Healthcare-associated infections are a major cause of morbidity and mortality. Dramatic changes in the delivery of healthcare during the past decade have changed the definition of healthcare-associated infections. Healthcare delivery changes include a reduction in the number of general hospital beds, an increase in the proportion of patients who are in intensive care units, a larger proportion of surgical procedures performed as outpatient procedures, a marked increase in patients cared for in outpatient settings, and an increase in the delivery of healthcare in the home setting. These changes have blurred the border between hospital- and community-acquired infections, increased the challenge of controlling transmission of antimicrobial-resistant pathogens, and complicated clinicians’ treatment decisions. Data from the National Nosocomial Infections Surveillance system show that between the periods of 1993-1997 and 1998, infections caused by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative staphylococci, and imipenem- or quinolone-resistant Pseudomonas aeruginosa have significantly increased. In addition, we have witnessed the emergence of vancomycin-intermediate resistant S aureus and the community transmission of MRSA. If we are to turn the tide on the continued emergence of antimicrobial-resistant pathogens, we will need to enhance and expand our infection control programs in all settings in which healthcare is provided and improve the appropriateness of antimicrobial use.
Jarvis WR, Sinkowitz-Cochran RL
Postgrad Med 2001 Feb;109(2 Suppl):3-9