HAIs are infections acquired by a patient while receiving medical care for another condition, and were not present or incubating at the time of admission. These infections are a serious public health concern, occurring in settings like hospitals, surgical centers, and long-term care facilities. HAIs pose a significant threat to patient safety, often leading to extended hospital stays and increased medical costs. Approximately one in 31 hospital patients in the United States has at least one HAI on any given day. Effective prevention strategies are paramount to protecting patients.
Foundational Infection Control Practices
Meticulous hand hygiene is the primary defense against the spread of infection. Healthcare personnel must perform hand hygiene before touching a patient, before performing an aseptic task, after exposure to body fluids, and after touching a patient’s surroundings. When hands are not visibly soiled, an alcohol-based hand rub containing at least 60% alcohol is the preferred method, as it is generally faster and less irritating to the skin.
Washing with soap and water is required when hands are visibly dirty or when caring for a patient with a known gastrointestinal infection, such as Clostridioides difficile, since alcohol is not effective against spores. The proper technique involves scrubbing all surfaces of the hands for a minimum of 20 seconds.
Environmental control also supports infection prevention by limiting pathogen reservoirs. Routine and targeted cleaning of surfaces is performed to reduce the risk of transmission from contaminated areas. Frequently touched surfaces, like bedrails, bedside tables, and call buttons, require consistent disinfection. Proper handling of linens and medical waste prevents the spread of germs. These standard practices are applied universally to every patient.
Preventing Infections Related to Medical Devices and Surgery
Specific, high-risk procedures and devices require specialized protocols to prevent infections.
Catheter-Associated Urinary Tract Infections (CAUTI)
CAUTI are common HAIs associated with the use of an indwelling urinary catheter. Prevention focuses on minimizing catheter use and duration, with reminder systems prompting their removal as soon as they are no longer necessary. When insertion is required, sterile technique must be maintained. This includes preparing the meatal area with an antiseptic like chlorhexidine, properly securing the catheter to prevent movement, and maintaining a closed drainage system. Keeping the collecting bag below the level of the bladder and ensuring unobstructed urine flow are mechanical steps that prevent backflow.
Central Line-Associated Bloodstream Infections (CLABSI)
CLABSI are serious infections where bacteria enter the bloodstream through a central venous catheter. Preventing CLABSI involves a bundle of practices that begin with sterile insertion, including the use of maximal sterile barrier precautions such as a mask, cap, gown, and large sterile drape. The insertion site is prepared with an antiseptic like chlorhexidine with alcohol. Maintenance involves scrubbing the access port before each use and changing dressings using aseptic technique. For patients 18 years or older, a chlorhexidine-impregnated dressing may be applied to the insertion site. Prompt removal of the central line once it is no longer indicated is the most impactful action.
Surgical Site Infections (SSI)
Surgical Site Infections (SSI) occur at or near the incision. Prevention efforts begin with pre-operative preparation. Patients may be instructed to bathe with an antiseptic solution, such as chlorhexidine gluconate, before the procedure to reduce the bacterial load on the skin. During surgery, appropriate administration of antimicrobial prophylaxis and maintaining sterility are paramount. Post-operative care includes meticulous wound management, ensuring the wound is kept clean and covered.
The Essential Role of Patients and Visitors
Preventing HAIs is a shared responsibility, requiring patients and visitors to be active partners in their own safety. Patients should feel empowered to speak up and ask healthcare staff if they have cleaned their hands before any interaction. This action reinforces compliance and significantly reduces the risk of germ transmission. Patients should also ask about the continued necessity of devices like urinary catheters or central lines, as prompt removal is a primary prevention strategy.
Visitors must adhere to strict infection control measures. They should refrain from visiting the facility if they are exhibiting any signs of illness. Visitors must perform hand hygiene before and after touching the patient, and avoid touching medical devices or wound dressings. Following instructions regarding isolation precautions, such as wearing a mask or gown, is essential.