Health care-associated infections continue to be one of the most common health care-related complications. This systematic review including 67 studies identified several cost-effective interventions addressing health care-associated infections, including screening high-risk individuals, universal decolonization in intensive care units, hand hygiene, environmental cleaning, and surveillance. The authors found limited evidence evaluating the cost-effectiveness of other strategies such as education and training or use of personal protective equipment.

Hand hygiene is known to be a critical part of effective infection prevention and control. This study examined the level of hand hygiene implementation using the WHO Hand Hygiene Self-Assessment Framework global survey and its drivers. There were 3,206 organizations from 90 different countries that responded. Over half of the participants indicated they had intermediate hand hygiene implementation, particularly those with higher county income levels and facility funding. Implementation of alcohol-based hand rub stations was an important system change associated with improved scores.

The large burden placed on hospitals and healthcare providers during the COVID-19 pandemic has raised concerns about nosocomial transmission of the virus. This narrative review summarizes existing reports on nosocomial outbreaks of COVID-19 and the strategies health systems have implemented to control healthcare-associated outbreaks. The authors found little evidence describing the role of healthcare workers in reducing or amplifying infection transmission in healthcare settings.  

This thematic analysis explored variations in the impact of hand hygiene interventions to prevent healthcare-associated infections. The analysis identified several directions for future research, including exploring ways to avoid the Hawthorne effect, embed the interventions into wider patient safety initiatives, and develop systematic approaches to implementation.

Presenteeism among healthcare workers can lead to burnout and healthcare-associated infections, but prior research has found that significant numbers of healthcare workers continue to work despite having influenza-like illness. This study surveyed 249 healthcare workers and 284 non-healthcare workers from 49 countries about their behaviors when experiencing influenza-like illness between October 2018 and January 2019. Overall, 59% of workers would continue to work when experiencing influenza-like illness, and the majority of healthcare workers (89.2-99.2%) and non-healthcare workers (80-96.5%) would continue to work with mild symptoms, such as a mild cough, fatigue or sinus cold.  Fewer non-healthcare workers (16.2%) than healthcare workers (26.9%) would continue working with fever alone.

This systematic review of interventions to prevent health care–associated infections identified organizational factors such as positive safety culture, hospital-wide infection control efforts, guidelines, training, auditing, feedback, and optimal staffing and ergonomics. The results suggest that reducing hospital-acquired infections requires a systems approach.

The seemingly simple act of hand hygiene has proved to be a formidable obstacle in patient safety, as hand hygiene rates remain unacceptably low at many hospitals. In this survey of hospitals participating in the World Health Organization's hand hygiene program, greater overall infection control staffing appeared to be associated with a higher level of engagement in the project.

This review examined programs that engage patients as partners in hand hygiene improvement. The authors report that successful programs include at least one of the following tactics: educational tools, motivational tools, or role modeling.

Engaging patients in safety efforts is required as one of the National Patient Safety Goals, and is a key component of providing patient-centered care. This review examines ways in which patients have been integrated into clinical decision-making, discusses examples of patient involvement in reducing medication errors and encouraging hand hygiene, and proposes a framework for including patients in safety efforts. Although patient engagement has significantly improved safety efforts in some circumstances, surveys have shown that patients may be reluctant to engage in safety programs if they feel they are being asked to challenge their health care providers.

Patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at risk for infections, particularly after undergoing surgery, and may also transmit the bacteria to other patients if hospital staff do not follow proper infection control practices. This study evaluated one widely advocated strategy for reducing MRSA infections: screening all patients for MRSA at admission. Although the hospital had a relatively high rate of MRSA colonization, the intervention did not reduce nosocomial MRSA infections. Despite these results, universal screening for MRSA is likely to become increasingly common in hospitals, as several states have passed legislation mandating this practice.

Lower nurse-to-patient ratios on hospital wards have been associated with an increased rate of post-surgical complications and an increased rate of overall complications of inpatient care. This single-center study evaluated the effect of changes in nurse staffing on nosocomial infection rates in the intensive care unit (ICU) and found that a slightly higher number of patients per nurse was associated with a significantly increased infection risk, after controlling for patient risk factors. The authors hypothesize that increased nursing workload may lead to breaches in infection control protocols.

The authors describe actions and implementation strategies suggested by the World Alliance for Patent Safety to minimize health care-associated infection.

The authors summarize the goals of the World Alliance for Patient Safety, the six priority areas selected by the alliance, and the first Global Patient Safety Challenge: health care–associated infection.

Hand hygiene is an important practice that prevents transmission of infections. This cross-sectional study directly observed and surveyed more than 160 physicians at a large university hospital to describe current practices and beliefs. Investigators discovered that adherence to hand hygiene averaged only 57% with wide variations across medical specialties. Whereas being a role model, having a positive attitude towards hand hygiene, and easy access to hand-rub solutions was associated with adherence, high workload and activities associated with high risk for transmission were risk factors for poor adherence. The authors discuss the challenges with promoting effective hand hygiene practices and suggest targeting high risk settings and reinforcing individual’s abilities to role model behaviors. The U.S Centers for Disease Control and Prevention provides guidelines, fact sheets, a press kit, and other tools to implement best practices.