Healthcare-associated Infections

Top CDC Recommendations to Prevent Healthcare-Associated Infections

Health and Human Services Secretary Kathleen Sebelius announced an initiative, the Partnership for Patients: Better Care, Lower Costs, aimed at protecting patients in America’s healthcare facilities through the prevention of healthcare-acquired conditions. Medical advances have brought lifesaving care to patients in need, yet many of these advances come with a risk of a healthcare-acquired conditions, including infections.
CDC’s top recommendations to prevent infections [PDF - 381 KB] are below:

To Prevent Catheter-Associated Urinary Tract Infections (CAUTIs:)

Insert catheters only for appropriate indications
Leave catheters in place only as long as needed
Ensure that only properly trained persons insert and maintain catheters
Insert catheters using aseptic technique and sterile equipment (acute care setting)
Follow aseptic insertion, maintain a closed drainage system
Maintain unobstructed urine flow
Comply with CDC hand hygiene recommendations and Standard Precautions

Also consider:

Alternatives to indwelling urinary catheterization
Use of portable ultrasound devices for assessing urine volume to reduce unnecessary catheterizations
Use of antimicrobial/antiseptic-impregnated catheters

For the full CAUTI prevention toolkit, visit the Prevention Tools page
Full CDC guidelines available at HICPAC website

To Prevent Surgical Site Infections (SSIs):

Before surgery

Administer antimicrobial prophylaxis in accordance with evidence-based standards and guidelines
Treat remote infections-whenever possible before elective operations
Avoid hair removal at the operative site unless it will interfere with the operation; do not use razors
Use appropriate antiseptic agent and technique for skin preparation

During Surgery

Keep OR doors closed during surgery except as needed for passage of equipment, personnel, and the patient

After Surgery

Maintain immediate postoperative normothermia
Protect primary closure incisions with sterile dressing
Control blood glucose level during the immediate post-operative period (cardiac)
Discontinue antibiotics according to evidence-based standards and guidelines

Also consider

Before surgery:

Nasal screening and decolonization for Staphylococcus aureus carriers for select procedures (i.e., cardiac, orthopaedic, neurosurgery procedures with implants).
Screen preoperative blood glucose levels and maintain tight glucose control

During surgery:

Redose antibiotic at the 3 hr interval in procedures with duration >3hrs
Adjust antimicrobial prophylaxis dose for obese patients (body mass index >30)
Use at least 50% fraction of inspired oxygen intraoperatively and immediately postoperatively in select procedure(s)

For the full SSI prevention toolkit, visit the Prevention Tools page
Full CDC guidelines available at HICPAC website

To Prevent Central Line-Associated Bloodstream Infections (CLABSIs) Outside ICUs:

Remove unnecessary central lines
Follow proper insertion practices
Facilitate proper insertion practices
Comply with CDC hand hygiene recommendations
Use appropriate agent for skin antisepsis
Choose proper central line insertion sites
Perform adequate hub/access port disinfection
Provide staff education on central line maintenance and insertion

Also consider:

Chlorhexidine bathing
Antimicrobial-impregnated catheters
Chlorhexidine-impregnated dressings

For the full CLABSI prevention toolkit, visit the Prevention Tools page
Full CDC guidelines available at HICPAC website

To Prevent Clostridium difficile Infections (CDI)

Contact Precautions for duration of diarrhea
Comply with CDC hand hygiene recommendations
Adequate cleaning and disinfection of equipment and environment
Laboratory-based alert system for immediate notification of positive test results
Educate about C. diff infection: healthcare personnel, housekeeping, administration, patients, families

Also consider:

Extend use of Contact Precautions beyond duration of diarrhea (e.g., 48 hours)
Presumptive isolation for symptomatic patients pending confirmation of C. diff infection
Evaluate and optimize testing for C. diff infection
Implement soap and water for hand hygiene before exiting room of a patient with C. diff infection
Implement universal glove use on units with high C. diff infection rates
Use EPA-registered disinfectants with sporicidal claim (e.g., bleach) or sterilants for environmental disinfection
Implement an antimicrobial stewardship program

For the full C. difficile prevention toolkit, visit the Prevention Tools page
Full CDC guidelines available at HICPAC website

To Prevent MRSA Infections

Comply with CDC hand hygiene recommendations
Implement Contact Precautions for MRSA colonized and infected patients
Recognize previously MRSA colonized and infected patients
Rapidly report MRSA lab results
Provide MRSA education for healthcare providers

Also consider:

Active surveillance testing – screening of patients to detect colonization even if no evidence of infection
Other novel strategies
- Decolonization
- Chlorhexidine bathing

For the full CAUTI prevention toolkit, visit the Prevention Tools page
Full CDC guidelines available at HICPAC website