Health Care-Associated Infections

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This page features helpful links to information, tools, and resources on healthcare-associated infections (HAIs), which are the most common complication of hospital care and are one of the top 10 leading causes of death in the United States. AHRQ-funded research and initiatives to reduce HAIs are also highlighted.

Introduction

A core part of the mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the safety of health care for all Americans. To support this mission, AHRQ has funded numerous projects to reduce healthcare-associated infections (HAIs), infections that patients acquire during the course of receiving treatment for other conditions within a health care setting.

HAIs are the most common complication of hospital care and are one of the top 10 leading causes of death in the United States, accounting for an estimated 1.7 million infections and 99,000 associated deaths in 2002. The financial burden attributable to these infections is estimated at $28 to $33 billion in excess health care costs each year.

Fact sheets on AHRQ-funded projects are available for:

• Fiscal year 2011.
• Fiscal year 2010.
• Fiscal year 2009.
• Fiscal year 2008 and earlier.

Information on the Comprehensive Unit-based Safety Program—which has been expanded to include all 50 States, Puerto Rico and the District of Columbia, to include other settings in addition to intensive care units, and to address other types of HAIs—is available at Using a Comprehensive Unit-based Safety Program to Prevent Healthcare-Associated Infections

This page features helpful links to HAI-related information, tools, and resources, and will direct you to AHRQ-funded research and initiatives to reduce HAIs. 

Tools & Resources

• Tools & Resources for Healthcare Providers and Others.
• Tools & Resources for Consumers.
• Articles of Interest.
• Press Releases.
• Congressional Hearings/Testimonies. 

Tools & Resources for Health Care Providers and Others

• AHRQ Commentary
  • Preventing Healthcare-Associated Infections: Initiating Promising Solutions and Expanding Proven Ones
• AHRQ Handbook Chapters: Patient Safety and Quality: An Evidence-Based Handbook for Nurses
  • Chapter 41, Preventing Healthcare-Associated Infections
  • Chapter 42, Targeting Healthcare-Associated Infections: Evidence-Based Strategies
• AHRQ Healthcare411 Newscasts:
  Features audio and video programs on AHRQ's latest research findings:
  •  Bloodstream Infections (Podcast Download; Transcript)
  •  Prevention of Central Line-Associated Bloodstream Infections (Podcast Download; Transcript)
  •  New Study Looks at Ways to Reduce Catheter-Related Bloodstream Infections in Hospital Intensive Care Units (ICUs (Podcast Download; Transcript)
• AHRQ Morbidity & Mortality Rounds (AHRQ WebM&M)
  Provides a searchable online journal and forum on patient safety and health care quality, including the topic of HAIs. Physicians and nurses can receive free continuing medical education (CME), continuing education units (CEU), or trainee certification by taking the Spotlight Quiz.
• AHRQ Reports:
  • Accelerating Change and Transformation in Organizations and Networks (ACTION) Reports Related to Surgical Site Infections
    • Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection—Denver Health
  • Eliminating CLABSI: A National Patient Safety Imperative—A Progress Report on the National On the CUSP: Stop BSI Project
  • Eliminating CLABSI: A National Patient Safety Imperative—Second Progress Report on the National On the CUSP: Stop BSI Project
  • Eliminating CLABSI, A National Patient Safety Imperative—Final Report on the National On the CUSP: Stop BSI Project
  • Companion Guide to the National On the CUSP: Stop BSI Project Final Report
  • Eliminating CLABSI, A National Patient Safety Imperative—A Progress Report on the National On the CUSP: Stop BSI Project, Neonatal CLABSI Prevention
  • Practice-Based Research Network Reports on Community Acquired Methicillin-Resistant Staphylococcus Aureus
    • Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA)—Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill & Duke Clinical Research Institute
    • Community-Acquired Skin Infections in the Age of Methicillin-Resistant Organisms—Iowa Research Network Practices, University of Iowa
    • Management by Primary Care Clinicians of Patients Suspected of Having Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections—State Network of Colorado Ambulatory Practices and Partners
• American Hospital Association (AHA): Hospitals in Pursuit of Excellence
  Features an overview of Hospitals in Pursuit of Excellence, a platform to disseminate field-tested practices, strategies, tools, and resources that can improve hospital care, including preventing HAIs.
• American Health Quality Association (AHQA)
  Offers perspectives from Quality Improvement Organizations and professionals that work to improve the quality of health care by sharing information about best practices with physicians, hospitals, nursing homes, home health agencies, and others on topics including HAIs.
• Association for Professionals in Infection Control and Epidemiology (APIC)
  Features news, guidelines, and education opportunities to improve health and patient safety by reducing risks of infection and other adverse outcomes.
• Centers for Disease Control and Prevention (CDC):
  • CDC National Healthcare Safety Network
    Features a secure, Internet-based surveillance system that integrates and expands patient and health care personnel safety surveillance systems.
  • Get Smart for Healthcare
    Features strategies to help hospitals and other inpatient facilities implement interventions to improve antibiotic use.
  • Get Smart: Know When Antibiotics Work
    Features information on appropriate antibiotic use.
• Centers for Medicare & Medicaid Services (CMS):
  • Hospital-Acquired Conditions Present on Admission Indicator
    Features CMS' list of conditions that hospitals will not receive additional payment for if one of the conditions was not present on admission.
  • Hospital-Acquired Conditions Fact Sheet (PDF File, 760 KB; Plugin Software Help)
    Offers a fact sheet on conditions that hospitals will not receive additional payment for if one of the conditions was not present on admission.
• Health Research & Educational Trust (HRET): National Implementation of the Comprehensive Unit-Based Safety Program (CUSP) to Reduce Central Line Associated Blood Stream Infections (CLABSI) in the Intensive Care Unit
  Offers toolkits to eliminate central line associated blood stream infections using a comprehensive unit-based safety program.
• Infectious Diseases Society of America (IDSA)
  Provides resources on reducing antimicrobial resistance and the need for new antibiotics.
• Institute for Healthcare Improvement (IHI)
  Features improvement methods, measurement plans, and tools to reduce HAIs.
• Johns Hopkins University:
  • Central Line Insertion Care Team Checklist
    Offers a checklist that provides critical steps that have been shown to reduce central line infections.
  • Johns Hopkins University Quality and Safety Research Group
    Provides education and research from a multidisciplinary team committed to improving quality and safety in health care.
  • On the CUSP: Stop BSI
    Features toolkits to eliminate central line associated blood stream infections using a comprehensive unit-based safety program.
• Michigan Keystone ICU Project
  Features news and collaborative activities surrounding Michigan Keystone ICU Project, a joint partnership between the Michigan Health & Hospital Association and the Johns Hopkins University that has reduce the number of infections in Michigan intensive care units (ICUs) to zero in more than half of participating hospitals.
• National Quality Forum's Safe Practices for Better Healthcare
  Features a document listing 34 safe practices that should be universally used in applicable clinical care settings to reduce the risk of harm to patients.
• Practice-Based Research Network reports on community acquired methicillin-resistant Staphylococcus aureus
  • Management by Primary Care Clinicians of Patients Suspected of Having Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections
  • Community-Acquired Skin Infections in the Age of Methicillin-Resistant Organisms
  • Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA)
• Society for Healthcare Epidemiology of America (SHEA)
  Offers recommendations and guidelines on drug-resistant organisms, including MRSA
• The Joint Commission: Five Things You Can Do To Prevent Infection: A Speak Up Initiative
  Links to a brochure on how to prevent HAIs.
• U.S. Department of Health and Human Services: Partnering to Heal: Teaming Up Against Healthcare-Associated Infections
  Computer-based, interactive learning tool for clinicians, health professional students, and patient advocates.
• World Health Organization (WHO): Save Lives: Clean Your Hands Campaign
  Features an overview of the campaign and offers tools and resources to prevent infections.

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Tools & Resources for Consumers

• Advice for consumers and patients from AHRQ Director Dr. Carolyn Clancy:
  • Healthcare-Associated Infections: They Can Happen to You
  • Simple Steps Can Reduce Healthcare-Associated Infections
• AHRQ Patient Safety Network (AHRQ PSNet)
  Features a National Web-based resource that posts news and resources on patient safety, including HAIs.
• Association for Professionals in Infection Control and Epidemiology (APIC):
  • PreventInfection.org
    Information to improve health and patient safety by reducing risks of infection.
  • HAI Compendium
    Strategies to prevent six of the most common HAIs: Clostridium difficile, Methicillin resistant Staphylococcus aureus (MRSA), central-line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, and surgical site infections.
• Consumers Advancing Patient Safety
  Offers resources on patient safety, including infection control, from a consumer-led nonprofit organization.
• Centers for Disease Control and Prevention (CDC):
  • CDC: Healthcare-Associated Infections
    Provides links to CDC resources, including estimates of HAIs, lists of infectious diseases in health care settings, and information on antimicrobial resistance.
  • CDC National MRSA Education Initiative: Preventing MRSA Skin Infection
    Offers CDC information on MRSA symptoms and includes fact sheets on MRSA in schools and athletes.
  • Get Smart: Know When Antibiotics Work
    Features information on appropriate antibiotic use.
• Food and Drug Administration (FDA) Consumer Health Information
  Provides information on topics of interest to consumers, including infections, medicines, and recalls.
• Healthfinder
  Offers links to frequently asked questions on MRSA and staphylococcus skin infections.
• HHS' Office of Public Health and Science (OPHS): HHS National Action Plan on HAIs
  Features a plan that establishes national goals for HAI prevention and outlines key actions for achieving identified short- and long-term objectives.
• National Library of Medicine (NLM)
  Links to information on bacteria, including preventing and treating infections.
• National Institute of Allergy and Infectious Diseases (NIAID)
  Offers information on antimicrobial drug resistance, including its causes, diagnosis, and treatment.
• National Patient Safety Foundation (NPSF): Preventing Infections in the Hospital: What You As a Patient Can Do
  Features a patient education brochure on how to prevent HAIs while hospitalized.

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Articles of Interest

The ability of intensive care units to maintain zero central line-associated bloodstream infections.
Lipitz-Snyderman A, Needham DM, Colantuoni E, Goeschel CA, et al. Arch Intern Med 2011 May 9;171(9):856-8.

Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit.
Berenholtz, SM, Pham JC, Thompson, DA, et al. ICHE 2011 Feb 17.

Eradicating central line-associated bloodstream infections statewide: The Hawaii experience.
Lin DM, Weeks K, Bauer L, et al. Am J Med Qual 2011 Sep 14. [Epub ahead of print]

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis.
Lipitz-Snyderman A, Steinwachs D, Needham DM, et al. BMJ 2011 Jan 28;342:d219. doi: 10.1136/bmj.d219.

A research framework for reducing preventable patient harm.
Pronovost PJ, Cardo DM, Goeschel CA, et al. Clin Infect Dis 2011 Feb;52(4):507-13.

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study.
Pronovost PJ, Goeschel CA, Colantuoni E, et al. BMJ 2010 Feb 4;340:c309.

An intervention to decrease catheter-related bloodstream infections in the ICU.
Pronovost P, Needham D, Berenholtz S, et al. N Engl J Med 2006 Dec 28;355(26):2725-32.

Integrating CUSP and TRIP to improve patient safety.
Romig M, Goeschel C, Pronovost P, et al. Hosp Pract (Minneap) 2010 Nov;38(4):114-21.

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study.
Pronovost PJ, Goeschel CA, Colantuoni E, et al. BMJ 2010 Feb 4;340:c309.

An intervention to decrease catheter-related bloodstream infections in the ICU.
Pronovost P, Needham D, Berenholtz S, et al. N Engl J Med 2006 355:2725-32.

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Press Releases

ICUs in Michigan Sustain Zero Blood Stream Infections for Up to 2 Years
May 9, 2011
Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units
February 17, 2011
Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units
January 31, 2011
AHRQ Awards $34 Million to Expand Fight Against Healthcare-Associated Infections
November 4, 2010
Annual Quality and Disparities Reports Include Data on Rates of Health Care-Associated Infections, Obesity and Health Insurance
April 13, 2010
Sebelius Announces Release of Recovery Act Funding to Improve Care in Nation's Ambulatory Surgical Centers
November 10, 2009
HHS Awards $17 Million in a New National Initiative to Fight Health Care-Associated Infections
October 23, 2009
Secretary Sebelius Releases Inaugural Health Care "Success Story" Report
July 13, 2009
Secretary Sebelius Highlights Two New Reports on Health Care Quality, Says Improving Quality is Key Component of Health Reform
May 6, 2009
10-State Project To Study Methods To Reduce Central Line-Associated Bloodstream Infections in Hospital ICUs
February 19, 2009
AHRQ Awards $3 Million To Help Reduce Central Line-Associated Bloodstream Infections in Hospital ICUs
October 1, 2008

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Congressional Hearings/Testimonies

Testimony on Reducing Health Care-Associated Infections
April 1, 2009

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