Health care-associated infections (HAIs) are infections people get while they are receiving health care for another condition. HAIs can happen in any health care facility, including hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities. HAIs can be caused by bacteria, fungi, viruses, or other, less common pathogens.

HAIs are a significant cause of illness and death — and they can have devastating emotional, financial, and medical consequences. At any given time, about 1 in 25 inpatients have an infection related to hospital care. These infections lead to the loss of tens of thousands of lives and cost the U.S. health care system billions of dollars each year.

These factors raise the risk of HAIs:

• Catheters (bloodstream, endotracheal, and urinary)
• Surgery
• Injections
• Health care settings that aren’t properly cleaned and disinfected
• Communicable diseases passing between patients and healthcare workers
• Overuse or improper use of antibiotics

Common HAIs patients get in hospitals include:

• Central-line associated bloodstream infections (CLABSI)
• Clostridium difficile infections
• Pneumonia
• Methicillin-resistant Staphylococcus aureus (MRSA) infections
• Surgical site infections
• Urinary tract infections

Catheter-associated urinary tract infections (CAUTI) are some of the most common HAIs.

Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable. CDC is providing guidelines and tools to the healthcare community to help end CLABSIs.

What is a central line?

A central line (also known as a central venous catheter) is a catheter (tube) that doctors often place in a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests. You may be familiar with intravenous catheters (also known as IVs) that are used frequently to give medicine or fluids into a vein near the skin’s surface (usually on the arm or hand), for short periods of time. Central lines are different from IVs because central lines access a major vein that is close to the heart and can remain in place for weeks or months and be much more likely to cause serious infection. Central lines are commonly used in intensive care units.

What is a central line-associated bloodstream infection?

A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line. Healthcare providers must follow a strict protocol when inserting the line to make sure the line remains sterile and a CLABSI does not occur. In addition to inserting the central line properly, healthcare providers must use stringent infection control practices each time they check the line or change the dressing. Patients who get a CLABSI have a fever, and might also have red skin and soreness around the central line. If this happens, healthcare providers can do tests to learn if there is an infection present.

What are some of the things that healthcare providers are doing to prevent CLABSI?

Healthcare providers can take the following steps to help prevent CLABSIs:

• Follow recommended central line insertion practices to prevent infection when the central line is placed, including:
  • Perform hand hygiene
  • Apply appropriate skin antiseptic
  • Ensure that the skin prep agent has completely dried before inserting the central line
  • Use all five maximal sterile barrier precautions:
    • Sterile gloves
    • Sterile gown
    • Cap
    • Mask
    • Large sterile drape
• Once the central line is in place:
  • Follow recommended central line maintenance practices
  • Wash their hands with soap and water or an alcohol-based handrub before and after touching the line
• Remove a central line as soon as it is no longer needed. The sooner a catheter is removed, the less likely the chance of infection.

What can patients do to help prevent CLABSI?

Here are some ways patients can protect themselves from CLABSI:

• Research the hospital, if possible, to learn about its CLABSI rate.
• Speak up about any concerns so that healthcare personnel are reminded to follow the best infection prevention practices.
• Ask a healthcare provider if the central line is absolutely necessary. If so, ask them to help you understand the need for it and how long it will be in place.
• Pay attention to the bandage and the area around it. If the bandage comes off or if the bandage or area around it is wet or dirty, tell a healthcare worker right away.
• Don’t get the central line or the central line insertion site wet.
• Tell a healthcare worker if the area around the catheter is sore or red or if the patient has a fever or chills.
• Do not let any visitors touch the catheter or tubing.
• The patient should avoid touching the tubing as much as possible.
• In addition, everyone visiting the patient must wash their hands—before and after they visit.

What is a central venous catheter, and why is it used?

A central venous catheter, also known as a central line, is a tube that doctors place in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly. These long, flexible catheters empty out in or near the heart, allowing the catheter to give the needed treatment within seconds. You may be familiar with standard intravenous lines (IVs). Central lines are much different from standard IVs that are used to give medicine into a vein near the skin’s surface, usually for short periods of time. A central venous catheter can remain for weeks or months, and some patients receive treatment through the line several times a day. Central venous catheters are important in treating many conditions, particularly in intensive care units (ICUs).

What is a central venous catheter used for?

Central venous catheters may be used for the following reason:

• To give medicines for treatment of pain, infection, or other medical issues (e.g., cancer or heart problems)
• To provide fluids for nutrition.
• To help conduct certain medical tests.

What types of central venous catheters are there?

There are several types of central venous catheters. Healthcare providers use the type that is best for each patient’s case.

• A peripherally inserted central catheter (PICC) line is placed into a vein in the arm.
• A tunneled catheter is surgically placed into a vein in the chest or neck and then passed under the skin. One end of the catheter comes out through the skin so medicines can be given right into the catheter.
• An implanted port is similar to a tunneled catheter, but an implanted port is placed entirely under the skin. Medicines are given by a needle placed through the skin into the catheter. An implanted port is not as visible as a tunneled catheter, does not require as much daily care, and does not get in the way of a patient’s regular activities as much as a PICC line or a tunneled catheter might.

Where are central venous catheters used?

Central venous catheters can be found in a number of settings: hospitals (Intensive Care Units, Special Care Units, and other hospital settings); long-term care facilities (LTCFs); and outpatient facilities such as ambulatory surgical clinics and dialysis centers. Additionally, sometimes a patient can have a central venous catheter while at home after a hospital stay or during long-term treatment for conditions like cancer.

What is a Surgical Site Infection?

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.

Symptoms include:

• Redness and pain around the area where you had surgery
• Drainage of cloudy fluid from your surgical wound
• Fever

Can SSIs be treated?

Yes. Most SSIs can be treated with antibiotics. The type of antibiotic given depends on the bacteria (germs) causing the infection. Sometimes patients with SSIs also need another surgery to treat the infection.

What are some of the things that hospitals are doing to prevent SSIs?

To prevent SSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:

• Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.
• Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.
• If indicated, remove some of your hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur.
• Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.
• When indicated, give you antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery.
• Clean the skin at the site of your surgery with a special soap that kills germs.

What can I do to help prevent SSIs?

Before surgery:

• Tell your doctor about other medical problems you may have. Health problems such as allergies, diabetes, and obesity could affect your surgery and your treatment.
• Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit before your surgery.
• Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection.

At the time of surgery:

• Speak up if someone tries to shave you with a razor before surgery. Ask why you need to be shaved and talk with your surgeon if you have any concerns.

After surgery:

• If you do not see your providers clean their hands, please ask them to do so.
• Family and friends who visit you should not touch the surgical wound or dressings.
• Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands.
• Make sure you understand how to care for your wound before you leave the hospital.
• Always clean your hands before and after caring for your wound.
• Make sure you know who to contact if you have questions or problems after you get home.
• If you have any symptoms of an infection, such as redness and pain at the surgery site, drainage, or fever, call your doctor immediately.

What is a urinary catheter?

An indwelling urinary catheter is a drainage tube that is inserted into the urinary bladder through the urethra, is left in place, and is connected to a closed collection system. Alternative methods of urinary drainage may be employed in some patients. Intermittent (“in-and-out”) catheterization involves brief insertion of a catheter into the bladder through the urethra to drain urine at intervals. An external catheter is a urine containment device that fits over or adheres to the genitalia and is attached to a urinary drainage bag. The most commonly used external catheter is a soft flexible sheath that fits over the penis (“condom” catheter). A suprapubic catheter is surgically inserted into the bladder through an incision above the pubis.

What is a urinary tract infection?

A urinary tract infection (UTI) is an infection that involves any of the organs or structures of the urinary tract, including the kidneys, ureters, bladder, and urethra. Some of the common symptoms of a urinary tract infection are burning or pain in the lower abdomen (that is, below the stomach), fever, burning during urination, or an increase in the frequency of urination. UTIs are the most common type of healthcare-associated infection (HAI) and are most often caused by the placement or presence of a catheter in the urinary tract.

What is a catheter-associated urinary tract infection (CAUTI)?

A catheter-associated urinary tract infection (CAUTI) occurs when germs (usually bacteria) enter the urinary tract through the urinary catheter and cause infection. CAUTIs have been associated with increased morbidity, mortality, healthcare costs, and length of stay. The risk of CAUTI can be reduced by ensuring that catheters are used only when needed and removed as soon as possible; that catheters are placed using proper aseptic technique; and that the closed sterile drainage system is maintained.

Can CAUTIs be treated?

Yes, most CAUTIs can be treated with antibiotics and/or removal or change of the catheter. The healthcare provider will determine the best treatment for each patient.

What are some of the things that hospitals are doing to prevent CAUTIs?

Hospitals should follow the recommendations in the 2009 CDC Guideline for Prevention of Catheter-associated Urinary Tract Infections. The guideline emphasizes the proper use, insertion, and maintenance of urinary catheters in different healthcare settings. It also presents effective quality improvement programs that healthcare facilities can use to prevent CAUTIs.

What can patients do to help prevent CAUTI?

Patients with a urinary catheter can take the following precautions to prevent CAUTI:

• Understand why the catheter is needed and ask the healthcare provider frequently if the catheter is still needed.
• If the patient has a long-term catheter, they must clean their hands before and after touching the catheter.
• Check the position of the urine bag; it should always be below the level of the bladder.
• Do not tug or pull on the tubing.
• Do not twist or kink the catheter tubing.

What is a Ventilator-associated Pneumonia (VAP)?

Ventilator-associated pneumonia (VAP) is a lung infection that develops in a person who is on a ventilator. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the neck. An infection may occur if germs enter through the tube and get into the patient’s lungs.

Why do patients need a ventilator?

A patient may need a ventilator when he or she is very ill or during and after surgery. Ventilators can be life-saving, but they can also increase a patient’s chance of getting pneumonia by making it easier for germs to get into the patient’s lungs.

What are some of the things that hospitals are doing to prevent VAP?

To prevent ventilator-associated pneumonia, doctors, nurses, and other healthcare providers can do the following things:

• Keep the head of the patient’s bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur.
• Check the patient’s ability to breathe on his or her own every day so that the patient can be taken off of the ventilator as soon as possible.
• Clean their hands with soap and water or an alcohol-based hand rub before and after touching the patient or the ventilator.
• Clean the inside of the patient’s mouth on a regular basis.
• Clean or replace equipment between use on different patients.

What can patients do to help prevent VAP?

Patients and family members can do the following things to help prevent VAP:

Patients

• Quit smoking. Patients who smoke get more infections. Seek information about how to quit before surgery.
• If healthcare providers do not clean their hands, ask them to do so.

Patients and Family Members

• Ask about raising the head of the bed.
• Ask when the patient will be allowed to try breathing on his or her own.
• If healthcare providers do not clean their hands, ask them to do so.
• Ask about how often healthcare providers clean the patient’s mouth.

Can VAP be treated?

Most of the time, these infections can be treated with antibiotics. The choice of antibiotics depends on which specific germs are causing the infection. The healthcare provider will decide which antibiotic is best.

Acinetobacter

Acinetobacter [asz−in−ée−toe–back−ter] is a group of bacteria commonly found in soil and water. Outbreaks of Acinetobacter infections typically occur in intensive care units and healthcare settings housing very ill patients. While there are many types or “species” of Acinetobacter and all can cause human disease, Acinetobacter baumannii [asz−in−ée−toe–back−ter bō–maa–nee–ie] accounts for about 80% of reported infections. Acinetobacter infections rarely occur outside of healthcare settings.

Burkholderia cepacia

Burkholderia cepacia [burk-hōld–er–ee-uh si−pay−shee−uh] is the name for a group or “complex” of bacteria that can be found in soil and water. Burkholderia cepacia bacteria are often resistant to common antibiotics. Burkholderia cepacia poses little medical risk to healthy people; however, it is a known cause of infections in hospitalized patients. People with certain health conditions, like weakened immune systems or chronic lung diseases (particularly cystic fibrosis), may be more susceptible to infections with Burkholderia cepacia. [Burkholderia cepacia is also called B. cepacia]

Candida auris

Healthcare facilities in several countries have reported that a type of yeast called Candida auris has been causing severe illness in hospitalized patients. In some patients, this yeast can enter the bloodstream and spread throughout the body, causing serious invasive infections. This yeast often does not respond to commonly used antifungal drugs, making infections difficult to treat. Patients who have been hospitalized in a healthcare facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast.

Clostridioides difficile

Clostridioides difficile [klos–TRID–e–OY-dees dif–uh–SEEL] (formerly known as Clostridium difficile and often called C. difficile or C. diff) is a bacterium (germ) that causes diarrhea and an inflammation of the colon called colitis.

Diarrhea and fever are the most common symptoms of C. diff infection. Overuse of antibiotics is the most important risk for getting C. diff.

Clostridium Sordellii

Clostridium sordellii [klo–strid–ee–um sore–dell–ee–I] is a rare bacterium that causes pneumonia, endocarditis, arthritis, peritonitis, and myonecrosis. Clostridium sordellii bacteremia and sepsis (bacteremia is when bacteria is present in the bloodstream; sepsis is when bacteremia or another infection triggers a serious bodywide response) occur rarely. Most cases of sepsis from Clostridium sordellii occur in patients with other health conditions. Severe toxic shock syndrome among previously healthy persons has been described in a small number of Clostridium sordellii cases, most often associated with gynecologic infections in women and infection of the umbilical stump in newborns. [Clostridium sordellii is also called C. sordellii]

Enterobacteriaceae (carbapenem-resistance)

Carbapenem-resistant Enterobacteriaceae are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria, that can become carbapenem-resistant.

In healthcare settings, CRE infections most commonly occur among patients who are receiving treatment for other conditions. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections.

Gram-negative bacteria

Gram-negative bacteria – Gram-negative bacteria cause infections including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in healthcare settings. Gram-negative bacteria are resistant to multiple drugs and are increasingly resistant to most available antibiotics. Gram-negative infections include those caused by Klebsiella, Acinetobacter, Pseudomonas aeruginosa, and E. coli., as well as many other less common bacteria.

Hepatitis

The word hepatitis means inflammation of the liver and also refers to a group of viral infections that affect the liver. The most common types are hepatitis A, hepatitis B, and hepatitis C.

The delivery of healthcare has the potential to transmit hepatitis to both healthcare workers and patients. Outbreaks have occurred in outpatient settings, hemodialysis units, long-term care facilities, and hospitals, primarily as a result of unsafe injection practices; reuse of needles, fingerstick devices, and syringes; and other lapses in infection control.

Human Immunodeficiency Virus (HIV/AIDS)

Human immunodeficiency virus (HIV) is the virus that can lead to acquired immune deficiency syndrome (AIDS). HIV destroys blood cells called CD4+ T cells, which are crucial to helping the body fight disease. This results in a weakened immune system, making persons with HIV or AIDS at risk for many different types of infections. Transmission of HIV to patients while in Healthcare Settings is rare. Most exposures do not result in infection. [Human immunodeficiency virus is also called HIV]

Influenza

Influenza is primarily a community-based infection that is transmitted in households and community settings. Each year, 5% to 20%of U.S. residents acquire an influenza virus infection, and many will seek medical care in ambulatory healthcare settings (e.g., pediatricians’ offices, urgent-care clinics). In addition, more than 200,000 persons, on average, are hospitalized each year for key facts about Influenza (flu).

Healthcare-associated influenza infections can occur in any healthcare setting and are most common when influenza is also circulating in the community. Therefore, influenza prevention measures should be implemented in all healthcare settings. Supplemental measures may need to be implemented during influenza season if outbreaks of healthcare-associated influenza occur within certain facilities, such as long-term care facilities and hospitals.

Klebsiella

Klebsiella [kleb–see–ell–uh] is a type of Gram-negative bacteria that can cause healthcare-associated infections including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. Increasingly, Klebsiella bacteria have developed antimicrobial resistance, most recently to the class of antibiotics known as carbapenems. Klebsiella bacteria are normally found in the human intestines (where they do not cause disease). They are also found in human stool (feces). In healthcare settings, Klebsiella infections commonly occur among sick patients who are receiving treatment for other conditions. Patients who have devices like ventilators (breathing machines) or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for Klebsiella infections. Healthy people usually do not get Klebsiella infections.

Methicillin-resistant Staphylococcus aureus (MRSA)

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. In the community, most MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur most frequently among patients in Healthcare Settings. [Methicillin-resistant Staphylococcus aureus is also called MRSA]

Mycobacterium abscessus

Mycobacterium abscessus [mī–kō–bak–tair–ee–yum ab–ses–sus] is a bacterium distantly related to the ones that cause tuberculosis and leprosy. It is found in water, soil, and dust. It has been known to contaminate medications and products, including medical devices. Healthcare-associatedMycobacterium abscessus can cause a variety of infections that require medical attention. Infections due to this bacterium are usually of the skin and the soft tissues under the skin. It can also cause lung infections in persons with various chronic lung diseases. [Mycobacterium abscessus is also called M. abscessus]

Norovirus

Noroviruses are a group of viruses that cause gastroenteritis [gas-trō-en-ter-ī-tis] in people. Gastroenteritis is an inflammation of the lining of the stomach and intestines, causing an acute onset of severe vomiting and diarrhea. Norovirus illness is usually brief in people who are otherwise healthy. Young children, the elderly, and people with other medical illnesses are most at risk for more severe or prolonged infection. Like all viral infections, noroviruses are not affected by treatment with antibiotics.

Pseudomonas aeruginosa

Pseudomonas infection is caused by strains of bacteria found widely in the environment; the most common type causing infections in humans is called Pseudomonas aeruginosa. Serious Pseudomonas infections usually occur in people in the hospital and/or with weakened immune systems.

Staphylococcus aureus

Staphylococcus aureus [staf I lō-kok is aw ree us] (staph), is a bacterium commonly found on the skin and in the nose of about 30% of individuals. Most of the time, staph does not cause any harm. These infections can look like pimples, boils, or other skin conditions and most are able to be treated.

Tuberculosis (TB)

Tuberculosis [tuh–burk–yoo–lō–sis] is caused by a bacterium called Mycobacteriumtuberculosis. Transmission of Mycobacterium tuberculosis is a recognized risk to patients and healthcare personnel in healthcare facilities. Transmission is most likely to occur from patients who have unrecognized pulmonary tuberculosis or tuberculosis related to their larynx, are not on effective anti-tuberculosis therapy, and have not been placed in tuberculosis isolation. Transmission of Mycobacterium tuberculosis in Healthcare Settings has been associated with close contact with persons who have infectious tuberculosis, particularly during the performance of cough-inducing procedures such as bronchoscopy and sputum induction. MycobacteriumTuberculosis is spread through air and can travel long distances. Cases of multidrug-resistant tuberculosis (MDR-TB, which includes extensively drug-resistant tuberculosis [XDR-TB]), have been recognized and are more difficult to treat. [Tuberculosis is also called TB]

Vancomycin-intermediate Staphylococcus aureus and Vancomycin-resistant Staphylococcus aureus

Vancomycin [vank–ō–mī–sin]-intermediate Staphylococcus aureus[staff–u–lu–kaw–kus aw–ree–us] (also called S. aureus) and vancomycin-resistant Staphylococcus aureus are specific staph bacteria that have developed resistance to the antimicrobial agent vancomycin. Persons who develop this type of staph infection may have underlying health conditions (such as diabetes and kidney disease), devices going into their bodies (such as catheters), previous infections with methicillin-resistant Staphylococcus aureus, and recent exposure to vancomycin and other antimicrobial agents. [Vancomycin-intermediate Staphylococcus aureus is also called VISA and vancomycin-resistant Staphylococcus aureus is also called VRSA]

Vancomycin-resistant Enterococci (VRE)

Vancomycin [van–kō–mī–sin]-resistant Enterococci [en–ter–ō–kō–kī] are specific types of antimicrobial-resistant bacteria that are resistant to vancomycin, the drug often used to treat infections caused by enterococci. Enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Most vancomycin-resistant Enterococci infections occur in hospitals. [Vancomycin-resistant Enterococci is also called VRE]

As health care quality activities progress, it’s important to recognize how HAIs, antibiotic use, and antibiotic resistance are related. Prevention of HAIs leads to fewer illnesses requiring antibiotic treatment — and proper use of antibiotics slows the development and spread of antibiotic-resistant organisms that can be difficult to treat.

Since the 1940s, antibiotics have greatly reduced illness and death — but using them also creates selective pressure that can lead to resistance. Widespread and indiscriminate use of antibiotics has accelerated the development of antibiotic-resistant organisms, making many antibiotics less effective.

Using antibiotics judiciously is essential if we are to slow the development of resistance and extend the useful lifetime of our most urgently needed antibiotics.

Hepatitis A

Healthcare-associated hepatitis A virus (HAV) occurs infrequently. HAV is spread by the fecal-oral route, and transmission to healthcare personnel usually occurs when the source patient has unrecognized hepatitis and is fecally incontinent or has diarrhea. Other risk factors for hepatitis A virus (HAV) transmission that increase the risk of fecal-oral contamination such as (a) eating or drinking in patient care areas; (b) not washing hands after handling an infected infant; and (c) sharing food, beverages, or cigarettes with patients, their families, or staff members.

Hepatitis B

Hepatitis B is a liver disease caused by the hepatitis B virus (HBV). HBV can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HBV is spread in healthcare settings when blood or other body fluid from an infected person enters the body of a person who is not infected. In a healthcare setting, this contact is primarily through contaminated needles, syringes, or other sharp instruments.

Hepatitis C

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). HCV can cause lifelong infection, cirrhosis, or liver cancer. HCV is spread by contact with the blood of an infected person. The spread of HCV from one person to another in healthcare settings is rare, but can occur. In a healthcare setting, this contact is primarily through contaminated needles, syringes, or other sharp instruments.

Human immunodeficiency virus (HIV) is the virus that can lead to acquired immune deficiency syndrome (AIDS). HIV destroys blood cells called CD4+ T cells, which are crucial to helping the body fight disease. This results in a weakened immune system, making persons with HIV or AIDS at risk for many different types of infections. Transmission of HIV to patients while in healthcare settings is rare. However, proper sterilization and disinfection procedures are required to prevent infection risks. Most exposures do not result in infection.

Transmission of HIV

Although HIV transmission is possible in healthcare settings, it is extremely rare. Medical experts emphasize that the careful practice of infection control procedures, including universal precautions (i.e., using protective practices and personal protective equipment to prevent transmission of HIV and other bloodborne infections), protects patients as well as healthcare providers from possible HIV transmission in medical and dental settings. Healthcare personnel are at risk for occupational exposure to bloodborne pathogens including HIV. Important factors that influence the overall risk for occupational exposures to bloodborne pathogens include the number of infected individuals in the patient population and the type and number of blood contacts. Transmission of HIV to patients while in healthcare settings is rare; however, proper sterilization and disinfection procedures are required.

CDC has documented rare cases of patients contracting HIV in healthcare settings from infected donor tissue.

Even though you’re staying in the hospital to get better, it’s possible to get an infection while you’re there. If you’re staying in the hospital for an injury or an illness, you may be at risk for getting a fungal infection, especially if you’re very sick or have a weak immune system. These types of infections are called healthcare-associated infections (HAIs).

Hospital staff and healthcare providers do everything they can to prevent HAIs, but some procedures and situations can increase your risk for fungal HAIs. The information provided below can help you understand your risk and help you be a safe patient while hospitalized.

What you need to know about fungal infections

Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can be deadly, like fungal pneumonia. Because of this, it’s important to get treatment as soon as possible to try to avoid serious infection.

Life-saving devices like central venous catheters (a special kind of IV tube) can increase your risk for fungal infection. During your hospital stay you may need a central venous catheter, which is a tube placed into a vein to give medications or liquids. This can make it easier for fungi to enter your body and increase your chances of getting a fungal bloodstream infection such as candidemia.

Disease-causing fungi can enter your body through cuts, wounds, and burns. Fungi naturally live on your skin and on healthcare workers’ hands. These fungi can enter your body through cuts and wounds and cause infection during a hospital stay, especially if your wounds are severe.

Staying in the intensive care unit (ICU). If you’re in the ICU because you’re critically ill or injured, you’re likely to need life-saving devices or procedures that can put you at risk for fungal infections, particularly Candida and Aspergillus infections.

Surgery can lead to infection. If you’ve had surgery, it’s possible to get a fungal infection in in the part of the body where the surgery took place. Surgical site infections are often caused by bacteria, but can also be caused by fungi.

Hospital construction. Hospital staff do everything they can to prevent fungal infections. Despite this, outbreaks of aspergillosis have happened among very sick patients staying at hospitals where there is ongoing construction or renovation.This is thought to be because construction stirs up the amount of fungal spores in the air.

Preventing fungal infections in hospitalized patients

Fungi are difficult to avoid because they are a natural part of the environment. Fungi live outdoors in soil, on plants, trees, and other vegetation. They are also on many indoor surfaces and on your skin. However, there may be some ways for you to lower your chances of getting a serious fungal infection.

Learn about fungal infections. There are different types of fungal infections. Learning about them can help you and your healthcare provider recognize the symptoms early, which may prevent serious illness.

Take medications as directed. Your healthcare provider may prescribe antifungal medications to prevent fungal infections. Scientists are still learning about which patients are at highest risk and how best to prevent fungal infections.

Be a safe patient. There are some actions that you can take to help protect yourself from infections, including:

• Speak up. Talk to your doctor about any worries you have about your safety and ask them what they are doing to protect you.
• Keep hands clean. If you do not see your providers clean their hands, please ask them to do so. Also remind your loved ones and visitors. Washing hands can prevent the spread of germs.

What to do after leaving the hospital. If you have a weakened immune system, you may still be at risk for getting a fungal infection after you leave the hospital.

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.”

You can help protect yourself from infections when you get medical care. This is especially important when you have a medical procedure, like surgery or dialysis.

Take these steps to help prevent infections when you have a medical procedure:

• Talk with your doctor or nurse about infections.
• Make sure your doctors, nurses, and visitors always wash their hands.
• Follow the instructions for preventing infections after your procedure.

How do medical procedures put people at risk for infections?

Germs can spread from one patient to another or from doctors and nurses to patients. You are at greater risk from germs that can cause infections if you have:

• An open wound (cut) after surgery
• An IV (intravenous) tube
• A catheter (tube in your vein or bladder)
• A ventilator (breathing tube)

The good news is that patients and doctors can work together to prevent the spread of germs and the infections they cause.

What types of infections can people get from medical procedures?

Infections people get from visiting a hospital, health clinic, doctor’s office, or other health care facility are called health care-associated infections (HAIs).

These infections can lead to sickness and even death. Blood infections and urinary tract infections from catheters are examples of HAIs.

How will I know if I have an infection?

Common signs that you may have an infection include:

• Fever
• Burning or pain below the stomach (the lower abdomen)
• Burning when peeing (urinating) or having to pee more often than usual
• Redness or pain around a catheter or wound
• Pus or other liquid coming from the skin
• Diarrhea (frequent, watery poop)

Take Action!

You and your doctor or nurse can work together to prevent infections by following these steps.

Talk with your doctor about preventing infections.

Before having surgery or getting another type of medical procedure, talk with your doctor or nurse about:

• Any medical problems you have, like diabetes
• What will be done before the procedure to help prevent an infection, like cleaning the skin with soap
• What you can do to help protect yourself from an infection after the procedure

Start the conversation by saying, “I know how easy it is for people to get infections. I don’t want it to happen to me.”

Speak up if something doesn’t seem right.

Don’t be afraid to speak up and ask questions before or after your procedure. For example, if your bandages aren’t clean, dry, or attached well, point this out to the doctor or nurse. Your safety is their priority.

After your procedure, pay close attention to changes in your health. If you get home and start to feel sick or notice signs of an infection, call your doctor or nurse right away.

Always make sure your doctors and nurses wash their hands.

Politely ask your doctors and nurses if they washed their hands. This is one of the most important ways to prevent infections. Even if they wear gloves, they still need to wash their hands before putting them on – just wearing gloves is not enough to prevent infections.

If you feel uncomfortable asking the doctors or nurses if their hands are clean, remember that it’s their job to help keep you safe and healthy.

Ask your visitors to wash their hands, too.

Make sure your family members and friends wash their hands when they visit you. And if a loved one isn’t feeling well, ask him or her to call you instead of visiting in person.

Take steps to prevent infections after a procedure.

• Wash your hands often, especially after you’ve had surgery. Be sure to wash your hands with soap and water after using the bathroom and before eating.
• Follow the instructions you get for what to do after a medical procedure.
• Always wash your hands before touching a wound or catheter.
• If you have a catheter, ask every day if it's time for the catheter to be removed.
• Be sure to keep any follow-up appointments.

Use medicines safely.

You may need to take antibiotics or other medicines after the procedure. Be sure to follow the instructions on when, how often, and how long you need to take your medicines.

If you are taking antibiotics:

• Take all doses of the antibiotic unless your doctor tells you to stop.
• Never share antibiotics with others.
• Safely get rid of any antibiotics that you don't use.
• Tell your doctor or nurse if you start having diarrhea.

Call your doctor, nurse, or pharmacist right away if you have any questions about your medicine – or if you are worried that your medicine is making you feel worse.

Stay up to date on your shots.

Ask your doctor about important shots (vaccines) to protect you from infections.

Protect yourself from seasonal flu.

Everyone age 6 months and older needs to get a flu vaccine every year.

Quit smoking.

Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit before your surgery. If you smoke, call 1-800-QUIT-NOW (1-800-784-8669) to make your quit plan. Get more ideas for quitting smoking.