Healthcare-Associated Infections (HAIs) are conditions acquired by a patient during medical treatment that were not present upon admission. These infections can occur in any healthcare setting, including hospitals, surgical centers, and long-term care facilities. Preventing HAIs is a fundamental goal of modern medicine, as they lead to prolonged hospital stays, increased healthcare costs, and patient suffering. Systematic implementation of evidence-based practices is necessary to break the chain of microbial transmission and protect vulnerable patients.
Foundational Infection Control Practices
Infection prevention begins with universal, standardized actions applied to everyone in the healthcare environment. Hand hygiene is the most effective measure to prevent pathogen spread. Healthcare workers follow the World Health Organization’s “Five Moments for Hand Hygiene,” which dictates exactly when hands must be cleaned to interrupt germ transmission. This includes cleaning hands before touching a patient, immediately before a clean or aseptic procedure, after any risk of body fluid exposure, after touching a patient, and after touching the patient’s surroundings. Proper technique involves using an alcohol-based hand rub or washing with soap and water for at least 20 seconds.
Standard Precautions involve the correct use of Personal Protective Equipment (PPE) to provide a physical barrier against infectious agents. Donning, or putting on, PPE follows a specific sequence to ensure maximum protection, typically starting with a gown, mask, eye protection, and then gloves. The sequence for doffing, or taking off, PPE is reversed and is even more deliberate, beginning with gloves to prevent contamination of the hands.
Respiratory hygiene and cough etiquette prevent the aerosolized spread of droplets. This requires covering the mouth and nose with a tissue when coughing or sneezing, immediately disposing of the tissue, and performing hand hygiene afterward. Facilities must provide tissues, no-touch waste receptacles, and hand sanitizer to facilitate these practices for staff, patients, and visitors.
Sterilization and Environmental Management
Controlling the physical environment and patient care equipment requires specific levels of microbial elimination based on the Spaulding Classification system. This system categorizes medical instruments based on the risk of infection they pose if contaminated. “Critical” items, such as surgical instruments and implants, enter sterile tissue or the vascular system and must undergo sterilization, which destroys all microbial life, including spores.
“Semi-critical” items, like endoscopes and respiratory equipment, contact mucous membranes or non-intact skin and require high-level disinfection. “Non-critical” items, such as blood pressure cuffs and stethoscopes, only contact intact skin and require cleaning followed by low-level disinfection. This classification ensures the appropriate level of germicidal treatment is applied to mitigate risk effectively.
Facility design manages air quality and flow to prevent infection spread. Highly vulnerable areas, such as operating rooms, are maintained under positive pressure, causing air to flow out when doors open, preventing hallway contamination. Airborne Infection Isolation (AII) rooms are kept under negative pressure, causing air to flow into the room to contain infectious particles. Environmental cleaning includes routine cleaning and terminal cleaning, which is a deep disinfection performed after a patient is discharged to eradicate pathogens from all surfaces.
Preventing Infections Related to Medical Devices and Surgery
Serious HAIs are often associated with invasive procedures and indwelling devices, requiring evidence-based “bundles” to standardize care. The Central Line-Associated Bloodstream Infection (CLABSI) prevention bundle focuses on five primary components during insertion. These include stringent hand hygiene, using maximal sterile barrier precautions (drape, cap, mask, gown), and preparing the skin with chlorhexidine antiseptic. Proper site selection is emphasized, generally avoiding the femoral vein in adults due to higher risk. Daily review is mandatory to assess the line’s necessity and advocate for prompt removal once it is no longer required.
The Catheter-Associated Urinary Tract Infection (CAUTI) bundle minimizes the duration and necessity of the device. Catheters should only be inserted for appropriate medical indications, and alternatives should be considered when feasible. Insertion requires strict aseptic technique and sterile equipment to prevent the introduction of pathogens into the urinary tract. During maintenance, the drainage system must remain closed and unobstructed, with the collection bag kept below the bladder level to prevent backflow contamination. Daily assessment of the catheter’s need is a core element, aiming for discontinuation as soon as possible to reduce the risk.
Surgical Site Infections (SSI) are prevented through a series of interventions spanning the pre-operative, intra-operative, and post-operative phases. Pre-operatively, patients may undergo decolonization, which includes using an antiseptic soap for bathing and sometimes applying an intranasal antibiotic like mupirocin to reduce Staphylococcus aureus colonization. Hair removal is performed using electric clippers just before surgery, as traditional shaving can create microscopic skin abrasions that harbor bacteria. Intra-operatively, prophylactic antibiotics are administered intravenously within 60 minutes of the incision. Maintaining normal body temperature and controlling blood glucose levels during the operation are also important, as both hypothermia and hyperglycemia can impair the immune response and wound healing capacity.
Patient and Visitor Responsibilities in Prevention
Infection prevention is a shared responsibility requiring active participation from patients and visitors. Visitors must avoid entering the facility if they are feeling unwell, especially with symptoms like fever, cough, or diarrhea, to protect vulnerable patients from community pathogens. Both patients and visitors should practice diligent hand hygiene using sanitizer or soap and water upon entering and leaving a patient’s room.
Patients are encouraged to ask staff members if they have performed hand hygiene before direct contact, reinforcing safety standards. If a patient is under isolation precautions, visitors must strictly follow posted instructions, which may require wearing specific PPE. Visitors should also limit personal belongings brought into the room and avoid placing items on the floor, as clutter interferes with cleaning.