Why Do Healthcare-Associated Infections Persist?

Updated: Oct 31, 2018

By Richard Stockton


Healthcare-associated infections (HAIs) are the most common complication people develop during their time in a hospital. In the developed world, 7 out of every 100 inpatients catch some kind of infection from their environment, while HAIs are the principal reason for 1 out of every 25 hospital admissions. Worse, facility-caused infections lead to 99,000 preventable deaths a year just in the United States. These infections have other, less-than-lethal consequences for patients and providers, including:

  • Higher treatment costs per patient

  • Excess inpatient days and slower recovery times

  • Increased antibiotic resistance among certain bacteria, notably MRSA

  • Potential for lawsuits for negligence and malpractice

  • Higher costs for both liability and health insurance

Clearly, infections are a major problem for every party involved in healthcare, from practitioners to patients. Before significant progress can be made in fighting healthcare-associated infections, they have to be understood in the context of situations where they occur and the ways they spread.


Where Do Healthcare-Associated Infections Happen?


The risk that a patient will contract a healthcare-associated infection varies wildly with several factors. A short outpatient visit to a family practitioner is risky enough, with a high-and-rising rate of HAI infections among the high volume of patients who pass through outpatient clinics. Among hospitalized patients, one European study found an incidence of 17 hospital infections per 1,000 days in intensive care. The risk of developing such an infection increases not just with the duration of a hospital stay, but also with the invasiveness of procedures performed and the nature of the environment where the care is given.


For example, urinary tract infections are the most common hospital infection in the world. This is likely due to the high frequency of and clinical setting for the use of invasive catheters. MRSA colonization is most common in the external nares, which is probably due to careless handling of less-invasive nasal cannulas. C. difficile infections are most common among patients undergoing aggressive antibiotic therapy, and the list goes on with different infections related to certain activities, situations and environments.


Practices That Encourage the Spread of Infection in Healthcare Facilities


Beyond clinical causes, healthcare-associated infections are easily spread by unhygienic conditions and practices. Hospital floors, for example, are frequently contaminated with biohazardous substances, such as blood and other bodily fluids, and may not be properly cleaned on a regular schedule. This is not strictly negligence; no facility could be expected to sterilize its floors like a surgical implement, which is what it would take to minimize the risk of contamination.


Other surfaces in hospitals, such as countertops, door handles and even pens, can easily take up and sequester infectious bacteria until they’re handled by patients, whose immune systems may not be up to fighting off the pathogens.


Poor personal hygienic practices also contribute to the spread of hospital infections. Handwashing is one of the most commonly performed – and the most commonly poorly performed – activity staff engages in to limit the spread of infections. The way cleaning crews work is also partly responsible for leaving surfaces contaminated – or even of spreading harmful bacteria – just by following the prescribed cleaning protocol in hospitals that may not have updated their procedures for a while. When cleaning a hospital room for a new patient, for example, staff may use a single bleach wipe on more than one surface. This is pretty common practice when people clean non-medical environments, but in a healthcare setting it can easily spread staph from a sink handle to a remote control. Clinical staff are also distressingly prone to skip universal precautions and may, for instance, remove a saline lock without wearing the required exam gloves.

Another issue that affects HAI prevalence, and one that really doesn’t get the attention it deserves, is monitoring of hand hygiene. As with any important process, it’s important to incorporate some kind of self-assessment mechanism into hand hygiene compliance to provide effective and sustainable operational insight and help keep patients safe. By installing currently-available sensors on soap dispensers near handwashing stations, or on hand sanitizer units in treatment areas, it’s possible to automatically remind workers to wash or sanitize via a wearable wristband. Apart from the occasional prod to the individuals, a system like this is an invaluable tool for gathering data on hand hygiene, compliance, and trends that can empower hospital admins to make necessary changes, from simply moving the location of a dispenser to wholesale retraining of staff.


What Can Be Done


The fact that healthcare workers’ actions play such a large role in spreading infections is both upsetting and hopeful. Far from laying blame on hundreds of thousands of hospital workers, hospice nurses and in-home caregivers, it’s worth noting that a problem caused by people’s well-intentioned but problematic behavior can be solved by modifying that behavior. Changes that would almost certainly reduce the spread of healthcare-associated infections include:

  • Training: To be safe, healthcare workers must know the risks associated with hospital infections. Special training modules, made compulsory for all employees, from doctors to custodial staff, can inform staff and give them the necessary sense of urgency to stay safe.

  • Supervision: Training must be supplemented with oversight to ensure procedures are routinely observed. Charge nurses, for instance, can be given the mandate – and the authority – to discipline subordinates caught violating precautions or using unsterilized equipment in a potentially risky way.

  • Inspection: Third-party verification helps identify problem areas quickly. Lab staff, for instance, can be asked to make periodic sweeps through a ward to test doorknobs, faucet handles and other frequently handled items to see if they’re harboring colonies of bacteria.

  • Detection: Patients can also be a vector for healthcare-associated infections, and detecting them early is as important for stopping the spread as it is for treating the infected patients themselves. Routine checks for the presence of MRSA or VRE should be a regular part of every hospital stay, especially in high-risk areas such as the ICU.

Hospital infections strike millions of people a year and cause tens of thousands of deaths that don’t have to happen. Simple precautions, informed by a general culture of hygiene and accountability, can almost certainly get healthcare-associated infections, and the tremendous costs associated with them, under better control.



Richard Stockton is a freelance writer and former allied healthcare professional from Sacramento, California. His background is in pre-hospital and acute-care settings, where he worked for many years before taking up writing.

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