National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination

Health Care-Associated Infections (HAIs)

Health care-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a health care setting. HAIs can be acquired anywhere health care is delivered, including inpatient acute care hospitals, outpatient settings such as ambulatory surgical centers and end-stage renal disease facilities, and long-term care facilities such as nursing homes and rehabilitation centers. HAIs may be caused by any infectious agent, including bacteria, fungi, and viruses, as well as other less common types of pathogens.

These infections are associated with a variety of risk factors, including:

  • Use of indwelling medical devices such as bloodstream, endotracheal, and urinary catheters
  • Surgical procedures
  • Injections
  • Contamination of the health care environment
  • Transmission of communicable diseases between patients and healthcare workers
  • Overuse or improper use of antibiotics

Magnitude of the Problem

HAIs are a significant cause of morbidity and mortality. At any given time, about 1 in every 25 inpatients has an infection related to hospital care. These infections cost the U.S. health care system billions of dollars each year and lead to the loss of tens of thousands of lives. In addition, HAIs can have devastating emotional, financial and medical consequences. 

A majority of hospital-acquired HAIs include:

  • Urinary tract infections
  • Surgical site infections
  • Bloodstream infections
  • Pneumonia

The U.S. Department of Health and Human Services (HHS) has identified the reduction of HAIs as an Agency Priority Goal for the Department and is committed to reducing the national rate of HAIs by demonstrating significant, quantitative, and measurable reductions in hospital-acquired central line-associated bloodstream infections and catheter-associated urinary tract infections.

Please visit HAI Agency Priority Goals for more information on HAI specific goals, including the progress made to date.

Please visit HHS Agency Priority Goals for more information on all of the HHS Agency Priority Goals. 

Call to Action

There is growing consensus that our ultimate goal should be the elimination of HAIs. To coordinate and maximize the efficiency of prevention efforts, a senior-level Federal Steering Committee for the Prevention of Health Care-Associated Infections was established in 2008. Members include clinicians, scientists, and public health leaders who are high-ranking officials from the HHS, U.S. Department of Defense, U.S. Department of Labor, and U.S. Department of Veterans Affairs. The Steering Committee marshaled the extensive and diverse resources across the federal government, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations.

In 2009, the Steering Committee developed the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan). At a meeting [PDF - 315 KB] held in late 2010, subject matter experts (SMEs) met to discuss strategies to accelerate the progress toward national infection reduction goals. Since the 2010 meeting, several other large national meetings, as well as specific stakeholder meetings have taken place to build upon the strategies discussed at the 2010 meeting.

Collaboration

In April 2011, HHS announced another way it is committed to patient safety: Partnership for Patients. It is a public-private partnership to make hospital care safer, more reliable, and less costly by:

  • Keeping hospital patients from getting injured or sicker
  • Helping patients heal without complication

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National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination


Action Plan Development

In recognition of health care-associated infections (HAIs) as an important public health and patient safety issue, the U.S. Department of Health and Human Services (HHS) convened the Federal Steering Committee for the Prevention of Health Care-Associated Infections (originally called the HHS Steering Committee, but was changed to reflect the addition of agencies outside of HHS). The Steering Committee's charge is to coordinate and maximize the efficiency of prevention efforts across the federal government. Members of the Steering Committee include clinicians, scientists, and public health leaders representing:

  • Administration for Community Living (ACL)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Centers for Disease Control and Prevention (CDC)
  • Centers for Medicare & Medicaid Services (CMS)
  • Food and Drug Administration (FDA)
  • Health Resources and Services Administration (HRSA)
  • Indian Health Service (IHS)
  • National Institutes of Health (NIH)
  • Office of the Secretary (OS)
    • National Vaccine Program Office (NVPO)
    • Office of Disease Prevention and Health Promotion (ODPHP)
  • Office of the Assistant Secretary for Planning and Evaluation (ASPE)
  • Office of the Assistant Secretary for Public Affairs (ASPA)
  • Office of the National Coordinator for Health Information Technology (ONC)
  • U.S. Department of Defense (DoD)
  • U.S. Department of Labor (DOL)
  • U.S. Department of Veterans Affairs (VA)

The Steering Committee marshaled the extensive and diverse resources of the Department, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations. Along with scientists and program officials across HHS, the Steering Committee released the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan). The HAI Action Plan provides a road map for preventing HAIs in acute care hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities.  The HAI Action Plan also includes a chapter on increasing influenza coverage of health care personnel. 

The Office of Disease Prevention and Health Promotion, on behalf of the Federal Steering Committee for the Prevention of Health Care-Associated Infections, releases the April 2013 National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. The latest HAI Action Plan reflects a significant update and expansion from the initial version issued in 2009. It includes new sections specific to infection reduction in ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities, as well as a section on increasing influenza vaccination of health care personnel.

The National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination includes:


Phase One: Acute-Care Hospitals

Phase One of the HAI Action Plan addresses the most common infections in acute care inpatient settings and outlines a prioritized research agenda, an integrated information systems strategy, policy options for linking payment incentives or disincentives to quality of care and enhancing regulatory oversight of hospitals, and a national messaging and communications plan to raise awareness of HAIs among the general public and prevention strategies among health care workers:

This HAI Action Plan includes five-year goals for eight specific measures of improvement in HAI prevention.


Phase Two: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Health Care Personnel

The health care and public health communities are increasingly challenged to identify, respond to, and prevent HAIs across the continuum of settings where health care is delivered. The public health model’s population-based perspective can increasingly be deployed to enhance the prevention of HAIs, particularly given the shifts in health care delivery from acute care settings to ambulatory and long-term care settings. The Steering Committee clearly articulated the need to maintain the HAI Action Plan as a “living document,” developing successor plans in collaboration with public and private stakeholders to incorporate advances in science and technology, shifts in the ways health care is delivered, changes in health care system processes and cultural norms, and other factors.

Below are the latest chapters for Phase Two:

  • Ambulatory Surgical Centers (April 2013) [PDF - 302 KB]
  • End-Stage Renal Disease Facilities (April 2013) [PDF - 654 KB]
  • Influenza Vaccination of Health Care Personnel (April 2013) [PDF - 418 KB]

These chapters comprise the second phase – Phase Two – of the HAI Action Plan, extending its scope to the outpatient environment and addressing the health and safety of health care workers, as well as the risks of transmission of influenza from health care personnel to patients.


Phase Three: Long-Term Care Facilities

Since the publication of the original HAI Action Plan in 2009 which focused on the acute care setting, there has been awareness of the need for strategies to address HAIs in long-term care facilities. A growing number of individuals are receiving care in long-term care settings, such as skilled nursing facilities and nursing homes. The population in these facilities is requiring more complex medical care as a result of increased transitions between health care settings. These trends can create an increased risk for HAIs, which can worsen health status and increase health care costs. The Steering Committee chose to address HAIs in long-term care facilities for Phase Three.  


Evaluation of the Health Care-Associated Infections Action Plan

The Office of Disease Prevention and Health Promotion (ODPHP), Division of Healthcare Quality, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC) contracted with Insight Policy Research, IMPAQ International (IMPAQ) and the RAND Corporation (RAND) to produce iterative and comprehensive evaluations of HHS programs related to the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.

Longitudinal Program Evaluation of the Health Care-Associated Infections HHS Action Plan-Year 1 Report (September 2011) [PDF – 1760 KB], the first report of the evaluation, examined initial progress toward achieving Action Plan targets. The evaluation found that measurable progress has been made in reducing health care-associated infections (HAIs) and specifically aimed to:

  • Record current and future design, content, and progress of the HAI Action Plan.
  • Provide feedback on how to strengthen monitoring capabilities
  • Offer insights to identify prospective high-yield opportunities to reduce HAIs.

In addition to the successes noted to date, the evaluation also identified several areas for improved coordination and outreach. For the Federal Steering Committee for the Prevention of Health Care-Associated Infections response to the report, view the cover letter [PDF – 315 KB].


State Healthcare-Associated Infection Prevention Plans

The 2009 Omnibus Law required states receiving Preventive Health and Health Services (PHHS) Block Grant funds to certify that they will submit a plan to prevent HAIs to the Secretary of Health and Human Services by January 2010. HHS received plans from all 50 states, the District of Columbia, and Puerto Rico.

The HHS Report to Congress on Healthcare-Associated Infections: FY 2010 State Action Plans addresses the adequacy of State Healthcare-Associated Infection (HAI) Action Plans for achieving state and national goals for reducing HAIs. It responds to the joint explanatory statement to accompany H.R. 1105, the Omnibus Appropriations Law, 2009 (Public Law 111-8):

"…Each State plan shall be consistent with the Department of Health and Human Services' national action plan for reducing healthcare-associated infections and include measurable 5-year goals and interim milestones for reducing such infections: Provided further, That the Secretary shall conduct a review of the State plans submitted pursuant to the preceding proviso and report to the Committees on Appropriations of the House of Representatives and the Senate…"

Find out what each state is doing to prevent HAIs.

National State-Specific HAI Summary Data Reports

To see the current Standardized Infection Ratio (SIR) NHSN National Data report along with previous reports visit CDCs NHSNs National HAI Data Report page.

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National Targets and Metrics

The national acute care hospital targets for the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination expired in December 2013. New targets for 2020 have been drafted based on discussions during a conference held in Washington, DC in September 2013.

See the draft of proposed new targets for 2020 [PDF – 107 KB].

Monitoring Progress Toward Action Plan Goals

The Federal Steering Committee for the Prevention of Health Care-Associated Infections intends to review on an annual basis progress toward achieving the eight targets in the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan).  The HAI Action Plan focuses on reducing the incidence of specific health care-associated infections and increasing adherence to specific sets of recommended prevention practices. Progress is steadily taking place. Below you will find a summary of the progress through October 2012:

  • Marked improvement in infection rates for central line-associated bloodstream infections, health care-associated invasive methicillin-resistant Staphylococcus aureus (MRSA) infections, and surgical site infections, constituting timely progress toward the 5-year targets;
  • Improvement in compliance with all five Surgical Care Improvement Project process measures to reduce the risk of surgical site infections;
  • Leveling of hospitalizations with Clostridium difficile infection, but not a marked decrease. More work is needed to reduce the rate to meet the 2013 goal.

Table 1: Summary of Progress Toward the National Targets for
Elimination of Health Care-Associated Infections

Metric

Source

National 5-year Prevention Target

On Track to Meet 2013 Targets?

Bloodstream infections

NHSN

50% reduction

Yes

Clostridium difficile (hospitalizations)

HCUP

30% reduction

No

Clostridium difficile infections

NHSN

30% reduction

No

Urinary tract infections

NHSN

25% reduction

No

MRSA invasive infections (population)

EIP

50% reduction

Yes

MRSA bacteremia (hospital)

NHSN

25% reduction

No

Surgical site infections

NHSN

25% reduction

Yes

Surgical Care Improvement Project Measures

SCIP

95% adherence

Retired

* 2010 - 2011 is the baseline period.
EIP is the CDC’s Emerging Infections Program; HCUP is AHRQ’s Healthcare Cost and Utilization Project; NHSN is the CDC’s National Healthcare Safety Network; SCIP is Surgical Care Improvement project.

Summary of the Progress

The information below offers greater detail regarding the current progress toward the eight goals. It includes the baseline measure, the most current assessment, and additional notes on the measures and data.

1. Central Line-Associated Bloodstream Infections (CLABSI)

  • 2013 National Prevention Target: 50% reduction in CLABSI in intensive care unit (ICU) and ward-located patients or 0.50 Standardized Infection Ratio (SIR)

    ON TRACK TO MEET TARGET*
  • 2012 Assessment (All inpatient locations in acute care hospitals, excluding long-term acute care facilities and rehabilitation facilities): 44% reduction or 0.56 SIR
  • 2011 Assessment [PDF - 254 KB] (All inpatient locations in acute care hospitals, excluding long-term acute care facilities and rehabilitation facilities): 41% reduction or 0.59 SIR
  • 2010 Assessment (All inpatient locations in acute care hospitals and excluding long-term acute care facilities and rehabilitation facilities): 32% reduction or 0.68 SIR
  • 2010 Assessment (Non-Neonatal Intensive Care Units [NICUs] and wards): 33% reduction or 0.67 SIR*

*This data was originally posted in October 2011. It was recalculated in April 2012 to account for more locations being used in the SIR calculation. The 2009 and 2010 SIR were initially calculated using only non-NICU ICUs and wards. The new methodology calculates the SIR using all inpatient locations in acute care hospitals and long-term acute care hospitals.

Data source: CDC’s National Healthcare Safety Network

Get more information on CLABSI.

2. Clostridium difficile (hospitalizations) [PDF - 2MB]

  • 2013 National Prevention Target: 30% reduction in hospitalizations with C. difficile

    NOT ON TRACK TO MEET TARGET
  • 2012 Assessment: 13.6 hospitalizations per 1,000 discharges; 17.2% increase from baseline
  • 2011 Assessment [PDF - 334KB]: 12.4 hospitalizations per 1,000 discharges; 6.9% increase from baseline
  • Baseline Measurement (2008): 11.6 hospitalizations with C. difficile per 1,000 discharges

Data source: AHRQ’s Healthcare Cost and Utilization Project

3. Clostridium difficile Infections

  • 2013 National Prevention Target: 30% reduction in facility-wide health care facility-onset C. difficile or 0.70 SIR

    NOT ON TRACK TO MEET TARGET
  • 2012 Assessment: 0.98 SIR; 2% decrease from baseline
  • Baseline Measurement [PDF - 342KB]: 2010-2011 is the baseline period

Data source: CDC’s National Healthcare Safety Network

4. Catheter-Associated Urinary Tract Infections (CAUTI)

  • 2013 National Prevention Target: 25% reduction in CAUTI in ICU and ward-located patients or 0.75 SIR

    NOT ON TRACK TO MEET TARGET
  • 2012 Assessment (all inpatient locations in acute care hospitals, excluding NICUs, long term acute care facilities, and rehabilitation facilities): 2.0% increase or 1.02 SIR
  • 2011 Assessment [PDF - 254KB] (all inpatient locations in acute care hospitals, excluding NICUs, long term acute care facilities, and rehabilitation facilities):  7.0% reduction or 0.93 SIR
  • 2010 Assessment (all inpatient locations, excluding NICUs and long-term acute care facilities and rehabilitation facilities): 6.0% reduction or 0.94 SIR
  • 2010 Assessment (Non-NICU ICUs and wards in acute care hospitals): 7.0% reduction or 0.93 SIR*

*This data was originally posted in October 2011. It was recalculated in April 2012 to reflect the addition of long-term care acute facilities to the SIR calculation.

^The data source changed its surveillance definition for CAUTI in January 2009, so the five-year target period has been extended from 2013 to 2014.

Data source: CDC’s National Healthcare Safety Network

Get more information on CAUTI.

5. MRSA Invasive Infections (Population)

  • 2013 National Prevention Target: 50% reduction in the incidence of health care-associated invasive MRSA infections

    ON TRACK TO MEET TARGET
  • 2012 Assessment: 31% reduction; 18.74 infections per 100,000 persons
  • 2011 Assessment [PDF - 307 KB]: 26.3% reduction; 20.06 infections per 100,000 persons
  • 2010 Assessment: 19.7% reduction; 21.76 infections per 100,000 persons*
  • Baseline Measurement (2007-2008): 27.08 infections per 100,000 persons*

*The data source changed the methodology to more accurately reflect the data and now adjusts for sex and receipt of chronic dialysis, in addition to age and race, which were already included in the calculations.

Data source: CDC’s Emerging Infections Program Active Bacterial Core Surveillance

Get more information on MRSA invasive (population).

6. MRSA Bacteremia (Hospital)*

  • 2013 National Prevention Target: 25% reduction in facility-wide health care facility-onset MRSA or 0.75 SIR

    NOT ON TRACK TO MEET TARGET
  • 2012 Assessment: 3% reduction or 0.97 SIR
  • Baseline Measurement [PDF - 295 KB]: 2010-2011 is the baseline period

* These data from the first half of 2012 are incomplete and therefore only preliminary at this time.

Due to a change in the data collection procedures in January 2010, the assessment period has been extended to December 2015, so that data are uniform for the entire period.

Data source: CDC’s National Healthcare Safety Network

7. Surgical Site Infections (SSI)

  • 2013 National Prevention Target: 25% reduction in admission and readmission SSI or 0.75 SIR

    ON TRACK TO MEET TARGET
  • 2012 Assessment: 20% reduction or 0.80 SIR
  • 2011 Assessment [PDF - 373KB]: 17% reduction or 0.83 SIR+
  • 2010 Assessment: 8% reduction or 0.92 SIR*

+Reporting of deep incisional and organ/space SSIs attributable to 2011 continues through the end of calendar year 2012 per NHSN protocol requirements.  Measure will be final in early 2013.

*The data that was originally posted in October 2011 (10% reduction or 0.90 SIR) differs slightly from the revised number here due to additional facility reporting and adjustments made through evaluations and validation studies.

Data source: CDC’s National Healthcare Safety Network

Get more information on SSIs.

Conclusion

Timely progress has been made toward most targets for which associated data are available. Although this progress is promising, continued efforts are needed to achieve the goals in the HAI Action Plan. In the case of Clostridium difficile, efforts must be enhanced and accelerated to achieve the target.  

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Organizational Structure of the HHS Initiative for the Prevention of Health Care-Associated Infections

The U.S. Department of Health and Human Services (HHS) has undertaken several inter-agency initiatives to improve and expand health care-associated infection (HAI) prevention efforts. One of these initiatives was the establishment of the Federal Steering Committee for the Prevention of Health Care-Associated Infections. The Division of Health Care Quality in the Office of Disease Prevention and Health Promotion coordinates the activities of the Steering Committee.

The Steering Committee includes senior-level representatives from the Operating and Staff Divisions of HHS and is chaired by a Deputy Assistant Secretary for Health. The Deputy Assistant Secretary for Health charged the Steering Committee with developing and implementing the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.

The Steering Committee uses a phased working group structure to accomplish its charge. Each of the ten working groups enumerated strategies for accomplishing a portion of the HAI Action Plan. The diagram below shows the organization of the working groups by phase:

  • Phase One focuses on addressing six high priority HAI-related areas within the acute care hospital setting - surgical site infections, central line-associated bloodstream infections, ventilator-associated events formely ventilator-associated pneumonia, catheter-associated urinary tract infections, Clostridium difficile infections, and methicillin-resistant Staphylococcus aureus (MRSA) infections.
  • Phase Two expands efforts outside of the acute care setting into outpatient facilities. It includes strategies to reduce HAIs in ambulatory surgical centers (ASCs) and end-stage renal disease facilities (ESRDs), as well as a strategy to increase influenza vaccination coverage among healthcare personnel (HCP).
  • Phase Three expands efforts into long-term care facilities, specifically skilled-nursing facilities (SNFs) and nursing facilities (NFs).

Working Groups of the Federal Steering Committee for the Prevention of Health Care-Associated Infections

1. Prevention and Implementation 

Roles:      

  • Identify prioritized clinical practices or evidence-based unit-level or facility-specific interventions to prevent HAIs
  • Promote implementation of priority clinical practices (i.e., CDC guidelines) or proven effective interventions

Agency Lead: Centers for Disease Control and Prevention (CDC)


2. Research 

Roles:

  • Identify gaps in the existing knowledge base of the effectiveness of HAI prevention practices, epidemiology of HAIs, and pathogenesis, transmission and colonization of health care-associated pathogens
  • Develop and implement a coordinated, complementary research agenda

Agency Lead: Agency for Healthcare Research and Quality (AHRQ) 


3. Information Systems and Technology 

Roles:

  • Develop and implement a coordinated strategy to integrate HAI-related surveillance and reporting systems
  • Align data definitions and standardize data measures needed to measure the burden of HAIs

Agency Leads: Office of the National Coordinator for Health Information Technology (ONC) & CDC 


4. Incentive and Oversight 

Role:

  • Identify options for and leverage payment policies and incentives to prevent HAIs
  • Identify policy and programmatic options for assuring compliance with HAI prevention practices in health care facilities

Agency Lead: Centers for Medicare & Medicaid Services (CMS) 


5. Outreach and Messaging 

Role:

  • Develop and implement a national messaging strategy for HAI prevention to raise awareness of the issue among various stakeholder groups, including patients or consumers

Agency Lead: Office of Disease Prevention and Health Promotion (ODPHP)


6. Evaluation 

Roles:

  • Develop the metrics and targets associated with the initiative in partnership with non-government stakeholders.
  • Develop and refine a framework for evaluating the Department’s activities related to the HAI Action Plan.

Agency Lead: ODPHP


7. Influenza Vaccination of Health Care Personnel

Role:

  • Develop benchmarks for measuring short term, mid-term and long-term progress objectives which will be aligned with the Healthy People 2020 objective for increasing seasonal influenza vaccination coverage of health care personnel (HCP).

Background:

Because most HCP provide care to, or are in frequent contact with, patients at high risk for complications of influenza, HCP are a high priority for expanding vaccine use. Achieving and sustaining high vaccination coverage among HCP will protect staff and their patients and reduce disease burden and health care costs.

Although it is a high priority for reducing morbidity associated with influenza in health care settings, preliminary data for the 2010-11 flu season suggest 63.5% of HCP reported receiving seasonal influenza vaccine.

Agency Lead: CDC 


8. Ambulatory Surgical Centers 

Role:

  • Identify comprehensive strategies to reduce the incidence of HAIs in this healthcare setting

Background:

ASCs are defined by CMS as distinct entities that operate exclusively to provide surgical services to patients who do not require hospitalization and are not expected to need to stay in a surgical facility longer than 24 hours. Many of the services performed in these facilities extend beyond procedures traditionally thought of as surgery, including endoscopy, injections to treat chronic pain, and dental care. Currently, there are over 5,300 Medicare-certified ASCs in the U.S., which represents a greater than 50% increase since 2001. In 2007 more than six million surgeries were performed in these facilities and paid for by Medicare at a cost of nearly $3 billion. Over the last decade, ASCs have demonstrated tremendous growth both in the volume and complexity of procedures being performed.

Agency Leads: CDC & Indian Health Service (IHS)


9. End-Stage Renal Disease Facilities 

Role: Identifies comprehensive strategies to reduce the incidence of HAIs in this health care setting

Background:

Infection is a leading cause of morbidity and is second only to cardiovascular disease as the leading cause of death in the chronic uremic patient on hemodialysis. According to the United States Renal Data System, the total death rate due to infection is 76 per 1,000 patient-days with sepsis responsible for three quarters of these infection-related deaths. In comparison to the general population, the incidence of sepsis in patients with ESRD can be up to 100 times higher. Infections are a major reason for hospitalizations in this population, estimated to be responsible for as many as 20% of all inpatient admissions. It has been predicted that the number of ESRD patients will increase approximately 1.5-fold by the year 2020, underscoring the importance for prevention efforts in this population to reduce the physical, emotional, and financial cost of infections.

Agency Lead: CMS


10. Long-Term Care Facilities

Role: Identifies comprehensive strategies to reduce the incidence of HAIs in this health care setting

Background: Current HAI burden estimates in SNFs and NFs, the two types of settings that the HAI Action Plan will initially focus on, show that between 1.6 and 3.8 million infections each year, with an estimated 150,000 additional hospitalizations and 380,000 additional deaths among nursing home (NH) residents, while adding an estimated $673 million in additional health care costs. 

Currently, data sources for HAIs in long-term care facilities (LTCF) are limited.  Most data collection systems currently in place are not designed as HAI surveillance systems, nor are they deemed adequate for HAI surveillance, which serves to highlight the need to develop the LTCF strategy in the HAI Action Plan.

Most common HAIs in NHs include: Urinary tract infections (UTIs), which includes both catheter-associated and non-catheter associated UTIs; Lower respiratory tract Infections, primarily influenza and pneumonia; gastroenteritis, primarily caused by Clostridium difficile or Norovirus infection; and skin and soft tissue infections.

Agency Leads: CDC & ODPHP

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