Prevention of Healthcare-Associated Infections in U.S. Hospital Settings

Kang, JaHyun

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March 22, 2019

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Kang, JaHyun
- School of Nursing

Abstract

Healthcare-associated infections (HAIs) are among the most common adverse events that threaten patient safety in the United States. However, many aspects of HAIs related to hospital infection control are unknown. Using a chain of HAIs conceptual model, this dissertation study examined HAIs from the agent (the healthcare-associated pathogen) to the infection control measures that can interrupt the interactions (transmission) among agent, host, and environment at the hospital level by connecting three areas that lacked critical information. First, changes in the incidence of HAIs by pathogen were examined using hospital-wide surveillance data. This study found significant changes in the incidence rate of HAIs by healthcare-associated pathogen that occurred between 2005 and 2011. Overall, across all service categories, the incidence of both overall HAIs and device-associated HAIs caused by the top 10 pathogens decreased, despite a significant increase in the number of patient-days. Only Clostridium difficile showed a significant increase in incidence. Second, a cost-effectiveness analysis was conducted using a decision-tree model to determine the most cost-effective active surveillance screening strategy for methicillin-resistant Staphylococcus aureus (MRSA) from an academic hospital perspective. Despite the possibility of variation and uncertainty in the input parameters, our model was robust and demonstrated that targeted surveillance of intensive care unit patients was the dominant cost-saving strategy for reducing MRSA HAIs. Third, current hospital policies regarding visitor use of personal protective equipment when entering the rooms of patients on isolation precautions were examined using an online survey of North Carolina hospitals. Among 82 participating acute care hospitals, 71% had a hospital visitor policy. This study illuminated variations in hospitals' policies regarding visitor isolation precautions. The current problems with hospital visitor policies (e.g., refusal to comply) call for a standard guideline. This study's findings suggest a need for further research related to C. difficile, active surveillance screening for important HAI pathogens, implementing isolation precautions (including issues related to cost, ethics, and practice), hospital infection control efforts, and enhancing the host defense mechanism (e.g., immunoprophylaxis) to prevent HAIs. Although we may not be able to create the desired HAI-free hospital, the rigorous battle against invisible healthcare-associated pathogens should never stop.

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