Objective Status

  • 2 Baseline only
  • 1 Developmental
  • 0 Research

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About the Workgroup

Approach and Rationale

HAIs threaten patient safety and health care quality. HAIs are infections people can get while receiving medical care in any health care setting. HAIs can be associated with procedures such as surgery and devices like catheters or ventilators. Many HAIs can be prevented by implementing proven best practices.

In hospitals alone, 1 in 31 hospitalized patients have at least 1 HAI at any given time, with more than 680,000 infections and billions of dollars in excess health care costs related to HAIs across the United States every year.1,2 Although significant progress has been made in preventing some HAI types over the last decade, there is much more work to be done. Furthermore, many of these infections are caused by antibiotic-resistant (AR) pathogens. HAIs and other infections can also lead to sepsis, which causes an estimated 1.7 million illnesses and 270,000 deaths annually in the United States.3 Reducing HAIs across all health care settings supports the HHS mission to prevent infections, improve patient safety, combat AR and its complications, and reduce excess health care costs. These efforts also align with the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination4 and the National Action Plan for Combating Antibiotic-Resistant Bacteria.5

The 2 core objectives identified by the HAI Workgroup aim to reduce hospital-onset C. diff (Clostridioides difficile) and hospital-onset MRSA (Methicillin-resistant Staphylococcus aureus) infections. In addition, the workgroup has added a developmental objective related to improving antibiotic use in outpatient settings. As more data become available, this developmental objective may become a core objective. 

C. diff is a preventable, life-threatening bacterial infection that can occur in both inpatient and outpatient health care settings. It causes severe diarrhea. Use of antibiotics is an important risk factor for this infection, and patient movement between health care facilities contributes to spreading these infections. 

MRSA is a common type of bacteria spread in health care facilities and the community. MRSA can cause difficult-to-treat staph infections because of resistance to some antibiotics and is often linked to life-threatening bloodstream infections, pneumonia, and surgical site infections, which can lead to sepsis and death. MRSA infections overall are dropping, but progress to prevent MRSA bloodstream infections in health care settings is slowing. In addition, the ongoing opioid epidemic may be contributing to community-associated MRSA infections and also slowing progress to reduce MRSA infections overall.

Antibiotics have been a critical health care and public health tool since the discovery of penicillin in 1928, saving the lives of millions of people around the world.4 Today, however, the emergence of drug resistance in bacteria is reversing the progress of the past 80 years, with drug choices for the treatment of many bacterial infections becoming increasingly limited, expensive, and — in some cases — nonexistent. Improving appropriate antibiotic use and prescribing practices is an important evidence-based intervention that improves individual patient outcomes, reduces risk of C. diff, reduces the overall burden of AR infections, shortens hospital stays, and reduces health care costs. Approximately 258 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States in 2017, with at least 30 percent of them considered unnecessary.6

Understanding Healthcare-Associated Infections

Data-driven strategies and tools to help prevent HAIs include improving infection control practices and hand hygiene, improving antibiotic use and prescribing practices, increasing attention to safety culture, and performing proper cleaning and disinfection at health care facilities. Using data for action informs prevention efforts and the development of tools and interventions for specific provider groups and health care settings. In addition, engaging health care providers and other partners (like health care systems, state and local health departments, professional organizations, payors, and accreditation organizations) is critical for driving progress in this area.

Emerging Issues in Healthcare-Associated Infections

Many efforts to prevent HAIs have focused on acute care settings. Increasingly, health care delivery, including complex procedures, is being shifted to outpatient settings — like ambulatory surgical centers — end-stage renal disease facilities, and long-term care facilities. These settings often have limited capacity for oversight and infection control compared to hospital-based settings. Because patients with HAIs often move between various types of health care facilities and settings, prevention efforts must also expand across the continuum of care. Moreover, challenges posed by AR organisms and C. diff are best addressed through coordinated action among health care facilities in a given region.



Centers for Disease Control and Prevention. (2020). Healthcare-Associated Infections Data Portal. Retrieved from https://www.cdc.gov/hai/data/portal/index.html


Magill, S.S. et al. (2018). Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. New England Journal of Medicine, 379, 1732-1744. DOI: 10.1056/NEJMoa1801550.


Rhee, C., et al. (2017). Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA, 318(13), 1241-1249. DOI: 10.1001/jama.2017.13836


Office of Disease Prevention and Health Promotion. (n.d.) National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. Retrieved from https://health.gov/hcq/prevent-hai-action-plan.asp


The White House. (2015). National Action Plan for Combating Antibiotic-Resistant Bacteria [PDF file]. Retrieved from https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf


Centers for Disease Control and Prevention. (2019). Outpatient Antibiotic Prescriptions — United States, 2017. Retrieved from https://www.cdc.gov/antibiotic-use/community/programs-measurement/state-local-activities/outpatient-antibiotic-prescriptions-US-2017.html