Central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are up, according to data from The Leapfrog Group.

The average risk of these three common healthcare-acquired infections (HAIs) spiked to a 5-year high during the COVID-19 pandemic and remains high. According to an analysis of Leapfrog Hospital Safety Grade Data:

• Average CLABSI standard infection ratio increased by 60%
• Average CAUTI standard infection ratio increased by 19%
• Average MRSA standard infection ratio increased by 37%

Leah Binder, president and CEO of The Leapfrog Group, said “The dramatic spike in HAIs ... should stop hospitals in their tracks.” The American Hospital Association (AHA) appears to agree; in late June, they issued a release on strategies and tactics that hospitals can use to prevent and control HAIs.

Why HAIs Require Immediate Action

HAIs remain a leading cause of death in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), one in 31 hospital patients in the U.S. has at least one HAI on any given day, and approximately one in every 10 patients with a HAI will die from their infection. Hospital-acquired infections also increase the length of hospital stays, add to overall healthcare costs, and increase the workloads of already stressed-out staff. 

While it’s tempting for hospital leaders to focus on workforce retention, staffing and drug shortages, and fiscal challenges, waiting to address HAIs is a costly choice. Without intervention, HAIs are unlikely to decrease. In fact, infections may increase. Additionally, patient experience scores are linked to clinical outcomes. Research has shown that patients and families give high satisfaction scores to hospitals with low complication rates. 

AHA Strategies for HAI Reduction

The AHA recommends 4 basic strategies to decrease and control HAIs:

1. Build an organizational culture of safety. 

This strategy requires staff engagement at all levels, from administration to environmental services. According to the AHA, senior leaders should “discuss HAI rates and infection prevention with other leaders during committee meetings, daily huddles, and board meetings,” and share and discuss this information with their staff. 

Regular – and widespread – institutional discussion of HAI rates and infection prevention keeps team members focused on HAI prevention and control. This attention is crucial to curtailing HAI rates, but it has additional benefits as well, as many interventions known to control infection (such as excellent communication and streamlined processes aligned with best practices) are correlated with positive clinical outcomes.

Remember to solicit input and recommendations from frontline workers. These staff members can pinpoint current obstacles to efficient infection control -- and often have good ideas for overcoming challenges. 

2. Train, retrain, and implement infection prevention basics.

Hospitals should focus on “foundational infection prevention strategies,” including hand hygiene. Effective hand hygiene is foundational to infection control, and yet it’s sometimes under-emphasized simply because it’s such a common, expected practice. 

Despite good intentions, healthcare providers, on average, only wash or sanitize their hands about half as often as they should. Improving hand hygiene rates throughout your hospital can have a measurable impact on HAIs. A 2020 article published in the Journal of Primary Care & Community Health noted that HAIs decreased at a tertiary care hospital during the COVID-19 pandemic – despite the increased strain on staff – likely because hand hygiene rates increased significantly during the pandemic.

3. Use performance improvement tools.

The Institute for Healthcare Improvement and American Society for Quality both offer quality improvement tools that hospitals can use to support HAI reduction efforts. Hospitals should also consider bringing in technical assistance as needed.

Electronic hand hygiene monitoring systems are tools that both track and encourage hand hygiene. The SwipeSense electronic hand hygiene monitoring system integrates seamlessly with clinical workflows and includes an automatic voice reminder that nudges staff to perform hand hygiene when a hand hygiene opportunity is skipped. According to a March 2023 article in The Journal of Hospital Infection, use of an electronic hand hygiene system can lead to sustained improvements in both hand hygiene and HAI rates.  

4. Use CDC tools. 

Hospitals are encouraged to utilize the CDC’s Targeted Assessment for Prevention strategy and Infection Control Assessment and Response Program. The CDC can also offer technical assistance to local hospitals and healthcare organizations, including data analysis, reports, and suggested interventions. 

Together, these strategies and tools can help hospitals disrupt the current status quo and reduce HAI rate.