NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. Geneva: World Health Organization; 2016.

Cover of Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level

Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level.

Show details

6The burden of health care-associated infection

There is a growing body of evidence on the global burden of harm caused by HAI, as well as the strategies necessary for its reduction (4). In 2011, WHO reported that (3):

  • on average at any given time 7% of patients in developed and 10% in developing countries will acquire at least one HAI;
  • death from HAI occurs in about 10% of affected patients;
  • European estimates showed that more than 4 million patients are affected by approximately 4.5 million episodes of HAI annually, leading to 16 million extra days of hospital stay, 37 000 attributable deaths and contributing to an additional 110 000;
  • in the United States of America (USA), it was estimated that around 1.7 million patients are affected by HAI each year, representing a prevalence of 4.5% and accounting for 99 000 deaths.

Limited data are available from LMICs, but the prevalence of HAI is estimated to be between 5.7% and 19.1%. The increased burden of HAI in LMICs affects especially high-risk populations, such as patients admitted to intensive care units (ICUs) and neonates, with HAI frequency several-fold higher than in high-income countries, notably for device-associated infections. For example, the proportion of patients with an ICU-acquired infection can be as high as one in three in LMICs. Increased length of hospital stay associated with HAI in developing countries ranges between 5 and 29.5 days and excess mortality due to these infections in adult patients in Latin America, Asia and Africa were 18.5%, 23.6% and 29.3% for catheter-associated urinary tract infections, central line-associated bloodstream infections and ventilator-associated pneumonia, respectively (4). In this same analyses, the pooled SSI incidence was 11.8 per 100 patients undergoing surgical procedures (95% CI: 8.6–16.0) and 5.6 per 100 surgical procedures (95% CI: 2.9–10.5). SSI was the most frequent HAI reported hospital-wide in LMICs and the level of risk was significantly higher than in developed countries (4).

Four types of HAI (catheter-associated urinary tract infections, catheter-related bloodstream infection, surgical site infection (SSI), ventilator-associated pneumonia) and interventions associated with their reduction/prevention have received the highest attention around the globe in relation to causes of patient harm and the recognized global burden of HAI.

Although the evidence is limited on the economic burden of HAI, particularly in LMICs, available data from the USA and Europe suggest a multi-billion dollar impact. According to the US Centers for Disease Control and Prevention, the overall, annual, direct medical costs of HAI to hospitals in the USA ranges from US$ 35.7 to US$ 45 billion (19), while the annual economic impact in Europe is as high as €7 billion (20).

HAI clearly presents a significant (and largely avoidable) economic impact at the patient and population level. This includes substantial extra costs to health services due to the increased length of hospital stay and the overall impact on the facility, as well as unnecessary investigations and treatment and additional time needed to perform patient care (21). Private costs to patients and informal carers relate to out-of-pocket expenditure and other quality of life related consequences (death, pain, discomfort, psychological trauma) and HAI is a well-known outcome measure in health-related quality of life research (22). Societal costs incurred include lost productivity due to morbidity and mortality.

It is important to note that current data on the global burden of harm caused by HAI does not address infections acquired by health care workers, data on outbreaks or data on bloodborne pathogens transmitted through transfusion, contaminated injections and other procedures. Combined with the acknowledged reporting gaps in existing surveillance systems, the burden of HAI is considered to be greatly underestimated.

Despite limitations in available knowledge, HAI is undoubtedly a common problem across developed and developing countries. Multiple factors are involved and include very limited WASH services in health care facilities in LMICs (23), the health care system and its organization, health care interventions, infrastructure and patient status. Significant progress has been made to reduce or eliminate HAI in many parts of the world. However, no country has successfully eliminated the risk of acquisition completely. An additional concern is that populations in all countries are under threat from AMR as antimicrobials are the treatment of choice for infections. While the international call to action against AMR requires multifaceted intersectoral action, one element does include the prevention and management of HAI and this increasing global challenge has highlighted the importance of fundamental IPC measures when providing health care where acquired infections may not be treatable (24-26).

A recent WHO report produced in collaboration with Member States and other partners outlines the magnitude of AMR and the current state of surveillance globally (27). This survey found that few countries reported having comprehensive national AMR plans. In addition, national surveillance was hindered by poor laboratory capacity, infrastructure and data management challenges, widespread sales of antimicrobial medicines without prescriptions, lack of public awareness across all regions and an overall inadequate IPC approach (27).

High proportions of resistance to third-generation cephalosporins are reported for Escherichia coli and Klebsiella pneumoniae, thus increasing the demand for and use of carbapenems, the last resort to treat severe community- and hospital-acquired infections. For K. pneumoniae, proportions of resistance to carbapenems as high as 54% are reported in most countries. For E. coli, the high reported resistance to fluoroquinolones means limitations for available oral treatment, while high rates of methicillin-resistant Staphylococcus aureus (MRSA) place pressure on the use of second-line therapeutics to treat suspected or verified severe S. aureus infections, such as common skin and wound infections (27).

For these reasons, programmes to prevent the spread of AMR are essential. Despite the fundamental need of WASH for quality health service delivery, access to WASH in health care facilities is alarmingly poor. A 2015 WHO/UNICEF global report reveals that 38% of health care facilities have no water source. Water coverage estimates reduce by half when factors such as reliability and functionality are taken into consideration. Furthermore, the provision of soap and water or alcohol-based handrubs for hand hygiene was absent in over one third of facilities and almost one fifth of facilities did not have improved sanitation. Findings from the African Region highlight significant challenges (23).

In conclusion, the impact of HAI is significant. It presents a continued threat to the safe effective functioning of health systems and adversely impacts on the quality of health service delivery. It prolongs hospital stay, causes long-term disability, increases the likelihood of resistance of microorganisms to antimicrobials, incurs a massive additional financial burden for health systems, results in high financial and quality of life-related costs for patients and their families and leads to excess deaths. Based on available reports and the academic literature, it is clear that HAI is a global problem.

Copyright © World Health Organization 2016.

Some rights reserved.

Sales, rights and licensing To purchase WHO publications, see To submit requests for commercial use and queries on rights and licensing, see

Third-party materials If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.

This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (

Bookshelf ID: NBK401766


Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...