Hospital Infection Prevention: How Much Can We Prevent and How Hard Should We Try?

Abstract

Purpose of Review To summarize the extent to which hospital-acquired infections (HAIs) are preventable and to assess expectations, challenges, and barriers to improve patient outcomes. Recent Findings HAIs cause significant morbidity and mortality. Getting to zero HAIs is a commonly stated goal yet leads to unrealistic expectations. The extent to which all HAIs can be prevented remains debatable and is subject to multiple considerations and barriers. Current infection prevention science is inexact and evolving. Evidence-based infection prevention practices are often incompletely implemented and at times controversial. Highly sensitive surveillance results in overdiagnosis, calling into question the real incidence of HAIs. Perceived reductions in HAIs by gaming the system lead to false conclusions about preventability and may cause harm. Successful HAI reduction programs require executive oversight yet keeping hospital leaders engaged in infection prevention is a challenge given competing priorities. Medicine is not a physical science with precisely defined laws; thus, infection prevention interventions are subject to variable outcomes. Summary Perhaps up to 55-70% of HAIs are potentially preventable. This is subject to a law of diminishing returns as the preventable proportion of HAIs may reduce over time with improvements in patient safety. As the principle tenet of medicine is first do no harm, infection prevention programs should relentlessly pursue reliable, sustainable, and practical strategies for heightened patient safety.

The learning hospital: From theory to practice in a hospital infection prevention program

“…• Hospital infection prevention: how much can we prevent and how hard should we try? -Bearman et al 123 • Averting a betrayal of trust: system and individual accountability in healthcare infection prevention -Bearman and Vokes 124 • Infection prevention in the hospital from past to present. evolving roles and shifting priorities -Doll et al 125 • Infection control precautions for visitors to healthcare facilities -Banach et al 126 • An unconventional house call -Bearman 127 • Mandatory public reporting in the USA: an example to follow?…”

Impact of a nutrition support therapy on hospital‐acquired infections: A value analysis

“…Numerous modalities have been described to directly prevent HAIs, including protocols in adequate cleaning and disinfection, hand washing, and sterilization of medical equipment. [16][17][18][19] These protocols emphasize the reduction in the spread of pathogens; however, other modalities, such as nutrition therapy, may enhance the patient's ability to prevent HAIs.…”

Continued wearing of gloves: a risk behaviour in patient care

“…The prevention of HAIs is therefore of great importance. Approximately one third (and as much as 70%) of all HAIs are considered to be preventable [ 1 , 2 ]. The single most important measure is for healthcare personnel (HCP) to be compliant with hand hygiene measures [ 3 ].…”