Healthcare-associated infections (HCAIs): The magnitude of the problem

Healthcare-associated infections (HCAIs) are an important and costly complication of healthcare throughout both primary and secondary sectors. In the European Union alone, the financial burden associated with HCAIs is up to €10b annually. HCAIs add unacceptable costs to healthcare economies – a 2- to 3-fold overall increase in the cost of the affected patient’s care in terms of extended hospital stay and associated costs. Increasing resistance following the use, mis-use, and over-use of antibiotics poses a world-wide problem that is compounded by the fact that no new antibiotics are in the pipeline. The recent and expanding appearance of carbapenemase resistance is of particular concern, as some strains of Klebsiella pneumoniae that produce carbapenemase are almost pan-resistant, meaning that antimicrobial therapy is virtually impossible. There is, however, good evidence that control measures can be effective. In the UK, the overall numbers of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections have fallen due to increased compliance with infection prevention/control procedures. In particular, the delivery of care bundles containing evidence-based interventions has proved highly effective in preventing MRSA bacteraemias along with the “clean-your-hands” campaign and other measures such as universal admission screening. Surgical site infection (SSI) is probably the most preventable HCAI, yet due to the inconsistent implementation of level 1A evidence-based interventions, the UK and US have shown disappointing failures to reduce SSI. The reason for this lack of progress in SSI likely reflects poor compliance with guidelines and checklists.