Guide — Infection Control
Healthcare-Associated Infections (HAIs)
Healthcare-associated infections (HAIs) are infections that patients acquire during the course of receiving healthcare that were not present or incubating at the time of admission. The four most common preventable HAIs — CAUTI, CLABSI, VAP, and SSI — together account for the majority of HAI morbidity, mortality, and cost.
12 min read · Infection Control
Educational use only. HAI definitions and prevention bundle elements reflect CDC, NHSN, and AHRQ guidelines. Prevention practices should be implemented per current evidence-based protocols and facility policy. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
HAIs affect approximately 1 in 31 hospitalized patients in the United States on any given day. They represent a major patient safety problem — the majority are preventable through evidence-based nursing practice. Nurses are on the front line of HAI prevention through consistent application of prevention bundles, daily device assessment, and patient advocacy.
CAUTI
Most common HAI
CLABSI
Highest mortality
VAP
Vent-associated
SSI
Surgical complication
CAUTI — Catheter-Associated Urinary Tract Infection
Definition
A UTI that develops in a patient with a urinary catheter in place for >2 days on the date of the event, or within 1 day of catheter removal.
Clinical Significance
Most common healthcare-associated infection — approximately 30–40% of all HAIs. Each day of catheterization increases risk by 3–7%.
Risk Factors
- Female sex
- Catheter in place > 6 days
- Breaks in closed drainage system
- Diabetes mellitus
- Immunocompromise
- Improper catheter care or positioning
- Urinary obstruction
Signs & Symptoms
- Fever, chills
- Flank or suprapubic pain
- Cloudy or foul-smelling urine
- Confusion (especially in older adults)
- Hematuria
Prevention Bundle
- Avoid catheter insertion unless medically necessary — consider alternatives (condom catheter, intermittent catheterization, incontinence pads)
- Use sterile technique for insertion
- Maintain closed drainage system — do not open connection
- Keep drainage bag below bladder level — never on floor
- Secure catheter to prevent urethral movement
- Daily assessment of catheter necessity — remove as soon as possible
- Perineal hygiene with soap and water — avoid antiseptic cleansers on meatus
- Do not irrigate routinely
Nursing Priority
The single most effective intervention for CAUTI prevention is daily necessity review and prompt removal. Question orders that maintain catheters without documented clinical necessity.
CLABSI — Central Line-Associated Bloodstream Infection
Definition
A primary bloodstream infection in a patient with a central venous catheter (CVC) in place for >2 calendar days when the infection is not related to infection at another site.
Clinical Significance
CLABSI carries 12–25% mortality and is among the most costly HAIs. The femoral site carries the highest risk; subclavian the lowest.
Risk Factors
- Femoral or jugular site (vs. subclavian)
- Duration of catheterization
- Total parenteral nutrition (TPN)
- Immunocompromise (oncology, transplant, HIV)
- Multiple lumen catheters
- Frequent line access
- Poor insertion technique or site care
Signs & Symptoms
- Fever or chills
- Erythema, warmth, or drainage at insertion site
- Positive blood cultures from central line
- Signs of sepsis (tachycardia, hypotension, altered LOC)
- Purulent drainage at site
Prevention Bundle
- Hand hygiene before any line access or care
- Maximal sterile barrier during insertion (cap, mask, sterile gown, sterile gloves, large sterile drape)
- Chlorhexidine-alcohol skin antisepsis — allow to dry fully before insertion
- Optimal site selection: subclavian > internal jugular > femoral (avoid femoral when possible)
- Daily necessity review — remove central line as soon as possible
- Chlorhexidine-impregnated dressing or disk at insertion site
- Scrub the hub before every access with chlorhexidine or 70% alcohol — 15 seconds minimum
- Change IV tubing per facility policy; change blood/lipid tubing every 24 hours
Nursing Priority
Scrubbing the hub for at least 15 seconds before every access is critical and frequently overlooked. The phrase 'scrub the hub' should be a reflex for any central line access.
VAP — Ventilator-Associated Pneumonia
Definition
Pneumonia that develops in a mechanically ventilated patient ≥48 hours after intubation. It is classified as early-onset (<5 days) or late-onset (≥5 days).
Clinical Significance
Occurs in 9–27% of ventilated patients, with mortality of 20–50%. Each day of mechanical ventilation increases risk by approximately 1–3%.
Risk Factors
- Supine positioning (flat)
- Prolonged mechanical ventilation
- Re-intubation
- Nasogastric tube (promotes aspiration)
- Sedation and paralysis (reduces cough and gag)
- Impaired immune function
- Prior antibiotic use (resistant organism risk)
- Poor oral hygiene
Signs & Symptoms
- New fever or worsening temperature
- New or worsening infiltrate on chest X-ray
- Increased secretions or change in sputum character
- Decreased SpO₂ or increased FiO₂ requirement
- Leukocytosis or leukopenia
- New-onset confusion (early sign in older patients)
Prevention Bundle
- Head-of-bed elevation 30–45° continuously — unless contraindicated (spinal instability)
- Oral care with toothbrushing every 2–4 hours and PRN — routine chlorhexidine is no longer recommended (2022 SHEA/IDSA)
- Daily sedation interruption (SAT — Spontaneous Awakening Trial) and breathing trial (SBT)
- Subglottic secretion drainage — use ETTs with subglottic suction ports
- Avoid scheduled ventilator circuit changes (change when visibly soiled or malfunctioning)
- Maintain endotracheal cuff pressure 20–30 cmH₂O
- Early mobilization when clinically appropriate
- Stress ulcer prophylaxis per protocol
Nursing Priority
HOB elevation is the highest-impact, lowest-cost VAP intervention. It must be continuously maintained — not just during assessments. Verify HOB angle with a protractor or angle-measuring tool, not by visual estimation.
SSI — Surgical Site Infection
Definition
An infection that occurs within 30 or 90 days of surgery (the window depends on the NHSN procedure type) at or near the surgical incision site.
Clinical Significance
SSIs represent approximately 20% of all HAIs and are a leading cause of hospital readmission. They add an average of 7–11 days to hospital stay.
Risk Factors
- Obesity (BMI >30)
- Diabetes mellitus (especially poorly controlled)
- Smoking and nicotine use
- Immunosuppression (steroids, chemotherapy, HIV)
- Prolonged surgical time
- Emergency surgery
- Remote site infection at time of surgery
- Perioperative hypothermia
Signs & Symptoms
- Erythema, warmth, induration around incision
- Purulent wound drainage
- Fever (especially postoperative day 3–5)
- Wound dehiscence
- Pain or tenderness at site beyond expected
- Elevated WBC
Prevention Bundle
- Preoperative antibiotic within 60 minutes before incision — use facility-approved agent for the specific surgery type
- Hair removal with clippers, not a razor — shave only if necessary, immediately before surgery
- Normothermia maintenance — prevent intraoperative hypothermia with warming blankets
- Blood glucose control — target <180 mg/dL perioperatively (hyperglycemia impairs immune function)
- Chlorhexidine-alcohol skin preparation at surgical site
- Sterile technique throughout procedure and postoperatively
- Wound assessment with each dressing change — note color, drainage, odor, approximation
- Patient education: no smoking, glycemic control, wound monitoring after discharge
Nursing Priority
Perioperative nurses drive SSI prevention through preparation compliance (antibiotics on time, appropriate prep solution, normothermia protocols). Post-op nurses drive early detection through structured wound assessment with every dressing change.
NCLEX Pearls
- ✦CAUTI: the #1 prevention strategy is daily necessity review and prompt catheter removal.
- ✦CLABSI: scrub the hub before every central line access — minimum 15 seconds with chlorhexidine or 70% alcohol.
- ✦VAP: HOB elevation 30–45° is the highest-priority nursing intervention for ventilated patients.
- ✦SSI: preoperative antibiotics must be given within 60 minutes before incision — not before or after.
- ✦Hyperglycemia impairs immune function — perioperative glycemic control (target <180 mg/dL) reduces SSI risk.
- ✦HAIs are largely preventable — questions testing HAI prevention are testing nursing accountability and bundle adherence.
- ✦The nursing role in HAI prevention: assess daily device necessity, apply bundle elements consistently, and advocate for timely removal.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with CDC / HICPAC · Infectious Diseases Society of America (IDSA) / SHEA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →