This thin-section transmission electron
micrograph (TEM) depicted the ultrastructural details of a
number of "human immunodeficiency virus" (HIV) virus
particles, or virions.
Photo courtesy of CDC; photo credit: Cynthia Goldsmith.
The National Healthcare Safety
Network (NHSN) is a secure, internet-based surveillance system
that integrates patient and healthcare personnel safety surveillance
systems managed by the Division of Healthcare Quality Promotion
(DHQP) at CDC. The NHSN was established in 2005 and integrates
three former networks: The National Nosocomial Surveillance
System (NNIS), the Dialysis Surveillance Network (DSN), and
the National Surveillance System for Healthcare Workers (NaSH).
Although most NHSN facilities voluntarily report data, some
states, including New York State, have mandatory reporting.
Facilities report their healthcare associated infection (HAI)
surveillance data for aggregation into a single national database
for the following purposes (CDC, 2008):
- Estimation of the magnitude of HAI;
- Discovery of HAI trends;
- Facilitation of inter-and intrahospital comparisons with
risk-adjusted data that can be used for local quality improvement
- Assistance for facilities in developing surveillance and
analysis methods that permit timely recognition of patient
safety problems and prompt intervention with appropriate
Currently the majority of facilities in the NHSN system are
hospitals, however, the enrollment in this system is growing
to include other healthcare facilities such as long term care,
ambulatory surgery centers, and others (Edwards, et al., 2008).
As indicated previously, almost 2 million HAIs occur annually
and 99,000 people die from these infections (CDC, 2007). Of
those infections, 99,000 people die from these infections
(CDC, 2007). The frequency of healthcare associated infections
varies by body site. Of the 1.7 million infections reported
among patients, the most common healthcare-associated infections
are (CDC, 2007a):
- urinary tract infections (32 percent),
- surgical site infections (22 percent),
- pneumonias (15 percent), and
- bloodstream infections (14 percent).
According to the CDC (2006), the following are pathogens
and infectious diseases that can potentially be acquired in
healthcare settings (these illnesses are linked to the CDC
website in the event the learner would like more information
about each disease):
In 2009, the CDC published the Direct Medical Costs of
Healthcare-Associated Infections in US Hospitals and the Benefits
of Prevention. This report used results from published
medical and economic literature to provide a range of estimates
for the annual direct hospital cost of treating healthcare-associated
infections (HAIs) in the United States. Applying two different
Consumer Price Index (CPI) adjustments to account for the
rate of inflation in hospital resource prices, the overall
annual direct medical costs of HAI to U.S. hospitals ranges
from $28.4 to $33.8 billion (after adjusting to 2007 dollars).
Clearly the prevalence of HAIs contributes significantly
to increased morbidity, mortality and cost in healthcare.
Therefore, it is critical that healthcare professionals do
all they can to minimize the risk that their behavior contributes
to the spread of infection.
Healthcare professionals, although well aware of the importance
of accepted principles and practices of infection control,
may at times, for multiple reasons, fail to follow these accepted
principles and practices. However, professionals have both
an ethical and professional responsibility to adhere
to scientifically accepted or evidence based practices and
principles of infection control.
There are multiple organizations that have developed "best
practices" related to infection control. For example, the
CDC has developed multiple guidelines for preventing infections
in patients and healthcare personnel, as well as treatment
guidelines, should exposure occur. These guidelines can be
accessed from the CDC website at http://www.cdc.gov/hai/.
Other organizations that focus on scientifically accepted
practices and principles of infection control include:
Multiple professional disciplines' Codes of Ethics
require that the professional maintain current knowledge in
In 1999 New York State included the legal responsibility
to adhere to such principles. A law was passed in which the
professional may be charged with unprofessional conduct if
he or she fails to adhere to scientifically accepted principles
and practices of infection control. This is true for the professional
her or himself, but also true for those whom the professional
has clinical or administrative oversight. In 2008, physicians,
physician assistants and specialist assistants were added
to the professions who had a legal responsibility to adhere
to scientifically accepted principles and practices of infection
control and they now can be disciplined if they fail to do
Some examples of these legal requirements may include:
- An attending physician does not correct the resident physician
in the emergency room who has neglected to utilize the "sharps"
containers after giving injections to patients;
- A licensed practical nurse does not intervene to correct
a certified nursing assistant who does not wash his/her
hands after providing care to a resident in a long term
- Certified nursing assistant, for whom the registered
nurse has supervisory responsibility, does not wash her
hands after removing gloves after completing care to a resident
in a long term care facility. The nurse can be charged with
unprofessional conduct if she does not intervene to correct
- An registered nurse witnesses a colleague utilizing unsafe
injection practices and does nothing;
- A laboratory supervisor who looks the other way with one
lab technician, an excellent employee, who just can't seem
to remember to wear gloves during phlebotomy;
- A dentist who witnesses the assistant not changing gloves
between patients and does not intervene.
- A registered nurse, in the operating room, notes that
the temperature and the humidity in the storage room is
unusually high and wonders if the sterilized instruments
used by the OR staff may be contaminated, but takes no action.
All of the examples above illustrate that professionals must
take the responsibility to adhere to scientific principles
of infection control. They must themselves practice in such
a manner, but in addition, New York State Law requires that
these professionals must also insure that those for whom they
have administrative or clinical oversight also practice to
this standard. Professionals who fail to follow accepted standards
of infection control will have the complaint investigated.
Possible outcomes of such charges include: disciplinary action,
revocation of professional license and professional liability.