National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination
- Action Plan Development
- Phase 1: Acute-Care Hospitals
- Phase 2: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Health Care Personnel
- Phase 3: Long-Term Care Facilities
- Phase 4: Antibiotic Stewardship
- Evaluation of the Health Care-Associated Infections Action Plan
- State HAI Prevention Plans
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, and for implementing antibiotic stewardship efforts as a means of HAI prevention. The HAI Action Plan also includes a chapter on increasing influenza coverage of health care personnel.
Phases One, Two, and Three of the HAI Action Plan led to meaningfully enhanced coordination of federal efforts to address HAIs by establishing a structure to regularly share best practices, resources, and lessons learned among federal partners. Phase Four, which was finalized in February 2018, reviews current federal antibiotic stewardship efforts across various health care settings, highlights the importance of antibiotic stewardship to prevent resistance in HAIs, and showcases the coordination between various health agencies.
The National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination includes:
- Table of Contents [PDF - 1,579 KB]
- Executive Summary [PDF - 402 KB]
- Framework [PDF - 336 KB]
- Phase One: Acute Care Hospitals
- Phase Two: Outpatient Settings and Influenza Vaccination of Health Care Personnel
- Phase Three: Long-Term Care Facilities
- Phase Four: Antibiotic Stewardship
- Conclusion [PDF - 102 KB]
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:
- Acute Care Hospitals [PDF - 1023 KB] (April 2013)
- HAI Action Plan Target and Metrics lists the 8 metrics with corresponding 5-year goals to focus efforts in reducing health care-associated infections.
This HAI Action Plan includes 5-year goals for 7 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 [PDF - 302 KB] (April 2013)
- End-Stage Renal Disease Facilities [PDF - 654 KB] (April 2013)
- Influenza Vaccination of Health Care Personnel [PDF - 418 KB] (April 2013)
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.
- Long-Term Care Facilities [PDF - 618 KB] (April 2013)
Phase Four: Antibiotic Stewardship
Phase Four showcases the essential coordination and collaboration among federal partners engaged in HAI prevention and antibiotic stewardship. It highlights the work of the Federal Steering Committee for the Prevention of Health Care-Associated Infections (FSC) to leverage existing relationships — including with the Presidential Advisory Council on Combatting Antibiotic Resistance (PACCARB). These partners are working collaboratively to realize a goal of the CARB Action Plan to slow the emergence of resistant bacteria through antibiotic stewardship programs in health care settings.
This update to the HAI Action Plan reaffirms a federal commitment to improving health care quality and protecting the health of all Americans.
- Antibiotic Stewardship [PDF - 471KB] (February 2018)
Evaluation of the Health Care-Associated Infections Action Plan
The Office of Disease Prevention and Health Promotion (ODPHP), Division of Health Care 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 [PDF – 1760 KB] (September 2011), 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 Health Care-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…"