Healthcare-associated infections (HAIs) rank among the leading causes of unnecessary illnesses and deaths in the United States, affecting patients receiving services in hospitals, surgery centers, outpatient clinics and long-term care facilities (including nursing and rehabilitation facilities).
Healthcare workers are vital in controlling and preventing HAIs, including understanding the risks, taking the necessary precautions and educating others. Patients and families can learn more to help protect themselves and others from infection.
Types of HAIs
A surgical site infection (SSI) occurs after surgery in the area of the body where the procedure was performed. Sometimes, an SSI is superficial, involving the skin only. It can also be more serious, involving under the skin, organs or implanted material.
Symptoms of an SSI include redness and pain around the surgery site, drainage of cloudy fluid from the surgical wound and fever.
How are SSIs Prevented?
Healthcare providers should adhere to the Centers for Disease Control and Prevention's (CDC) SSI prevention guideline, including those below.
Before Surgery
- Identify and treat any remote infections.
- Remove hair at the surgery site using electric clippers, but only if it will interfere with the procedure.
- Clean the skin at the surgery site with a germicidal soap.
- Clean hands with soap and water or an alcohol-based hand rub.
- If the patient does not see a healthcare provider clean their hands, ask them to do so.
During Surgery
- Monitor operating room traffic in/out to ensure an aseptic environment.
- Maintain surgical wound dressing.
- Wear special hair covers, masks, gowns and gloves during surgery to keep the area clean
After Surgery
- Clean hands again with soap and water or an alcohol-based hand rub.
- Control blood glucose levels during the immediate postoperative period.
Before Leaving the Hospital
- Understand proper wound care.
- Confirm whom to contact with questions or problems.
Once at Home
- If there are symptoms of an infection, such as redness and pain at the surgery site, warmth, drainage or fever, call their healthcare provider immediately.
Resources
- Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, CDC
- HAI Prevention Toolkits, CDC
- SSI Basics, CDC
- SSI Prevention Guideline, CDC
- Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update, Society for Healthcare Epidemiology of America (SHEA)
What is CDI?
Clostridium difficile [pronounced Klo-STRID-ee-um dif-uh-SEEL] infection (CDI) or C. diff. is a germ that causes diarrhea, often found in patients taking antibiotics. Symptoms of CDI are watery stools, fever, loss of appetite, nausea and belly pain.
The definition of CDI includes a case of diarrhea or toxic megacolon without other known etiology that meets one or more of the following criteria:
- The stool sample yields a positive result of a laboratory assay for C. difficile toxin A and/or B, or a toxin-producing C. difficile organism is detected in the stool sample by culture or other means.
- Endoscopic examination or surgery reveals pseudomembranous colitis.
- Pseudomembranous colitis appears in histopathological examination results.
How is CDI Prevented?
Healthcare providers should adhere to CDC's CDI prevention strategies, including:
- Isolating and initiating contact precautions for suspected or confirmed Clostridioides difficile infection (CDI).
- Wearing gloves and a gown when treating patients with CDI, even during short visits. Gloves are important because hand sanitizer doesn’t kill CDI, and handwashing might not be sufficient to eliminate all spores.
- Performing hand hygiene after removing gloves.
- Cleaning and disinfecting any shared medical equipment.
- Using antibiotics appropriately.
What Can Patients Do?
Patients can take precautions to prevent CDI by:
- Cleaning hands often with soap and water or an alcohol-based hand rub, especially after using the bathroom and before eating.
- Only taking antibiotics as needed and as prescribed by a healthcare provider.
- Asking healthcare providers to clean their hands.
- At home, regularly cleaning items touched by hands, such as doorknobs, electronics, refrigerator handles, toilet handles and seats.
- If experiencing diarrhea, using a separate bathroom. If this is not possible, ensuring the bathroom is well-cleaned before others use it.
Resources
Preventing CDI
- C. diff Guidelines and Prevention Resources, CDC
- CDI Prevention Strategies, CDC
- Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, CDC
- HAI Prevention Toolkits, CDC
- MRDO/CDI Module, National Healthcare Safety Network (NHSN)
- Preventing C. diff Infections, Morbidity and Mortality Weekly Report, CDC
Additional Resources
What is CAUTI?
A catheter-associated urinary tract infection (CAUTI) occurs when microorganisms (usually bacteria) enter the urinary tract through a urinary catheter and cause infection.
Urinary catheters drain urine in patients who cannot urinate independently and measure the amount of urine produced during intensive care, during and after surgery or tests of the kidneys or bladder. Microorganisms can travel along the catheter and cause an infection. A urinary tract infection associated with a catheter does not require a minimum period for the catheter to be in place.
How are CAUTIs Prevented?
Healthcare providers should adhere to the CDC's CAUTI prevention strategies, including:
- Following standard precautions, including wearing gloves and a sterile gown and cleaning hands with soap and water or an alcohol-based hand rub.
- Not using urine drain tubes. If they must be used, inserting them properly and keeping them clean.
- Putting in catheters only when necessary and removing them as soon as possible.
- Ensuring only appropriately trained healthcare professionals insert and maintain catheters.
- Inserting catheters using the aseptic technique and sterilizing equipment (acute care setting).
- Following aseptic insertion, maintaining a closed drainage system.
- Maintaining unobstructed urine flow.
What Can Patients Do?
Patients with a urinary catheter can take precautions to prevent CAUTI by:
- Understanding why and for how long the catheter is needed.
- Cleaning hands often with soap and water or an alcohol-based hand rub, and always before and after touching the catheter.
- Checking the position of the urine bag. It should always be below the level of the bladder.
- Not tugging or pulling on tubing.
- Not twisting or kinking the catheter tubing.
- Asking healthcare providers to clean their hands.
Resources
Preventing CAUTI
- Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, CDC
- Guideline for Preventing CAUTI, CDC
- HAI Prevention Toolkits, CDC
- Preventing CAUTI: A Patient-Centered Approach (with CAUTI Elimination Guide), Prevention Strategist, Association of Professionals in Infection Control and Epidemiology (APIC)
Additional Resources
What is CLABSI?
A central line-associated bloodstream infection (CLABSI) occurs when bacteria or other pathogens enter the bloodstream by traveling down a central line — a catheter placed into a large vein to draw blood, give fluids or administer medication.
Symptoms of a CLABSI include fever, chills and sore and red skin around the catheter.
How are CLABSIs Prevented?
Healthcare providers should adhere to the CDC’s core infection control and prevention practices, including:
- Following standard precautions, including wearing gloves and a sterile gown and cleaning hands with soap and water or an alcohol-based hand rub.
- Selecting a vein where the catheter can be safely inserted with minimal risk of infection and performing daily audits to assess whether each central line is still needed.
- Following proper insertion practices, such as hand hygiene before insertion; adhering to an aseptic technique; using maximal sterile barrier precautions; performing skin antisepsis with >0.5% chlorhexidine and alcohol; and choosing the best site to minimize infections and mechanical complications.
- Handling and maintaining central lines appropriately by complying with hand hygiene requirements, scrubbing the access port immediately before each use with appropriate antiseptic, accessing catheters only with sterile devices and performing dressing changes under the aseptic technique.
What Can Patients Do?
Patients with a central line can take precautions to prevent CLABSI by:
- Understanding why and for how long the central line is needed.
- Talking to their healthcare provider about questions or concerns.
- As much as possible, avoid touching the tubing and where the central line exits the skin.
- Cleaning hands often with soap and water or an alcohol-based hand rub, and always before and after touching the catheter.
- Asking healthcare providers to clean their hands.
Resources
Preventing CLABSI
- Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, CDC
- HAI Prevention Toolkits, CDC
- Strategies for Preventing CLABSI in Acute Care Hospitals, JSTOR
- Toolkit for Reducing CLABSI, Agency for Healthcare Research and Quality (AHRQ)
Additional Resources
Multidrug-resistant organisms (MDROs) are bacteria, fungi or other microorganisms that resist multiple classes of antimicrobial drugs. This resistance renders standard antibiotics or antifungal medications challenging, if not impossible, to use in treatment.
Prevention Strategies
Research shows that MDROs can spread long before detection, making a proactive prevention approach more impactful than a response plan alone.
In support of this, the CDC provides guidance and a broad selection of other administrative resources.
Containment Strategies
Containing the spread of MDROs or resistance mechanisms is vital. In preparation, healthcare facilities should have a response plan that follows CDC guidance and includes detailed strategies for infection control both within and between facilities.
The goals of an initial containment response are to:
- Identify affected patients.
- Promptly implement appropriate infection control measures to limit further spread.
- Determine if transmission within a healthcare facility and dissemination to other facilities are occurring.
- Characterize novel organisms or mechanisms to guide further response actions, patient management and future responses.
- Coordinate response with ongoing prevention activities (e.g., MDRO education, infection prevention and control improvement initiatives, routine colonization screening, and improved interfacility communication) in the region.
Colonization Screening
When a healthcare facility discovers an MDRO, it should conduct colonization screening to understand the infection’s scope and potential transmission risk. The CDC provides guidance and a variety of helpful tools and resources.