You go to the hospital to get well, right? Of course, but did you know that you can get infections in the hospital while you are being treated for something else?

Time in the hospital can put you at risk for a healthcare-associated infection (HAI), such as a blood, surgical site, or urinary tract infection.

Every day, patients get infections in healthcare facilities while they are being treated for something else. These infections can have devastating emotional, financial, and medical effects. Worst of all, they can be deadly.

Healthcare procedures can leave you vulnerable to germs that cause HAIs. These germs can be spread in healthcare settings from patient to patient on unclean hands of healthcare personnel or through the improper use or reuse of equipment.

These infections are not limited to hospitals. For example, in the past 10 years alone, there have been more than 30 outbreaks of hepatitis B and hepatitis C in non-hospital healthcare settings such as

• outpatient clinics,
• dialysis centers, and
• long-term care facilities.

Protect yourself and your family from harmful germs that can cause infections

• Keep your hands clean. Regular hand cleaning is one of the best ways to remove germs, avoid getting sick, and prevent spreading germs.
• Take antibiotics only when your provider thinks you need them. Ask if your antibiotic is necessary. If you take antibiotics when you don’t need them, you’re only exposing yourself to unnecessary risk of side effects and potentially serious infections in the future. If you do need antibiotics, take them exactly as they’re prescribed.
• Watch for signs of infection and its complications, like sepsis. Get care right away—don’t delay.
  • Tell your doctor if you think you have an infection, or if your infection is not getting better or is getting worse.
• Watch out for life-threatening diarrhea caused by C. difficile. If you have been taking an antibiotic, tell your doctor if you have 3 or more diarrhea episodes in 24 hours.
• Get vaccinated against flu and other infections to avoid complications.

Be a safe patient in the hospital

• Tell your doctors if you have been hospitalized in another facility, have recently received health care outside of the United States, or have recently had an infection.
• Ask your healthcare provider what they and the facility will do to protect you and your family from an antibiotic-resistant infection.
  • If you have a catheter, ask daily when it can be removed.
  • If you are having surgery, ask your doctor how they prevent infections. Also, ask how you can prepare for surgery to reduce your infection risk.
• Keep your hands clean. Make sure everyone cleans their hands before touching you. Remind healthcare personnel and your visitors to clean their hands.
• Let your doctors check you for resistant germs if needed. Hospitals need to screen patients if they’re exposed, and this helps protect you and those around you.
• Understand that if you have a resistant bacteria, healthcare providers may use gowns and gloves when caring for you.
• Allow people to clean your room while you’re in the hospital, even when it feels inconvenient for you.
  • Environmental services workers are the people who clean patient rooms in the hospital, and they are important members of the healthcare team.
  • Allowing them to clean and disinfect your room helps keep you safe by reducing your risk of developing an infection—don’t say, “come back later.”

Overview

People receiving medical care can get serious infections called healthcare-associated infections (HAIs), which may lead to sepsis or death. Hospitals report common HAIs to CDC, including infections caused by C. difficile, infections following surgery, and infections following placement of a tube in the bladder or a large vein (catheter). These infections can be caused by bacteria that are resistant to antibiotics, making them difficult to treat. In certain kinds of hospitals, one in four of these infections (not including C. difficile) are caused by antibiotic-resistant bacteria identified by CDC as urgent or serious threats to health.* Although progress has been made, more work is needed. Three critical efforts to prevent an HAI are

1. prevent infections related to surgery or placement of a catheter,
2. prevent spread of bacteria between patients, and
3. improve antibiotic use. It’s important that healthcare providers take these actions with every patient every time to prevent HAIs and stop the spread of antibiotic resistance.

Healthcare providers need to:

• Follow recommendations for preventing C. difficile and infections that can occur after surgery or are related to single-use catheters placed in the body. Follow the recommended actions with every patient every time. Isolate patients when appropriate, and know antibiotic resistance patterns in your facility/area.
• Prescribe antibiotics correctly. Get cultures, start antibiotics promptly, and reassess 24-48 hours later. Know when to stop antibiotic treatment.

*Long-term acute care hospitals, which provide complex medical care, such as ventilator or wound care, for long periods of time.

6 urgent or serious antibiotic-resistant threats, plus C. difficile, can cause HAIs.

50% of one common deadly HAI is currently being prevented.

1 in 4 catheter- and surgery-related HAIs are caused by six resistant bacteria in certain kinds of hospitals.

Problem

Antibiotic-resistant HAIs are a threat to all patients.

• HAIs are commonly caused by antibiotic-resistant bacteria, which may lead to sepsis or death. One in seven catheter- and surgery-related HAIs in acute care hospitals, and one in four catheter- and surgery-related HAIs in long-term acute care hospitals, is caused by any of six resistant bacteria (not including C. difficile).
• These six bacteria are among the most deadly antibiotic-resistant bacteria, identified as urgent or serious threats by CDC: CRE (carbapenem-resistant Enterobacteriaceae), MRSA (methicillin-resistant Staphylococcus aureus ), ESBL-producing Enterobacteriaceae (extended-spectrum ß-lactamases), VRE (vancomycin-resistant enterococci), multi-drug resistant pseudomonas, and multi-drug resistant Acinetobacter.
• Progress has been made in preventing HAIs, including a 50% decrease in central line-associated blood stream infections from 2008 to 2014, but more work is needed.
• C. difficile is the most common type of bacteria responsible for infections in hospitals. Most C. difficile is not resistant to the antibiotics used to treat it, but antibiotic use puts patients at high risk for deadly diarrhea.

What Can Be Done

The Federal government is

• Preventing infections and their spread:
  Conducting surveillance for HAIs and antibiotic resistance, using data to target prevention, and promoting implementation of recommendations. Identifying emerging resistant threats. Promptly responding to and controlling outbreaks.
• Improving antibiotic use:
  Promoting appropriate use and providing guidance/assessing implementation of stewardship programs across health care settings.
• Promoting use of data:
  Preventing HAIs and improving antibiotic use to better protect patients. Collaborating with partners to implement prevention and stewardship strategies, including in federal facilities.

Healthcare providers need to

• Prevent infections and their spread:
  Follow recommendations for preventing C. difficile and infections that can occur after surgery or related to single-use catheters placed in the body. Follow recommended actions with every patient every time. Isolate patients when appropriate, and know antibiotic resistance patterns in your facility/area.
• Improve antibiotic use:
  Prescribe antibiotics correctly. Get cultures, start antibiotics promptly, and reassess 24-48 hours later. Know when to stop antibiotic treatment.

Health care facility CEOs/ administrators can

• Prevent infections and their spread:
  Follow CDC guidelines for preventing infections and promote data use to target prevention and improvements. Make sure staff follow hand hygiene, isolation, and environmental/device cleaning practices.
• Improve antibiotic use:
  Establish stewardship program and enroll your hospital to submit data to CDC’s Antimicrobial Use and Resistance (AUR) Module to target improvements.
• Prioritize:
  Make infection prevention, sepsis prevention, and stewardship a priority; participate in a Quality Innovation Network.

State and local health departments can

• Prevent infections and their spread:
  Set goals, monitor your state’s progress in preventing infections, promote action, and achieve regional prevention. Support institutions to meet goals.
• Improve antibiotic use:
  Support stewardship efforts and know antibiotic resistance patterns in your area.

Patients and their families can

• Prevent infections and their spread:
  If you have a catheter, ask daily if it’s necessary. If you are having surgery, ask your doctor how he/she prevents infections. Insist that everyone clean their hands before touching you. Clean your hands often. Explore Hospital Compare tool for HAI data.
• Improve antibiotic use:
  Ask if your antibiotic is necessary and what is being done to improve antibiotic use and protect patients.

Overview

We’re at a tipping point: an increasing number of germs no longer respond to the drugs designed to kill them. Inappropriate prescribing of antibiotics and lack of infection control actions can contribute to drug resistance and put patients at risk for deadly diarrhea (caused by C. difficile). Even if one facility is following recommended infection controls, germs can be spread inside of and between health care facilities when patients are transferred from one health care facility to another without appropriate actions to stop spread. Lack of coordination between facilities can put patients at increased risk. Now more than ever is the time for public health authorities and health care facilities to work together, sharing experiences and connecting patient safety efforts happening across the state.

Health care facility CEOs/administrators can:

• Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
• Review and perfect infection control actions within your facility.
• Get leadership commitment to join healthcare-associated infection (HAI)/antibiotic resistance prevention activities in the area.
• Connect with the public health department to share data about antibiotic resistance and other HAIs.
• Make sure clinical staff have access to prompt and accurate laboratory testing for antibiotic-resistant germs.

Antibiotic-resistant germs cause more than 2 million illnesses and at least 23,000 deaths each year in the US.

Up to 70% fewer patients will get CRE over 5 years if facilities coordinate to protect patients.

Preventing infections and improving antibiotic prescribing could save 37,000 lives from drug-resistant infections over 5 years.

Problem

Germs spread between patients and across health care facilities.

Antibiotic resistance is a threat.

• Nightmare germs called CRE (carbapenem-resistant Enterobacteriaceae) can cause deadly infections and have become resistant to all or nearly all antibiotics we have today. CRE spread between health care facilities like hospitals and nursing homes when appropriate actions are not taken.
• MRSA (methicillin-resistant Staphylococcus aureus) infections commonly cause pneumonia and sepsis that can be deadly.
• The germ Pseudomonas aeruginosa can cause HAIs, including bloodstream infections. Strains resistant to almost all antibiotics have been found in hospitalized patients.
• These germs are some of the most deadly resistant germs identified as “urgent” and “serious” threats.

C. difficile infections are at historically high rates.

• C. difficile (Clostridium difficile), a germ commonly found in health care facilities, can be picked up from contaminated surfaces or spread from a healthcare provider’s hands.
• Most C. difficile is not resistant to antibiotics, but when a person takes antibiotics, some good germs are destroyed. Antibiotic use allows C. difficile to take over, putting patients at high risk for deadly diarrhea.

Working together is vital.

• Infections and antibiotic use in one facility affect other facilities because of patient transfers.
• Public health leadership is critical so that facilities are alerted to data about resistant infections, C. difficile, or outbreaks in the area, and can target effective prevention strategies.
• When facilities are alerted to increased threat levels, they can improve antibiotic use and infection control actions so that patients are better protected.
• National efforts to prevent infections and improve antibiotic prescribing could prevent 619,000 antibiotic-resistant and C. difficile infections over 5 years.

What Can Be Done

Health care facility CEOs/administrators can

• Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
• Review and perfect infection control actions within your facility.
• Get leadership commitment to start or join HAI/antibiotic resistance prevention activities in the area.
• Connect with the public health department to share data about antibiotic resistance and other HAIs.
• Make sure clinical staff have access to prompt and accurate laboratory testing for antibiotic-resistant germs.

Prescribers and healthcare staff can

• Prescribe antibiotics correctly. Get cultures then start the right drug promptly at the right dose for the right duration. Know when to stop antibiotics.
• Be aware of antibiotic resistance patterns in your facility and area to protect your patients.
• Ask patients if they have recently received care in another facility.

Patients and their families can

• Ask your healthcare provider what they and the facility will do to protect you and your family from an antibiotic-resistant or C. difficile infection.
• Tell your doctor if you have been hospitalized in another facility.
• Insist that everyone wash their hands before touching you, and wash your hands often.

In dentistry, the diseases we are most concerned about are those caused by bloodborne pathogens (BBP). Examples are hepatitis B and C and human immunodeficiency virus (HIV). Transmission may occur from a patient to a dental health care provider (DHCP), from a DHCP to a patient, or from one patient to another patient. The best way to prevent the transmission of BBP is adherence to Standard Precautions.

What is the risk of bloodborne pathogens (e.g., hepatitis B virus (HBV) and HIV) being transmitted through aerosols generated during the use of an ultrasonic scaler or high-speed dental drill?

A visible spray is created during the use of rotary dental and surgical instruments (e.g., handpieces, ultrasonic scalers) and air-water syringes. This spray contains primarily a large-particle spatter of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing either on the floor, nearby operatory surfaces, the dental health care personnel providing care, or the patient. This spatter can commonly be seen on faceshields, protective eyewear, and other surfaces immediately after the dental procedure, but after a short time it may dry clear and not be easily detected. The spray may also contain some aerosol. Aerosols take considerable energy to generate, consist of particles less than 10 microns in diameter, and are not typically visible to the naked eye. Aerosols can remain airborne for extended periods of time and may be inhaled. Aerosols should not be confused with the large-particle spatter that makes up the bulk of the spray from handpieces and ultrasonic scalers. To prevent contact with splashes and spatter, dental health care personnel should position patients properly and make appropriate use of barriers (e.g., faceshields, surgical masks, gowns), rubber dams, and high-volume evacuators.
Although it is known that bloodborne pathogens can be transmitted through mucous membrane exposure, there are no known instances of a bloodborne pathogen being transmitted by an aerosol in a clinical setting. In studies conducted in dental operatories and hemodialysis centers, hepatitis B surface antigen could not be detected in the air during the treatment of hepatitis B carriers, including during procedures known to generate aerosols. This suggests that detection of HIV in aerosols would also be uncommon, since the concentration of HIV in blood is generally lower that that of HBV. Finally, detection of HIV in an aerosol would not necessarily mean that HIV is readily transmissible by this route. In the health care setting, the major risks of HIV infection are blood contact due to percutaneous injuries and, to a lesser extent, mucous membrane and skin contact. The possibility that HIV may be transmitted via aerosolized blood must be considered theoretical at this time.

First responders are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV).

Exposure incidents may occur through the following:

• Needlesticks or cuts from sharp objects contaminated with another person’s blood.
• Contact of the eyes, mouth, nose, or broken skin with blood or other potentially infectious body fluids.

Some employees are reluctant to report exposure incidents. Encourage your employees to report all exposures. This way, you can carry out your responsibility to take appropriate post-exposure actions to protect your workers, their families, and the public against infection from bloodborne pathogens.

Why Are Employees Reluctant to Report Exposures?

Although rates of underreporting are difficult to ascertain, studies estimate that high percentages of workers do not report all exposures.

Employees give many reasons for not reporting exposures:

• They do not think they will get an infection from the exposure.
• They think the exposure may have been their fault.
• They were not wearing the proper personal protective equipment.
• They are embarrassed by the exposure incident.
• They think it takes too much time away from work to report.
• They think reporting may result in a negative performance evaluation.
• They fear losing their job.
• They think that wiping blood or other body fluids off their skin is sufficient.
• They are not sure whether certain incidents should be considered exposures.

Are some of your workers failing to report exposures for these reasons? Encourage your workers to report possible exposure incidents as soon as possible.

Why Should Employees Report All Exposures?

First, reporting exposures to blood or potentially infectious body fluids will help protect your workers, their families, and the public. It allows you to provide appropriate, prompt, medical assessment and treatment.

Second, by documenting exposures, you can identify causes and prevent them from occurring again. This keeps your workers on the job, reducing costs in the long run.

How Can You Encourage Reporting?

• Establish a policy that all potential exposures must be reported!
• Identify and address issues, workplace culture, or barriers that discourage reporting.
• Make sure employees know what an exposure is.
• Explain the risks of infection.
• Establish an easy-to-use system for reporting and evaluating exposures.
• Ensure reports are handled promptly and confidentially.
• Make sure all employees and managers understand the department’s reporting protocol.
• Cover reporting procedures in the initial and annual bloodborne pathogens training.
• Regularly remind your workers to promptly report all potential bloodborne pathogens exposures.
• Assure your employees that reporting an exposure will not affect their job or performance evaluation.
• Keep a record of exposures. Look for patterns of exposure and seek solutions to prevent future exposures.
• Show workers how reporting helps prevent future exposures.

Get the word out! Tell your employees about the policy, the steps you are taking to implement it, and how they can help.