, yet are the most common complication of healthcare and can cause significant morbidity and mortality. A recent study estimated that on any given day, approximately one out of every 25 inpatients in U.S. acute care hospitals has at least one HAI1. This is most likely an underestimate of the total burden of HAIs since the study did not take into account infections outside of acute care hospitals (i.e., nursing homes) or infections diagnosed after discharge. HAIs are also costly and add avoidable costs to the already overburdened U.S. healthcare system. A 2009 Centers for Disease Control and Prevention (CDC) report estimated the annual medical costs of HAIs to U.S. hospitals to be between $28 and $45 billion dollars2.

Who we are 

In 2010, the DC HAI Program was established within the District of Columbia Department of Health (DC DOH) Division of Epidemiology-Disease Surveillance and Investigation (DEDSI) in response to a growing recognition of the important role of public health departments in ensuring patient safety and quality services in DC healthcare facilities. A state HAI prevention plan was developed to identify priority prevention targets, coordinate and implement prevention activities, and report on progress towards reductions in the number of HAI cases. Both surveillance and prevention activities are necessary to reduce the number of patients with HAIs. Our program monitors HAI infection rates and uses the data to promote interventions to prevent infections, provides support and technical assistance to healthcare facilities during outbreaks, and collaborates with partners to develop and implement prevention activities to drive quality improvement.

Additional Information for the Public


Mandated Reporting of HAIs

According to DC Municipal regulations, healthcare facilities must report priority healthcare-associated infections (HAIs) and any outbreaks or clusters that occur.  DC DOH provides both oversight and support for these mandatory HAI reporting activities through its HAI Program. Please refer to the links below to view the current regulations. For more information, please contact the DOH HAI Program at [email protected].

Reporting HAI Outbreaks or Clusters to DC DOH

DC DOH conducts passive surveillance of HAI outbreaks and clusters within DC healthcare facilities.  While reporting of HAI outbreaks and clusters are mandated by DCMR 22-B208.2, it is ultimately up to each individual healthcare facility to report any outbreak or cluster that is occurring at their facility. The DC DOH HAI Program is available to provide guidance and resources to any type of healthcare facility that suspects an HAI outbreak or cluster.  Examples of resources that can be provided by the HAI Program include laboratory support, subject matter expertise and coordination with the CDC. The DC DOH HAI Program tracks the number of HAI outbreaks and clusters using a line list and can also look back at NHSN data to detect outbreaks and clusters that have happened in the past.

Healthcare facilities in DC report outbreaks and clusters electronically to DC DOH through DC REDCap (DCRC), our online reporting system. Facilities also have the option to report by phone or email.

Reporting Individual HAI Cases to DC DOH

Healthcare facilities in DC report individual HAI cases to DOH through NHSN. This is done for both mandated and voluntarily reported HAIs.  Healthcare facilities that do not currently use NHSN also have the option of reporting individual HAI cases to the HAI Program either by fax or telephone. For more information about how to report individual HAI cases to DOH, please contact the DOH HAI Program at [email protected].

Confidentiality of Surveillance Data 

DC DOH is a covered entity under the Health Insurance Portability and Accountability Act’s (HIPPA) Privacy Rule.  This means that healthcare facilities are allowed to disclose Protected Health Information (PHI) when it is requested by DC DOH for public health surveillance purposes, such as routine HAI surveillance and HAI outbreak and cluster investigations. DC DOH is not allowed to disclose or use any of this PHI for non-surveillance purposes.  For more information about the confidentiality of public health surveillance data, please refer to the links below: 

Reports and Information about HAIs in DC


1Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, et al. Multistate Point-Prevalence Survey of Health Care – Associated Infections. NEJM. 2014; 370:1198-208. 

2Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009. (accessed April 7, 2009). [PDF]