Types & Impact
HAI: infections acquired during hospital care. Common: CLABSI (central line), CAUTI (catheter), VAP (ventilator), SSI (surgical site), C. difficile. Impact: increased length of stay, morbidity, mortality, costs. CMS non-payment for certain HAI. Tracking: NHSN (National Healthcare Safety Network). Facility-specific rates compared to benchmarks. HAI prevention is everyone responsibility — nursing is at the frontline.
Prevention Bundles
CLABSI: hand hygiene, full barrier precautions, CHG prep, optimal site, daily necessity review. CAUTI: avoid catheters, sterile insertion, maintain closed drainage, daily necessity review, remove ASAP. VAP: HOB 30-45°, daily sedation interruption, daily extubation assessment, oral care with CHG q4h, peptic ulcer prophylaxis, DVT prophylaxis (ventilator bundle). SSI: appropriate perioperative antibiotics, normothermia, glycemic control, wound care. C. diff: soap and water (not ABHR), contact precautions, bleach cleaning.
Surveillance
Track HAI rates by unit, type, causative organism. NHSN reporting. Root cause analysis for each HAI. Feedback to staff. Education and training. Hand hygiene compliance audits (direct observation, product use). PPE compliance. Environmental cleaning audits (ATP, fluorescent markers). Antibiotic stewardship. Outbreak investigation. Patient and family education. HAI prevention champions. Integrate prevention into daily workflow — make it easy to do the right thing.
Important Notes
- C. difficile requires SOAP AND WATER for hand hygiene — alcohol-based hand rub does NOT kill spores.
- CAUTI prevention: avoid catheters when possible, remove ASAP — each day a catheter stays, infection risk increases 5%.
Clinical Tips
- Ventilator bundle: HOB elevated 30-45°, daily sedation interruption, daily extubation assessment, oral care with CHG q4h — reduces VAP by up to 60%.
- CLABSI prevention: scrub the hub for 15 seconds with CHG before every access — single most important measure.
Summary
HAI prevention requires evidence-based bundles (CLABSI, CAUTI, VAP, SSI), surveillance, hand hygiene, and prompt removal of unnecessary devices.
