Infections are a leading cause of mortality worldwide. In 2008, respiratory infections, diarrheal diseases and HIV/AIDS accounted for over 9 million deaths globally . Most infections are caused by bacteria or viruses , which can be transmitted through direct contact with skin or mucous membranes, inhalation of infectious agents, exposure to blood, bodily fluids and secretions, and other methods . To further complicate the problem of infections, the unabated global spread of antimicrobial resistance has resulted in pathogens that are no longer treatable with traditional antibiotics, leading to longer hospital stays and increased patient mortality [4, 5] .
While infections pervade communities and healthcare facilities worldwide, many are preventable [6, 7]. Organizations such as the Centers for Disease Control and Prevention, World Health Organization, Agency for Healthcare Research and Quality, Association for Professionals in Infection Control and Epidemiology, and Society for Healthcare Epidemiology of America are committed to preventing the spread of infectious diseases and have made a wealth of knowledge surrounding infection prevention publicly available.
Antimicrobial resistance occurs when pathogens are no longer sensitive to traditional treatment. While antibiotics have been used to treat infections for the past seventy years, their widespread use has enabled pathogens to adapt, rendering once effective antimicrobials less effective . This is evidenced by the emergence of methicillin-resistant Staphylococcus aureus (MRSA), multi-drug resistant Klebsiella species and Escherichia coli, as well as antibiotic-resistant Streptococcus pneumoniae . Rates of infections associated with organisms such as Clostridium difficile and Klebsiella pneumoniae are increasing due to the emergence of novel strains and biologic variants [9, 10] . Similarly, there is a growing proportion of cases of multidrug-resistant tuberculosis (MDR-TB) globally . See Figure 1. Such resistance causes treatment complications, leading to longer hospital stays, increased costs and greater patient morbidity and mortality [4, 5].
|Figure 1. Percentage of MDR-TB among new TB cases, 1994-2010 |
Antimicrobial Resistance Key Resources
Healthcare-associated infections (HAIs) are infections that patients develop while receiving treatment within hospitals, long-term care facilities, ambulatory and rehabilitation centers, nursing homes, and community clinics . Approximately 1 in every 20 hospitalized patients develops an infection , and rates are even higher in long-term care facilities and among particularly vulnerable groups, such as those receiving chronic dialysis or other invasive procedures . About 1.7 million infections occur in hospitals annually, resulting in approximately 99,000 deaths . The four major types of HAIs are catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infections (CLABSI) . See Figure 2. The estimated cost of these infections ranges from $28.4 to $33.8 billion annually in the United States . In recent years, literature has emphasized that HAIs are preventable, namely through provider practice and the promotion of a culture of safety [18-20] .
|Figure 2. Leading Types of Healthcare-Associated Infections |
HAI Key Resources
Community-associated infections remain a leading cause of death worldwide with infections such as influenza, HIV/AIDS, and diarrheal diseases claiming approximately 4.5 million lives each year [1, 21]. In the United States, common community-associated infections include skin infections, such as community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), droplet-caused infections, such as influenza and ingestion-based infections such as norovirus. CA-MRSA has increased seven times from 1999-2006 , and of the 1,518 outbreaks of norovirus between 2010-2011, 22% occurred in the community . See Figure 3. The prevention of community associated infections has been highlighted in the literature; CA-MRSA and norovirus prevention emphasizes good hygiene, such as usage of hand sanitizers and the maintenance of a clean environment [24, 25]; and influenza prevention emphasizes vaccination as well as good hygiene . Of note, community-associated infections have become more complicated as antimicrobial resistant infections, which were once confined to hospital settings, have emerged as significant health problems in communities, perhaps due to shifting care patterns from inpatient to outpatient settings .
|Figure 3. Setting of 1,518 Confirmed Norovirus Outbreaks, U.S., 2010-2011: Long-term Care Facility 59% (889 Outbreaks); Restaurants 8% (123 Outbreaks); Party & Event 7% (99 Outbreaks); Hospital 4% (65 Outbreaks); School 4% (64 Outbreaks); Cruise Ship 4% (55 Outbreaks); Other & Unknown 14% (223 Outbreaks) |
Community-associated Infections Key References