Healthcare-associated infections (HAIs) are one of the leading causes of death in the United States and are becoming increasingly problematic for hospitals and healthcare facilities throughout the country. The World Health Organization has reported that approximately 1.4 million people have an HAI at any given time. Compounding the problem is that little is known about the burden of infections outside of hospitals, particularly in long-term care facilities, ambulatory surgical centers, and other outpatient settings. The emergence of HAIs caused by multidrug-resistant microorganisms is another increasing concern.

As Americans continue to age and healthcare costs continue to rise, the elimination of HAIs is paramount for improving patient health and healthcare savings. “The number of people who become sick or die from HAIs is unacceptably high, and these infections cause a significant financial burden,” says Denise Cardo, MD. “As consumers are increasingly asking for transparency and accountability in healthcare, their expectations on how well these infections are managed will continue to increase. This is a unique and timely opportunity to move toward the elimination of these infections.”

Inconsistent Implementation

According to Dr. Cardo, tried and true preventive measures for HAIs are inconsistently implemented. “The success of prevention efforts has varied considerably from one setting to the next,” she says. “However, we have a growing body of knowledge that defines a full range of prevention interventions that can address specific HAIs when consistently applied across settings. HAIs can be eliminated by implementing a proven framework for prevention at all levels of healthcare delivery. For the infections that we know how to prevent, we must prevent them consistently and effectively. For the infections we’re still learning about, we must adhere to currently available guideline recommendations and strive to identify more effective preventive measures.”

Guiding Principles

In the November 2010 issues of Infection Control and Hospital Epidemiology and the American Journal of Infection Control, Dr. Cardo and other experts published a white paper, which describes a framework for achieving the elimination of HAIs using successful preventive practices and public health strategies. The white paper was jointly authored by representatives from leading public health and infectious diseases groups, including the CDC, Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Association of State and Territorial Health Officials, Council of State and Territorial Epidemiologists, and Pediatric Infectious Disease Society.

A four-part framework to achieve the goal of eliminating HAIs was established based on lessons from recent successes. The four components include: 1) implementing evidence-based practices that protect patients; 2) aligning incentives to promote system-wide strategies for HAI prevention; 3) addressing gaps in knowledge to push beyond the current medical knowledge; and 4) collecting data to target prevention efforts and to measure progress (Figure). “Constant action and vigilance are required to accomplish these framework components,” says Dr. Cardo.

Adherence to Guidelines

Increasing adherence to guidelines is essential to further reducing the burden of HAIs on the U.S. healthcare system (Table). The strategies recommended in the white paper are evidence-based and have been employed in combating other diseases and infection types. For example, significant progress has been made in controlling central line-associated bloodstream infections (CLABSIs) based on improved adherence to guidelines. Recent local and regional initiatives have observed 60% to 70% overall decreases of CLABSIs in ICUs. Some locations have reported zero CLABSIs for up to 4 years following the implementation of proven prevention strategies. “While there have been some successes, the lack of adherence to proven prevention strategies remains suboptimal in many locations,” says Dr. Cardo. “More progress is needed in acute care and other healthcare settings, such as outpatient surgery centers, long-term care facilities, and dialysis clinics. These settings must make prevention of HAIs a greater priority.”

The Time is Now

In the white paper, the elimination of HAIs was defined as the maximal reduction of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts. Continued measures to prevent the reestablishment of transmission are required. “These efforts must be supported by sufficient investments and resources, and a strong collaboration among a broad coalition of public and private stakeholders,” says Dr. Cardo. “Now is the time to build on the momentum and investments that have been made at the federal, state, and local levels. At the recent Fifth Decennial International Conference on HAIs, we highlighted some of the successes for reducing the burden of HAIs. We now have an opportunity to expand on the successes so that all healthcare settings can benefit.”



Cardo D, Dennehy PH, Halverson P, et al; HAI Elimination White Paper Writing Group. Moving toward elimination of healthcare-associated infections: a call to action. Infect Control Hosp Epidemiol. 2010;31:1101-1105. Available at:

Klevens R, Edwards JR, Richards CL, et al. Estimating healthcare‐associated infections and deaths in US hospitals, 2002. Public Health Rep. 2007;122:160-166.

Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial‐resistant pathogens associated with healthcare‐associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29:996-1011.

Pearson A, Chronias A, Murray M. Voluntary and mandatory surveillance for methicillin‐resistantStaphylococcus aureus (MRSA) and methicillin‐susceptible S. aureus (MSSA) bacteraemia in England. J Antimicrob Chemother. 2009;64(suppl 1):i11–i17.