Top 10 Most Common Hospital-Acquired Infections

Hospital-acquired infections (also referred to as hospital-associated infections, or simply HAIs) are one of the leading adverse events within healthcare delivery. The average annual occurrence of HAIs, defined as infections that are contracted during or shortly after a patient receives care in a hospital, continues to fluctuate — despite longstanding efforts to minimize them.

What does this indicate? While a lingering problem in healthcare, HAIs can be properly managed with renewed, industry-wide efforts and education measures focused on achieving optimal patient outcomes. Here we’ll address some of the most common hospital-acquired infections, how they spread, and best practices for preventing them at your facility.

Understanding the Most Common Hospital Infections Acquired In-House: FAQ

Before we get into the details of the most common hospital-acquired infections, let’s review some of the basics of this major healthcare issue by first answering some commonly asked questions.

What qualifies as a hospital-acquired infection?

There are several key factors that define a hospital-acquired infection (HAI). These unfortunate developments are characterized as HAIs when an infection occurs:

• While the patient is receiving care in the inpatient setting.
• 48-hours (or more) after admission.
• Within 30 days of receiving care after discharge.

When considering infections associated with healthcare in general, the same approximate parameters apply but aren’t strictly relegated to care received in hospital settings.

Hospital-acquired infections are called nosocomial, too — what’s the difference?

Through the years, the same issue has been labelled by three different, yet interchangeable names.

• Hospital-Acquired Infections (HAIs)
• Hospital-Associated Infections (HAIs)
• Healthcare-Associated Infections (HAIs)
• Nosocomial Infections

These terms refer to the same adverse event — so the most common nosocomial infections in hospitals are identical to the most common HAIs — leaving the choice of name entirely up to you. To align with the current CDC and WHO verbiage, the use of hospital (or healthcare) associated infections is arguably the most current choice.

What is the most common cause of healthcare-associated infections?

According to certain analyses, surgical-site infections (SSIs) are some of the most common HAIs — potentially related to improper sterile procedures or follow-up care. However, another study indicates that hospital-acquired pneumonia (HAP) may affect the largest number of patients. Due to the many variables that lead to HAIs, here are some general predisposing factors to consider.

Why are hospital-acquired infections so dangerous?

Across care settings, healthcare-acquired infections are associated with significant mortality and patient morbidities, leading to around 1.7 million annual cases and nearly 100,000 deaths each year. Patients in acute settings are specifically vulnerable. On any given day, 1 in every 31 patients likely suffers from an HAI.

These numbers don’t simply impact patient safety and quality reports, they significantly affect healthcare funding, too. Some insurance providers — Medicare, for example — won’t pay for hospital-associated infections. This, alongside additional treatment expenses, adds up to almost $28.4 billion in annual HIA-related costs for healthcare facilities.

How Can Facilities Prevent Common Hospital-Acquired Infections?

You’re well aware of what’s at stake by allowing the spread of common bacterial infections in hospitals (extending to viral and fungal transmissions, too). The primary strategy for avoiding HAIs is by employing proper standard precautions and infection control.

The 10 Most Common HAIs: Overview

You’re now aware that there’s no straightforward answer to, What is the most common hospital-acquired infection? However, establishing the 10 most common HAIs is less complex. We’ll start by introducing the two categories that classify them.

• Etiology-related (device-associated, for example)
• The Pathogen itself (including any of the multi-drug resistant organisms)

These two umbrella categories house all types of nosocomial infections. We’ll review the 10 most prevalent, starting with the top 5, which are etiology-related.

1. Ventilatory-Associated Pneumonia (VAP)

One of the most common HAIs, VAPs, develop when bacteria is introduced (fungal and viral contaminants are rarer) to a ventilated patient’s lungs, causing a hospital-acquired respiratory infection. Beyond elongating hospital stays and increasing the risk of patient morbidity, VAP cases also can cost organizations as much as $40,000 in additional costs.

Care-Related VAP Risks:

• Infrequent or ineffective oral care
• Poor positioning and inadequate turning
• Insufficient suctioning or secretion management

2. Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP)

Affecting almost 1 in every 100 hospital patients, with a mortality rate somewhere between 15-30%, NV-HAP is thought to cost the U.S. Healthcare system upwards of $3 billion per year. Like VAPs, it occurs when bacteria, viruses, and/or fungi infiltrate and colonize the lungs.

Care-Related NV-VAP Risks:

• Inadequate respiratory hygiene measures
• Prolonged patient immobility (staying in bed vs. moving to a chair or walking in hallways, for example)
• Aspiration due to improper head of bed positioning (particularly with patients receiving tube feeds)

3. Central-Line Associated Bloodstream Infections (CLABSIs)

CLABSIs contribute to thousands of patient deaths every year, costing the healthcare industry billions in extra expenses. They occur when a central line (or central venous catheter) introduces germs (often bacteria or fungi) into the patient’s bloodstream.

Care-Related CLABSI Risks:

• Improper hand hygiene before accessing the line (to administer fluids or medication, for example)
• Infrequent and or improper dressing changes (or failure to use antiseptics such as chlorhexidine)
• Breaks in sterile technique while accessing line

4. Catheter Associated Urinary Tract Infections (CAUTIs)

CAUTIs are unfortunately common. In hospitals, 75% of CAUTIs are related to urinary catheters (including intermittent and indwelling), which are used in 15-25% of all admissions. That means that a quarter of all inpatients are routinely at risk for one of the most common hospital infections acquired during hospitalization.

Care-Related CAUTI Risks:

• Breaking sterile technique during catheter placement
• Infrequent bathing and catheter care
• Prolonged catheter dwell time — nurses should be advocating for removal whenever (or as soon as) possible

5. Surgical Site Infections (SSIs)

SSIs occur at the site where surgery took place, affecting either skin, tissue, organs, or implanted material (such as an artificial joint). SSIs can extend hospital stays up to nearly 10 days and increase the associated care costs upwards of $20,000.

Care-Related SSI Risks:

• Inadequate pre-operative preparation (such as failure to provide a pre-op antiseptic skin prep)
• Breaks in sterile technique during the procedure
• Improper wound care and protocol maintenance (like surgical drain care)

6. Clostridioides difficile (C. Diff.) Infections

Another type of common hospital-acquired infections, C. Diff, is the most frequently reported HAI by California hospitals. It’s transmitted via the fecal-oral route, flourishing only when normal intestinal flora are compromised (usually due to antibiotic use).

Care-Related C. Diff Risks:

• Delayed recognition of symptoms and implementation of proper precautions
• Improper or insufficient environmental cleanliness (like not cleaning equipment thoroughly before use with another patient)
• Ineffective hand hygiene practices (like using hand sanitizer, which does not kill C. Diff spores)

7. Methicillin-Resistant staphylococcus aureus(MRSA) Infections

MRSA is considered a leading cause in global deaths related to antimicrobial resistance. It’s most often associated with skin infections and pneumonia, sometimes contributing to life-threatening HAIs. Because of its resistance to antibiotics, prevention is key.

Care-Related MRSA Risks:

• Improper hand hygiene and PPE use
• Inadequate cleaning or disinfection of shared equipment
• Inappropriate handling of soiled linens and patient laundry, leading to cross-contamination

8. Vancomycin-Resistant Enterococcus (VRE) Infections

VRE is responsible for many hospital-acquired infections — particularly in intensive care. Its resistance to antibiotics (notably Vancomycin) makes it difficult to treat, leading to high morbidity and mortality rates for patients with VRE infections like UTIs or endocarditis.

Care-Related VRE Risks:

• Improper use of standard precautions (such as proper PPE use and hand hygiene)
• Failure to evaluate prolonged use (or overuse) of certain antibiotics, like Vancomycin
• Inadequate line care (such as catheter or central line hygiene measures)

9. Multi-Drug Resistant Gram Negative Bacilli (MDR-GNB) Infections

These microorganisms are resistant to multiple classes of antibiotics and are harbored by up to 7% of ICU patients at any given time. An HAI develops when MDR-GNB are allowed to proliferate and colonize a patient during hospitalization, increasing the risk that it spreads to others.

Care-Related MDR-GNB Risks:

• Improper ventilator management, leading to MDR-GNB pneumonia
• Insufficient or ineffective hand hygiene and PPE usage
• Inadequate environmental measures, like cleaning equipment between uses

10. Contaminated Device or Procedure Infections

The last type of discussed HAI, this covers any infection that arises due to a device or procedure that is not otherwise listed. An example occurrence includes an infection (such as Hepatitis B) that occurs after a contaminated needlestick.

Care-Related Contaminated Device (or Procedure) Risks:

• Unsafe injection practices (such as using the same medication vial between patients, risking cross contamination)
• Accidental incidences that introduce contaminants, like needlestick occurrences
• Improper implementation of standard precautions (like handwashing and cleaning equipment between uses)

Strengthen Your Patient Safety Programs

With information about care-related risk factors for the 10 most common hospital-acquired infections, you’re better equipped to tackle this challenging healthcare issue. For help with more of your safety initiatives, IntelyCare’s facility guides and best practice tips can help you bolster staff education and quality innovation projects.