Healthcare-associated infections (HAIs) represent a serious threat to patient safety in all types of clinical settings. According to the Centers for Disease Control and Prevention, 722,000 HAIs occur annually in acute care hospitals alone, resulting in approximately 75,000 deaths.¹ The annual rate exceeds 1 million HAIs when factoring in other settings across the U.S. healthcare system.² Stemming the tide of HAIs requires in-service education of front-line staff on sources of infection, common pathogens and their prevention through universal infection control precautions.

Sources of HAIs
HAIs develop when bacteria, viruses, fungi or other pathogens invade the blood and/or tissues of patients while they are receiving treatment for other medical conditions. HAIs are commonly associated with:
 

• Surgical procedures
   
• Prolonged and/or inappropriate use of medical devices
   
• Heavy antibiotic dosing
   
• Unsafe injection practices
   
• Immunocompromised and/or other chronic underlying conditions
   
• Contact with infected carriers
   
• Substandard environmental hygiene and/or waste disposal
   
• Insufficient infection control precautions
   

Common types of HAIs
HAIs that are especially frequent in clinical settings include:
 

• Catheter-associated urinary tract infections due to incorrect placement, maintenance or use of indwelling catheters.
   
• Central line-associated bloodstream infections due to incorrect placement and/or maintenance of intravascular catheters.
   
• Clostridium difficile (C. Diff) infections due to antibiotic overuse and the destruction of healthy intestinal bacteria.
   
• Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia due to patient/resident contact with contaminated surfaces, medical devices or infected healthcare personnel, resulting in pathogens entering the bloodstream.
   
• Surgical site infections due to contaminated medical implants and/or poor sterilization techniques during surgery.
   
• Ventilator-associated pneumonia due to cross-contamination via an endotracheal tube.
   

Precautions against the spread of HAIs
The goal of universal precautions training is to minimize the risk of clinical cross-contamination of dangerous, hard-to-treat pathogens. Annual training sessions should reinforce these universal biosafety practices by highlighting:
 

• Hand hygiene before and after contact with patients/residents, bodily fluids and soiled materials; after removing gloves and using the restroom; and whenever hands are visibly soiled. (Hand hygiene guidance also should be offered to patients/residents and family members via signage and live demonstrations of washing techniques.)
   
• Protective equipment (i.e., gloves, gowns, masks, eyewear) whenever there is a reasonable chance of contact with blood, bodily fluids, secretions or excretions, or with any items contaminated by these fluids.
   
• Respiratory etiquette, e.g., properly covering the mouth and nose when coughing or sneezing and requiring individuals with a communicable disease to wear a surgical mask.
   
• Safe injection practices when handling needles and sharps to prevent transmission of bloodborne pathogens and other occupational needle-stick injuries.
   
• Proper disposal of medical waste to ensure that infectious materials are appropriately separated, labeled, stored and transported.
   

  
Training aids for HAIs
In addition to universal precautions training, in-service education should focus on the prevention and management of common HAIs. For training purposes, these targeted CDC resources are available:
 

• Catheter-associated urinary tract infection
   
• Central line-associated bloodstream infection
   
• Clostridium difficile infection
   
• MRSA infection
   
• MRSA management
   
• Surgical site infection
   
• Ventilator-associated pneumonia
   

Documentation should be maintained for all infection control training or certification sessions, including dates, names of attendees and proficiency testing results, and copies of certificates earned should be kept on file. By ensuring that staff members are trained in the infection surveillance practices outlined here, healthcare organizations can make significant strides in reducing the rate of HAIs.

¹ Centers for Disease Control and Prevention, HAI Data and Statistics.
² Agency for Health Care Research and Quality, Health Care-Associated Infections.