Healthcare-associated infections (HAIs) are infections that patients acquire while receiving medical care for another condition. HAIs affect millions of people globally each year, placing a substantial burden on patients and the healthcare system and potentially leading to serious illness or death. Preventing these infections requires a comprehensive, multi-faceted approach involving strict adherence to protocols by providers and active participation from patients and their families. This effort relies on consistent application of established practices to minimize the risk of pathogen transmission within all healthcare settings.
Foundational Protocols for Infection Control
The single most effective measure for stopping the spread of germs in a healthcare environment is proper hand hygiene. Healthcare workers adhere to the World Health Organization’s “5 Moments for Hand Hygiene,” which dictates when hands must be cleaned to protect the patient and the provider’s environment. These moments include:
- Before touching a patient.
- Before an aseptic procedure.
- After potential body fluid exposure.
- After touching a patient.
- After touching the patient’s surroundings.
Hand cleansing involves using an alcohol-based hand rub, which is preferred for routine care, or washing with soap and water when hands are visibly soiled or after caring for a patient with certain infections like Clostridioides difficile.
Personal Protective Equipment (PPE) provides a physical barrier against potential contamination and is used based on the anticipated risk of exposure. Standard Precautions apply to all patients and require PPE like gloves and gowns when contact with blood, body fluids, or non-intact skin is likely. Transmission-Based Precautions (such as Contact, Droplet, or Airborne precautions) require additional PPE and specific room placement for known or suspected highly transmissible infections.
Environmental cleaning is also a fundamental defense, focusing on systematically removing dirt and germs from surfaces. This includes routinely disinfecting high-touch surfaces in the patient zone, such as bed rails, call buttons, and bedside tables, as these items can harbor pathogens. Cleaning staff must follow specific protocols, often progressing from cleaner to dirtier areas, to prevent the accidental spread of microorganisms within the facility.
Preventing Infections Related to Medical Devices
Invasive medical devices represent a common pathway for HAIs, necessitating targeted prevention strategies known as “bundles” of care. A bundle is a small, evidence-based set of practices that, when performed collectively, significantly reduces the risk of a specific infection. Device-related infections like Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infections (CAUTI), and Ventilator-Associated Pneumonia (VAP) are all addressed through these structured protocols.
Preventing CLABSIs, which occur when bacteria enter the bloodstream through a central venous catheter, begins with strict insertion protocols. This involves using maximal sterile barrier precautions during the line placement procedure, including:
- A mask.
- A cap.
- A sterile gown.
- Sterile gloves.
- A large sterile drape.
The insertion site must be prepared with an antiseptic solution, such as chlorhexidine with alcohol. Daily maintenance includes bathing the patient with a chlorhexidine preparation and scrubbing the catheter hub before each access.
The CAUTI prevention bundle focuses on minimizing the use and duration of indwelling urinary catheters, as the risk of infection increases the longer the device remains in place. Prevention involves ensuring the catheter is used only for appropriate indications, inserting it using sterile technique, and maintaining a closed drainage system. Healthcare providers must regularly assess the patient to determine if the catheter can be safely removed, which is the most effective step in prevention.
For patients on mechanical ventilation, the VAP bundle targets the reduction of bacteria in the respiratory tract. Core elements include elevating the head of the bed to 30 to 45 degrees to prevent aspiration of oral or stomach contents. Other practices involve rigorous oral care, often using chlorhexidine mouthwash, and implementing daily sedation interruptions and spontaneous breathing trials to safely minimize the time the patient spends on the ventilator.
The Role of Antibiotic Stewardship
Antibiotic stewardship is a coordinated program that promotes the appropriate use of antimicrobials, ensuring that antibiotics are prescribed only when needed, selecting the correct drug, dose, and duration. This practice addresses the systemic threat of antimicrobial resistance, which is accelerated by the inappropriate use of these medications.
The overuse and misuse of antibiotics drive the evolution of drug-resistant organisms, making treating HAIs significantly more difficult and increasing the risk of treatment failure. By conserving the effectiveness of existing antibiotics, stewardship programs indirectly prevent future resistant infections. Actions within a stewardship program include reviewing prescriptions to confirm the indication, ensuring a narrow-spectrum agent is used when possible, and adjusting therapy based on culture results.
These programs are structured around core elements, including leadership commitment, accountability, and the expertise of infectious disease specialists and pharmacists. By tracking antibiotic usage data and reporting outcomes, facilities can identify areas for improvement and implement targeted educational initiatives for prescribing clinicians. Optimizing antibiotic use helps combat resistance and reduces the risk of adverse drug events and secondary infections, such as C. difficile.
How Patients and Families Can Participate in Prevention
Patients and their families are partners in infection prevention and can take steps to reduce their risk during a healthcare stay. The most direct action is to observe and gently inquire about hand hygiene before a caregiver touches the patient or any medical devices. Asking a simple question like, “Did you have a chance to wash your hands?” supports a culture of safety.
Communication with the care team is another effective measure, especially regarding environmental concerns or changes in the patient’s condition. Patients or family members should promptly report anything that appears unsanitary, such as spills or soiled linens, or any sign of potential infection, like pain, redness, or discharge at an IV site. Being aware of the purpose of any invasive device, such as a catheter or central line, and asking daily if it is still needed, encourages timely removal and lowers infection risk.
Personal hygiene, when the patient is able, and managing visitors also play a role in prevention. Patients should follow instructions for wound care and bathing, including the use of special antiseptic wipes if provided. Family and friends should be instructed to stay home if they are feeling unwell or have recently been exposed to a contagious illness.