New Interventions Targeting Healthcare-Associated Infections

  • Thaís Guimarães
  • Silvia F. Costa
New Technologies and Advances in Infections Prevention (AR Marra, Section Editor)
Part of the following topical collections:
  1. Topical Collection on New Technologies and Advances in Infection Prevention


Purpose of review

Healthcare-associated infections (HCAIs) are still a major cause of patient morbidity and mortality nowadays and there are evidences that these infections are highly preventable. Although many efforts have been made to prevent them, we live with a global burden of HCAIs and low- and middle-income countries reported HCAIs rates higher than in high-income countries accompanied by the problem of multidrug resistant microorganisms.

Recent findings

Basic measures for infection control and prevention must be put into practice and new techniques and methodologies have to be incorporated into HCAI control programs. The purpose of this review is discuss new interventions targeting HCAIs such as the use of practice bundles, behavioral change strategies, public reporting of infection rates, environmental cleaning, hand hygiene, and antimicrobial stewardship programs.


We emphasize that all preventive measures require adherence by healthcare workers that depends on behavioral changes and reinforce that classical subjects as hand hygiene, environmental cleaning, and prudent use of antimicrobials need to be rethinking on the set of new technologies using electronic media for alerts, consultations, and audits.


Healthcare-associated infections Control interventions Behavioral strategies 


Compliance with Ethical Standards

Conflict of Interest

Dr. Guimaraes declares that she has no conflict of interest.

Dr. Costa declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    World Health Organization available in Accessed in 03/12/2017
  2. 2.
    World Health Organization. Report on the burden of endemic health care-associated infection worldwide. 2011 Available in Accessed in 01/01/2018
  3. 3.
    Cassini A, Plachouras D, Eckmanns T, et al. Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med. 2016;13:e1002150.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    • Allegranzi B, Kilpatrick C, Storr J, Kelley E, Park BJ, Donaldson L. Global infection prevention and control priorities 2018–22: a call for action. Lancet Glob Health. 2017;5(12):e1178–80. In this article the authors call attention to the need for international organizations to recognize that global health security relies on effective infection prevention and control program to control emerging health threats (including antimicrobial resistance) and that there is a need to intensify the support to countries and the international community.CrossRefPubMedGoogle Scholar
  5. 5.
    Cardo D, Dennehy PH, Halverson P, Fishman N, Kohn M, Murphy CL, et al. Moving toward elimination of healthcare-associated infections: a call to action. Infect Control Hosp Epidemiol. 2010;31(11):1101–5.Google Scholar
  6. 6.
    World Health Organization. Core components for infection prevention and control programmes: Report of the second meeting, Informal Network on Infection Prevention and Control in Health Care, Geneva, Switzerland, 26–27 June 2008. 2009.Google Scholar
  7. 7.
    Resar R, Griffin F, Haraden C, Nolan T. Using care bundles to improve health care quality. IHI innovation series white paper Cambridge. Institute for Healthcare Improvement: Massachusetts; 2012.Google Scholar
  8. 8.
    Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(6):724–34.Google Scholar
  9. 9.
    • Reyes DCV, Bloomer M, Morphet J. Prevention of central venous line associated bloodstream infections in adult intensive care units: a systematic review. Intensive Crit Care Nurs. 2017;43:12–22. In this systematic review, the authors identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters.CrossRefGoogle Scholar
  10. 10.
    Entesari-Tatafi D, Orford N, Bailey MJ, Chonghaile MN, Lamb-Jenkins J, Athan E. Effectiveness of a care bundle to reduce central line-associated bloodstream infections. Med J Aust. 2015;202(5):247–9.CrossRefPubMedGoogle Scholar
  11. 11.
    • Klompas M. What is new in the prevention of nosocomial pneumonia in the ICU? Curr Opin Crit Care. 2017;23(5):378–84. The author summarizes and contextualizes recent evidences on preventing ventilator-associated pneumonia and suggests new ways to optimize the selection of ventilator bundle components and their implementation.Google Scholar
  12. 12.
    Li Bassi G, Senussi T, Aguilera XE. Prevention of ventilator-associated pneumonia. Curr Opin Infect Dis. 2017;30(2):214–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Davis J, Finley E. The breadth of hospital-acquired pneumonia: non-ventilated versus ventilated patients in Pennsylvania. Pa Patient Saf Advis. 2012;9:99–105.Google Scholar
  14. 14.
    Montravers P, Harpan A, Guivarch E. Current and future considerations for the treatment of hospital-acquired pneumonia. Adv Ther. 2016;33:151–66.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Baker D, Quinn B. Hospital Acquired Pneumonia Prevention Initiative-2: incidence of non-ventilator hospital-acquired pneumonia in the United States. Am J Infect Control. 2017;
  16. 16.
    Bono SD, Heling G, Borg MA. Organizational culture and its implications for infection prevention and control in healthcare institutions. J Hosp Infect. 2014;86:1–6.CrossRefPubMedGoogle Scholar
  17. 17.
    • Griffiths P, Renz A, Hughes J, Rafferty AM. Impact of organization and management factors on infection control in hospitals: a scoping review. J Hosp Infect. 2009;74:1–14. This scoping review sought evidence about organizational and management factors affecting infection control in general hospital settings. The organizational characteristics identified in this review should be considered risk factors for infection.CrossRefGoogle Scholar
  18. 18.
    Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroeder L, Krein SL. The importance of leadership in preventing healthcare associated infection: results of a multistate qualitative study. Infect Control Hosp Epidemiol. 2010;31:901–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Sinkowitz-Cochran RL, Burkitt KH, Cuerdon T, et al. The associations between organizational culture and knowledge, attitudes and practices in multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus. Am J Infect Control. 2012;40:138–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Kay J, Ashline V, Erickson D. Critical care bug team: a multidisciplinary team approach to reducing ventilator-associated pneumonia. Am J Infect Control. 2000;28:197–201.CrossRefGoogle Scholar
  21. 21.
    • Boyce JM. Update on hand hygiene. Am J Infect Control. 2013;41:S94–6. The author discuss recent developments related to hand hygiene including new test methods for evaluating hand hygiene products, improvements in alcohol-based hand rubs, novel methods of hand antisepsis, and new strategies and technologies for monitoring hand hygiene practices among health care personnel.CrossRefPubMedGoogle Scholar
  22. 22.
    Cabana MD, Rand CS, Powe NRP, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65.CrossRefPubMedGoogle Scholar
  23. 23.
    Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290:1617–23.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. How active resisters and organizational constipators affect health-care acquired infection prevention efforts. Joint Comm J Qual Imag. 2009;35:239–46.Google Scholar
  25. 25.
    Turnell EP, White GL. Using behavior change theories to enhance hand hygiene behavior. Educ Health (Abingdon). 2005;18:80–4.CrossRefGoogle Scholar
  26. 26.
    Castro-Sanchez E, Holmes AH. Impact of organizations on healthcare-associated infections. J Hosp Infect. 2015;89:346–50.CrossRefPubMedGoogle Scholar
  27. 27.
    McGuckin M, Waterman R, Shubin A. Consumer attitudes about health care-acquired infections and hand hygiene. Am J Med Qual. 2006;21:342–6.CrossRefPubMedGoogle Scholar
  28. 28.
    McGuckin M, Govednik J, Hyman D, Black B. Public reporting of health care–associated infection rates: are consumers aware and engaged? Am J Med Qual. 2014;29(1):83–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Martin M, Zingg W, Hansen S, Gastmeier P, Wu AW, Pittet D, et al. on behalf of the PROHIBIT study group. Public reporting of healthcare-associated infection data in Europe. What are the views of infection prevention opinion leaders? J Hosp Infect. 2013;83:94–8.Google Scholar
  30. 30.
    Kiernan MA. Public reporting of healthcare-associated infection: professional reticence versus public interest. J Hosp Infect. 2013;83:92–3.CrossRefPubMedGoogle Scholar
  31. 31.
    • Dancer SJ. The role of environmental cleaning in the control of hospital acquired infection. J Hosp Infect. 2009;73:378–85. This review examines the links between the hospital environment and various pathogens, including meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile, and Acinetobacter spp. Google Scholar
  32. 32.
    French GL, Otter JA, Shannon KP, Adams NMT, Watling D, Parks MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect. 2004;57:31–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Richard RD, Bowen TR. What orthopaedic operating room surfaces are contaminated with bioburden? A study using the ATP bioluminescence assay. Clin Orthop Relat Res. 2017;475(7):1819–24.CrossRefPubMedGoogle Scholar
  34. 34.
    Gould DJ, Chudleigh JH, Moralejo D, Drey N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev. 2007;2:CD005186.Google Scholar
  35. 35.
    • Al-Tawfiq JA, Pittet D. Improving hand hygiene compliance in healthcare settings using behavior change theories: reflections, Teaching and Learning. Medicine. 2013;25(4):374–82. This article discusses the application of behavioral theories in hand hygiene promotion in a theoretical manner. The program relies on the trans theoretical model of health behavior change, John Keller’s model of motivational design, and the theory of planned behavior.Google Scholar
  36. 36.
    Boyce JM. Measuring healthcare worker hand hygiene activity: current practices and emerging technologies. Infect Control Hosp Epidemiol. 2011;32:1016–28.CrossRefPubMedGoogle Scholar
  37. 37.
    Morgan DJ, Pineles L, Shardell M, et al. Automated hand hygiene count devices may better measure compliance than human observation. Am J Infect Control. 2012;40:955–9.CrossRefPubMedGoogle Scholar
  38. 38.
    • Society for Healthcare Epidemiology of America. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33(4):322–7. This article is a position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America that outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the USA.CrossRefGoogle Scholar
  39. 39.
    Kullar R, Goff DA. Transformation of antimicrobial stewardship programs through technology and informatics. Infect Dis Clin N Am. 2014;28:291–300.CrossRefGoogle Scholar
  40. 40.
    Moodley A, Mangino JE, Goff DA. Review of infectious diseases applications for iPhone/iPad and Android: from pocket to patient. Clin Infect Dis. 2013;57(8):1145–54.CrossRefPubMedGoogle Scholar
  41. 41.
    O’Neill J. Review on antimicrobial resistance: tackling drug-resistant infections globally—final report and recommendations (Wellcome Trust, UK Government, 2016). Available at: paper_with cover.pdf. Accessed on 05 december 2017.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Infection Control Department, Instituto Central, Hospital das ClínicasFaculdade de Medicina da Universidade de São PauloSão PauloBrazil
  2. 2.Infection Control DepartmentHospital do Servidor Público Estadual de São PauloSão PauloBrazil

Personalised recommendations