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INTRODUCTION

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Approximately 2 million people are infected with healthcare-associated infections (HAIs) in the United States annually. This results in 90 000 deaths and over $5 billion in expenses per year. The most prevalent HAIs, responsible for over 80% of infections, are listed in Table 186-1.

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TABLE 186-1Healthcare-Associated Infections (HAIs)
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The Department of Health and Human Services (HHS) Action Plan to Prevent HAIs was formulated in 2008. The Centers for Medicare and Medicaid Services (CMS) reinforced the impact of the HHS plan by utilizing pay for reporting and performance in regard to methods to decrease HAIs. Anesthesiologists reduce the incidence of HAI with implementation of best practices for prevention of surgical site infections (SSIs), central line infections, ventilator-associated pneumonia, and methicillin-resistant Staphylococcus aureus (MRSA).

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PREVENTION OF HEALTHCARE-ASSOCIATED INFECTION

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Hand Hygiene

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Hand washing is a simple and effective way to decrease patient HAI and to protect the provider (Table 186-2). Alcohol-based solutions are recommended for hand hygiene when there is no visible contamination. However, in the case of visible contamination, hand washing with soap and water should be performed. Spore-forming Clostridium difficile and Bacillus anthracis are poorly inactivated by alcohol-based solutions. They require hand washing with soap and water.

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TABLE 186-2Indications for Hand Hygiene
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Human hands carry 3.9 × 104 to 4.6 × 106 colony-forming units/cm2 of bacteria. Subungual locations, or beneath the fingernails, have the highest bacterial concentrations and are frequently colonized with coagulase-negative Staphylococcus, gram-negative rods, Corynebacteria, and yeast.

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Prevention of Surgical Site Infections

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Anesthesiologists contribute to several aspects of SSI prevention (Table 186-3).

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TABLE 186-3Perioperative Factors to Reduce SSI

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