When the Department of Health and Human Services (HHS) announced a request for public comments for an updated National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination, it brought with it some happy news. Healthcare-associated infections (HAI) in the United States are down.

According to the Centers for Disease Control and Prevention (CDC), HAIs have been declining since HHS first introduced the National Action Plan in 2009. Central line-associated bloodstream infections have declined by 33 percent, surgical site infections have declined by 10 percent and catheter-associated urinary tract infections have declined by 7 percent. Methicilin-resistant Staphylococcus aureus, more commonly known as MRSA, also declined by 18 percent.

“Today, we celebrate the rapid progress achieved through concerted efforts to reduce preventable infections in hospitals,” stated Dr. Howard Koh, HHS assistant secretary. “Already, we are saving lives and reducing unnecessary healthcare expenditures.”

Unfortunately, HHS announced bad news, as well – clostridium difficile, or C.diff, is not showing much improvement. It kills an estimated 14,000 Americans each year, and it’s moving beyond hospitals into other care settings such as nursing homes.

HHS has laid out nine goals for its next action plan to substantially reduce HAIs by 2013. These include a 50 percent reduction in bloodstream infections as well as MRSA invasive infections. HHS also seeks to reduce urinary tract infections, MRSA bacteremia and surgical site infections each by 25 percent and C.diff infections and C.diff hospitalizations each by 30 percent. The department is also aiming for 100 percent adherence to central-line insertion practices and 95 percent adherence to surgical care improvement project measures.

As HHS finalizes its methods to reach these goals, medical settings across the healthcare continuum should already be doing their part to continue on the overall downward trend of HAIs and to begin to reduce incidences for other HAIs, such as C.diff.

What Providers Can Do

C.diff is most commonly acquired during or after the use of antibiotics. C.diff causes gastrointestinal symptoms when competing bacteria in the gastrointestinal tract have been wiped out by other antibiotics. Avoiding over-prescription of antibiotics is the most effective method providers can use to prevent C.diff cases.

Other ways to reduce HAIs have to do with culture among personnel. Are they meticulous about personal protective equipment (PPE) and thorough hand hygiene? According to the CDC, hand hygiene is the most important factor in infection prevention in medical settings. Best practices for hand hygiene include using an alcohol-based rub or soap and water. Also, make sure your staff has easy access to PPE since easy accessibility makes it much more likely that staff will adhere to these policies. 


When it comes to surface cleaning, performing it inaccurately can exacerbate the issue. Remember the commercial of a mother cleaning her kitchen with a piece of raw chicken? The point is that improper cleaning can actually spread harmful microorganisms even if the visible dirt is gone. The same concept applies to the medical setting.

The open bucket method of “dip and squeeze” for instance, can leave live and infectious pathogens floating in the cleaning solution. With each squeeze, the mop drops off microorganisms and picks them up again with each dip. Instead, use a closed-bucket wiper dispensing system.

Healthcare providers should also ensure that disinfectants are applied adequately and appropriately. Many common cleaning tools such as rags and paper wipes are often ineffective since pathogen-killing properties tend to bind to cotton and paper fabrics. Typically, the best option is a wipe made from polypropylene. Healthcare facilities should make sure not to neglect other “high-touch” but often overlooked areas such as television buttons, light switches, handrails and door handles.

According to Healthcare Realty, there are other methods gaining steam, as well, such as liquid markers that can only be seen under ultraviolet light and identifies areas missed during cleaning.

“Healthcare-associated infections are quite costly, and coupled with low Medicare reimbursements, [these] are important factors driving hospitals to find cost-saving measures,” Healthcare Realty says. “Adding incentives to promote quality improvement is a good way hospitals may achieve bonus payments, decrease costs and most importantly, save lives.”

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