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CHAPTER 17: INFECTIONS ACQUIRED IN HEALTH CARE FACILITIES

Robert A. Weinstein

INTRODUCTION

The costs of hospital-acquired (nosocomial) and other health care–associated infections are great. These infections have affected as many as 1.7 million patients at a cost of ~$28–33 billion and 99,000 lives in U.S. hospitals annually. Although efforts to lower infection risks have been challenged by the numbers of immunocompromised patients, antibiotic-resistant bacteria, fungal and viral superinfections, and invasive devices and procedures, a prevailing viewpoint—often termed “zero tolerance”—is that almost all health care–associated infections should be avoidable with strict application of evidence-based prevention guidelines (Table 17-1). In fact, rates of device-related infections—historically, the largest drivers of risk—have fallen steadily over the past few years. Unfortunately, at the same time, antimicrobial-resistant pathogens have risen in number and are estimated to contribute to ~23,000 deaths in and outside of hospitals annually. This chapter reviews health care–associated and device-related infections as well as basic surveillance, prevention, control, and treatment activities.

TABLE 17-1SOURCES OF INFECTION CONTROL GUIDELINES AND OVERSIGHT
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TABLE 17-1 SOURCES OF INFECTION CONTROL GUIDELINES AND OVERSIGHT
ORGANIZATION ROLE MAJOR CONSTITUENTS WEBSITE
Joint Commission Regulatory Hospitals, long-term-care facilities, laboratories www.jointcommission.org
CAP Regulatory Laboratories www.cap.org
OSHA Regulatory Workers www.osha.gov
CMS Regulatory Medicare/Medicaid providers www.cms.hhs.gov
PQRI Regulatory and advisory Eligible professionals www.cms.hhs.gov/pqri/
HHS Action Plan Regulatory and advisory Health care and infection prevention personnel www.hhs.gov/ash/initiatives/hai/actionplan/
CDC
 DHQP Advisory Health care facilities and personnel www.cdc.gov/ncezid/dhqp/
 HICPAC Advisory Health care facilities and personnel www.cdc.gov/hicpac/
 NIOSH Advisory Workers www.cdc.gov/niosh/
AHRQ Advisory Broad (e.g., health care personnel) www.ahrq.gov
NQF Advisory Broad (e.g., health care personnel) www.qualityforum.org
IOM Advisory Broad (e.g., health care personnel) www.iom.edu
Federal Influenza Planning Advisory Health care and public health personnel www.flu.gov/planning-preparedness/hospital#
Trust for America’s Health Advisory Broad (e.g., the public) healthyamericans.org
CSTE Advisory and professional society Public health personnel www.cste.org
IDSA Professional society Infectious disease physicians/researchers www.idsociety.org
SHEA Professional society Health care epidemiologists www.shea-online.org
HIS Professional society Health care epidemiologists www.his.org.uk
APIC Professional society Infection preventionists www.apic.org
MedQIC Quality improvement Broad (e.g., health care personnel) www.qualitynet.org
IHI Quality improvement Broad (e.g., health care personnel) www.ihi.org
Leapfrog Group Quality improvement Broad (payers, consumers, employers, and health care personnel) www.leapfroggroup.org
NSQIP Quality improvement Surgery services www.acsnsqip.org

Abbreviations: AHRQ, Agency for Healthcare Research and Quality; APIC, Association for Professionals in Infection Control and Epidemiology; CAP, College of American Pathologists; CDC, Centers for Disease Control and Prevention; CMS, Centers for Medicare & Medicaid Services; CSTE, Council of State and Territorial Epidemiologists; DHQP, Division of Healthcare Quality Promotion; HHS, Health and Human Services; HICPAC, Healthcare Infection Control Practices Advisory Committee; HIS, Hospital Infection Society; IDSA, Infectious Diseases Society of America; IHI, Institute for Healthcare Improvement; IOM, Institute of Medicine; MedQIC, Medicare Quality Improvement Community; NIOSH, National Institute for Occupational Safety and Health; NQF, National Quality Forum; NSQIP, National Surgical Quality Improvement Program; OSHA, Occupational Safety & Health Administration; PQRI, Physician Quality Reporting Initiative; SHEA, Society for Healthcare Epidemiology of America.

ORGANIZATION, RESPONSIBILITIES, ...

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