SciELO - Scientific Electronic Library Online

vol.11 número1Percepción de los pacientes hospitalizados respecto del cuidado de enfermeríaVulnerabilidades experimentadas en la escuela de niños y adolescentes con enfermedades crónicas: perspectiva de profesionales de la educación índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados



Links relacionados


Enfermería: Cuidados Humanizados

versión impresa ISSN 1688-8375versión On-line ISSN 2393-6606

Enfermería (Montevideo) vol.11 no.1 Montevideo jun. 2022  Epub 01-Jun-2022 

Original Articles

Implications of Healthcare-Associated Infections in Health Management: Review

Sónia Cristina Meira Gonçalves1

Tânia Isabel Gomes do Carmo2

1 Centro Hospitalar de Setúbal, Portugal

2 Centro Hospitalar de Setúbal, Portugal,



Describe the scientific evidence of the implications Healthcare-Associated Infections (HAI) in health management.


Systematic review in electronic database using DeCs descriptors.


Thirteen articles were analyzed, resulting in ten categories of analysis. HAIs contribute to higher mortality rate and financial costs of hospitalization related to higher: average number of days of hospitalizations; increased spending on antimicrobials, diagnostic and complementary tests and invasive devices or procedures; length of hospital stay in intensive care units (ICU); possibility of readmission and development of other complications.


HAIs have direct and indirect repercussions on patients’ lives as they represent a threat to the safety and quality of care. Prevention programs and infection control measures are considered effective in reducing the incidence rate of HAIs and consequently in reducing costs.

Keywords:  hospital-acquired infections; health management; health care costs



Conhecer a evidência científica sobre as implicações das infeções associadas aos cuidados de saúde (IACS) na gestão em saúde.


Revisão sistemática da literatura mediante o uso de descritores DeCS.


Foram analisados 13 artigos dos quais resultaram dez categorias de análise. As IACS contribuem para o aumento da taxa de mortalidade e dos custos financeiros do internamento hospitalar pelo aumento do número médio de dias de internamento, aumento dos gastos com antimicrobianos, exames complementares de diagnóstico e procedimentos médicos invasivos; aumento do tempo de permanência em unidades de cuidados intensivos (UCI); maior possibilidade de reinternamento e desenvolvimento de outras complicações.


As IACS têm repercussões diretas e indiretas na vida dos doentes pois representam uma ameaça à segurança e à qualidade dos cuidados. Os programas de prevenção e medidas de controlo de infeção são considerados eficazes na diminuição da taxa de incidência das IACS e consequentemente na redução dos custos.

Palavras-chave: infecção hospitalar; gestão em saúde; custos de cuidados de saúde



Conocer la evidencia científica sobre las implicaciones de las infecciones asociadas a la atención de la salud (IAAS) en la gestión de la salud.


Revisión sistemática de la literatura utilizando los descriptores del DeCS.


Se analizaron trece artículos, que dieron lugar a diez categorías de análisis. Las IAAS contribuyen al aumento de la tasa de mortalidad y a los costes financieros de la estancia hospitalaria, ya que aumentan el número medio de días de hospitalización, el gasto en antimicrobianos, las pruebas diagnósticas complementarias y los procedimientos médicos invasivos; el aumento de la duración de la estancia en las unidades de cuidados intensivos (UCI); la mayor posibilidad de reingreso y el desarrollo de otras complicaciones.


Las IAAS tienen repercusiones directas e indirectas en la vida de los pacientes, ya que representan una amenaza para la seguridad y la calidad de la atención. Los programas de prevención y las medidas de control de la infección se consideran eficaces para reducir la tasa de incidencia de las IAAS y, en consecuencia, los costes.

Palabras clave: infección hospitalaria; gestión en salud; costos de la atención en salud


Healthcare-Associated Infections (HAIs) are a public health concern on a global scale, 1 described by the European Center for Disease Prevention and Control (ECDC) as an infection acquired during health care provision in a hospital or other health institution. 2) This type of infections has direct and indirect costs in societies, associated not only with healthcare costs, but also by the increasing of the patient’s dependency after discharge. 3) The ECDC 4 recognizes the existence of high charges for European countries associated with HAIs, particularly about the patient security. According to the Centers for Disease Control and Prevention (CDC) in 2015 in the USA, more than 687.000 HAIs occurred in hospitalized patients and 72.000 of these having died during these infections. 5 The ECDC estimates that daily, in the ICU of the European hospitals, are approximately 81.089 patients with HAIs. 4 In 2017, the prevalence of HAIs in Portugal was 7.8 % and several health institutions recognize the existence of associated financial, economic, social, and individual costs.6,7 This issue has a direct influence on health management, making it urgent to understand its dimensions as well as the measures to prevent it. (8 Lorenzetti et al. (9 define health management as the knowledge applied to the planning of health organizations, involving the management of health networks to guarantee universal, total, and equitable assistance to the needs of populations.

The central importance of understanding how the prevalence of HAIs limits health management on the high financial and safety impact that these infections imply for health systems, making it mandatory to adopt preventive measures by the entities of health for their prevention. (10

Prior studies to the current systemic review already have found a direct association between HAIs and the impact of health management. Barros concluded that patients with HAIs had twice of the financial cost during hospitalization compared to those who did not develop any infection. (11

Given these statements, this article aims to describe the scientific evidence of the implications of HAIs in health management and its dimensions.


A systemic review was performed following the PRISMA 2009 Checklist protocol, containing a 27-item checklist and a four-step flowchart whose objective is to help authors to improve the reporting of systematic reviews. (12 The process began with the elaboration of the research question according to the PICo format: “What are the implications for Health Management (I) attributable to Healthcare Associated Infections Associated (P)?”

The review considered studies written in Portuguese, English and Spanish, published between 2009 and 2019, full text presentation, free access with peer review and at least 2 descriptors. Other systematic reviews and studies with more than 10 years, repeated, in other languages, without free access or with population younger than 18 years were excluded. In addition, studies that did not correspond to the topic based on titles/abstracts were excluded.

The research was carried out in June 2019 using the EBSCOhost platform CINAHL with full text and Medline with full text), SciELO and PubMed. The following descriptors (DeCS) were used in a Boolean logic: “cross infection” (S1) AND “cost and cos analysis” (S2) AND “health management” (S3). Figure 1 depicts the methodological approach that was employed.

Figure 1:  Study selection process 


Thirteen studies published between 2009 and 2017 were analyzed. These studies are predominantly retrospective with comparison and analysis between groups. The privileged data treatment was the statistical analysis. These studies are from several countries on different continents, which enrich the cultural diversity of this review. Most of the articles were written in English. Study participants were hospitalized patients divided into two groups: patients with HAIs and patients without HAIs. The objective was to compare the costs associated with the presence of HAIs and their implications. The articles that made up the corpus of analysis are shown in Table 1 2 3 4.

It should be noted that the analysis of the articles was carried out by double review, having resorted to a third reviewer in case of doubt and/or disagreement.

Table 1: Articles selected for análisis 

Source: Own elaboration (2019)

Source: Own elaboration (2019)

Source: Own elaboration (2019)

Source: Own elaboration (2019)

After filling in the table, we formulated categories of results considering the distribution of data by frequencies, that is, the number of studies in which a certain result is mentioned.

From the analysis of the 13 articles, ten categories of results were obtained (Table 2).

Table 2: Results categories 

Source: Own elaboration (2019)

The overall HAIs rate in the studies analyzed ranged from 1.8 % (13 to 17 %. (18. In turn, the most frequent HAIs reported was respiratory tract infections,13-15,17,18,23,25 bloodstream infections,13,15,23,25 urinary tract infections (UTI),13-15,18 gastrointestinal infections,23 skin and soft tissue14 and other locations.13 Regarding the microorganisms described in the studies were found: vancomycin-resistant enterococci (VRE),24,25 Pseudomonas aeruginosa,14 Clostridium difficile (CD),19,23 methicillin-resistant aureus (MRSA),16,20 Gram negative bacilli13 and fungi.13

Pneumonia (15,21,23 and bloodstream infection (15 were associated with higher financial costs. The ICU units had the highest incidence of HAIs and was the service with higher financial costs associated. (14-16,18,19,25 The other services with high number of HAIs occurrences were the surgical service, (13,19 medicine service (18,19 and emergency service.18


HAIs are an important public health concern that arises from adverse effects of care, contributing to higher mortality/morbidity and monetary costs, mainly due to the increased length of hospital days, increased costs with antimicrobials, increased complications and the degree of dependence of the patient after discharge,13,15-21,25,26 also inflating the costs at a socioeconomic and family level.27 Furthermore, the life quality of patients and their families is also affected.28,29

The increased financial costs associated with higher length of hospital stay in patients with HAIs were reported in 12 of the 13 studies analyzed. In a study by Nangino et al. (15) it was observed that infected patients had expenses 9 times higher per day (R$1,093.94 vs. R$9,763.78 (Brazilian real)), with ventilator-associated pneumonia (VAP) and bloodstream infection associated with higher costs/day. These results are similar to those found in the article by Pina et al. (30 where they report that VAP can represent an additional cost of 40.000 dollars per episode. In addition, the need of isolation precautions in most patients with HAIs also contributes to the increase in hospitalization costs, namely expenses with personal protective equipment. (19

The increased length of hospital stay in several days was also reported in 12 studies. (13-24) In the studies, the increase was, on average, from 217 to 2014 more days. In a study by Izaias et al 18) the elderly with HAIs had an average of 24 days of hospitalization, which resulted in an average increase of 15 days compared to the elderly without HAIs, and subsequent increased in costs with medication, exams, and other procedures.

The increased costs related to the use and acquisition of antimicrobials were reported in 10 studies. (13-16,18,19,21,23-25) In a study by Saavedra et al. (13 the median cost of using antimicrobials in infected patients was 28 times higher than the daily value of patients without HAIs (US$132.5 vs. US$4.7 (US dollar)). In addition, the excessive use of antimicrobials promotes multidrug resistance. (14,31,32) According to epidemiological surveillance data from the European Antimicrobial Resistance Surveillance Network, (33) Portugal has a high rate of antimicrobial resistance (AMR), being among the European countries with the highest rate of MRSA, Enterococcus faecium resistant to vancomycin and Acinetobacter with combined antimicrobial resistance. The more antimicrobials are previously used, the probability of HAIs occurrence is higher, namely infections by VRE25 or CD.19) Patients with infections caused by resistant microorganisms have a higher number of co-morbidities or more several clinical conditions, earlier mortality, longer hospital stays and a high consumption of health resources.6,16) The ECDC reported 33.000 deaths in Europe annually and €1 billion in annual health expenditures, which highlights the critical need to ensure that antimicrobials are used with prudence and that infection prevention and control measures are implemented.34) Thus, it is essential to understand the problem of multi-resistance to antimicrobials, since they have a strong impact on the economy.14

For this, it is necessary to improve the knowledge of HAIs and AMR, promote good practices and the training of health professionals (36-39 to reduce HAIs and AMRs and strengthen the local, regional, and national structures of the Infection Prevention and Control Program and AMR (1,7

An increased mortality rate was reported in 7 studies. (13,14,16,17,20,24,25 The mortality rate varied between 7 % (20 and 64.6 % in the study by Jiang et al. (25, which compared patients with VRE and patients with vancomycin-sensitive enterococci (VSE) (39.4 %). In the study by Saavedra et al.13 the mortality rate in patients with HAIs was 31.6 % compared to 5.1 % in patients without HAIs; in patients resistant and with multidrug resistance to antimicrobials caused by Pseudomonas aeruginosa, the mortality rate was approximately twice as compared to patients without resistance (24.6 % vs. 12.8 %);14 in a comparative study among patients with MRSA/methicillin-sensitive staphylococcus aureus (MSSA), the mortality rates were respectively, 60.7 % and 45.1 %.16) It should be noted that in this last study, 53% of the individuals have died during hospitalization. In a similar study of Resch et al. (20 patients with MRSA had an average of 7 % higher mortality (18.3 % vs. 10.9 %). Only in the study by Cheah et al. (24 there was no increase in mortality in patients with VRE bacteremia compared to patients with VSE bacteremia.

Other implication of HAIs was the increased length of hospital stay of patients in ICU or the greater number of patients with ICU need, reported in 7 studies. (13-16,21,23,24) In the study by Saavedra et al. (13 54.5 % of infected patients required hospitalization in ICU with an increase of 5 days of hospitalization compared to patients without HAIs who also required ICU. Greco et al. (23 found a mean increase in a length of stay in patients with HAIs of 14 days, with 47 % of that time being due to the need for ICU admission. In 2013, the ECDC estimated that, daily, in the ICU of European hospitals there were 81.089 patients with HAIs. The annual case numbers of HAIs are around 3.2 million people. (40) Nangino et al. (15 referred to the impact on public health that patients with HAIs represents, since, by increasing the number of days of hospitalization, they will restrict the access of other patients, namely to ICU units. (41) In turn, the increase in the length of stay in the ICU leads to an increase in expenditure/day. In the study of Nangino et al. (15) this value was approximately 1.7 times higher. This amount includes the increase in monetary expenses with complementary diagnostic tests. (14,16,19,21,23 In the study by Barrero et al. (16) the amount spent on laboratory tests and diagnostic images in patients with MRSA was 1.6 times higher than the amount spent compared to patients with MSSA. Ortiz-Mayorga et al. (21 concluded that exams and laboratory tests performed on patients with HAIs represented the second highest cost associated with hospitalization - 13.5 % of the total value. In the study by Magali et al. (19 2.28 % of the total cost of hospitalization was spent on laboratory tests associated with the diagnosis of CD.

In most studies, patients with HAIs or AMRs showed increased disease severity and clinical instability, requiring invasive medical procedures as invasive mechanical ventilation, hemodialysis, bronchoscopy, digestive endoscopy, central venous catheter (CVC) or surgery. (14,16,20,25 In the study by Resch et al. (20 patients with MRSA were 7 % more likely to require invasive mechanical ventilation.

Four of the studies analyzed reported a higher probability of developing other complications. (13,16,19,25 Barrero et al. (16) reported that patients with infections caused by resistant microorganisms may present a greater number of co-morbidities or more severe clinical conditions, progressing, in this case, to septic shock. In the study by Magali et al. (19 17.3 % of the patients developed serious complications of CD infection (organ failure, hypotension, anemia requiring blood transfusions) and 4.5 % of them required surgical interventions (colectomy total, ileostomy, and colostomy).

The development of a secondary HAI in the same hospitalization was mentioned in two studies. (13,18 In the study by Saavedra et al. (13 19.1 % of the patients had more than one HAI during the same period of hospitalization, while Martins et al. (26 mentioned slightly higher values (38.89 % of patients presented two HAIs).

At last, the higher probability of readmission (23 reported by Greco et al. (23 show that patients who developed HAIs in the first hospitalization had a higher rate of readmission (33 %). In Oliveira et al. (42, the surgical site infection was the main cause of hospital readmission (in 13.2 % of cases). About 48 % of readmissions associated with HAIs could be avoided and are associated with indicators of low-quality care. (43

In the analyzed studies, the overall rate of HAIs varied between 1.8 % (13 and 17 %.18 Data from the Portuguese Health Systems Observatory (7 reported that the prevalence rate of HAIs in a hospital context in Portugal was 7.8 %, in 2017.

The ECDC in its HAIs and AMR prevalence study reported that 5.9 % of patients developed an HAIs. (34 The prevalence and typology of HAIs are variable, denoting differences worldwide. In the USA, the most common infections are UTI and VAP. In Europe, the most prevalent HAIs are respiratory tract infection (pneumonia in 21.45 % of episodes), UTI (18.9 %) and bloodstream infections (10.8 %). (44

In several studies (30,45-47, the authors refer to surgical procedures, the use of invasive devices, the use of antimicrobials and the length of hospital stay as the main risk factors for the acquisition of HAIs, as well as the infections by multidrug-resistant microorganisms, which currently represent a significant threat due to the therapeutic impasse they cause. In the USA, in a 2011 study, (7 25.6 % of HAIs occurred in association with the use of a medical device. Several authors (27,40,45,48-50 have corroborated the relationship between the development of HAIs and the presence of invasive devices, namely ventilator-associated pneumonia, CVC-associated bloodstream infection and catheter-associated UTI. More than half of these infections are preventable based on the implementation of preventive strategies, given the scientific evidence. (51,52 Thus, it is essential to reduce the use of invasive devices to prevent infection and minimize cross-transmission. (53

Patients with co-morbidities such as lung and heart disease, (17,19,23,54-56 changes in kidney and liver function, (19,42,54 diabetes, (19,22,42,54-56 hemodialysis, (55 chemotherapy (25,56 and immunosuppression (19,21,57 may have predisposition to HAIs.

International and national studies show that the prevalence of HAIs is higher in patients admitted to ICUs where, on average, 19.5 % of patients have at least one HAI, while in all other units the average is 5.2 %. (40 The problem of antimicrobial resistance is also higher in ICUs, mostly associated with the severity of the patients' clinical situation, the frequent use of antibiotics and the heterogeneity in the implementation of HAIs prevention and control measures. (58

Effective treatments for certain multidrug-resistant microorganisms caused by HAIs, such as MRSA, VRE and Gram-negative producers of extended-spectrum beta-lactamase (ESBL), are becoming scarce. (27,59,60) In 2017, the most frequent microorganisms isolated in Portugal were Pseudomonas Aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus. (61

As already mentioned, HAIs entail high financial costs. It is estimated that the total annual cost to the Portuguese National Health Service of additional days of hospital stay due to IACS is approximately 280 million euros. Most of this savings would be available as soon as infection rates are reduced. (62


In addition to the clinical burden that HAIs entail, there are also economic and social consequences, such as abstention from work, disability, reduced quality of life, etc.

The main limitation of this systematic review is contemplating articles from different countries and continents, with illustrating different realities in different health care services. In addition, data were presented differently in each article (frequencies, percentages, and different currency units), as well as the categories of results, which made comparisons difficult. Other limitation is the fact that the studies were carried out only in the hospital setting. No data were found regarding social implications and the degree of dependence after discharge.

It is concluded that HAIs significantly increase the financial costs of hospitalization and have direct and indirect repercussions on the lives of patients, compromising the safety and quality of care provided. (28,63 The reduction of hospitalization days and the rational use of antimicrobials are mentioned as major factors to minimize the implications with these infections. Prevention programs and proper infection control measures, as well as the implementation of automated surveillance systems, are considered effective strategies to reduce the incidence of HAIs and the subsequent costs associated with these infections. (1,52,61,62,64-66


1. Almeida, G, Alves, J, Mendes, JJ, Perelman, J, Lobão, MJ, Sousa, P. Infeções associadas a cuidados de saúde. Contributo da Indústria de meios de diagnóstico in vitro para o seu controlo. (Internet). 2016 (cited 2022 feb 28). Available from: [ Links ]

2. European Centre for Disease Prevention and Control. Directory of online resources for prevention and control of antimicrobial resistance and healthcare-associated infections. (Internet). 2021 (cited 2022 feb 28). Available from: Available from: . [ Links ]

3. World Health Organization. Prevention of hospital-acquired infections: a practical guide (2ª ed.). (Internet). 2002 (cited 2021 mar 10). Available from: Available from: ]

4. European Centre for Disease Prevention and Control. Realização, Desafios e principais resultados de 2016. (Internet). 2017 (cited 2021 mar 10). Available from: Available from: ]

5. Centers for Disease Control and Prevention. Data Portal of Healthcare-Associated Infections. (Internet). 2015 (cited 2022 mar 01). Available from: Available from: . [ Links ]

6. Direção-Geral da Saúde. Infeções e Resistências aos Antimicrobianos: Relatório Anual do Programa Prioritário. (Internet). 2018 (cited 2021 mar 12). Available from: Available from: . [ Links ]

7. Observatório Português dos Sistemas de Saúde. Meio caminho andado. Relatório Primavera 2018. (Internet). 2019 (cited 2021 mar 12). Available from: Available from: . [ Links ]

8. Scott, RD, Culler, SD, Rask, KJ. Understanding the Economic Impact of Health Care-Associated Infections: A Cost Perspective Analysis. J Infusion Nurs. (Internet). 2019 mar/apr (cited 2021 mar 13);42(2):61-69. Available from: Available from: DOI: 10.1097/NAN.0000000000000313 [ Links ]

9. Lorenzetti, J, Lanzoni, GM, Assuiti, LF, Pires, DE, Ramos, FR. Health management in Brazil: dialogue with public and private managers. Scielo Brazil (Internet). 2014 (cited 2022 mar 01);23(02):417-425. Available from: Available from: DOI: 10.1590/0104-07072014000290013 [ Links ]

10. Cardoso, RA. As infeções associadas aos cuidados de saúde. (Dissertação de Mestrado na Internet). Coimbra (Portugal): Universidade de Coimbra, Faculdade de Economia; 2015 (cited 2022 mar 01).100 p. Available from: Available from: . [ Links ]

11. Barros, CS. Custos atribuídos às infeções de sitio cirúrgico em um hospital univeritário em Salvador-Bahia. (Tese Doutoramento na Internet). Brasil: Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz; 2016 (cited 2022 mar 01). 102 p. Available from: Available from: Links ]

12. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. BMJ (Internet). 2009 (cited 2019 jun);339, b2535. DOI: 10.1136/bmj.b2535 [ Links ]

13. Saavedra, CH, Ordóñez, KM, Díaz, JA. Impacto de la infección nosocomial en un hospital de Bogotá, Colombia: efectos en mortalidad y costos. Rev Chil Infectol (Internet). 2015 feb (cited 2019 jun);32(1):25-9. DOI 10.4067/S0716-10182015000200004 [ Links ]

14. Morales, E, Cots, F, Sala, M, Comas, M, Belvis, F, Riu, M, et al. Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. BMC Health Serv Res. (Internet). 2012 may (cited 2019 jun);12(122):1-8. DOI: 10.1186/1472-6963-12-122. [ Links ]

15. Nangino, GO, Oliveira, CD, Correia, PC, Machado, NM, Dias, DA. Impacto financeiro das infecções nosocomiais em unidades de terapia intensiva em hospital filantrópico de Minas Gerais. Rev Bras Ter Intensiva (Internet). 2012 dec (cited 2019 jun);24(4):357-61. DOI: DOI: 10.1590/S0103-507X2012000400011Links ]

16. Barrero, LI, Castillo, JS, Leal, AL, Sánchez, R, Cortés, JA, Álvarez, CA, et al. Impacto económico de la resistencia a la meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá. Biomédica (Internet). 2014 (cited 2019 jun);34:345-54. DOI: 10.7705/biomedica.v34i3.1692 [ Links ]

17. Azmi, S, Mohamed, S, Maimaiti, N, Ali, A, Muhammad, A, Rosas-valera, MD, et al. Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and jthe Philippines. Int J Infect Dis (Internet). 2016 aug (cited 2019 Jun);49:87-93. DOI: 10.1016/j.ijid.2016.05.021 [ Links ]

18. Izaias, ÉM, Rossaneis, MÂ, Belei, RA. Custo e caracterização de infecção hospitalar em idosos. Ciência & Saúde Coletiva (Internet). 2014 aug (cited 2019 jun);19(8):3395-402. DOI: 10.1590/1413-81232014198.12732013 [ Links ]

19. Magalini, S, Pepe, G, Panunzi, P, Spada, A, Gaetano, A, Gui, D. An economic evaluation of Clostridium difficile infection management in an Italian hospital environment. Eur Rev Med Pharmacol Sci (Internet). 2012 dec (cited 2019 jun);16:2136-41. [ Links ]

20. Resch, A, Wilke, M, Fink, C. The cost of resistance : incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals. Eur J Heal Econ (Internet). 2009 jul (cited 2019 jun);10:287-97. DOI: 10.1007/s10198-008-0132-3 [ Links ]

21. Ortiz-Mayorga, J, Pineda-Rodríguez, I, Dennis, R, Porras, A. Costos atribuidos a las infecciones asociadas a la atención en una Institución Prestadora de Salud de Colombia, 2011 a 2015 Attributed. Rev Biomédica (Instituto Nac Salud) (Internet). 2019 jan/mar (cited 2019 jun). DOI: 10.7705/biomedica.v39i1.4061 [ Links ]

22. Kaye, KS, Patel, DA, Stephens, JM, Khachatryan, A. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections : Recent Trends and Economic Impact. PLoS One (Internet). 2015 nov 24 (cited 2019 jun);10(11):1-13. DOI: 10.1371/journal.pone.0143276 [ Links ]

23. Greco, G, Shi, W, Michler, RE, Meltzer, DO, Ailawadi, G, Hohmann, SF, et al. Costs Associated With Health Care - Associated Infections in Cardiac Surgery. J Am Coll Cardiol (Internet). 2015 jan 6 (cited 2019 jun);65(1):15-23. DOI: 10.1016/j.jacc.2014.09.079. [ Links ]

24. Cheah, A, Spelman, T, Liew, D, Peel, T, Howden, BP, Spelman, D, et al. Enterococcal bacteraemia : factors influencing mortality , length of stay and costs of hospitalization. Clin Microbiol Infect. European Society of Clinical Infectious Diseases (Internet). 2013 apr (cited 2019 jun);19(4):181-9. DOI: 10.1111/1469-0691.12132 [ Links ]

25. Jiang, H, Zhou, Z, Wang, L, Fang, Y, Li, Y, Chu, C. The Risk Factors, Costs, and Survival Analysis of Invasive VRE Infections at a Medical Center in Eastern Taiwan. Int J Infect Dis (Internet). 2017 jan (cited 2019 jun);54:18-24. DOI: 10.1016/j.ijid.2016.11.005 [ Links ]

26. Martins, PC, Vaz, AK. Infecções prevalentes na unidade de terapia intensiva de um hospital universitário. Enferm Bras (Internet). 2020 (cited 2021 mar 19);19(3):238-45. DOI: 10.33233/eb.v19i3.3948 [ Links ]

27. Coelho, N, Cunha, M. Padrão de Infeção e Antibioterapia em Unidade de Cuidados Intensivos. Millenium (Internet). 2020 (cited 2021 mar 17);2:317-38. DOI: 10.29352/mill0205e.33.00339 [ Links ]

28. Cassini, A, Hogberg, LD, Plachouras, D, Quattrocchi, A, Hoxha, A, Simonsen, GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European economic area in 2015: a population-level modelling analysis. Lancet Infect Dis (Internet). 2019 (cited 2021 mar 17);19(1):56-66. DOI: 10.1016/S1473-3099(18)30605-4 [ Links ]

29. Reis, C. et al. A segurança do paciente como dimensão da qualidade do cuidado de saúde - um olhar sobre a literatura. Rio de Janeiro: Ciência e Saúde Coletiva (Internet). 2013 jul (cited mar 17);18(7):2029-2036. DOI: 10.1590/S1413-81232013000700018 [ Links ]

30. Pina, E, Ferreira, E, Marques, A, Matos, B. Infeções associadas aos cuidados de saúde e segurança do doente. Revista Portuguesa de Saúde Pública (Internet). 2010 (cited 2019 aug 20);27-39. [ Links ]

31. O’Neil, J. Tackling drug-resistant infections globally: final report and recommendations. Review on Antimicrobial Resistance (Internet). 2016 may (cited 2021 mar 18);84p. Available from: Available from: Links ]

32. Oh, AL, Goh, LM, Azim, NA, Tee, CS, Phung, CW. Antibiotic usage in surgical prophylaxis: a prospective surveillance of surgical wards at a tertiary hospital in Malaysia. J Infect Dev Ctries (Internet). 2014 feb (cited 2021 mar 27);8(2):193-201. DOI: 10.3855/jidc.3076 [ Links ]

33. Direção-Geral da Saúde. Prevenção e Controlo de Infeções e de Resistência aos Antimicrobianos em Números - 2015 (Internet). 2016 (cited 2021 mar 16). Available from: Available from: Links ]

34. European Centre for Disease Prevention and Control. Surveillance of antimicrobial resistance in Europe 2018 (Internet). 2019 (cited 2021 mar 02). Available from: Available from: ]

35. World Health Organization. Clean Care is Safer Care. Background to Clean Care is Safer Care (Internet). 2017 (cited 2021 mar 03). Available from: Available from: ]

36. Park, S, Ko, S, An, H, Bang, J, Chung, W. Implementation of central line-associated bloodstream infection prevention bundles in a surgical intensive care unit using peer tutoring. Antimicrobial Resistance and Infection Control (Internet). 2017 oct 02 (cited 2021 mar 04);6(103). DOI: 10.1186/s13756-017-0263-3 [ Links ]

37. Bianco, A, Capano, M, Mascaro, V, Pileggi, C, Pavia, M. Prospective surveillance of healthcare-associated infections and patterns of antimicrobial resistance of pathogens in an Italian intensive care unit. Antimicrobial Resistance and Infection Control (Internet). 2018 apr 3 (cited 2021 mar 06);7(48). DOI: 10.1186/s13756-018-0337-x [ Links ]

38. Direção-Geral da Saúde. “Feixe de intervenção” de Prevenção de Infeção de local cirúrgico (Internet). 2015 (cited 2021 mar 27). Available from: Available from: ]

39. World Health Organization. A crescente ameaça da resistência antimicrobiana: Opções de ação (Internet). 2012 (cited 2021 mar 20);16 p. Available from: Available from:;jsessionid=9100DFBC7426C549DFFA5CF0911C9A58?sequence=3Links ]

40. European Centre for Disease Prevention and Control. Annual epidemiological report Reporting on 2011 surveillance data and 2012 epidemic intelligence data (Internet). 2013 (cited 2021 mar 17). Available from: Available from: ]

41. Jia, H, Li, L, Li, W, Hou, T, Ma, H, Yang, Y. et al. Impact of Healthcare-Associated Infections on Length of Stay: A Study in 68 Hospitals in China. BioMed Research International (Internet). 2019 apr (cited 2021 mar 19);(1):1-7. DOI: 10.1155/2019/2590563 [ Links ]

42. Oliveira, R, Lopes, S. Impacto da infeção do local cirúrgico nas readmissões hospitalares de doentes ortopédicos. (Trabalho de campo para obtenção do grau de Especialista em Administração Hospitalar). Lisboa (Portugal): Universidade Nova de Lisboa; 2018 (cited 2021 mar 14);67 p. Available from: Available from: ]

43. Suetens, C, Latour, K, Kärki, T, Ricchizzi, E, Kinross, P, Moro, M, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill (Internet). 2018 (cited 2021 mar 20);23(46). DOI: 10.2807/1560-7917.ES.2018.23.46.1800516 [ Links ]

44. Iordanou, I, Middleton, N, Papathanassoglou, E, Raftopoulos, V. Surveillance of device associated infections and mortality in a major intensive care unit in the Republic of Cyprus. BMC Infectious Diseases (Internet). 2017 sep 6 (cited 2021 mar 24);17(1):607. DOI: 10.1186/s12879-017-2704-2. [ Links ]

45. Ruiz-Giardin, J, Chamorro, I, Ríos, L, Aroca, J, Arata, M, López, J et al. Blood stream infections associated with central and peripheral venous catheters. BMC Infectious Diseases (Internet). 2019 (cited 2021 mar 24);19:841. DOI: 10.1186/s12879-019-4505-2 [ Links ]

46. Metsini, A, Vazquez, M, Sommerstein, R, Marschall, J, Voide, C, Troillet, N, et al. Point prevalence of healthcare-associated infections and antibiotic use in three large Swiss acute-care hospitals. Swiss Med Wkly (Internet). 2018 apr 26 (cited 2021 mar 25);148. DOI: 10.4414/smw.2018.14617 [ Links ]

47. Huis, A, Schouten, J, Lescure, D, Krein, S., Ratz, D, Saint, S et al. Infection prevention practices in the Netherlands: results from a National Survey. Antimicrobial Resistance and Infection Control (Internet). 2020 jan 6 (cited mar 26);9(7). DOI: [ Links ]

48. Laan, B, Spijkerman, I, Godfried, M, Pasmooij, B, Maaskant, J, Borgert, M et al. De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study. BMC Infectious Diseases (Internet). 2017 jan 10 (cited mar 19);17(53). DOI: 10.1186/s12879-016-2154-2 [ Links ]

49. Alvim, A, Couto, B, Gazzinelli, A. Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae. Rev Esc Enferm USP (Internet). 2019 (cited mar 19);53. DOI: 10.1590/S1980-220X2018001903474 [ Links ]

50. Slegt, J, Laan, L, Veen, E, Hendriks, Y, Romme, J, Kluytmans, J. Implementation of a Bundle of Care to Reduce Surgical Site Infections in Patients Undergoing Vascular Surgery. PLOS ONE (Internet). 2013 aug 13 (cited mar 26);8(8):1-7. DOI: 10.1371/journal.pone.0071566. [ Links ]

51. Wichmann, D, Campos, C, Ehrhardt, S, Kock, T, Weber, C, Rohde, H et al. Efficacy of introducing a checklist to reduce central venous line associated bloodstream infections in the ICU caring for adult patients. BMC Infectious Diseases (Internet). 2018 jun 08 (cited apr 02);18(267). DOI: 10.1186/s12879-018-3178-6 [ Links ]

52. Bonten, M. Ventilador-Associated Pneumonia: Preventing the Inevitable. Clinical Infectious Diseases (Internet). 2011 jan 01 (cited mar 28);52(1):115-21. DOI: 10.1093/cid/ciq075 [ Links ]

53. Quartin, A, Scerpella, E, Puttagunta, S, Kett, D. A comparison of microbiology and demographics among patients with healthcare-associated, hospital-acquired, and ventilator-associated pneumonia: a retrospective analysis of 1184 patients from a large, international study. BMC Infect Dis (Internet). 2013 nov 27 (cited mar 17);13(561). DOI: 10.1186/1471-2334-13-561 [ Links ]

54. Sinésio, M, Magro, M, Carneiro, T, Silva, K. Fatores de risco às infecções relacionadas à assistência em unidades de terapia intensiva. Cogitare Enf (Internet). 2018 (cited apr 02);(23)2. DOI: 10.5380/ce.v23i2.53826 [ Links ]

55. Kaye, KS, Sloane, R, Sexton, DJ, Schmader, KA. Risk Factors for Surgical Site Infections in Older People. J Am Geriatr Soc (Internet). 2006 Mar (cited apr 03);54(3):391-6. DOI: 10.5380/ce.v23i2.53826 [ Links ]

56. Torres, RA, Torres, BR. Importância e bases de um programa de controle e prevenção de infecção em unidade de terapia intensiva geral. Rev Med Minas Gerais (Internet). 2015 (cited apr 07);25(4):577-82. DOI: 10.5935/2238-3182.20150125 [ Links ]

57. European Centre for Disease Prevention and Control. Healthcare-associated infections acquired in intensive care units: Annual Epidemiological report for 2017 (Internet). 2019 (cited 2021 apr 10). Available from: Available from: ]

58. Center for Disease Control and Prevention. Management of multi-drug-resistant organisms in healthcare settings (2006) (Internet). 2017 (cited 2021 apr 15). Available from: Available from: ]

59. Różańska, A, Chmielarczyk, A, Romaniszyn, D, Bulanda, M, Walkowicz, M, Osuch, P, et al. Antibiotic resistance, ability to form biofilm and susceptibility to copper alloys of selected staphylococcal strains isolated from touch surfaces in Polish hospital wards. Antimicrobial Resistance and Infection Control (Internet). 2017 aug 14 (cited apr 27);6(80). DOI: 10.1186/s13756-017-0240-x [ Links ]

60. Direção-Geral da Saúde. Programa de Prevenção e Controlo de Infeções e de Resistência aos Antimicrobianos (Internet). 2017 (cited apr 28). Available from: Links ]

61. Fundação Calouste Gulbenkian. Um futuro para a saúde - todos temos um papel a desempenhar (Internet). 2014 (cited 2021 apr 18). Available from: Available from: ]

62. Miranda, S, Tavares, D. Healthcare-associated infections: is portugal homogeneous? (Dissertação de Mestrado na Internet). Portugal: Instituto Universitário Egas Moniz. 2020 (cited apr 29). 62 p. Available from: ]

63. Costa, A. Controlo de infecção. Tecno hospital (Internet). 2011 (cited 2021 may 01);43:13-16. Available from: Available from: ]

64. Vaughn, V, Saint, S, Krein, S, Forman, J, Meddings, J, Ameling, J, et al. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Qual Saf (Internet). 2019 jan (cited 2021 may 07);28(1):74-84. DOI: 10.1136/bmjqs-2017-007573 [ Links ]

65. López, E, Oleastro, M. Infeção por Clostridioides difficile em Portugal, 2018 - Dados da norma do sistema de Vigilância Epidemiológica das Resistências aos Antimicrobianos (Internet). 2019 (cited 2021 may 08). Available from: Available from: Links ]

66. Benbassat, J, Taragin, M. Hospital readmissions as a measure of quality of care. Archives of Internal Medicine (Internet). 2000 apr 24 (cited 2021 may 08);160(8):1074-1081. DOI: 10.1001/archinte.160.8.1074. [ Links ]

How to cite: Gonçalves SCM, Carmo TIGD. Implications of Healthcare-Associated Infections in Health Management: Review. Enfermería: Cuidados Humanizados. 2022;11(1), e2746. DOI: 10.22235/ech.v11i1.2746

Contribution of the authors: a) Study conception and design, b) Data acquisition, c) Data analysis and interpretation, d) Writing of the manuscript, e) Critical review of the manuscript. S. C. M. G. has contributed in a, b, c, d, e; T. I. G. D. C. in a, b, c, d, e.

Managing scientific editor: Dr. Natalie Figueredo

Received: November 17, 2021; Accepted: March 18, 2022

Creative Commons License Este é um artigo publicado em acesso aberto sob uma licença Creative Commons