Healthcare-Associated Infections Workgroup

HAIs threaten patient safety and health care quality. HAIs are infections people can get while receiving medical care in any health care setting. HAIs can be associated with procedures such as surgery and devices like catheters or ventilators. Many HAIs can be prevented by implementing proven best practices.

In hospitals alone, 1 in 31 hospitalized patients have at least 1 HAI at any given time, with more than 680,000 infections and billions of dollars in excess health care costs related to HAIs across the United States every year.^1,2 Although significant progress has been made in preventing some HAI types over the last decade, there is much more work to be done. Furthermore, many of these infections are caused by antibiotic-resistant (AR) pathogens. HAIs and other infections can also lead to sepsis, which causes an estimated 1.7 million illnesses and 270,000 deaths annually in the United States.³ Reducing HAIs across all health care settings supports the HHS mission to prevent infections, improve patient safety, combat AR and its complications, and reduce excess health care costs. These efforts also align with the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination⁴ and the National Action Plan for Combating Antibiotic-Resistant Bacteria.⁵

The 2 core objectives identified by the HAI Workgroup aim to reduce hospital-onset C. diff (Clostridioides difficile) and hospital-onset MRSA (Methicillin-resistant Staphylococcus aureus) infections. In addition, the workgroup has added a developmental objective related to improving antibiotic use in outpatient settings. As more data become available, this developmental objective may become a core objective. 

C. diff is a preventable, life-threatening bacterial infection that can occur in both inpatient and outpatient health care settings. It causes severe diarrhea. Use of antibiotics is an important risk factor for this infection, and patient movement between health care facilities contributes to spreading these infections. 

MRSA is a common type of bacteria spread in health care facilities and the community. MRSA can cause difficult-to-treat staph infections because of resistance to some antibiotics and is often linked to life-threatening bloodstream infections, pneumonia, and surgical site infections, which can lead to sepsis and death. MRSA infections overall are dropping, but progress to prevent MRSA bloodstream infections in health care settings is slowing. In addition, the ongoing opioid epidemic may be contributing to community-associated MRSA infections and also slowing progress to reduce MRSA infections overall.

Antibiotics have been a critical health care and public health tool since the discovery of penicillin in 1928, saving the lives of millions of people around the world.⁴ Today, however, the emergence of drug resistance in bacteria is reversing the progress of the past 80 years, with drug choices for the treatment of many bacterial infections becoming increasingly limited, expensive, and — in some cases — nonexistent. Improving appropriate antibiotic use and prescribing practices is an important evidence-based intervention that improves individual patient outcomes, reduces risk of C. diff, reduces the overall burden of AR infections, shortens hospital stays, and reduces health care costs. Approximately 258 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States in 2017, with at least 30 percent of them considered unnecessary.⁶