HEALTH CARE–ASSOCIATED INFECTIONS: INTRODUCTION

The costs of hospital-acquired (nosocomial) and other health care–associated infections are great. It is estimated that these infections affect >2 million patients, cost $4.5 billion, and contribute to 88,000 deaths in U.S. hospitals annually. Efforts to lower infection risks have been challenged by the growing numbers of immunocompromised patients, antibiotic-resistant bacteria, fungal and viral superinfections, and invasive devices and procedures. Nevertheless, evidence-based guidelines for prevention and control are available (Table 125-1); according to some estimates, consistent application of these guidelines may reduce the risk of health care–associated infection by more than one-third, and the growing viewpoint of consumer advocates is that almost all such infections are preventable. This chapter reviews health care–acquired and device-related infections and the basic surveillance, prevention, control, and treatment activities that have been developed to deal with these problems.

Table 125-1 Sources of Infection-Control Guidance and Oversight

Organization	Role	Major Constituents	Web Site
JCAHO	Regulatory	Hospitals, long-term-care facilities, laboratories	http://www.jcaho.org
CAP	Regulatory	Laboratories	http://www.cap.org
OSHA	Regulatory	Workers	http://www.osha.gov
CMS (formerly HCFA)	Regulatory	Medicare/Medicaid providers	http://www.cms.hhs.gov
CDC
DHQP	Advisory	Health care facilities and personnel	http://www.cdc.gov/ncidod/dhqp/index.html
HICPAC	Advisory	Health care facilities and personnel	http://www.cdc.gov/ncidod/dhqp/hicpac_charter.html
NIOSH	Advisory	Workers	http://www.cdc.gov/niosh/
AHRQ	Advisory	Broad (e.g., health care personnel)	http://www.ahrq.org
NQF	Advisory	Broad (e.g., health care personnel)	http://www.qualityforum.org
IOM	Advisory	Broad (e.g., health care personnel)	http://www.iom.edu
IDSA	Professional society	Infectious disease physicians/researchers	http://www.idsociety.org
SHEA	Professional society	Hospital epidemiologists	http://www.shea-online.org
APIC	Professional society	Infection-control practitioners	http://www.apic.org
MedQIC	Quality improvement	Broad (e.g., health care personnel)	http://www.medqic.org
IHI	Quality improvement	Broad (e.g., health care personnel)	http://www.ihi.org

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