Madison Hemminger

Mayli Bennett
Alex Salai
2-8-2022

EXPLAIN THE IMPORTANCE

Out of the 2022 Nursing Care Center Goals, we chose the goal to reduce the risk of

healthcare–associated infections. The CDC has reported that “Healthcare-associated infections

(HAIs) are complications of healthcare and linked with high morbidity and mortality. Each year,

about 1 in 25 U.S. hospital patients is diagnosed with at least one infection related to hospital

care alone; additional infections occur in other healthcare settings” (2017). The CDC has also

reported that rates of HAIs are decreasing since 2006. However, with the frame of mind that

“just one HAI is unacceptable”, the healthcare system still faces the problem of trying to combat

these HAIs. The CDC has listed target numbers for the healthcare system to reach by the end of

the year, and while numbers improve, they have not met or gone below the goal. For example

central line-associated bloodstream infections (CLABSIs) had a standardized infection ratio of 1

in 2006, but has dropped to 0.5 in 2014, but the goal the CDC published was 0.4. Similarly with

surgical site infections which had a standardized infection ratio of 1 has dropped to 0.8, but has

dropped for the past three years, missing their goal of 0.7. Perhaps the most improved, the spread

of methicillin-resistant Staphylococcus aureus (MRSA), has dropped from 27 infections (for

every 100,000) patients in 2007 to 17 in 2014, but even this does not meet the goal of 10.87.

Catheter-associated urinary tract infections (CAUTI) have not shown progress as the

standardized infection ratio was one in 2009 and was still reported as one in 2014 (CDC 2017).

An article written by Scott, broke down where the costs for these HAIs come from.. When a

patient acquires an infection, this increases the length of stay for that patient and increases

healthcare cost. With the patient in the hospital, there are direct hospital costs, one of which is,
“fixed costs” that are being used; the building, utilities, equipment and technology, and labor

(laundry, environmental services, administration, healthcare workers). Then there are also

variable costs for each patient which include; medications, food, consultation, treatments,

procedures, devices, testing, and supplies. The indirect costs that the hospital and family

members spend on HAIs are; wages, diminished work productivity, mortality, income loss, and

time. Not only are there monetary costs to consider, but there are intangible costs which include;

psychological costs (anxiety, grief, disability), pain and suffering, and change in daily activities

(2007). The article goes on to break down the individual cost of each type of HAI, because each

are different in nature and therefore, different in cost. SSIs were reported to cost as low as

$10,443 and as high as $25,546 per infection. CLABSIs were estimated to cost anywhere from

$5,734 to $22,939 per infection. When taken into consideration, the costs of these HAIs (which

are preventable by the staff of the healthcare team) mount a threat to the costs of diseases. For

example in 2006 coronary artery disease cost the healthcare system $17.5 billion dollars, heart

attacks and congestive heart failure costs came out to a grand total of $11.8 billion dollars and

$11.2 dollars respectively. While the cost of the diseases are higher than the costs of HAIs, HAIs

have gone beyond some diseases such as; stroke ($6.7 billion dollars a year), diabetes mellitus

($4.5 billion dollars a year), and chronic obstructive pulmonary disease (COPD) ($4.2 billion

dollars a year) (Scott II, 2007). Implementations need to take place if these HAIs costs are to be

reduced, and while such interventions might cost money themselves; “intervention costs will

certainly reduce the magnitude of the direct medical cost savings (or benefits) and must be

considered in any cost-effectiveness or cost-benefit analysis of infection control policies and

programs”(Scott II, 2009).

ventilator-associated pneumonia, central-line associated bloodstream infections, C. difficile

infections, and catheter associated urinary tract infections (healthypeople.gov, 2021).. Not only

are these common, but the article revealed what the cost of these infections are in terms of

monetary value. It reported that the US spends around $9.8 billion USD a year in managing these

HAIs (healthypeople.gov 2021). Not only should this issue of HAI be viewed through a

monetary lens, but the lives of the patients are also negatively impacted, and could result in them

and possibly their loved ones to be afraid of seeking care in the future.

REVIEW THE GUIDELINE

“1. Implement a program that follows categories IA, IB, and IC of either the current Centers for

Disease Control and Prevention (CDC) and/or the current World Health Organization (WHO)

hand hygiene guidelines.

2. Set goals for improving compliance with hand hygiene guidelines. (See also IC.03.01.01, EP

3. Improve compliance with hand hygiene guidelines based on established goals”

(jointcommission.org)

AMERICA:

Jinadatha et al. noted that an issue related to HAIs is that hospital rooms are not being adequately

disinfected and that staff are neglecting to disinfect their personal medical equipment (PME)

(2017). The article approaches the problem of HAIs by stating that disinfection of the rooms is

not being done adequately and that the staff is also neglecting to disinfect their own personal

medical equipment (PME).

Report more cases, because they are underreporting. Interventions to control the outbreaks are

instituted or recommended enhancing hand hygiene and education

SIGNIFICANT FINDINGS

AMERICA:

The five specific interventions that were taught to the leaders were evidence-based-practice

interventions such as; hand-washing, using full-barrier precautions during the insertion of central

venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site if possible, and

removing unnecessary catheters. After the leaders received the education, and disseminated it to

their fellow co-workers, information regarding the rates of infection was gathered monthly for 18

months (Pronovost et al., 2006)

The overall median rate of catheter-related bloodstream infection decreased from 2.7

(mean, 7.7) infections per 1000 catheter-days at baseline to 0 (mean, 2.3) at 0 to 3 months

after implementation of the study intervention (P≤0.002) and

was sustained at 0 (mean,

1.4) during 18 months of follow-up… The multilevel Poisson regression model showed a

significant decrease in rates of catheter-related bloodstream infection during all study

periods as compared with baseline rates, with incidence-rate ratios continuously

decreasing from 0.62 (95% confidence interval [CI], 0.47 to 0.81) at 0 to 3 months to

0.34 (95% CI, 0.23 to 0.50) at 16 to 18 months after implementation of the study

intervention (Pronovost, et al., 2006).

In South Africa, the prevalence of HAIs among all hospital inpatients is estimated to be between

3% and 15%, but outbreaks are infrequently reported.

Klebsiella pneumoniae (19%), Staphylococcus aureus (19%), and Enterococcus (16%). Most

outbreaks were reported from university and tertiary hospitals.

CONCLUSION

In conclusion, the best way to reach the goal of reducing the risk of healthcare–associated

infections is to “comply with either the current Centers for Disease Control and Prevention

(CDC) hand hygiene guidelines and/or the current World Health Organization (WHO) hand

hygiene guidelines” (National Patient Safety Goals). By comparing the United States to an

undeveloped country, like South Africa, it shows that significant reporting is helpful in

addressing this issue. Failure to detect and/or report outbreaks can increase the risk of ongoing

infections and recurrent outbreaks. By doing this nurses and other medical personnel will be

able to reduce the spread of HAIs and in the end, have better outcomes for their patients. This

will lead to lower costs of hospital stays and discharge patients within a timely manner.

References

Centers for Disease Control and Prevention .Healthcare-Associated Infections (HAIs). (2017).
 https://www.cdc.gov/winnablebattles/report/HAIs.html

Ebook central - proquest. https://about.proquest.com/en/products-services/ebooks-main/

Office of Disease Prevention and Health Promotion. (n.d.). Healthcare-Associated Infections.

U.S. Department of Health and Human Services.

https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infecti

ons

National Patient Safety Goals - jointcommission.org. (n.d.). Retrieved February 8, 2022, from

https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety

-goals/2022/simple_2022-hap-npsg-goals-101921.pdf.

Scott RD. (2009). The direct medical costs of healthcare-associated infections in US hospitals

and the benefits of prevention. Atlanta: Centers for Disease Control and Prevention.

https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf