Infection Control

Healthcare-Associated Infections

The CDC has found, based on a larger sample of US acute care hospitals, that about 1 in 25 hospital patients has at least one healthcare-associated infection (HAI).  There were an estimated 722,000 HAIs in US acute care hospitals in 2011, and about 75,000 of these patients died during their hospitalizations.   HAIs lead to extended hospital stays, contribute to increased medical costs, and are a cause of morbidity and mortality to patients. 

 

Central Line-Associated Bloodstream Infection (CLABSI)

CLABSIs result in thousands of deaths each year and billions of dollars in extra costs to the healthcare system.  These infections are preventable.  CLABSIs are serious infections that occur when germs (usually bacteria or viruses) enter the bloodstream through the central line.  A central line (central venous catheter) is a catheter that is often placed in a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests.  Central lines are different from intravenous (IV) catheters because they access a major vein that is close to the heart and can remain in place for weeks or months and be much more likely to cause infection.  Central lines are commonly used in intensive care units (ICUs).  Healthcare providers must follow a strict protocol when inserting the line to make sure the line remains sterile and a CLABSI does not occur.  In addition to inserting the central line properly, healthcare providers must use stringent infection control practices each time they check the line or change the dressing.  

Healthcare providers can take the following steps to help prevent CLABSIs:

• Follow recommended central line insertion practices to prevent infection when the central line is placed, including: hand hygiene, applying appropriate skin antiseptic, ensuring that the skin prep agent has completely dried before inserting the central line, using all five maximal sterile barrier precautions (sterile gloves, sterile gown, cap, mask, large sterile drape).
• Once the central line is in place: Follow recommended central line maintenance practices and wash hands with soap and water or an alcohol-based handrub before and after touching the line.
• Remove a central line as soon as it is no longer needed.  The sooner a catheter is removed, the less likely the chance of infection. 

CDC CLABSIs Resources for Patients and Healthcare Providers

Catheter-Associated Urinary Tract Infections (CAUTI)

A catheter-associated urinary tract infection (CAUTI) occurs when germs (usually bacteria) enter the urinary tract through the urinary catheter and cause infection.  These types of infections have been associated with increased morbidity, mortality, healthcare costs, and length of stay.  The risk of a CAUTI can be reduced by:

• • Ensuring that catheters are used only when needed and removed as soon as possible;
  • Making sure catheters are placed using proper aseptic technique; and
  • Verifying that the closed sterile drainage system is maintained.

Most CAUTIs can be treated with antibiotics and/or removal or change of the catheter.  The healthcare provider will determine the best treatment for each patient. 

Hospitals should follow the recommendations in the 2009 CDC Guideline for Prevention of Catheter-Associated Urinary Tract Infections.  This guideline emphasizes the proper use, insertion, and maintenance of urinary catheters in different healthcare settings.  It also presents effective quality improvement programs that healthcare facilities can use to prevent CAUTIs. 

Surgical Site Infections (SSI)

A surgical site infection is an infection that occurs after surgery often in the part of the body where the surgery took place.  Surgical site infections can sometimes be superficial infections involving the skin only.  Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.  Most SSIs can be treated with antibiotics.  The type of antibiotic given depends on the bacteria causing the infection.  Sometimes patients with SSIs also need another surgery to treat the infection.  

To prevent SSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:

• • Cleaning their hands and arms up to their elbows with an antiseptic agent just before the surgery;
  • Cleaning their hands with soap and water or an alcohol-based hand rub before and after caring for each patient;
  • If indicated, remove body hair immediately before surgery using electric clippers if there is hair where the procedure will occur;
  • Wearing special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean;
  • When indicated, give you antibiotics before your surgery starts (within 60 minutes before the surgery starts and stopped within 24 hours after surgery); and
  • Cleaning the skin at the site of your surgery with a special soap that kills germs. 

Ventilator-Associated Pneumonia (VAP)

Ventilator-Associated Pneumonia is a lung infection that develops in a person who is on a ventilator.  An infection may occur if germs enter through the tube and get into the patient's lungs.  Most of the time, these infections can be treated with antibiotics.  The choice of antibiotics depends on which specific germs are causing the infection.

To prevent VAPs, doctors, nurses, and other healthcare providers can do the following things:

• • Keep the head of the patient's bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur;
  • Check the patient's ability to breathe on his or her own every day so that the patient can be taken off of the ventilator as soon as possible;
  • Clean their hands with soap and water or an alcohol-based hand rub before and after touching the patient or the ventilator;
  • Clean the inside of the patient's mouth on a regular basis; and
  • Clean or replace equipment between use on different patients.

Clostridioides difficile Information

Clostridioides difficile (C. diff) is a bacterium that causes an inflammation of the colon called colitis.  Diarrhea and fever are the most common symptoms of an infection.  Overuse of antibiotics is the most important risk for getting a C. diff infection.  C. diff remains at historically high levels for HAIs, linked to 14,000 US deaths each year. 

CDC: Clostridioides difficile Infection

Carbapenem-Resistant Enterobacteriaceae (CRE) Information

CRE are a family of germs that are difficult to treat because they have a high level of resistance to antibiotics.  Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria, that can become resistant to carbapenem (a strong antibiotic).  In healthcare settings, CRE infections most commonly occur among patients who are receiving treatment for other conditions.  Patients whose care requires devices like ventilators, urinary catheters, or intravenous catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections. 

CDC: CRE in Healthcare Settings 

 

Content source: Centers for Disease Control and Prevention.