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Healthcare-associated infections: where we came from and where we are headed
  1. Daniel Escobar1,2,
  2. David Pegues1,2,3
  1. 1Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  2. 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
  3. 3Healthcare Epidemiology, Infection Prevention and Control, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  1. Correspondence to Dr Daniel Escobar, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; Daniel.Escobar{at}

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Healthcare-associated infections (HCAIs) are those infections acquired by an individual who is seeking medical care in any healthcare facility, including acute care hospitals, long-term care facilities (including nursing homes), outpatient surgical centres, dialysis centres or ambulatory care clinics.1 They are further defined as occurring at least 48 hours after hospitalisation or within 30 days of receiving medical care.2 HCAIs have plagued hospitals, physicians and patients for centuries and likely played a role in the reputation that hospitals historically had as dangerous places.3 In the mid-19th century, Ignaz Semmelweis observed that labouring mothers in an obstetrics unit had a high incidence of Puerperal (Childbed) fever, which he thought was related to direct contact with medical students. After working with cadavers, students often moved directly from the anatomy lab to the hospital, leading Semmelweis to postulate that students were contaminated and bringing a pathogen into the unit. He saw dramatic improvements in maternal mortality after introducing a chlorinated lime hand wash for healthcare providers.4 Though not quickly accepted at large, his observations would become part of the foundation of the germ theory that we intuitively accept today.

Over a century after Semmelweis introduced the idea of hand hygiene, infection prevention in healthcare settings has been thrust into the spotlight worldwide. In the 1960s, the US Centers for Disease Control and Prevention (CDC) conducted research within the Comprehensive Hospital Infections Project and introduced surveillance and control techniques still used today. The creation of the National Healthcare Safety Network (NHSN) propelled infection control onto a national public health platform in the USA.3 Today, reduction of HCAIs has become a regulatory, financial and quality imperative across the world.

Healthcare frequently involves the use of invasive devices and procedures that can increase the risk of HCAIs, including catheter-associated urinary tract infections, …

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