Preventing Hospital-Acquired Infections: Evidence-Based Strategies for Safer Patient Care

Preventing Hospital-Acquired Infections: A Practical Guide for Hospitalists

Hospitals treat serious illness.

They also create opportunities for infection.

Hospitalized patients may be exposed to:

• Invasive devices
• Antibiotics
• Procedures
• Shared equipment
• Resistant organisms
• Respiratory pathogens
• Prolonged healthcare contact

Many are also older, immunocompromised, critically ill, recently operated on, or living with chronic illnesses that increase vulnerability.

Preventing healthcare-associated infections therefore requires more than a single intervention.

It requires a system.

For hospitalists, infection prevention becomes part of everyday decisions about:

Hands.

Devices.

Antibiotics.

Isolation.

Diagnostics.

Mobility.

Aspiration risk.

Transitions of care.

The central question is:

What infection risk can we reduce for this patient today?

Clinical note: This article is intended for professional education. Infection-prevention practices should follow current CDC guidance, applicable public-health recommendations, institutional infection-prevention policies, local epidemiology, patient-specific circumstances, and consultation with infection-prevention and infectious-disease specialists when appropriate.

What Is a Healthcare-Associated Infection?

A healthcare-associated infection, or HAI, is an infection associated with receiving healthcare.

Important hospital-associated infections include:

• Central line-associated bloodstream infection
• Catheter-associated urinary tract infection
• Hospital-acquired pneumonia
• Ventilator-associated pneumonia
• Surgical-site infection
• Clostridioides difficile infection
• Infections involving multidrug-resistant organisms
• Healthcare-associated respiratory viral transmission
• Infections associated with procedures, injections, or contaminated equipment

Not every infection occurring during hospitalization is preventable.

And an infection diagnosed in the hospital is not automatically hospital acquired.

Timing, definitions, exposures, surveillance criteria, and clinical context matter.

But many infection risks can be reduced through reliable evidence-based practices.

Infection Prevention Is a System, Not a Single Checklist

Successful infection prevention requires coordination among:

• Physicians
• Nurses
• Infection-prevention specialists
• Pharmacists
• Environmental services
• Respiratory therapists
• Laboratory personnel
• Occupational health
• Hospital epidemiology
• Quality and safety teams
• Hospital leadership
• Patients and families

Hospitalists have an important role because they make daily decisions about devices, antimicrobials, testing, isolation, discharge planning, and escalation of care.

But infection prevention should never be framed as the responsibility of one profession.

The goal is a system in which safe practices are easy to perform reliably.

1. Start With Standard Precautions

Standard Precautions apply to the care of every patient.

They include core practices such as:

• Hand hygiene
• Appropriate use of personal protective equipment
• Respiratory hygiene
• Safe injection and medication practices
• Environmental cleaning
• Appropriate handling and reprocessing of equipment
• Exposure prevention

The important principle is:

Do not wait until a patient is known to be infectious before practicing infection prevention.

2. Make Hand Hygiene Routine

Hand hygiene is foundational.

Healthcare personnel may transfer microorganisms through contact with:

• Patients
• Wounds
• Invasive devices
• Bed rails
• Shared equipment
• Work surfaces
• Patient surroundings

Hand hygiene should be performed according to current institutional and public-health guidance, including appropriate moments before and after patient contact and aseptic tasks.

Gloves do not eliminate the need for hand hygiene.

The Hospitalist’s Role

Hospitalists should:

• Perform appropriate hand hygiene consistently
• Make sanitizer access part of workflow
• Model expected behavior
• Avoid allowing rounds to normalize skipped hand hygiene
• Support patients who appropriately ask whether clinicians cleaned their hands

Infection-prevention culture is shaped partly by what teams see senior clinicians do.

3. Choose PPE Based on the Exposure

Personal protective equipment should reflect the anticipated exposure and required precautions.

Before entering the room, ask:

• What infectious material could I encounter?
• Could my hands be exposed?
• Could my clothing be contaminated?
• Is splash or spray possible?
• Is respiratory protection required?
• What additional precautions apply?

Depending on the situation, PPE may include:

• Gloves
• Gown
• Eye protection
• Face protection
• Appropriate respiratory protection

Correct removal matters too.

Poorly removed PPE can contaminate the healthcare worker or surrounding environment.

4. Recognize When Standard Precautions Are Not Enough

Some suspected or confirmed infections require additional Transmission-Based Precautions.

Depending on the pathogen and route of transmission, these may involve:

• Contact precautions
• Droplet precautions
• Airborne precautions
• Specific patient placement
• Dedicated equipment
• Transport restrictions
• Enhanced environmental measures

Do not necessarily wait for final laboratory confirmation when the clinical syndrome warrants additional precautions.

Examples requiring prompt consideration may include:

• Suspected tuberculosis
• Measles
• Varicella
• Selected respiratory infections
• Certain infectious diarrheal syndromes
• Fever with a concerning rash
• Selected meningitis presentations
• Emerging infectious diseases

Follow institutional infection-prevention guidance for the exact precautions and duration.

Daily Question

Once precautions have been initiated, also ask:

Are they still indicated?

Unnecessary isolation can create its own care challenges.

5. Review Every Central Line Every Day

A central venous catheter may be essential.

It is also an invasive device with potential complications.

Prevention begins with appropriate insertion and continues with meticulous maintenance.

Important practices include:

• Hand hygiene
• Aseptic technique
• Appropriate sterile barriers during insertion
• Appropriate skin antisepsis
• Proper dressing care
• Hub/access-port disinfection according to protocol
• Site assessment
• Maintaining dressing integrity
• Daily review of necessity

For the hospitalist, one of the most important questions is simple:

Does this patient still need central access today?

If the original indication has disappeared, continuing the line solely for convenience should be reconsidered.

6. Review Every Urinary Catheter Every Day

The same principle applies to indwelling urinary catheters.

Use them for appropriate indications.

Insert them correctly.

Maintain a closed system and unobstructed flow.

Then remove them when the indication ends.

Potential indications can include selected situations involving:

• Acute urinary retention or obstruction
• Accurate urine-output measurement in critically ill patients
• Certain perioperative circumstances
• Selected wound-management situations
• Specific immobilization circumstances
• Comfort-focused end-of-life care

Institutional criteria should guide use.

Consider Alternatives

Depending on the clinical situation, alternatives may include:

• Scheduled toileting
• Urinals
• Bedside commodes
• Bladder scanning
• Intermittent catheterization
• External urinary devices

Do not let:

“The catheter was already there”

become the indication.

Device necessity belongs naturally in daily rounds. The Daily Hospitalist Checklist provides a broader framework for reviewing urinary catheters, central access, telemetry, oxygen, laboratory testing, and other interventions every hospital day.

7. Treat Every Invasive Device as a Daily Decision

Infection prevention should extend beyond central lines and urinary catheters.

Review:

• Peripheral IVs
• Arterial lines
• Feeding tubes
• Surgical drains
• Chest tubes
• Other invasive devices

Ask:

Why is it still here?

Is it functioning appropriately?

Is the site concerning?

Does it still provide more benefit than risk?

Device review should be part of routine care rather than something that occurs only after a complication.

8. Prevent Hospital-Acquired Pneumonia Across the Hospital

Pneumonia prevention is not limited to ventilated ICU patients.

Risk can be influenced by:

• Aspiration
• Oral bacterial burden
• Immobility
• Sedating medications
• Dysphagia
• Enteral feeding
• Mechanical ventilation
• Reintubation
• Functional decline

For Mechanically Ventilated Patients

Follow current ICU protocols and critical-care guidance.

Relevant strategies may include:

• Appropriate positioning
• Oral care
• Sedation management
• Assessment for spontaneous awakening and breathing trials when appropriate
• Ventilator liberation
• Mobility when feasible
• Aspiration-risk reduction

Our critical care guide for hospitalists reviews ventilator management, sedation, delirium, mobility, and ICU transitions from the hospitalist perspective.

For Nonventilated Patients

Consider:

• Oral care
• Mobility
• Appropriate positioning
• Swallow evaluation when indicated
• Feeding assistance
• Aspiration precautions
• Avoiding unnecessary sedation
• Reviewing medications that may contribute to aspiration risk

Hospital-acquired pneumonia prevention is a multidisciplinary process.

9. Make Oral Care Part of Patient Safety

Oral care is easy to overlook because ownership may be unclear.

But oral bacterial burden and aspiration can contribute to pneumonia risk.

Hospitals should have clear protocols for oral care, particularly for patients who:

• Are mechanically ventilated
• Have dysphagia
• Have impaired consciousness
• Are frail
• Need assistance with personal care
• Have limited mobility

The hospitalist does not need to personally perform oral care.

But the medical plan should recognize when oral hygiene and aspiration prevention are clinically important.

10. Use Antibiotics Deliberately

Antibiotics save lives when they are indicated.

They can also cause harm when they are unnecessary, overly broad, incorrectly dosed, or continued longer than needed.

Potential consequences include:

• C. difficile infection
• Drug reactions
• Kidney or other organ toxicity
• Drug interactions
• Selection of resistant organisms
• Additional IV access
• Diagnostic anchoring

Antimicrobial stewardship is therefore part of infection prevention.

Use a Daily Antibiotic Time-Out

For every patient receiving antimicrobial therapy, ask:

What infection are we treating?

Then:

• Is the diagnosis still likely?
• What cultures or diagnostic results are available?
• Is source control needed?
• Is the antimicrobial spectrum still appropriate?
• Can therapy be narrowed?
• Is the dose appropriate?
• Is IV therapy still required?
• What duration is planned?
• Is infectious-disease input needed?

Starting antibiotics is a decision.

Continuing them should be a decision too.

11. Distinguish Infection From Colonization

A positive test does not automatically mean active infection.

Hospitalists frequently need to distinguish:

• Infection
• Colonization
• Contamination
• Asymptomatic carriage
• Noninfectious inflammation

This is especially important when interpreting:

• Urine cultures
• Blood cultures
• Respiratory cultures
• Wound cultures
• Molecular diagnostic tests

The result should be interpreted within the clinical syndrome.

A Common Example: Urine Testing

Pyuria or bacteriuria does not by itself establish symptomatic urinary infection.

Before treating, ask:

• What symptoms or signs support infection?
• Was there an appropriate reason to obtain the test?
• Could another diagnosis explain the presentation?
• Is the organism likely clinically relevant?

Do not let a laboratory result replace the clinical assessment.

12. Practice Diagnostic Stewardship

Antibiotic stewardship begins before the prescription.

It begins with the test.

Poorly selected testing can generate results that are difficult to interpret and may lead to unnecessary treatment.

Potential examples include:

• Urine cultures without an appropriate clinical indication
• Repeated blood cultures without a clear reason
• Wound cultures without evidence of active infection
• C. difficile testing without an appropriate diarrheal syndrome
• Low-quality respiratory specimens
• Repeating microbiologic tests without considering how treatment affects yield

Before ordering a microbiologic test, ask:

What clinical question am I trying to answer?

How will a positive result change management?

How will a negative result change management?

Am I testing for disease—or simply looking for an organism?

13. Approach C. difficile Prevention as a System

Preventing Clostridioides difficile infection involves more than one intervention.

Important components can include:

• Appropriate antibiotic use
• Prompt recognition of compatible symptoms
• Appropriate testing
• Correct precautions
• PPE
• Environmental cleaning and disinfection
• Hand-hygiene practices consistent with current guidance
• Communication during transfers

A common oversimplification is:

“C. diff means alcohol hand rub doesn’t work, so everyone must always use soap and water.”

The actual infection-control approach is more nuanced and should follow current CDC and institutional guidance.

Gloves and gowns, appropriate removal technique, environmental measures, and outbreak-specific hand-hygiene recommendations all matter.

14. Keep the Environment and Shared Equipment Clean

Microorganisms can move through the patient-care environment.

High-touch items can include:

• Bed rails
• Call buttons
• Door handles
• Over-bed tables
• IV poles
• Computer equipment
• Mobile workstations
• Blood-pressure cuffs
• Stethoscopes
• Glucose meters
• Ultrasound equipment
• Telephones

The hospitalist does not own the entire environmental-cleaning program.

But clinicians do share responsibility for equipment they bring between patients.

Clarify Ownership

For every shared device, someone should know:

Who cleans it?

When?

With what product?

Using what contact time?

If nobody knows who owns the task, reliability suffers.

15. Use Safe Injection and Medication Practices

Injection safety is part of Standard Precautions.

Important principles include:

• Aseptic technique
• A new sterile needle and syringe for each injection
• Safe handling of medication containers
• Clean medication-preparation areas
• Appropriate use of single-dose and multidose vials
• Safe IV-system handling
• Prompt sharps disposal

Medication preparation should occur in an environment protected from contamination.

This is not merely a nursing issue.

It is a patient-safety standard.

16. Prevent Surgical-Site Infection During Co-Management

Hospitalists frequently co-manage surgical patients.

While the operative team owns many aspects of surgical-site prevention, hospitalists can contribute by reviewing:

• Antimicrobial indication
• Antimicrobial duration
• Glucose management
• Wound findings
• Fever
• Drain necessity
• Nutrition
• Mobility
• Respiratory status

Postoperative fever does not automatically mean surgical-site infection.

Likewise, unnecessary postoperative antibiotics should not continue simply because the patient recently underwent surgery.

Coordinate concerns with the surgical team and follow current procedure-specific guidance.

17. Recognize Sepsis Without Abandoning Stewardship

Sepsis requires timely recognition and appropriate treatment.

But stewardship remains important throughout the patient’s course.

When infection is strongly suspected and the patient is critically ill, do not allow unnecessary diagnostic delay to interfere with time-sensitive treatment.

Then keep reassessing.

Ask:

• Is infection still the best explanation?
• What is the likely source?
• What do cultures show?
• Is source control adequate?
• Can therapy be narrowed?
• Can antibiotics stop if infection becomes unlikely?

Our review of the 2026 Surviving Sepsis Campaign guidelines examines the current sepsis framework in greater detail.

Sepsis care and antimicrobial stewardship are not competing goals.

Both require repeated clinical reassessment.

18. Protect Patients From Respiratory Transmission

Healthcare-associated respiratory infections require attention to:

• Early recognition
• Respiratory hygiene
• Appropriate patient placement
• PPE
• Ventilation and environmental controls where applicable
• Testing when clinically appropriate
• Vaccination
• Staff illness policies
• Outbreak response

Appropriate precautions depend on the pathogen, transmission route, community epidemiology, patient population, and current public-health and institutional guidance.

Do not rely on one static respiratory-virus policy indefinitely.

19. Protect Healthcare Personnel Too

Infection prevention protects both patients and healthcare workers.

Hospitals should support:

• Recommended vaccination
• Appropriate respiratory protection
• Fit testing when required
• Occupational-health access
• Exposure evaluation
• Post-exposure management
• Clear illness-reporting procedures
• Appropriate work restrictions
• Adequate PPE and supplies

A safety culture should make it possible for an ill healthcare worker to report symptoms and follow appropriate occupational-health guidance without inappropriate pressure to work.

20. Make Infection Prevention Part of Daily Rounds

Hospitalists can incorporate infection prevention into normal clinical workflow without creating an entirely separate rounding process.

For each patient, consider:

PRECAUTIONS

• Are Standard Precautions being followed?
• Are additional precautions needed?
• Are existing isolation precautions still appropriate?

DEVICES

• Does the central line still have an indication?
• Does the urinary catheter still have an indication?
• Can another invasive device be removed?

ANTIMICROBIALS

• What infection are we treating?
• Does the diagnosis still fit?
• Can therapy be narrowed?
• Is IV therapy still necessary?
• What duration is planned?

DIAGNOSTICS

• Are cultures being interpreted in context?
• Are we treating colonization?
• Does another test actually need to be ordered?

PNEUMONIA RISK

• Is aspiration risk addressed?
• Is oral care occurring?
• Is unnecessary sedation contributing?
• Can the patient mobilize?

TRANSITIONS

• What infection-control information needs to follow the patient?

This infection-focused review can fit inside the broader Daily Hospitalist Checklist rather than becoming a competing workflow.

21. Communicate Infection Risk During Handoffs

Important infection-related information can be lost during:

• Shift changes
• Unit transfers
• ICU transfers
• Interfacility transfers
• Discharge

Handoffs may need to communicate:

• Suspected or confirmed infection
• Isolation requirements
• Pending cultures
• Resistant organisms
• Antimicrobial regimen
• Intended duration
• Required laboratory monitoring
• Device status
• Source-control procedures
• Pending microbiology

Do not make the next clinician reconstruct the antimicrobial plan from scattered orders.

22. Make Infection Prevention Part of Discharge Planning

Infection-related care may continue after hospitalization.

Before discharge, clarify when relevant:

• Antimicrobial name
• Dose
• Route
• Duration
• Stop date
• Monitoring requirements
• IV-access plan
• Wound care
• Device care
• Pending cultures
• Pending pathology or microbiology
• Follow-up
• Warning symptoms
• Who owns pending results

If a patient is leaving with a device or antimicrobial plan, ownership should be clear.

23. Document Antimicrobial Reasoning

Useful documentation can include:

• Suspected or confirmed source
• Important microbiology
• Why antimicrobial therapy is indicated
• Major change in spectrum
• Planned duration when known
• Source-control status
• Relevant uncertainty
• Reason treatment was discontinued

Avoid vague documentation such as:

“Continue antibiotics.”

A better note might say:

“Continue ceftriaxone for suspected community-acquired pneumonia; cultures remain negative, respiratory status is improving, and spectrum/duration will be reassessed tomorrow.”

Documentation should make the reasoning visible.

For broader principles of clinically useful inpatient notes, see our Hospitalist Documentation guide.

24. Use Surveillance and Feedback

Hospitals need data to know whether infection-prevention systems are working.

Depending on the program, useful measures may include:

• HAI rates
• Device utilization
• Hand-hygiene adherence
• Central-line bundle adherence
• Urinary-catheter utilization and appropriateness
• Environmental-cleaning performance
• Antimicrobial use
• Isolation compliance
• Occupational-health measures

Data should lead to action.

Simply producing a dashboard does not improve care.

Teams should ask:

What happened?

Why?

Was the process followed?

Was the process itself adequate?

What system change would make recurrence less likely?

25. Avoid Turning Infection Metrics Into Blame

HAIs should be reviewed seriously.

But a useful safety review is different from searching for someone to punish.

Ask:

• Was the device necessary?
• Was the bundle practical?
• Were supplies available?
• Was staffing adequate?
• Was responsibility clear?
• Was the patient unusually high risk?
• Was there a process failure?
• Was there a diagnostic problem?
• Was the policy followed?
• Does the policy need improvement?

The purpose of review is learning and prevention.

A culture dominated by blame can discourage reporting and hide system weaknesses.

26. Make It Easy to Do the Right Thing

Infection prevention becomes more reliable when the system supports the desired behavior.

Examples include:

• Hand sanitizer where care occurs
• PPE immediately available
• Clear isolation signage
• Device indications visible
• Automatic or structured device review
• Antibiotic reassessment prompts
• Clear cleaning responsibility
• Accessible infection-prevention expertise
• Timely microbiology reporting
• Feedback to frontline teams

Do not design infection prevention around perfect memory.

Design it around reliable systems.

Common Infection-Prevention Mistakes

Avoid:

• Assuming gloves replace hand hygiene
• Waiting unnecessarily for final testing before initiating indicated precautions
• Continuing devices without a current indication
• Treating colonization as infection
• Treating contamination as infection
• Ordering microbiology without a clinical question
• Continuing broad-spectrum therapy without reassessment
• Failing to define antimicrobial duration
• Ignoring source control
• Assuming somebody else cleaned shared equipment
• Overlooking oral care
• Overlooking aspiration risk
• Continuing unnecessary postoperative antimicrobials
• Failing to communicate infection-control needs during transfer
• Treating infection prevention as somebody else’s job

The Hospitalist Infection-Prevention Checklist

Use this as a compact rounding prompt rather than a substitute for institutional protocols.

HANDS AND PRECAUTIONS

• Hand hygiene performed appropriately
• PPE matched to exposure risk
• Additional precautions reviewed
• New transmissible syndrome recognized
• Isolation need communicated

DEVICES

• Central-line indication reviewed
• Urinary-catheter indication reviewed
• Other invasive devices reviewed
• Device sites assessed when relevant
• Unnecessary devices removed or removal discussed

ANTIMICROBIALS

• Infection indication confirmed
• New cultures reviewed
• Spectrum reassessed
• Dose reviewed
• IV-to-oral transition considered
• Duration considered
• Source control addressed

DIAGNOSTICS

• Positive tests interpreted clinically
• Colonization considered
• Contamination considered
• Unnecessary repeat cultures avoided
• New tests tied to a clinical question

PNEUMONIA PREVENTION

• Aspiration risk considered
• Oral care addressed
• Mobility encouraged when appropriate
• Sedating medications reviewed
• Ventilator-liberation plan reviewed when applicable

ENVIRONMENT

• Shared equipment cleaned appropriately
• Cleaning ownership clear
• Dressing or wound concerns addressed

TRANSITIONS

• Infection status included in handoff
• Isolation needs communicated
• Antimicrobial plan communicated
• Pending microbiology assigned
• Discharge antimicrobial plan clear

What Hospitalists Directly Control—and What They Don’t

It is useful to distinguish individual clinical responsibilities from system responsibilities.

Hospitalists Can Directly Influence

• Hand hygiene
• Appropriate PPE use
• Device necessity
• Antibiotic reassessment
• Diagnostic stewardship
• Source-control escalation
• Aspiration-risk recognition
• Isolation initiation
• Documentation
• Handoff communication
• Discharge planning

Hospitals Must Build Reliable Systems For

• Environmental cleaning
• Surveillance
• Infection-prevention staffing
• PPE supply
• Isolation infrastructure
• Sterilization and reprocessing
• Occupational health
• Staff vaccination programs
• Outbreak response
• Antibiotic-stewardship infrastructure
• Education and competency assessment
• Data collection and feedback

Strong infection prevention requires both.

It is unfair and ineffective to ask clinicians to compensate indefinitely for broken systems.

How This Article Fits With Other Hospitalist Resources

This page should own:

hospital-acquired infection prevention

device-associated infection prevention

infection-control practices

antimicrobial and diagnostic stewardship as prevention tools

The Daily Hospitalist Checklist owns the broader daily rounding workflow.

The Critical Care for Hospitalists guide owns unstable physiology and ICU-level care.

The 2026 Sepsis Guidelines page owns acute sepsis management.

The Hospitalist Documentation guide owns clinical documentation.

That keeps this article focused on preventing healthcare-associated infection, rather than turning it into another general hospitalist safety checklist.

Where Continuing Education Fits

Infection prevention changes as:

• Pathogens emerge
• Resistance patterns evolve
• Diagnostic technologies change
• New evidence becomes available
• Infection-control recommendations are updated

Hospitalists therefore need continuing education in:

• Infectious diseases
• Antimicrobial stewardship
• Sepsis
• Device safety
• Diagnostic stewardship
• Patient safety
• Quality improvement

Clinicians looking for structured inpatient education can review current Hospitalist CME programs and compare the curriculum with their clinical learning needs.

For infection-control questions, current CDC guidance and local infection-prevention policies should remain primary references.

Final Thoughts

Preventing hospital-acquired infection does not depend on one heroic intervention.

It depends on dozens of reliable decisions.

Clean your hands.

Use the right precautions.

Remove unnecessary devices.

Ask whether the antibiotic is still needed.

Interpret cultures in context.

Reduce aspiration risk.

Keep equipment clean.

Communicate infection risk during transitions.

Learn from surveillance data.

Build systems that make safe practice easier.

For hospitalists, one of the most useful questions to ask during rounds is also one of the simplest:

What infection risk can we remove today?

For current hospital medicine education, explore upcoming CME Getaways conferences.

Infection prevention is not one task. It is a system of reliable clinical decisions.

Key References

Centers for Disease Control and Prevention. Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings.

Centers for Disease Control and Prevention. Standard Precautions for All Patient Care.

Centers for Disease Control and Prevention. Current infection-control guidance addressing hand hygiene, isolation precautions, intravascular catheters, urinary catheters, environmental infection control, injection safety, surgical-site infection prevention, and healthcare-associated pneumonia.

Society for Healthcare Epidemiology of America. Strategies to Prevent Healthcare-Associated Infections in Acute-Care Hospitals: 2022 Update series.