Why Do Hospital-Acquired Infections Continue to Rise? Is It Low Patient Safety Compliance?

Updated: Sep 12

By Paul Gallese

As health care organizations work to improve compliance with programs designed to improve patient safety, hospital-acquired infections (HAIs) continue to rise unabated. The human and financial costs are high.

Hospital-acquired conditions (HACs) also have an adverse impact on patient safety and healthcare organization financial margins, according to a report from the Agency for Healthcare Research and Quality (AHRQ, 2017)) titled “Estimating the Additional Hospital Inpatient Cost and Mortality Associated with Selected Hospital-Acquired Conditions.”

The direct patient care costs of HAIs and HACs have been estimated to be $35 billion to $45 billion in 2007 dollars, the Centers for Disease and Control and Prevention (CDC, 2009) reports. And these costs are only the beginning, leading to additional costs within the healthcare system: legal liabilities, reimbursement penalties, higher mortality rates, and more.

HAIs and HACs also leave healthcare organizations vulnerable to medical liability claims. The cost of preventing and defending against these claims, including the practice of defensive medicine, was estimated to be $55.6 billion in 2008, or 2.4 percent of total healthcare spending (Mello et al., 2010).

Vitalacy’s recently published white paper, Finding New Ways to Prevent Healthcare-Acquired Infections and Conditions, details the continual increase of HAIs and HACs, despite all of the patient safety initiatives and awareness programs emphasizing infection control and hand hygiene. The paper also covers how Vitalacy works with organizations wishing to reduce these infections and conditions and enhance patient safety by implementing workflow monitoring solutions that improve the efficacy of nurse rounding and hand hygiene compliance.

Failure to perform appropriate hand hygiene is the leading cause of HAIs, WHO says

Even though the World Health Organization (WHO) has identified hand hygiene as a simple, low-cost action to prevent the spread of HAIs, hand hygiene compliance remains a serious challenge. “Failure to perform appropriate hand hygiene is considered the leading cause of HAIs and spread of multidrug-resistant organisms,” a WHO (2009) report states.

Research studies show that on average, healthcare providers clean their hands less than half of the times that they should (CDC, 2017; Erasmus, et al., 2010). While hand hygiene compliance under 50 percent is insufficient, there is recent evidence showing that the average compliance rate is even lower (McLaws et al., 2018; Eiamsitrakoon et al., 2013; Pan S-C, et al., 2013).

The connection between proper hand hygiene and HAI prevention is proven

This low compliance is bad news considering the connection between proper hand hygiene and HAI prevention. As many as 65 to 70 percent of cases of CABSI and CAUTI and 55 percent of cases of surgical-site infections and ventilator-associated pneumonia may be preventable with current evidence-based strategies including proper hand hygiene (Umscheid, et al., 2011).

A study conducted in Michigan hospitals where an evidence-based intervention including hand washing was implemented achieved up to a 66 percent reduction in catheter-related bloodstream infections (Pronovost et al., 2006). Another study quantified the contamination found on the hands of healthcare workers during critical moments of care in a wound care center. Healthcare workers there had at least one healthcare-associated pathogen on their hands during 28.3 percent of all patient care encounters. Hands sampled before a clean or aseptic procedure and after body fluid exposure risk were each contaminated in 17.4 percent of instances. The pathogens included MRSA, C. diff., vancomycin-resistant Enterococcus, and multidrug-resistant Acinetobacter species (Bingham et al., 2016).

Creating the conditions for organizations to advance and sustain patient safety improvement

The Vitalacy white paper presents a case study describing how the Vitalacy automated monitoring system was implemented in about half of the medical and surgical beds of an academic medical center with a higher-than-average HAI rate. The system increased the number of compliance observations from 1,500 to more than 225,000 per quarter, improved compliance from 30 percent to 70 percent, and drove down infections for two consecutive quarters.

Vanderbilt University Medical Center’s hand hygiene program has produced significant results relating to reduced infections, as well. CAUTIs in intensive care units dropped 33 percent. Ventilator-related pneumonia dropped 61 percent, and CASBIs in intensive care units dropped 80 percent.

Mount Sinai Health System recently announced a 20 percent improvement in hand hygiene compliance leading to reduced infections. The health system reported that average hand hygiene had improved from 69 percent to 89 percent. "Progress in hand hygiene compliance has occurred simultaneously with a 59 percent decrease in hospital-acquired infections between 2015 and 2018," wrote Rebecca Anderson, Mount Sinai's senior director of patient safety initiatives, in a Joint Commission blog post (Anderson, 2019).

The common thread running through all examples of patient safety improvement is the necessity of acquiring the willingness and ability to change behavior in the healthcare environment. The Institute for Healthcare Improvement, in a 2018 monograph, wrote: “...to reach a higher level of performance and reliability, improvement teams and healthcare organizations will need to create the conditions for people to advance and sustain improvement.”

This statement provides a succinct and accurate description of the core beliefs of the Vitalacy team. We are in the business of providing the data that affects change. By improving the ability to observe events leading to HACs, we can enable better patient safety.


Agency for Healthcare Research and Quality (AHRQ). Final report: Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. AHRQ publication No. 18-0011-EF, November 2017.

Anderson, R. How Mount Sinai Health System improved hand hygiene compliance by 20 percent. The Joint Commission High Reliability Healthcare blog, March 5, 2019.

Bingham J, et al: Healthcare worker hand contamination at critical moments in outpatient care settings. American Journal of Infection Control, Nov. 1, 2016;44(11):1198-1202.

Centers for Disease Control and Prevention (CDC). Clean hands count for safe healthcare. (2017).

Centers for Disease Control and Prevention (CDC): The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. March 2009.

Eiamsitrakoon T, et al: Hand hygiene behavior: translating behavioral research into infection control practice. Infection Control and Hospital Epidemiology, November 2013;34(11): 1137-1145.

Erasmus V, et al: Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control and Hospital Epidemiology, 2010;31:283-294.

McLaws M-L, et al: Hand hygiene compliance rates: Fact or fiction?, American Journal

of Infection Control (2018). DOI: 10.1016/j.ajic.2018.03.030.

Mello MM, et al: National costs of a medical liability system. Health Affairs, 2010;29(9):1569–1577.

Pan S-C, et al: Compliance of healthcare workers with hand hygiene practices: independent advantages of overt and covert observers, Public Library of Science, Jan. 14, 2013.


Pronovost P, et al: An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 2006;355:2725-32.

Umscheid CA, et al: Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection Control and Hospital Epidemiology, Feb. 2011;32(2):101-14. doi: 10.1086/657912.

Vitalacy, Inc. Finding new ways to prevent healthcare-acquired infections and conditions. (2019).

World Health Organization 2009. Guidelines on hand hygiene in healthcare. WHO. Geneva.

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