Hospital-Acquired Infections
Ethan D. Fried
Abstract
Hospital-Acquired Infections (HAIs) are infectious complications of care in health-related settings. Many approaches to reducing the occurrence of HAIs have been tried. These began with simple hand hygiene and progressed to a variety of evidence-based checklists and procedures designed to reduce the incidence of Catheter Associated Urinary Tract Infections (CAUTIs), Central Line-Associated Bloodstream Infections (CLABSIs), Ventilator-Associated Pneumonias (VAP), C. diff associated diarrhea (CDAD), and Surgical Site Infections (SSIs). When the Center for Medicare and Medicaid Services (CMS) created their list of “Never Events” and withheld payment to hospitals for HAI-related extensions in length of stay and other HAI-associated complications, there was some reduction in SSIs and CAUTIs but other infections continued to occur. Antibiotic stewardship has reduced some HAIs further, but the COVID-19 pandemic forced the suspension of many monitoring systems and HAIs rose sharply. Continued efforts to use evidence-based infection control practices, vigilant antibiotic stewardship, and the slow return of pre-COVID 19 disrupted practices should once again reduce the occurrence of these entirely avoidable events. With regard to C. diff, at least one institution is experimenting with adding shoe coverings to standard contact isolation protocols as a 2022 study found that over 25% of shoes are contaminated with C. diff spores (Jinhee Jo, Anne J. Gonzales-Luna, Chris K. Lancaster, Jacob K. McPherson, Khurshida Begum, M. Jahangir Alam, Kevin W. Garey. Multi-country surveillance of Clostridioides difficile demonstrates high prevalence of spores in non-healthcare environmental settings. Anaerobe. https://doi.org/10.1016/j.anaerobe.2022.102543 ).