Infection prevention and control

The burden of health care-associated infection worldwide

Photo of a patient in hospital

Health care-associated infection (HAI), also referred to as "nosocomial" or "hospital" infection, is an infection occurring in a patient during the process of care in a hospital or other health care facility which was not present or incubating at the time of admission. HAI can affect patients in any type of setting where they receive care and can also appear after discharge. Furthermore, they include occupational infections among staff. HAI represents the most frequent adverse event during care delivery and no institution or country can claim to have solved the problem yet. Based on data from a number of countries, it can be estimated that each year, hundreds of millions of patients around the world are affected by HAI. The burden of HAI is several fold higher in low- and middle-income countries than in high-income ones. There is also now a worldwide consensus that urgent action is needed to prevent and control the spread of antibiotic resistant organisms and in health care effective infection prevention and control (IPC) is one solution.

Every day, HAI results in prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, massive additional costs for health systems, high costs for patients and their family, and unnecessary deaths.

Although HAI is the most frequent adverse event in health care, its true global burden remains unknown because of the difficulty in gathering reliable data: most countries lack surveillance systems for HAI, and those that do have them struggle with the complexity and the lack of uniformity of criteria for diagnosing it.

The burden of HAI is one of the key areas of work of the WHO IPC global unit. Systematic reviews of the literature have been conducted to identify published studies from both developed and developing countries and highlight the magnitude of the HAI problem.

An original article focusing on the HAI endemic burden in developing countries was published online on 10 December 2010 in The Lancet.

A comprehensive WHO Report on the burden of endemic health care-associated infection worldwide issued on 5 May 2011 which highlights the importance of HAI in different settings and related risk factors, describes advantages and challenges of HAI surveillance, reports available data on HAI endemic burden in high-, middle- and low-income countries and their impact worldwide, and finally points out lessons learned and future perspectives.

What are the solutions to the problem of HCAI?

Many infection prevention and control measures, including hand hygiene, are simple, low-cost and effective, however they require staff accountability and behavioural change.

The main solutions and perspectives for improvement identified are:

  • Identifying local determinants of the HAI burden.
  • Improving reporting and surveillance systems at the national level.
  • Ensuring minimum requirements in terms of facilities and dedicated resources available for HAI surveillance at the institutional level, including microbiology laboratories' capacity.
  • Ensuring that core components for infection control are in place at the national and health-care setting levels.
  • Implementing standard precautions, including best hand hygiene practices at the bedside.
  • Improving staff education and accountability.
  • Conducting research to adapt and validate surveillance protocols based on the reality of developing countries.
  • Conducting research on the potential involvement of patients and their families in HAI reporting and control.

The WHO Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level were published in 2016. They cover eight areas of IPC and comprise 14 recommendations and best practice statements and should be implemented by all Member States and health care facilities.

In 2017, a publication led by WHO’s IPC Global Unit was also issued: