Sürveyanstan Önlemeye Giden Yol: Sağlık Hizmeti İlişkili Enfeksiyonların Kontrolünde Kanıta Dayalı Uygulamalar ve Güncel Stratejiler

Abstract

Bu derleme, sağlık hizmeti ilişkili enfeksiyonların (SHİE) küresel yükünü, başlıca türlerini ve kanıta dayalı önleme stratejilerini ele alarak, enfeksiyon kontrolünde sürveyans odaklı yaklaşımdan proaktif bir önleme paradigmasına geçişi incelemektedir. Çalışma, SHİE’nin hastalar, sağlık sistemleri ve ekonomiler üzerinde yarattığı ciddi morbidite, mortalite ve finansal yükü ortaya koymakta; bu yükün özellikle yoğun bakım üniteleri ve hemodiyaliz merkezleri gibi yüksek riskli alanlarda, cerrahi alan enfeksiyonları, kateter ilişkili enfeksiyonlar, ventilatör ilişkili pnömoni ve Clostridioides difficile enfeksiyonları gibi temel enfeksiyon türleri üzerinden yoğunlaştığını vurgulamaktadır. Ayrıca etkili sürveyansın vazgeçilmez olmasının yanı sıra, enfeksiyon oranlarını azaltmada tek başına yeterli olmadığı görülmektedir. Anlamlı ve kalıcı ilerlemenin; sürveyans verilerinin el hijyeni, invaziv cihaz bakım protokolleri, çevresel temizlik uygulamaları ve cerrahi bakım paketleri gibi kanıta dayalı uygulamalara dönüştürüldüğü çok bileşenli stratejilerin hayata geçirilmesiyle mümkün olabilmektedir. Antimikrobiyal direnç, bu mücadelede merkezi bir tehdit olarak ele alınmakta ve antimikrobiyal yönetim programlarının enfeksiyon önleme girişimleriyle bütünleştirilmesinin stratejik önemi özellikle vurgulanmaktadır. Bunun yanı, bu stratejilerin koordinasyonunda, sağlık çalışanlarının eğitiminde ve uygulamaların sürdürülebilirliğinin sağlanmasında enfeksiyon kontrol hemşireleri ve ekiplerinin kilit rolünü ortaya koymaktadır. Makale; klinik uygulama, kurumsal yönetim ve sağlık politikaları olmak üzere üç düzeyde somut öneriler sunarak, standartlaştırılmış protokoller, güçlü liderlik ve sürekli iyileştirme kültürüne dayalı bir önleme sistemine geçiş için kapsamlı bir yol haritası önermektedir. Sonuç olarak, SHİE kontrolünün ancak teknik müdahaleleri, davranış değişimini ve örgütsel bağlılığı bir arada ele alan bütüncül bir yaklaşımla etkili biçimde sağlanabileceğini göstermektedir.

Keywords

• Çapraz enfeksiyon
• Enfeksiyon Kontrolü
• Enfeksiyon Kontrol Hemşireliği
• Hasta Güvenliği
• Sağlık Hizmeti İlişkili Enfeksiyonlar

The Path from Surveillance to Prevention: Evidence-Based Practices and Current Strategies in Healthcare-Associated Infection Control

Abstract

This review examines the global burden, major types, and evidence-based prevention strategies for healthcare-associated infections (HAIs), analyzing the shift in infection control from a surveillance-focused approach to a proactive prevention paradigm. The study highlights the significant morbidity, mortality, and financial strain HAIs impose on patients, healthcare systems, and economies, emphasizing that this burden is concentrated in high-risk areas such as intensive care units and hemodialysis centers through major infection types including surgical site infections, catheter-associated infections, ventilator-associated pneumonia, and Clostridioides difficile infections. The core argument posits that while effective surveillance is necessary, it is insufficient alone to reduce infection rates. Meaningful progress is achievable through implementing multifaceted strategies where surveillance data is translated into evidence-based practices such as hand hygiene, invasive device care protocols, environmental cleaning, and surgical care bundles. Antimicrobial resistance is addressed as a central threat in this struggle, underscoring the strategic importance of integrating antimicrobial stewardship programs with infection prevention efforts. Furthermore, the analysis explores the pivotal role of infection control nurses and teams in coordinating these strategies, providing education, and ensuring sustainability. The article offers concrete recommendations across three levels—from clinical practice to institutional management and health policy—proposing a roadmap for transitioning to a prevention system built on standardized protocols, strong leadership, and a culture of continuous improvement. In conclusion, it demonstrates that HAI control can only be achieved through a holistic approach that combines technical interventions, behavioral change, and organizational commitment.

Keywords

• Cross infection
• infection control
• infection control nursing
• patient safety
• healthcare-associated infections

References

1. Allegranzi, B., Nejad, S. B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D. (2011). Burden of endemic health-care associated infection in developing countries: Systematic review and meta-analysis. The Lancet, 377(9761), 13(10), e1002150. https://doi.org/10.1371/journal.pmed.1002150 228-241.
2. Andersen, B. M. (2019). Hospital infections: Surveillance. Springer. https://doi.org/10.1007/978-3-319-99921-0
3. Anderson, D. J., Kaye, K. S., Classen, D. C., Arias, K. M., Podgorny, K., Burstin, H., & Yokoe, D. S. (2008). Strategies to prevent surgical site infections in acute care hospitals. Infection Control & Hospital Epidemiology, https://doi.org/10.1086/591064 29(6), 605–627.
4. Bajaj, D. L. L., & Bajaj, D. B. L. (2024). Antibiotic resistance in hospital-acquired infections: Current trends and prevention strategies. Nanotechnology Perceptions, 20(6), 54–63.
5. Ban, K. A., Minei, J. P., Laronga, C., Harbrecht, B. G., Jensen, E. H., Fry, D. E., ... & Duane, T. M. (2017). American College of Surgeons and Surgical Infection Society: Surgical site infection guidelines, 2016 update. Journal of the American College of Surgeons, 224(1), 59-74. https://doi.org/10.1016/j.jamcollsurg.2016.10.029
6. Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J., ... & Dellit, T. H. (2016). Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases, 62(10), https://doi.org/10.1093/cid/ciw118 e51-e77.
7. Boyce, J. M. (2016). Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrobial Resistance & Infection Control, 5, https://doi.org/10.1186/s13756-016-0111-x 10.
8. Cassini, A., Plachouras, D., Eckmanns, T., Sin, M. A., Blank, H., Ducomble, T., & Suetens, C. (2016). Burden of six healthcare-associated infections on European population health: Estimating incidence based disability-adjusted life years through a Dellit, T. H., Owens, R. C., McGowan, J. E., Gerding, D. N., Weinstein, R. A., Burke, J. P., ... & Infectious Diseases Society of America. (2007). Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases, 44(2), https://doi.org/10.1086/510393 159-177.

9. El-Saed, A., Balkhy, H. H., Alshamrani, M. M., Aljohani, S., Alsaedi, A., & Al Nasser, W. (2020). Integration of nursing practice in infection prevention programs: Impact on healthcare associated infections. Infection Control & Hospital Epidemiology, 41(10), https://doi.org/10.1017/ice.2020.225 1174–1181.
10. Garnacho-Montero, J., Escoresca-Ortega, A., & Fernández-Delgado, E. (2020). Antibiotic de escalation in the ICU: How is it best done? Current Opinion in Infectious Diseases, 33(2), 177-185. https://doi.org/10.1097/QCO.0000000000000632 Harbarth, S., Sax, H., & Gastmeier, P. (2003). The preventable proportion of nosocomial infections: An overview of published reports. Journal of Hospital Infection, 54(4), 258-266. https://doi.org/10.1016/S0195-6701(03)00150-6
11. Houghton, M. (2019). Organizational factors influencing infection control practices in healthcare settings. Journal of Infection Prevention, 20(5), 199–204. https://doi.org/10.1177/1757177419858786
12. Karkar, A., Bouhaha, B. M., & Dammak, M. M. (2020). Infection control in hemodialysis units: A review. Saudi Journal of Kidney Diseases and Transplantation, 31(2), 275-288. https://doi.org/10.4103/1319-2442.284940
13. Klompas, M., Branson, R., Eichenwald, E. C., Greene, L. R., Howell, M. D., Lee, G., ... & Berenholtz, S. M. (2014). Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, https://doi.org/10.1086/677144 60 35(8), 915-936.
14. Ramos, G. M., Vigário, L. C., & Costa, S. F. (2021).
15. Longtin, Y., Sax, H., Leape, L. L., Sheridan, S. E., Donaldson, L., & Pittet, D. (2011). Patient participation: Current knowledge and applicability to patient safety. Mayo Clinic Proceedings, 86(1), 44-54. https://doi.org/10.4065/mcp.2010.0321
16. Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review. BMJ Quality & Safety, 23(4), 277-289. https://doi.org/10.1136/bmjqs-2012-001774
17. Miccolis, L., Di Siena, F. P., Serpentino, M., Rigoni, M., Zanovello, S., & Mondino, S. (2023). Healthcare-associated infections in an orthopaedic setting: A multidisciplinary approach. Lo Scalpello, 36(2), 75–81.
18. Monegro, A. F., Muppidi, V., & Regunath, H. (2023). Hospital-acquired infections. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441857/
19. Nelson, R. E., Slayton, R. B., Stevens, V., Jones, M., Khader, K., Rubin, M., & Samore, M. H. (2017). Attributable mortality of healthcare associated infections due to multidrug-resistant gram-negative bacteria and methicillin-resistant Staphylococcus aureus. Infection Control & Hospital Epidemiology, 38(7), https://doi.org/10.1017/ice.2017.85 848–856.
20. Nelson, R. W., Ashby, L., Bennett, M., Bridges, A., Chatterjee, P., Choi, H., & Jinadatha, C. (2022). Excess cost of healthcare-associated infections. Open Forum Infectious Diseases, 9(Suppl 2), S534–S535. https://doi.org/10.1093/ofid/ofac492.1076
21. Ngema, S. A., Bale, T. L. A., & Ramukumba, T. S. (2025). Impact of infection prevention and control quality improvements in haemodialysis facilities: A scoping review. BMC Nephrology, 26, 527. https://doi.org/10.1186/s12882-025-04459-8
22. Okeah, B. O., Morrison, V., & Huws, J. C. (2021). Antimicrobial stewardship and infection prevention interventions targeting healthcare-associated Clostridioides difficile and carbapenem-resistant Klebsiella pneumoniae infections: A scoping review. BMJ Open, 11(8), e051983. https://doi.org/10.1136/bmjopen-2021-051983
23. The role of the environment in the spread of multidrug-resistant gram-negative Antibiotics, 10(11), https://doi.org/10.3390/antibiotics10111333
24. Ranji, S. R., Shetty, K., Posley, K. A., Lewis, R., Sundaram, V., & Winston, L. G. (2007). Closing the quality gap: Prevention of healthcare-associated infections. Agency for Healthcare Research and Quality.
25. Rutala, W. A., & Weber, D. J. (2019). Disinfection and sterilization in health care facilities: An overview and current issues. Infectious Disease Clinics, 33(4), https://doi.org/10.1016/j.idc.2019.06.002 891-909.
26. Saint, S., Kowalski, C. P., Banaszak-Holl, J., Forman, J., Damschroder, L., & Krein, S. L. (2010). The importance of leadership in preventing healthcare-associated infection: Results of a multisite qualitative study. Infection Control & Hospital Epidemiology, https://doi.org/10.1086/655459 31(9), 901-907.
27. Sartelli, M. (2022). Prevention of healthcare associated infections: Current perspectives. World Journal of Emergency Surgery, 17, 16. https://doi.org/10.1186/s13017-022-00406-3
28. Sickbert-Bennett, E. E., DiBiase, L. M., Willis, T. M., Wolak, E. S., Weber, D. J., & Rutala, W. A. (2016). Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerging Infectious Diseases, 22(9), 1628-1630. https://doi.org/10.3201/eid2209.151440
29. Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & the Healthcare Infection Control Practices Advisory Committee. (2007). Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. American Journal of Infection Control, 35(10 Suppl 2), S65 S164. https://doi.org/10.1016/j.ajic.2007.10.007
30. Stone, P. W., Dick, A. W., Pogorzelska-Maziarz, M., Furuya, E. Y., & Larson, E. L. (2022). Staffing and structure of infection prevention and control programs in US hospitals: Findings from a national survey. Journal of Patient Safety, 18(1), e16-e22. https://doi.org/10.1097/PTS.0000000000000709 61
31. Thandar, M. M., Rahman, M. O., Haruyama, R., Matsuoka, S., Okawa, S., & Baba, T. (2022). Effectiveness of infection control teams in reducing healthcare-associated infections: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(17), 10775. https://doi.org/10.3390/ijerph191710775
32. Weinstein, R. A., Milstone, A. M., & Passaretti, C. L. (2023). Healthcare-associated infections in vulnerable populations. In Bennett & Brachman's Hospital Infections (7th ed., pp. 123-145). Wolters Kluwer. Wong, A., Otles, E., Donnelly, J. P., Krumm, A., McCullough, J., DeTroyer-Cooley, O., ... & Singh, K. (2021). External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Internal Medicine, 181(8), 1065-1070. https://doi.org/10.1001/jamainternmed.2021.2626
33. World Health Organization. (2016). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. WHO. https://apps.who.int/iris/handle/10665/251730
34. World Health Organization. (2024). Global report on infection prevention and control 2024. WHO. https://www.who.int/publications
35. Yokoe, D. S., Anderson, D. J., Berenholtz, S. M., Calfee, D. P., Dubberke, E. R., Ellingson, K. D., Gerding, D. N., Haas, J. P., Kaye, K. S., Klompas, M., Lo, E., Marschall, J., Mermel, L. A., Nicolle, L. E., Salgado, C. D., Bryant, K., Classen, D., Crist, K., Deloney, V. M., … Weinstein, R. A. (2014). A compendium of strategies to prevent healthcare associated infections in acute care hospitals: 2014 updates. Infection Epidemiology, Control 35(8), https://doi.org/10.1086/677216 & Hospital 967–977.
36. Zimlichman, E., Henderson, D., Tamir, O., Franz, C., Song, P., Yamin, C. K., Keohane, C., Denham, C. R., & Bates, D. W. (2013). Health care associated infections: A meta-analysis of costs and financial impact on the US health care system. JAMA Internal Medicine, 173(22), 2039–2046. https://doi.org/10.1001/jamainternmed.2013.9763