(HAIs) are infections that patients acquire during treatment in a healthcare setting, such as a hospital, long-term care facility, or dialysis center. Hospital Acquired Infections (HAI) is the term used by CMS to describe HAIs acquired during certain medical and surgical procedures. These include surgeries of the heart and blood vessels, urinary tract/bladder, gastrointestinal tract, and respiratory system; open-heart surgery; dialysis; and selected skin and wound care procedures.
HAIs in the post-acute healthcare setting (PAC) can be substantially higher than in acute care settings (Katz et al., 2009). For example, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in PAC was 4.5% compared to 1.7% for acute care patients (Fang et al., 2007).
Patient Safety Indicators (PSI)-10 is an HAI measure set by CMS to identify specific types of infections acquired during hospitalization. PSI-10 is based on the Agency for Healthcare Research and Quality (AHRQ) National Healthcare Safety Network (NHSN) criteria.
Staphylococcus aureus is the causal agent of Staph infections. The term "Staph" refers to the family of bacteria, not just Staphylococcus aureus. There are actually over 30 different types of Staph bacteria that can cause disease in humans. Many of these types of bacteria are found in our noses, skin, and throats without causing any symptoms.
S. Aureus is present on about 50% of all humans' skin, which makes it one of the most common normal flora found on human skin. It is known to colonize axillae (armpits), groins, perineum, and nasal area in particular.
It has been estimated that one out of three people carries this bacterium on their skin or in their nose. Staph infections can cause a wide range of symptoms, depending upon which part of the body is infected. Skin infections caused by S. aureus are usually minor and can include pimples or boils that have pus, or impetigo, which is an infection of the superficial layers of skin.
When there is an invasion below the dermis, staphylococci can sometimes cause serious infections such as endocarditis, osteomyelitis (bone infection), and sepsis.
In 2009, The Joint Commission (TJC) developed the Universal Protocol to Prevent Healthcare Associated Infections. The Universal Protocol is a globally applicable, science‐based initiative to help reduce and prevent healthcare associated infections.
The Universal Protocol is patient-centered, preventative guidance to healthcare professionals. It is based on the principle that everyone involved in caring for a patient should consistently follow four steps of hand hygiene before and after touching a patient or their surroundings.
1. Handwashing with soap and water or an alcohol-based hand sanitizer. Washing with soap and water is the most effective method to reduce bacteria on the hands.
2. Cleaning patient-care equipment or surfaces with appropriate cleaning agents before touching them.
3. Putting on a new pair of gloves when moving from one patient to another or engaging in clean/aseptic tasks that do not touch the patient. Procedures that do not involve touching a patient or their surroundings can be performed without gloves as long as hand hygiene is done after the procedure.
4. Removing gloves before touching a patient, their surroundings, or clean equipment and surfaces.
A recent statewide safety initiative in Michigan, called "Keystone ICU", was funded by the Agency for Healthcare Research and Quality (AHRQ) and sought to change and sustain provider behavior in 130 Intensive Care Units (ICUs) throughout the state.
The program's results found that the interventions, including a centralized team-based education program, nearly eliminated catheter-related bloodstream infections over a period of 18 months.
Hospitals can also aim to prevent or reduce the overall antibiotic resistance of infection-causing bacteria. CDC has developed the Campaign to Prevent Antimicrobial Resistance in Healthcare Settings to disseminate guidance on the prevention of bacteria transmission and the prudent use of antimicrobials.
Infection Control Program (Drs Harbarth, Sax, and Pittet and Mss Fankhauser and Bandiera-Clerc), Microbiology Laboratory (Dr. Schrenzel and Mr. Renzi), Department of Surgery (Drs Christenson and Gervaz), and Hospital Pharmacy (Dr. Vernaz), University of Geneva Hospitals and Medical School, Geneva, Switzerland.