Improving Quality by Reducing Health Care-Associated Infections


By Don Wright, MD, MPH, Deputy Assistant Secretary for Health; Director, ODPHP

don-wright-photo-2014Imagine a scenario in which your trusted family doctor told you that you need routine surgery. You might have been anxious or nervous at first, but you’ve had a chance to ask your doctor all your questions; you’ve planned for your recovery; and you are looking forward to living a healthier life afterward. During the surgery, however, you contract an infection that drastically impacts your recovery. Infections that people acquire while they are receiving treatment for medical or surgical conditions in a health care setting are called health care-associated infections or HAIs. Examples of HAIs include surgical site infections, central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, Clostridium difficile, and Methicillin-resistant Staphylococcus aureus (MRSA).

When patients seek medical care for an injury or illness, they expect to receive quality care and treatment and shouldn’t have to worry about an additional illness or complication. The Centers for Disease Control and Prevention (CDC) estimate that, at any one time, one in every 25 hospitalized patients has an HAI. These infections  are a serious public health issue and often result in health care complications which  impact a patient’s recovery time and quality of life; increase costs to  the patient and the health care system; and at worst, lead to an untimely death.

The good news is that many HAIs are preventable. The U.S. Department of Health and Human Services (HHS) released the National Action Plan to Prevent Health Care-Associated Infections: Roadmap to Elimination (HAI Action Plan) in 2009 to reduce HAIs in health care settings and improve the coordination of efforts across the Department. The HAI Action Plan set targets for the nation; included measures to track the reduction of HAIs in acute care hospitals; and identified gaps in research, prevention tools and resources. Since then, we have seen improvements in the prevention of HAIs, particularly central line-associated bloodstream infections. These reductions are due to improved practices and a better understanding of the problems that can lead to HAIs.

New Targets for 2020

Although we have made progress, we need to do more to prevent infections such as invasive MRSA and Clostridium difficile. Recently, HHS Secretary Sylvia M. Burwell approved new reduction targets to be achieved by 2020. The new targets reflect HHS’s continued dedication to reducing and eliminating HAIs.

The HAI Action Plan consists of three phases intended to reduce HAIs in several health care settings. Phase 1 of the HAI Action Plan focuses on preventing and reducing seven important HAIs in acute care hospital settings. To ensure that we continue working to reduce these HAIs in acute care hospitals, HHS set the following targets for 2020:

  • 50% reduction in central line-associated bloodstream infections between 2015 and 2020
  • 25% reduction in catheter-associated urinary tract infections between 2015 and 2020
  • 50% reduction in invasive methicillin-resistant Staphylococcus aureus, commonly known as MRSA, between 2015 and 2020
  • 50% reduction in facility-onset MRSA between 2015 and 2020
  • 30% reduction in Clostridium difficile infections between 2015 and 2020
  • 30% reduction in Clostridium difficile hospitalizations between 2015 and 2020
  • 30% reduction in surgical site infections between 2015 and 2020

The Office of Disease Prevention and Health Promotion (ODPHP), within the Office of the Assistant Secretary for Health, coordinates departmental efforts to reduce HAIs. The new targets were developed in collaboration with the Office of the Assistant Secretary for Health, Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, other HHS divisions and informed by discussions among stakeholders convened by HHS.

Moving Forward

Several Federal and non-Federal efforts to improve the quality of health care are currently underway to work toward achieving the new targets. These efforts are centered around five key areas:

  • Research to better understand these infections, including their  transmission and prevention
  • Resources to help providers and institutions improve practices and decrease risk
  • Incentives to providers and health care settings to reduce infections
  • Surveillance through data collection and monitoring
  • Resources to educate and engage patients in HAI prevention

Over the next five years, ODPHP will track national progress toward meeting the new targets using data collected by CDC and AHRQ. In the past seven years since the HAI Action Plan was launched, the Nation has seen a significant reduction in HAIs. Through fully implementing the HAI Action Plan, Federal and non-Federal partners will reduce the risk to patients of acquiring an HAI when visiting a health care setting through improved quality of care, resulting in better health outcomes, quality of life, and, ultimately, lives saved.