National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination

• Action Plan Development
• Phase 1: Acute-Care Hospitals
• Phase 2: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Health Care Personnel
• Phase 3 Long-Term Care Facilities
• State HAI Prevention Plans

Action Plan Development

In recognition of health care-associated infections (HAIs) as an important public health and patient safety issue, the U.S. Department of Health and Human Services (HHS) convened the Federal Steering Committee-for the Prevention of Health Care-Associated Infections (originally called the HHS Steering Committee, but was changed to reflect the addition of agencies outside of HHS). The Steering Committee's charge is to coordinate and maximize the efficiency of prevention efforts across the federal government.  Members of the Steering Committee include clinicians, scientists, and public health leaders representing:

• Administration for Community Living (ACL)
• Agency for Healthcare Research and Quality (AHRQ)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare & Medicaid Services (CMS)
• Food and Drug Administration (FDA)
• Health Resources and Services Administration (HRSA)
• Indian Health Service (IHS)
• National Institutes of Health (NIH)
• Office of the Secretary (OS)
  • National Vaccine Program Office (NVPO)
  • Office of Disease Prevention and Health Promotion (ODPHP)
• Office of the Assistant Secretary for Planning and Evaluation (ASPE)
• Office of the Assistant Secretary for Public Affairs (ASPA)
• Office of the National Coordinator for Health Information Technology (ONC)
• U.S. Department of Defense (DoD)
• U.S. Department of Labor (DOL)
• U.S. Department of Veterans Affairs (VA)

The Steering Committee marshaled the extensive and diverse resources of the Department, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations. Along with scientists and program officials across HHS, the Steering Committee released the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination (HAI Action Plan). The HAI Action Plan provides a road map for preventing HAIs in acute care hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities.  The HAI Action Plan also includes a chapter on increasing influenza coverage of health care personnel. 

Phase One: Acute-Care Hospitals

Phase One of the HAI Action Plan addresses the most common infections in acute care inpatient settings and outlines a prioritized research agenda, an integrated information systems strategy,  policy options for linking payment incentives or disincentives to quality of care and enhancing regulatory oversight of hospitals, and a national messaging and communications plan to raise awareness of HAIs among the general public and prevention strategies among health care workers:

• National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination (in sections)
• HAI Action Plan Target and Metrics lists the nine metrics with corresponding five-year goals to focus efforts in reducing healthcare-associated infections.

This HAI Action Plan includes five-year goals for eight specific measures of improvement in HAI prevention.

Phase Two: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Health Care Personnel

The health care and public health communities are increasingly challenged to identify, respond to, and prevent HAIs across the continuum of settings where health care is delivered. The public health model’s population-based perspective can increasingly be deployed to enhance the prevention of HAIs, particularly given the shifts in health care delivery from acute care settings to ambulatory and long-term care settings. The Steering Committee clearly articulated the need to maintain the HAI Action Plan as a “living document,” developing successor plans in collaboration with public and private stakeholders to incorporate advances in science and technology, shifts in the ways health care is delivered, changes in health care system processes and cultural norms, and other factors.

In late 2009, the Steering Committee approved an expansion of the HAI Action Plan, and through this expansion three new draft chapters or strategies were released in September 2010.  Below are the revised draft chapters for Phase Two:

• Ambulatory Surgical Centers (April 2012 Draft) [PDF - 270 KB]
• End-Stage Renal Disease Facilities (April 2012 Draft) [PDF - 484 KB]
• Influenza Vaccination of Healthcare Personnel (April 2012 Draft) [PDF - 358 KB]

These chapters comprised the second phase – Phase Two – of the HAI Action Plan, extending its scope to the outpatient environment and addressing the health and safety of health care workers, as well as the risks of transmission of influenza from healthcare personnel to patients.

Phase Three: Long-Term Care Facilities

Since the publication of the original HAI Action Plan in 2009 which focused on the acute care setting, there has been awareness of the need for strategies to address HAIs in long-term care facilities. A growing number of individuals are receiving care in long-term care settings, such as skilled nursing facilities and nursing homes. The population in these facilities is requiring more complex medical care as a result of increased transitions between health care settings. These trends can create an increased risk for HAIs, which can worsen health status and increase health care costs. The Steering Committee chose to address HAIs in long-term care facilities for Phase Three.  

• Long-Term Care Facilities DRAFT Chapter (July 2012) [PDF - 724 KB].

State Healthcare-Associated Infection Prevention Plans

The 2009 Omnibus Law required states receiving Preventive Health and Health Services (PHHS) Block Grant funds to certify that they will submit a plan to prevent HAIs to the Secretary of Health and Human Services by January 2010. HHS received plans from all 50 states, the District of Columbia, and Puerto Rico.

HHS Report to Congress: Healthcare-Associated Infections: FY 2010 State Action Plans

The report addresses the adequacy of State Healthcare-Associated Infection (HAI) Action Plans for achieving state and national goals for reducing HAIs. It responds to the joint explanatory statement to accompany H.R. 1105, the Omnibus Appropriations Law, 2009 (Public Law 111-8):

"…Each State plan shall be consistent with the Department of Health and Human Services' national action plan for reducing healthcare-associated infections and include measurable 5-year goals and interim milestones for reducing such infections: Provided further, That the Secretary shall conduct a review of the State plans submitted pursuant to the preceding proviso and report to the Committees on Appropriations of the House of Representatives and the Senate…"

National State-Specific HAI Summary Data Reports:

To see the current Standardized Infection Ratio (SIR) NHSN National Data report along with previous reports visit CDCs NHSNs National HAI Data Report page.