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Infections Acquired in Health Care Facilities

INTRODUCTION

The costs of hospital-acquired (nosocomial) and other health care–associated infections are great. These infections have affected as many as 1.7 million patients at a cost of ~$28–33 billion and 99,000 lives in U.S. hospitals annually. Although efforts to lower infection risks have been challenged by the numbers of immunocompromised patients, antibiotic-resistant bacteria, fungal and viral superinfections, and invasive devices and procedures, a prevailing viewpoint—often termed “zero tolerance”—is that almost all health care–associated infections should be avoidable with strict application of evidence-based prevention guidelines (Table 168-1). In fact, rates of device-related infections—historically, the largest drivers of risk—have fallen steadily over the past few years. Unfortunately, at the same time, antimicrobial-resistant pathogens have risen in number and are estimated to contribute to ~23,000 deaths in and outside of hospitals annually. This chapter reviews health care–associated and device-related infections as well as basic surveillance, prevention, control, and treatment activities.

TABLE 168-1Sources of Infection Control Guidelines and Oversight

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