Healthcare-associated infections (HAI) are a threat to patient safety and a top priority for the Department of Health and Human Services. To provide a roadmap for HAI prevention, HHS released the National Action Plan to Prevent Health Care-Associated Infections: Roadmap to Elimination (HAI National Action Plan) in 2009 with updates made in 2013 and 2018. HHS is currently working to update this plan with new indicator targets and data, new research and intervention efforts, and a review of the impact of the COVID-19 public health emergency on HAIs.
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
- Phase 4: Antibiotic Stewardship
- Evaluation of the Health Care-Associated Infections Action Plan
- State HAI Prevention Plans
Action Plan Development
In recognition that HAIs are an important public health and patient safety issue, the U.S. Department of Health and Human Services (HHS) convened a federal steering committee for the prevention of healthcare-associated infections in 2008. The Steering Committee's charge was to coordinate and maximize the efficiency of prevention efforts across the federal government. Members of the Steering Committee included 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 Assistant Secretary for Health (OASH)
- National Vaccine Program Office (NVPO)
- Office of Disease Prevention and Health Promotion (ODPHP) (through 2020)
- Office of Infectious Disease and HIV/AIDS Policy (added in 2020)
- 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 Departments, 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 and other Departments, the Steering Committee released the National Action Plan to Prevent Health Care-Associated Infections (HAI National Action Plan) in 2009 with subsequent updates. The HAI Action Plan provides a roadmap for preventing HAIs in acute care hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities, and for coordinating the implementation of antibiotic stewardship efforts as a means of HAI prevention. The latter complements efforts outlined in the National Action Plan for Combating Antibiotic Resistant Bacteria. The HAI National Action Plan also includes a chapter on increasing influenza coverage of health care personnel.
Phases One, Two, and Three of the HAI Action Plan led to meaningfully enhanced coordination of federal efforts to address HAIs by establishing a structure to regularly share best practices, resources, and lessons learned among federal partners. Phase Four, which was finalized in February 2018, reviews federal antibiotic stewardship efforts across various healthcare settings, highlights the importance of antibiotic stewardship to prevent resistance in HAIs, and showcases the coordination between various health agencies.
The National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination includes:
- Table of Contents [1,579 KB]
- Executive Summary [402 KB]
- Framework [336 KB]
- Phase One: Acute Care Hospitals
- Phase Two: Outpatient Settings and Influenza Vaccination of Health Care Personnel
- Phase Three: Long-Term Care Facilities
- Phase Four: Antibiotic Stewardship
- Conclusion [102 KB]
Phase One: Acute-Care Hospitals
Phase One of the HAI Action Plan, originally released in 2009, 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 healthcare workers:
- Acute Care Hospitals [1023 KB] (updated April 2013)
- HAI Action Plan Target and Metrics (updated for 2015-2020) lists the 7 metrics with corresponding 5-year goals to focus efforts in reducing healthcare-associated infections.
Phase Two: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Health Care Personnel
The healthcare and public health communities are increasingly challenged to identify, respond to, and prevent HAIs across the continuum of settings where healthcare 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 healthcare 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 healthcare is delivered, changes in healthcare system processes and cultural norms, and other factors.
Below are the chapters for Phase Two:
- Ambulatory Surgical Centers [302 KB] (April 2013)
- End-Stage Renal Disease Facilities [654 KB] (April 2013)
- Influenza Vaccination of Health Care Personnel [418 KB] (April 2013)
These chapters comprise the second phase — Phase Two — of the HAI Action Plan, extending its scope to the outpatient environment and addressing the health and safety of healthcare 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 healthcare settings. These trends can create an increased risk for HAIs, which can worsen health status and increase healthcare costs. The Steering Committee chose to address HAIs in long-term care facilities for Phase Three.
- Long-Term Care Facilities [618 KB] (April 2013)
Phase Four: Antibiotic Stewardship
Phase Four showcases the essential coordination and collaboration among federal partners engaged in HAI prevention and antibiotic stewardship. It highlights the work of the Federal Steering Committee for the Prevention of Health Care-Associated Infections (FSC) to leverage existing relationships — including with the Presidential Advisory Council on Combatting Antibiotic Resistance (PACCARB). These partners are working collaboratively to realize a goal of the CARB Action Plan to slow the emergence of resistant bacteria through antibiotic stewardship programs in healthcare settings.
This update to the HAI Action Plan reaffirms a federal commitment to improving healthcare quality and protecting the health of all Americans.
- Antibiotic Stewardship [471KB] (February 2018)
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 submit a plan to prevent HAIs to the Secretary of Health and Human Services by January 2010. Since October 2015, many states have updated their HAI state plans to incorporate additional HAI prevention activities (e.g., assessing infection prevention and control practices and improving detection and response efforts to prevent HAI outbreaks). Find out what each state is doing to prevent HAIs.
Evaluation of the Health Care-Associated Infections Action Plan
National and State Healthcare-Associated Infections Progress Report
CDC's National Healthcare Safety Network (NHSN) is the nation's most widely used HAI tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts and ultimately eliminate HAIs. CDC's annual National and State Healthcare-Associated Infections Progress Report (HAI Progress Report) provides a closer look at the HAIs most commonly reported to CDC's NHSN. This report describes national and state progress in preventing central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), select surgical site infections (SSI), hospital-onset C. difficile infections, and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (bloodstream infections).