Abstract
A healthcare-associated infection (defined as an infection acquired within a healthcare facility), such as due to transmission via medical equipment or by healthcare providers is the most frequent adverse event in the healthcare delivery system. But why does the problem persist, when infection control measures are known, simple, and low-cost? We reviewed some biological- and treatment-factors in Part 1, and we now review some human-factors. Healthcare-associated infections are a major public health problem even in advanced healthcare systems. They affect hundreds of millions of patients each year, and are responsible for increased morbidity, mortality, and financial burden. This is perplexing, since good-hygiene practices are known and promoted. Disinfection, sterilization, handwashing, and alcohol rubs should be more effective, but human-factors interfere. The persistent high prevalence of nosocomial infections, despite known hygienic practices, is attributable to two categories of factors: biological and inherent shortcomings of some practices (considered in Part 1), and human factors (considered here). A new approach is considered in Part 3.
Highlights
Recognition of the problem of healthcare-associated infection [1] [2] [3] and efforts to address the problem date back nearly 200 years [4]
Despite governmental-agency and professional-organization guidelines, codes, and standards that are directed at eliminating the problem [4], the prevalence of healthcare-associated infection (HAI) is estimated to remain as much as 12% in developed countries and as much as 20% in low- and middle-income countries, which translates into hundreds of millions of affected people worldwide [5] [6] [7] [8]
The positive evidence was reinforced by Allegranzi and Pittet (2009) [25], who tabulated the more than 20 hospital-based studies conducted between 1977 and 2008 that examined the impact of hand hygiene on the risk of HAI, and found a strong correlation between improved hand hygiene practices and reduced infection and cross-transmission (HAI) rates
Summary
Recognition of the problem of healthcare-associated infection Despite governmental-agency and professional-organization guidelines, codes, and standards that are directed at eliminating the problem [4], the prevalence of healthcare-associated infection (HAI) is estimated to remain as much as 12% in developed countries and as much as 20% in low- and middle-income countries, which translates into hundreds of millions of affected people worldwide [5] [6] [7] [8]. The first involves biological-centric factors (e.g., resistant nosocomial strains) and treatment-centric factors (e.g., lack of antimicrobial efficacy of soap)—which we reviewed in Part 1 [9]. The second involves human-centric factors (e.g., lack of training, inconvenience, negative outcomes, etc.), which we review here
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