Infections (HAIs): A Public Health Challenge


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A nosocomial infection also called
“hospital acquired infection”

An infection acquired in hospital
by a patient who was admitted for a reason other than that infection and occupational
infections among staff of the healthcare facility. Healthcare-associated
infections also known as (HAIs) remain a considerable problem within the
healthcare industry. They are one of the major causes for morbidity and
mortality in healthcare settings. The specific groups of infection the CDC
analyzed for this study were pneumonia, gastrointestinal illness, urinary tract
infections, and primary bloodstream infections, surgical site infections from
any inpatient surgery, and other types of infections. Many efforts have been
made to reduce the occurrence of these issues across the United States. To a
certain extent, success has been proven.


 Dixon (2011) cited that in 1847, Ignaz
Semmelweis presented evidence of childbed fever spreading from person to person
via unclean hands of healthcare providers. By the 1960s, hospital-based
infection control efforts had been established in scattered hospitals
throughout the United States. There are large numbers of hospitals in USA
started preventive program to HAIs during the 1970s, and HAI control programs
were established in virtually most of the hospitals by the early 1990s. These programs
  adopted to control and prevent the HAIs
, it hold valuable lessons about the ways that other public health initiatives
can be designed, developed, and implemented.

Hospital-acquired infections add to
functional disability and emotional stress of the patient and many in some
cases, lead to disabling conditions that reduce the quality of life. Nosocomial
infections are also one of the leading causes of death. The economic costs are
considerable. The increased length of stay for infected patients is the
greatest contributor to cost. Prolonged stay not only increases direct costs to
patients or payers but also indirect costs due to lost work. The increased use
of drugs, the need for isolation, and the use of additional laboratory and
other diagnostic studies also contribute to costs. Hospital-acquired infections
add to the imbalance between resource allocation for primary and secondary
health care by diverting scarce funds to the management of potentially
preventable conditions. CDC jointly released the toolkit Eliminating
Healthcare-Associated Infections: State Policy Options, which is available at
www.astho.org/HAI_Policy_Toolkit. This toolkit provides guidance to senior
policy-makers on various promising ways to use legal and policy interventions
to implement a comprehensive HAIs prevention program. The toolkit assesses the
landscape of state policies to advance HAIs prevention and will benefit states
wishing to initiate or enhance existing HAIs policies. The policies described
in the toolkit include public reporting options, advisory councils, financial
incentives and disincentives, and licensure and training requirements. To
inform development of the toolkit, ASTHO assembled an expert working group of
HAIs prevention leaders nationwide, including state health agency staff,
legislative liaisons, legal counsel, infection preventionists, epidemiologists
and consumer advocates. The Policies for Eliminating Healthcare-Associated
Infections: Lessons from State Stakeholder Engagement report is phase of the
project. Phase builds on the HAIs policy toolkit and examines the early impact
of policy. It is based on phone consultations with stakeholders from seven
states and in-person meetings with broad representation in three states. The
150 participating stakeholders represented state and local health agencies,
consumer and patient groups, quality improvement organizations, hospitals and
hospital associations, outpatient settings, healthcare professionals, and
healthcare payers.

Some state laws require public
reporting of hospital-acquired infection rates. Federal incentives have also
been established to further encourage the reduction of HAIs across the U.S. The
need for regulation is not only a moral endeavor but also a financial sound
necessity. A state
health agency’s power to oversee and regulate HAIs prevention and control
activities is generally granted or delegated by the state legislature. State
should provide authority with HAIs law for regulatory oversight to either the
state health agency or commissioner of health 
law that can help control the  


The CDC healthcare-associated
infection (HAI) prevalence survey External Web Site Icon provides an updated
national estimate of the overall problem of HAIs in U.S. hospitals. Based on a
large sample of U.S. acute care hospitals, the survey found that on any given
day, about 1 in 25 hospital patients has at least one healthcare-associated
infection. A prevalence study conducted in 2011 by the Centers for Disease
Control and Prevention (CDC), estimated that the total number of HAIs occurring
in acute care hospitals in the United States was 721,800. The CDC states, “about
75,000 hospital patients with HAIs died during their hospitalizations. More
than half of all HAIs occurred outside of the intensive care unit.”
Approximately 1 out of 9 people who obtained an HAI within the acute hospital
setting later died due to the progression of infections. The specific groups of
infection the CDC analyzed shown in the table.



The infection can be caused by
bacterial, viral or fungal. A common bacterial organism include staphylococcus,
streptococcus, MRSA. For viral can be cause by Hepatitis, HIV, Herbies virus.

For fungal the common is candida
infection, aspergillus and Cryptococcus Neoformans Specially in immune compromised

    Despite the efforts been
exerted to prevent it, Health Associated Infections has been noticed to be
rising by millions. The literature indicates that healthcare workers are aware
and understand that their patients are susceptible to HAIs and that they
themselves can affect patient outcomes. 
However, despite this awareness and the existence of evidence based HAIs
guidelines there are clear gaps between what is recommended and practiced,
greatly impacting the development of HAIs.

        The purpose of this
capstone project is to assess for gaps between HAIs recommendations and
practices in the health care settings and provide interventions to reduce these
gaps, and there by impact HAIs development and patient outcomes.    

  The overall incidence of HAIs has been rising in the last 20 years,
was estimated to be increased by 36% (Stone, 2009).  In 2002, the number of HAIs was estimated to
be in the millions and was directly associated with 99,000 deaths in United
States each year, costing nearly $28 to $33 billion in excess health care costs
each year (AHRQ, 2011; Scott, 2009).  making
HAIs the fourth leading cause of death among the U.S. patient population (AHRQ,
2011).  There is an enormous financial
burden being placed on healthcare systems associated with these infections
(Stone, 2009), however, despite costs, the morbidity, and mortality associated
with HAIs, compliance with HAI prevention measures remain suboptimal,

          The project evaluates information in
medical and health care literature that addresses the methods and efforts
against Hospital-Acquired Infections (HAIs), while adding value to the current
situation to make the methods and efforts more effective in controlling and
preventing HAIs. The project establishes an in-depth research review that
investigates why the methods implemented in various hospitals could not help preventing
the development and spread of the infections in these hospitals and to find out
an answer of the research question; Can the hands washing be enforced more
systematically to be the best effective tools to prevent this problem from occurrence.

  To address the reasons and purposes relevant
to the spread of education and training facilitating the prevention of HAIs
among healthcare workers in various hospitals around the world, we need to
study the gap in the practice. In a report published in 2000 by The Institute
of Medicine’s (IOM), To Err is Human “identified the clear gaps between what is
a recommended and what is practice as these inconsistencies could greatly
impact patient outcomes (AHRQ, 2011).

The CDC stress on
the importance of prevention by requiring the organizations incorporate HAI
staff education at all levels as an essential element of their HAIs preventive


 Laws and

Laws and regulations regarding the
prevention and reduction of HAIs were created in 2004 and have greatly
increased since then. Every state health department is responsible for
establishing their own requirements and reporting mechanisms. Federal
incentives have also been established to further encourage the reduction of
HAIs across the U.S. The need for regulation is not only a moral endeavor but
also a financial necessity. Ramanathan states, “Economic analyses conducted at
the . . . CDC report that HAIs in hospitals alone result in up to $33 billion
in excess medical costs every year.” In 2010, the CDC initiated a call to
action from the American Journal of Infection Control and Hospital
Epidemiology. They proposed that greater adherence to evidence-based guidelines
would help healthcare providers reduce unnecessary HAIs. The American Recovery
and Reinvestment Act of 2009 and the Patient Protection and Affordable Care Act
of 2010 were efforts by Congress to shed light on the increasing burden of
HAIs. The latter, “funded states to devote employee time and resources to
target HAIs elimination,” according to Ramanathan. Many states have adopted
strict regulations and laws regarding the recording and prevention of HAIs, but
Michigan still lacks these stringent guidelines. Data submission requirements,
public reporting provisions, and facility identifiers are also not currently
required by Michigan state law. However, Michigan Admin. Code r. § 325.172,
Rule 2 regarding communicable and related diseases states; (The unusual
occurrence, outbreak, or epidemic of any condition, including healthcare-associated
infections) must be reported. On the other end of the spectrum, federal
programs such as the Centers for Medicare and Medicaid Services (CMS) are
beginning to offer incentives for reduction and prevention of HAIs. In the past,
there was little encouragement for a hospital to improve their quality of care.
CMS would still pay for the treatment of infections regardless if errors could
have been prevented.  Medicare, Medicaid,
and many private health care sectors are now beginning to transform their
payment models to a change payment system to reward better outcomes rather than
volumes of service. Medicare has also created programs such as the
Hospital-acquired Conditions (HAC) Program, Hospital Value-Based Purchasing,
Hospital Inpatient Quality Reporting Program, and the Hospital Readmissions
Reduction Program. Conway (2013) claims “these programs already are creating
strong incentives for hospitals to preempt infections and errors.”

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