Page header will display here

HAIs: What They Are

Healthcare-acquired infections (HAIs), also known as nosocomial infections, are infections that patients get while receiving treatment for medical or surgical conditions. HAIs occur in all settings of care, including hospitals, surgical centers, ambulatory clinics, and long-term care facilities such as nursing homes and rehabilitation facilities.

Who's At Risk

All hospitalized patients are susceptible to contracting a nosocomial infection. Some patients are at greater risk than others-young children, the elderly, and persons with compromised immune systems are more likely to get an infection. Other risk factors are long hospital stays, the use of indwelling catheters, failure of healthcare workers to wash their hands, and overuse of antibiotics.

In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

  • 32 percent of all healthcare acquired infection are urinary tract infections
  • 22 percent are surgical site infections
  • 15 percent are pneumonia (lung infections)
  • 14 percent are bloodstream infections

What's at Stake

Patients who acquire infections from surgery spend, on average, an additional 6.5 days in the hospital, are five times more likely to be readmitted after discharge and twice as likely to die. Moreover, surgical patients who develop infections are 60 percent more likely to require admission to a hospital's intensive care unit. Surgical infections are believed to account for up to ten billion dollars annually in healthcare expenditures.

What Providers Are Doing to Prevent HAIs

Recent reports have shown that many HAIs can be prevented through the strict adherence to evidence-based best practices. Recommendations include:

  • healthcare providers cleaning their hands with soap and water or an alcohol-based hand rub before and after caring for every patient;
  • catheters being used only when necessary and removed as soon as possible;
  • cleaning the skin where the catheter is being inserted or the surgical site, and
  • providers wearing hair covers, masks, gowns and gloves when appropriate.

Healthcare providers are making great strides to reduce, and in some cases eliminate, HAIs. In this section resources are identified and case study examples are highlighted to assist healthcare providers to improve the prevention of HAIs.  

How to Protect Yourself Against HAIs

The CDC has released these example questions for patients to raise to their nurses and doctors to protect themselves from Healthcare-associated Infections.

CDC Checklist for Core Elements of Hospital Antibiotic Stewardship Programs - March, 2014

The checklist (link below) is a companion to Core Elements of Hospital Antibiotic Stewardship Programs. This checklist should be used to systematically assess key elements and actions to ensure optimal antibiotic prescribing and limit overuse and misuse of antibiotics in hospitals. CDC recommends that all hospitals implement an Antibiotic Stewardship Program.

Facilities using this checklist should involve one or more knowledgeable staff to determine if the following principles and actions to improve antibiotic use are in place. The elements in this checklist have been shown in previous studies to be helpful in improving antibiotic use though not all of the elements might be feasible in all hospitals.

Click here for checklist


CDC Antibiotic Resistance Threats in the United States -  

September, 2013

Executive Summary

Antibiotics Resistance Threats in the United States, 2013 is a snapshot of the complex problem of antibiotic resistance today and the potentially catastrophic consequences of inaction. The overriding purpose of this report is to increase awareness of the threat that antibiotic resistance poses and to encourage immediate action to address the threat. This document can serve as a reference for anyone looking for information about antibiotic resistance. It is specifically designed to be accessible to many audiences. For more technical information, references and links are provided.

This report covers bacteria causing severe human infections and the antibiotics used to treat those infections.  In addition, Candida, a fungus that commonly causes serious illness, especially among hospital patients, is included because it, too, is showing increasing resistance to the drugs used for treatment.  When discussing the pathogens included in this report, Candida will be included when referencing "bacteria" for simplicity. Also, infections caused by the bacteria Clostridium difficile (C. difficile) are also included in this report.  Although C. difficile infections are not yet significantly resistant tot he drugs used to treat them, most are directly related to antibiotic use and thousands of Americans are affected each year..READ MORE


CDC Releases Infection Prevention Guide to Promote Safe Outpatient Care

According to recent findings, medical care in outpatient settings has surged in recent years, yet in many cases, adherence to standard infection prevention practices in outpatient settings is lacking. To protect patients and help educate clinicians about minimum expectations of safe care, the Centers for Disease Control and Prevention (CDC) this week released a new guide and checklist specifically for healthcare providers in outpatient care settings. The Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care is based on existing, evidence-based CDC guidelines that apply to a wide range of healthcare facilities but are mostly used by hospitals. The guide is accompanied by an infection prevention checklist for outpatient settings and supporting materials including a new, no-cost, certified continuing medical education course titled Unsafe Injection Practices: Outbreaks, Incidents, and Root Causes that is offered for clinicians in all healthcare settings. The guide also recommends that all outpatient practices should have at least one staff member with specific training in infection control. The guide and supporting materials can be used for internal assessment within a facility or practice. (CDC, press release, 7/13/11)


CDC Releases IV Catheter Infection Prevention Guidelines

The Centers for Disease Control and Prevention (CDC) just released the "Guidelines for the Prevention of Intravascular Catheter-Related Infections" that were developed for hospital, outpatient and home healthcare settings. 

They provide guidance for all types of intravascular catheters for adults and pediatrics, including:

  • Education, training and hand hygiene;
  • Skin preparation and barriers for insertion;
  • Maintenance including dressing regimens and replacement;
  • Antimicrobial catheters, cuffs, flushes, locks; and
  • Arterial catheters and pressure monitoring devices.


CDC - HAI reduction and implementation tool kits

The American Recovery and Reinvestment Act of 2009, Public Law 111-5 (ARRA), was signed into law on February 17, 2009. Within the Recovery Act, $50 million was authorized to support states in the prevention and reduction of healthcare-associated infections. Many of these funds are being used to support activities outlined in the HHS Action Plan to Prevent Health Care-Associated Infections. This CDC site tracks states' efforts to meet the goals of the plan and the results can be located on the CDC Healthcare-Associated Infections: Recovery Act site. CDC is assisting states in this process with implementation tool kits located at Premier's Safety Institute's Healthcare-Associated Infection Web site.

  • CLABSI (Catheter-related bloodstream infection)
  • C.diff (Clostridium difficile infection)
  • CAUTI (Catheter-related urinary tract infections)
  • MRSA (Methicillin-resistant S. aureus)
  • SSI (Surgical site infection


    Infection Prevention: Highlights from Massachusetts Hospitals

    For the past two years, the Massachusetts Coalition for the Prevention of Medical Errors (the Coalition) and the Massachusetts Hospital Association (MHA) have been offering programming to support the prevention of hospital-acquired infections throughout the Bay State.Massachusetts hospitals have made infection prevention a top priority for patient safety and quality improvement; executive and clinical leadership at 100% of acute-care hospitals have signed on to participate in this initiative.   The Coalition and MHA are pleased to present a sample of the infection prevention successes from Massachusetts hospitals across the state. If you are a consumer, use this guide to see what hospitals in your area are doing to prevent hospital-acquired infections. If you are a provider, look for ideas that you can incorporate into your own infection prevention efforts.

        The World Health Organization's initiative "SAVE LIVES: Clean Your Hands"

      On 5 May 2010 this initiative celebrated its second year of global action, inviting hospitals and health-care facilities throughout the world to take part in a global initiative, to continue to raise hand hygiene awareness, to move action to the point of care, and to reduce health care-associated infection (HAI). Be part of a global movement to improve hand hygiene.
    • Join the network of countries that already have hand hygiene campaigns operating.
    • Help fight HAI in your country.
    • Use the WHO tools and resources to improve hand hygiene compliance and have access to other updates and resources from WHO Patient Safety.
    • Share your knowledge and successes with others.
    • Make patient safety Your No 1 priority.


    Joint Commission Opens Portal on Health Care-Associated Infections


    The Joint Commission has announced the launch of a Web-based portal that allows health care providers to access information and resources on health care-associated infections.

    The portal contains both no-cost and for-purchase information on:

    - Common types of HAIs;
    - HAI tracking tools;
    - Strategies to prevent HAIs;
    - Strategies to identify HAIs;
    - Staff and patient education
    - A list of related performance measures.

    More information can be found at


    CDC: Hospitals continue progress in preventing infections

    The Centers for Disease Control and Prevention today announced significant gains in hospitals' efforts to prevent healthcare-associated infections in 2010. These include a 33% reduction in central line-associated bloodstream infections, 18% reduction in healthcare-associated invasive MRSA (methicillin-resistant Staphylococcus aureus), 10% reduction in surgical-site infections, and 7% reduction in catheter-associated urinary tract infections, according to data submitted to the CDC's National Healthcare Safety Network. Data on Clostridium difficile infections and MRSA bloodstream infections will be available from the network next year. "Today's news reflects the enormous amount of work and effort by hospitals, physicians, nurses and other caregivers," said John Combes, M.D., AHA senior vice president and senior fellow at the Health Research and Educational Trust. "We applaud their efforts to improve quality for patients."
    Read More>>  


    Report of the Expert Panel to Review Immediate Implant-Based Breast Reconstruction Following Mastectomy for Cancer


    A report from the Massachusetts Board of Registration in Medicine, Quality and Patient Safety Division, Betsy Lehman Center for Patient Safety and Medical Error Reduction. AHRQ-funded joint initiative
    Read More>>  


    What It Takes To Eliminate Blood Stream Infections

    An AHRQ-funded joint initiative

    Central line-associated bloodstream infections kill 31,000 patients a year; nearly as many deaths as breast cancer.  Most of these infections are preventable and you are part of the cure. We have seen an ever-increasing number of hospitals reach and sustain a rate of zero central line-associated bloodstream infections (CLABSIs) for over a year. Each quarterly report of data shows that many clinical areas can eliminate CLABSIs.  You can too.  There is no single therapy that will wipe out these infections.  It will take the concerted efforts of many people and tasks to reach zero.
    Read More>>


    AHRQ awards $34 million to expand fight against health care-associated infections

    The U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) announced the award of $34 million for projects focused on preventing health care-associated infections (HAIs). This new funding will help improve the quality of care delivered to patients and expand the fight against HAIs in hospitals, ambulatory care settings, end-stage renal disease facilities and long-term care facilities. The Centers for Disease Control and Prevention (CDC) estimate there are nearly 2 million HAIs in hospitals each year, contributing to almost 100,000 deaths. AHRQ has also collaborated with the CDC, Centers for Medicare and Medicaid Services (CMS) and the National Institute of Health (NIH) to identify research gaps to improve HAI prevention. This new funding will allow researchers to address prevention gaps as well as why they occur, methods of prevention, improving antibiotic prescribing practices and delivery and enhance communication and teamwork among health care providers. (AHRQ, press release, 11/4/10)


        On The CUSP: Stop BSI

    Twelve Massachusetts hospitals are enrolled in the national project: On the CUSP:  Stop BSI.  This project is aimed at reducing central line associated blood stream infection rates (CLABSI) in intensive care units (ICU) and improving the patient safety culture through the Comprehensive Unit-based Safety Program (CUSP).

    Read More »