Interprofessional Approaches to the Prevention and Management of Nosocomial Infections: Integrating Pharmacological, Administrative, and Nursing Perspectives
Abstract
Background: Healthcare-associated infections (HAIs) represent a major global public health challenge, contributing significantly to patient morbidity, mortality, and healthcare costs. These infections, acquired during the course of medical care, are frequently caused by multidrug-resistant organisms and are linked to invasive procedures and devices.
Aim: This article aims to synthesize a comprehensive, interprofessional approach to the prevention and management of HAIs, integrating the distinct yet complementary roles of pharmacological, administrative, and nursing perspectives to improve patient safety and outcomes.
Methods: The review consolidates evidence on the etiology, epidemiology, and pathophysiology of major HAIs—including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), and pneumonia (HAP/VAP). It evaluates management strategies centered on rapid diagnosis, source control, and targeted antimicrobial therapy, underpinned by robust infection prevention and control (IPC) protocols.
Results: Effective management hinges on a triad of rapid source control, timely and pathogen-directed antimicrobial therapy, and unwavering adherence to prevention bundles. Key outcomes include reduced infection rates, shorter hospital stays, lower mortality, and decreased antimicrobial resistance. The success of these measures is fundamentally dependent on seamless interprofessional collaboration.
Conclusion: A unified, interprofessional model is paramount for combating HAIs. This model integrates antimicrobial stewardship from pharmacists, rigorous implementation of IPC protocols by nursing staff, and supportive policy and resource allocation from administrators to create a safer healthcare environment.
Full text article
References
Magill SS, O'Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, Wilson LE, Kainer MA, Lynfield R, Greissman S, Ray SM, Beldavs Z, Gross C, Bamberg W, Sievers M, Concannon C, Buhr N, Warnke L, Maloney M, Ocampo V, Brooks J, Oyewumi T, Sharmin S, Richards K, Rainbow J, Samper M, Hancock EB, Leaptrot D, Scalise E, Badrun F, Phelps R, Edwards JR, Emerging Infections Program Hospital Prevalence Survey Team. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. The New England journal of medicine. 2018 Nov 1:379(18):1732-1744. doi: 10.1056/NEJMoa1801550.
Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, Jans B, Hopkins S, Hansen S, Lyytikäinen O, Reilly J, Deptula A, Zingg W, Plachouras D, Monnet DL, Healthcare-Associated Infections Prevalence Study Group. 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 surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2018 Nov:23(46):. doi: 10.2807/1560-7917.ES.2018.23.46.1800516.
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet (London, England). 2011 Jan 15:377(9761):228-41. doi: 10.1016/S0140-6736(10)61458-4.
Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, Price L, Egger M, Grayson ML, Kelley E, Allegranzi B, WHO Guidelines Development Group. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrobial resistance and infection control. 2017:6():6. doi: 10.1186/s13756-016-0149-9.
Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK, Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. The New England journal of medicine. 2014 Mar 27:370(13):1198-208. doi: 10.1056/NEJMoa1306801.
Ewan VC, Witham MD, Kiernan M, Simpson AJ. Hospital-acquired pneumonia surveillance-an unmet need. The Lancet. Respiratory medicine. 2017 Oct:5(10):771-772. doi: 10.1016/S2213-2600(17)30296-5.
Falagas ME, Kopterides P, Siempos II. Attributable mortality of Acinetobacter baumannii infection among critically ill patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2006 Aug 1:43(3):389; author reply 389-90
Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009 Dec 2:302(21):2323-9. doi: 10.1001/jama.2009.1754.
Jernigan JA, Hatfield KM, Wolford H, Nelson RE, Olubajo B, Reddy SC, McCarthy N, Paul P, McDonald LC, Kallen A, Fiore A, Craig M, Baggs J. Multidrug-Resistant Bacterial Infections in U.S. Hospitalized Patients, 2012-2017. The New England journal of medicine. 2020 Apr 2:382(14):1309-1319. doi: 10.1056/NEJMoa1914433.
Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, Kallen A, Limbago B, Fridkin S, National Healthcare Safety Network (NHSN) Team and Participating NHSN Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infection control and hospital epidemiology. 2013 Jan:34(1):1-14. doi: 10.1086/668770.
Spivak ES, Hanson KE. Candida auris: an Emerging Fungal Pathogen. Journal of clinical microbiology. 2018 Feb:56(2):. doi: 10.1128/JCM.01588-17
Weiner LM, Webb AK, Limbago B, Dudeck MA, Patel J, Kallen AJ, Edwards JR, Sievert DM. Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011-2014. Infection control and hospital epidemiology. 2016 Nov:37(11):1288-1301
Park JH, Ryu SH, Lee JY, Kim HJ, Kwak SH, Jung J, Lee J, Sung H, Kim SH. Airborne fungal spores and invasive aspergillosis in hematologic units in a tertiary hospital during construction: a prospective cohort study. Antimicrobial resistance and infection control. 2019:8():88. doi: 10.1186/s13756-019-0543-1.
Lemaire B, Normand AC, Forel JM, Cassir N, Piarroux R, Ranque S. Hospitalized Patient as Source of Aspergillus fumigatus, 2015. Emerging infectious diseases. 2018 Aug:24(8):1524-1527. doi: 10.3201/eid2408.171865. Epub
Aitken C, Jeffries DJ. Nosocomial spread of viral disease. Clinical microbiology reviews. 2001 Jul:14(3):528-46
Ganczak M, Barss P. Nosocomial HIV infection: epidemiology and prevention--a global perspective. AIDS reviews. 2008 Jan-Mar:10(1):47-61
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995 Aug 23-30:274(8):639-44
Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public health reports (Washington, D.C. : 1974). 2007 Mar-Apr:122(2):160-6
Ling ML, Apisarnthanarak A, Madriaga G. The Burden of Healthcare-Associated Infections in Southeast Asia: A Systematic Literature Review and Meta-analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2015 Jun 1:60(11):1690-9. doi: 10.1093/cid/civ095.
Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. European respiratory review : an official journal of the European Respiratory Society. 2020 Mar 31:29(155):. doi: 10.1183/16000617.0068-2020.
Climo M, Diekema D, Warren DK, Herwaldt LA, Perl TM, Peterson L, Plaskett T, Price C, Sepkowitz K, Solomon S, Tokars J, Fraser VJ, Wong E. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infection control and hospital epidemiology. 2003 Dec:24(12):942-5
Bell T, O'Grady NP. Prevention of Central Line-Associated Bloodstream Infections. Infectious disease clinics of North America. 2017 Sep:31(3):551-559. doi: 10.1016/j.idc.2017.05.007.
Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg RP, Ebadi E. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PloS one. 2020:15(1):e0227772. doi: 10.1371/journal.pone.0227772.
Letica-Kriegel AS, Salmasian H, Vawdrey DK, Youngerman BE, Green RA, Furuya EY, Calfee DP, Perotte R. Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ open. 2019 Feb 21:9(2):e022137. doi: 10.1136/bmjopen-2018-022137.
Isikgoz Tasbakan M, Durusoy R, Pullukcu H, Sipahi OR, Ulusoy S, 2011 Turkish Nosocomial Urinary Tract Infection Study Group. Hospital-acquired urinary tract infection point prevalence in Turkey: differences in risk factors among patient groups. Annals of clinical microbiology and antimicrobials. 2013 Nov 4:12():31. doi: 10.1186/1476-0711-12-31. Epub 2013 Nov 4
Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection control and hospital epidemiology. 2014 Sep:35 Suppl 2():S66
Mukagendaneza MJ, Munyaneza E, Muhawenayo E, Nyirasebura D, Abahuje E, Nyirigira J, Harelimana JD, Muvunyi TZ, Masaisa F, Byiringiro JC, Hategekimana T, Muvunyi CM. Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study. Patient safety in surgery. 2019:13():10. doi: 10.1186/s13037-019-0190-8.
Mioton LM, Jordan SW, Hanwright PJ, Bilimoria KY, Kim JY. The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients. Archives of plastic surgery. 2013 Sep:40(5):522-9. doi: 10.5999/aps.2013.40.5.522.
Gibbons C, Bruce J, Carpenter J, Wilson AP, Wilson J, Pearson A, Lamping DL, Krukowski ZH, Reeves BC. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Health technology assessment (Winchester, England). 2011 Sep:15(30):1-156, iii-iv. doi: 10.3310/hta15300.
Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infection control and hospital epidemiology. 2014 Sep:35 Suppl 2():S133-54
Komiya K, Ishii H, Kadota J. Healthcare-associated Pneumonia and Aspiration Pneumonia. Aging and disease. 2015 Feb:6(1):27-37. doi: 10.14336/AD.2014.0127.
Kózka M, Sega A, Wojnar-Gruszka K, Tarnawska A, Gniadek A. Risk Factors of Pneumonia Associated with Mechanical Ventilation. International journal of environmental research and public health. 2020 Jan 19:17(2):. doi: 10.3390/ijerph17020656.
Kumar ST, Yassin A, Bhowmick T, Dixit D. Recommendations From the 2016 Guidelines for the Management of Adults With Hospital-Acquired or Ventilator-Associated Pneumonia. P & T : a peer-reviewed journal for formulary management. 2017 Dec:42(12):767-772
Roberts K, Smith CF, Snelling AM, Kerr KG, Banfield KR, Sleigh PA, Beggs CB. Aerial dissemination of Clostridium difficile spores. BMC infectious diseases. 2008 Jan 24:8():7. doi: 10.1186/1471-2334-8-7.
Loo VG, Bourgault AM, Poirier L, Lamothe F, Michaud S, Turgeon N, Toye B, Beaudoin A, Frost EH, Gilca R, Brassard P, Dendukuri N, Béliveau C, Oughton M, Brukner I, Dascal A. Host and pathogen factors for Clostridium difficile infection and colonization. The New England journal of medicine. 2011 Nov 3:365(18):1693-703. doi: 10.1056/NEJMoa1012413.
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine. 2020 May:46(5):888-906. doi: 10.1007/s00134-020-05980-0.
Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S, Nguyen HH, Huang B, Tang YW, Lee LW, Kim K, Taylor S, Romano PS, Panacek EA, Goodell PB, Solnick JV, Cohen SH. Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era. JAMA internal medicine. 2015 Nov:175(11):1792-801. doi: 10.1001/jamainternmed.2015.4114.
Madden GR, Poulter MD, Sifri CD. Diagnostic stewardship and the 2017 update of the IDSA-SHEA Clinical Practice Guidelines for Clostridium difficile Infection. Diagnosis (Berlin, Germany). 2018 Sep 25:5(3):119-125. doi: 10.1515/dx-2018-0012.
Lutwick L, Al-Maani AS, Mehtar S, Memish Z, Rosenthal VD, Dramowski A, Lui G, Osman T, Bulabula A, Bearman G. Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2019 Jul:84():22-29. doi: 10.1016/j.ijid.2019.04.014.
Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE, Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2010 Mar 1:50(5):625-63
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Surgical Infection Society (SIS), Society for Healthcare Epidemiology of America (SHEA). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surgical infections. 2013 Feb:14(1):73-156. doi: 10.1089/sur.2013.9999.
Khanna S, Assi M, Lee C, Yoho D, Louie T, Knapple W, Aguilar H, Garcia-Diaz J, Wang GP, Berry SM, Marion J, Su X, Braun T, Bancke L, Feuerstadt P. Efficacy and Safety of RBX2660 in PUNCH CD3, a Phase III, Randomized, Double-Blind, Placebo-Controlled Trial with a Bayesian Primary Analysis for the Prevention of Recurrent Clostridioides difficile Infection. Drugs. 2022 Oct:82(15):1527-1538. doi: 10.1007/s40265-022-01797-x.
Feuerstadt P, Louie TJ, Lashner B, Wang EEL, Diao L, Bryant JA, Sims M, Kraft CS, Cohen SH, Berenson CS, Korman LY, Ford CB, Litcofsky KD, Lombardo MJ, Wortman JR, Wu H, Auniņš JG, McChalicher CWJ, Winkler JA, McGovern BH, Trucksis M, Henn MR, von Moltke L. SER-109, an Oral Microbiome Therapy for Recurrent Clostridioides difficile Infection. The New England journal of medicine. 2022 Jan 20:386(3):220-229. doi: 10.1056/NEJMoa2106516.
Dinleyici M, Vandenplas Y. Clostridium difficile Colitis Prevention and Treatment. Advances in experimental medicine and biology. 2019:1125():139-146. doi: 10.1007/5584_2018_322.
Polage CR, Solnick JV, Cohen SH. Nosocomial diarrhea: evaluation and treatment of causes other than Clostridium difficile. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2012 Oct:55(7):982-9. doi: 10.1093/cid/cis551.
Koch AM, Nilsen RM, Eriksen HM, Cox RJ, Harthug S. Mortality related to hospital-associated infections in a tertiary hospital; repeated cross-sectional studies between 2004-2011. Antimicrobial resistance and infection control. 2015:4():57. doi: 10.1186/s13756-015-0097-9.
Kanerva M, Ollgren J, Virtanen MJ, Lyytikäinen O, Prevalence Survey Study Group. Risk factors for death in a cohort of patients with and without healthcare-associated infections in Finnish acute care hospitals. The Journal of hospital infection. 2008 Dec:70(4):353-60. doi: 10.1016/j.jhin.2008.08.009.
Vincent JL. Nosocomial infections in adult intensive-care units. Lancet (London, England). 2003 Jun 14:361(9374):2068-77
Soufir L, Timsit JF, Mahe C, Carlet J, Regnier B, Chevret S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infection control and hospital epidemiology. 1999 Jun:20(6):396-401
Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Gomez DY, Leblebicioglu H, Abu Khader I, Miranda Novales MG, Berba R, Ramírez Wong FM, Barkat A, Pino OR, Dueñas L, Mitrev Z, Bijie H, Gurskis V, Kanj SS, Mapp T, Hidalgo RF, Ben Jaballah N, Raka L, Gikas A, Ahmed A, Thu le TA, Guzmán Siritt ME, INICC Members. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. American journal of infection control. 2010 Mar:38(2):95-104.e2. doi: 10.1016/j.ajic.2009.12.004.
Arefian H, Hagel S, Fischer D, Scherag A, Brunkhorst FM, Maschmann J, Hartmann M. Estimating extra length of stay due to healthcare-associated infections before and after implementation of a hospital-wide infection control program. PloS one. 2019:14(5):e0217159. doi: 10.1371/journal.pone.0217159.
Shepard J, Frederick J, Wong F, Madison S, Tompkins L, Hadhazy E. Could the prevention of health care-associated infections increase hospital cost? The financial impact of health care-associated infections from a hospital management perspective. American journal of infection control. 2020 Mar:48(3):255-260. doi: 10.1016/j.ajic.2019.08.035.
Esatoğlu AE, Agirbas I, Onder OR, Celik Y. Additional cost of hospital-acquired infection to the patient: a case study in Turkey. Health services management research. 2006 Aug:19(3):137-43
Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA internal medicine. 2013 Dec 9-23:173(22):2039-46. doi: 10.1001/jamainternmed.2013.9763.
Mathai E, Allegranzi B, Kilpatrick C, Pittet D. Prevention and control of health care-associated infections through improved hand hygiene. Indian journal of medical microbiology. 2010 Apr-Jun:28(2):100-6. doi: 10.4103/0255-0857.62483.
Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, Boyce JM, WHO Global Patient Safety Challenge, World Alliance for Patient Safety. Evidence-based model for hand transmission during patient care and the role of improved practices. The Lancet. Infectious diseases. 2006 Oct:6(10):641-52
Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. The Journal of hospital infection. 2009 Dec:73(4):305-15. doi: 10.1016/j.jhin.2009.04.019.
Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bulletin of the World Health Organization. 2011 Oct 1:89(10):757-65. doi: 10.2471/BLT.11.088179.
Colgan R, Powers JH. Appropriate antimicrobial prescribing: approaches that limit antibiotic resistance. American family physician. 2001 Sep 15:64(6):999
Weiner LM, Fridkin SK, Aponte-Torres Z, Avery L, Coffin N, Dudeck MA, Edwards JR, Jernigan JA, Konnor R, Soe MM, Peterson K, McDonald LC. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals - United States, 2014. MMWR. Morbidity and mortality weekly report. 2016 Mar 11:65(9):235-41. doi: 10.15585/mmwr.mm6509e1.
Authors
Copyright (c) 2025 Khadijah Ahmad Abdallh Bin Zarah, Amnah Hamood Althalabi, Mohammed Muqbil Alqahtani, Saad Musaad Z Alotaibi, Saad Abdulaziz Alrabiah , Khalid Ayidh Muqbil Alotaibi, Mohammed Muqbil Alqahtani, Abdullah Faraj Hijab Al-Otaibi, Mohammed Ali Mousa Dreab, Zahra Ali Mohsin Alnakhli, Nadiyah Dallaj M Almutairi
This work is licensed under a Creative Commons Attribution 4.0 International License.