Healthcare-associated infections (HAIs) are among the top five killers in the United States. How is this possible in the 21st century, when basic hand hygiene equipment, running water, electricity, and infection prevention education are ubiquitous in U.S. healthcare facilities? 

The fact remains, one in 31 hospital patients in the United States has at least one HAI on any given day, according to the U.S. Centers for Disease Control and Prevention (CDC). On average, one in every 10 affected patients will die from their HAI, adding up to almost 100,000 HAI-related deaths annually. 

Understanding why HAIs are still a problem points the way toward solutions that can decrease morbidity and mortality.

Workforce Strain Increases Risk of HAIs

It’s no secret that healthcare providers are stressed. Healthcare is a physically and emotionally demanding job even in the best of times, and the past few years have not been the best of times. 

The uncertainty, increased demand, and supply chain and workforce disruptions caused by the COVID-19 pandemic created nearly impossible situations. In many cases, healthcare workers valiantly tried to protect their health and their patients’ health with subpar personal protective equipment (PPE) and not nearly enough qualified staff. 

Perhaps unsurprisingly, HAIs increased in 2020, after years of decline. Central line-associated bloodstream infections (CLABSIs) increased by 47% in the fourth quarter of 2020; urinary catheter-associated urinary tract infections (CAUTIs) increased by 18.8% and ventilator-associated events (VAEs), including ventilator-associated pneumonia, increased by 44.8%. 

These stark increases underscore a strong and powerful link between workforce capacity and HAIs. Without enough adequately supported, qualified healthcare workers, HAI levels increase. 

Antibiotic Resistance Also Contributes to HAIs

The discovery and development of antibiotic medication was (rightly) hailed as a medical breakthrough. A century or so later, however, the availability and overuse of antibiotics has paradoxically contributed to the continued persistence of HAIs. 

In the United States, HAIs are increasingly caused by antibiotic-resistant germs. Infections caused by Clostridium difficile (C. diff), an easy-to-spread bacterium that can cause severe diarrhea and intestinal inflammation, is now responsible for more than 12% of all HAIs, according to the Agency for Healthcare Research and Quality. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) also commonly cause HAIs. 

How To Decrease HAIs

To decrease HAIs, hospitals and healthcare facilities must:

• Emphasize hand hygiene

Effective hand hygiene is the “single most important practice to prevent and control” healthcare-associated infections, according to the World Health Organization. A 2018 review published in Infection and Drug Resistance notes that strategies to “improve hand hygiene that rely on … enhanced monitoring of hand hygiene, feedback on hand hygiene practice, and sociocultural approaches have resulted in improved hand hygiene at many hospitals and other health care facilities.” 

Aim high. In a post published by the Institute of Healthcare Improvement, Denise Murphy, RN, a past president of the Association for Professionals in Infection Control and Epidemiology (APIC), encourages healthcare facilities to aim for zero HAIs and “zero tolerance for non-compliance with proven prevention measures.”

Regular and consistent hand hygiene monitoring is necessary to pinpoint (and fix) systemic problems that contribute to poor hygiene. Electronic hand hygiene monitoring can be implemented seamlessly to boost hand hygiene rates and reduce HAIs without disrupting clinical workflow.

• Support staff

Harried, overworked staff simply do not have the capacity to consistently practice good hand hygiene and infection control. Given the choice between stopping to wash their hands after a patient encounter and missing an opportunity to catch a falling patient, or skipping hand hygiene but getting to the patient in time to prevent a fall, most healthcare workers will help the falling patient. 

Short staffing is an unfortunate reality in today’s era of pervasive workforce shortages. Automated nurse rounding technology can help hospital leaders and bedside nurses organize clinical workflow to prioritize regular nurse/patient interactions that decrease both infection and fall risk – and provide data that charge nurses and others can use to provide just-in-time staffing support. 

• Clean surfaces

Contaminated hospital surfaces play a role in the transmission of HAI-causing microorganisms, including C. diff and MRSA. Researchers have found that “meticulous cleaning of hospital surfaces is … vital” to reduce the risk of HAIs. Robotic and automated ultrasonic cleaning devices or hydrogen peroxide vapor-emitting devices can help healthcare facilities efficiently cleanse surfaces.

• Use antibiotics judiciously

Responsible antibiotic stewardship must be part of a concerted effort to decrease HAIs. Patients should be taught that antibiotics do not help viral infections and that unnecessary use of antibiotics increases antibiotic resistance and contributes to the prevalence of HAIs.

With effort and determination, it is possible to decrease the scourge of HAIs.