Preventing Healthcare-Associated Infections

Breaking the Chain of Infection

Healthcare-associated infections (HAIs) remain a pervasive threat to patient safety and hospital outcomes. In U.S. hospitals alone, the CDC estimates that about 1 in 31 patients contracts an HAI during their care (Magill et al., 2018). These infections range from surgical site infections and pneumonias to bloodstream and urinary tract infections, often involving drug-resistant organisms. HAIs not only cause direct patient harm but also prolong hospital stays and increase mortality. A landmark analysis estimated that HAIs add $28.4 to $45 billion in excess healthcare costs annually in the United States and contribute to nearly 99,000 deaths per year, making them one of the top causes of preventable mortality (Stone, 2009; Klevens et al., 2007). Beyond clinical outcomes, high HAI rates create operational and financial burdens for healthcare facilities – including regulatory penalties, higher resource utilization, and reputational damage in quality-of-care rankings. They strain healthcare operations by requiring additional treatments, isolation measures, and extended bed occupancy. Preventing HAIs is, therefore, paramount for both patient safety and effective hospital management.

Stopping these infections requires more than routine cleaning and disinfecting; it demands a proactive, multilayered approach woven into every facet of care. The following evidence-based strategies – from advanced disinfection technologies to data-driven interventions – can effectively break the chain of infection while improving hospital hygiene and safety.

How HAIs Spread: Common Transmission Pathways

Hospital-acquired infections can originate from invasive procedures or exposure within the hospital environment. Understanding how HAIs spread is essential for implementing effective prevention strategies. HAIs generally arise through one of three sources:

  • Iatrogenic Infections – Result from invasive medical procedures such as catheter insertions, surgical interventions, or mechanical ventilation. For example, studies have shown that catheter-associated bloodstream infections (CLABSIs) increase by about 28% when sterile protocols are not strictly followed (Fakih et al., 2021).
  • Nosocomial Infections – Acquired due to environmental exposure in hospitals, including contaminated medical devices, patient bedding, or healthcare workers’ hands. For instance, Clostridioides difficile (C. diff) spores can spread through contaminated bedding and improperly sanitized equipment, leading to prolonged hospital stays and increased treatment costs (Guerrero et al., 2012).
  • Exogenous Infections – Stem from external contaminants entering the hospital environment. High-touch surfaces such as privacy curtains, bed rails, doorknobs, and call buttons serve as reservoirs for harmful microbes. Studies show that privacy curtains become rapidly contaminated; one study found 87.5% of curtains tested positive for MRSA by day 14 and 100% by day 21 after hanging (Shek et al., 2018)​, underscoring the need for frequent changing or cleaning of such items.

In terms of modes of transmission, HAIs spread primarily through four key routes – surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated UTIs – which together account for roughly 75% of HAIs in acute-care hospitals (Magill et al., 2018). These infections can result from medical interventions (iatrogenic causes) or person-to-person and environmental spread (nosocomial transmission). Nosocomial spread occurs via several pathways:

  • Contact Transmission: The most common route. It occurs when healthcare workers’ hands, gloves, or instruments transfer pathogens from one patient to another. For example, a nurse’s hands can pick up Staphylococcus aureus from one patient and carry it to another. Many antibiotic-resistant bacteria (like MRSA and VRE) are predominantly spread by contact, underscoring the critical need for strict hand hygiene and glove use (CDC, 2019).
  • Droplet Transmission: Droplet spread happens when an infected person’s coughs or sneezes release respiratory droplets that travel a short distance (generally a few feet) before falling out of the air (CDC, 2019). These droplets do not remain airborne over long distances but can directly infect nearby individuals or contaminate surfaces. Common respiratory pathogens like influenza, SARS-CoV-2, adenovirus, Bordetella pertussis (whooping cough), Neisseria meningitidis, and RSV are transmitted via droplets (CDC, 2019). In healthcare settings, droplet precautions (e.g. masks and private rooms) are used to block this route of HAI spread (CDC, 2019).
  • Airborne Transmission: Airborne spread involves much smaller particles (<5 µm) that can remain suspended in the air and travel longer distances (CDC, 2019). Organisms like Mycobacterium tuberculosis (TB), varicella zoster (chickenpox), and measles virus are transmitted this way. These pathogens may infect people even without close contact, as infectious droplet nuclei can circulate through ventilation systems. Hospitals use Airborne Infection Isolation Rooms with specialized negative-pressure ventilation and require N95 respirators for staff to prevent airborne HAIs (CDC, 2019). Although there are few true airborne diseases, they pose high outbreak potential inwards if not adequately contained.
  • Fomite Transmission: Fomites are inanimate objects or surfaces that can carry infectious agents. Pathogens on surfaces can transfer to patients when surfaces are touched and not adequately disinfected. For example, if not thoroughly cleaned, C. difficile spores can survive up to 5 months on hospital room surfaces. High-touch objects are a significant reservoir: one study noted that about 92% of hospital privacy curtains were contaminated with potentially pathogenic bacteria (including MRSA) within one week of being hung (Ohl et al., 2012). This highlights how fomites can sustain transmission if cleaning is infrequent or inadequate.

By recognizing these transmission pathways, healthcare providers can tailor interventions (e.g. hand hygiene, airborne isolation, aggressive environmental cleaning) to break each link in the chain of infection.

The Cost and Consequences of HAIs

Beyond patient morbidity and mortality, HAIs impose extensive financial and operational burdens on healthcare systems. The consequences include prolonged hospitalizations, high treatment costs, regulatory penalties, legal liability, and strain on staff and resources. Below we examine these impacts:

Extended Hospital Stays and Readmissions

Patients who develop an HAI often require substantially longer inpatient stays. A Pennsylvania statewide analysis found that patients with an HAI had an average hospital stay of 21.9 days, compared to just 5.0 days for patients without an HAI (Pennsylvania Health Care Cost Containment Council [PHC4], 2012). Such prolonged hospitalization increases exposure risk to other complications and ties up hospital beds. HAIs also drive up rehospitalizations – the same analysis showed that 41.9% of HAI patients were readmitted within 30 days, versus only 16.3% of patients without an HAI (PHC4, 2012). This nearly three-fold increase in 30-day readmission rates reflects the downstream complications and recovery challenges associated with hospital-acquired infections. Each additional day or readmission due to an HAI represents care that could have been avoided with adequate prevention.

Financial Costs and Medicare Penalties

Financially, hospital-acquired infections are enormously expensive. The CDC estimates that annual direct medical costs of HAIs range from $28.4 billion to $45 billion in the U.S. (Stone, 2009)​pmc.ncbi.nlm.nih.gov, reflecting expenses like antibiotics, additional surgeries, extended ICU care, and other treatments. On a per-case basis, complex infections can be very costly – one analysis found that a single central line-associated bloodstream infection costs around $45,000, a ventilator-associated pneumonia about $40,000, and a surgical site infection over $20,000 in added expenses. In contrast, even a “minor” catheter-associated UTI can add nearly $1,000 (Scott, 2009). These are costs that insurers increasingly will not cover. Medicare, for instance, no longer reimburses hospitals for certain preventable HAIs, which it deems “avoidable complications” (Centers for Medicare & Medicaid Services [CMS], 2019). Under Medicare’s Hospital-Acquired Condition (HAC) Reduction Program, the worst-performing 25% of hospitals (those with the highest infection and complication rates) incur a 1% penalty on their total Medicare reimbursements (Advisory Board, 2020)​ advisory.com. In Fiscal Year 2020, 786 U.S. hospitals – including several major academic centers – faced these financial penalties due to high infection rates (Advisory Board, 2020). Such policies put hospitals under economic pressure to invest in infection prevention or risk losing significant revenue.

Litigation and Liability Risks

Hospitals may also bear substantial legal costs from HAIs. Preventable infections can lead to malpractice lawsuits if patients or their families claim negligence. According to an analysis in Becker’s Hospital Review, a typical large hospital faces around 7 HAI-related lawsuits per year, with an average settlement of $1.5 million per case – totaling an estimated $10.5 million in potential liability annually (Page, 2010) beckershospitalreview.com. Now that 27 U.S. states require public reporting of hospital infection rates, the number of legal actions is expected to rise as consumers become more aware of facility-specific infection data (Page, 2010)​ beckershospitalreview.com. In addition to settlement payouts, these lawsuits bring added costs in legal fees and can damage a hospital’s reputation, indirectly impacting revenue. The growing legal exposure provides a strong incentive for hospitals to reduce their HAI rates aggressively.

Resource Strain and Staffing Challenges

Every HAI event commands considerable hospital resources and can exacerbate staffing challenges. Infected patients often require isolation rooms, dedicated equipment, enhanced cleaning protocols, and one-on-one nursing care – which diverts healthcare workers and supplies from other needs. This can be incredibly taxing in units that are already short-staffed. Outbreaks of highly transmissible infections amplify the burden dramatically, sometimes sidelining healthcare workers themselves. A published case study of a nosocomial norovirus outbreak in a U.S. hospital documented 105 staff members falling ill, leading to acute staffing shortages and a temporary freeze on new patient admissions (Johnston et al., 2007). The same outbreak incurred about $650,000 in costs due to lost productivity and intensive decontamination efforts (Johnston et al., 2007)​ pmc.ncbi.nlm.nih.gov. Even smaller-scale HAIs force hospitals to spend extra on protective gear, lab tests, and extended cleaning protocols. Infection control departments must continually monitor cases, train staff, and conduct audits – a significant operational effort. All of these demands, from arranging coverage for sick nurses to closing units for deep cleaning, illustrate how HAIs can strain hospital operations and contribute to workforce burnout. In contrast, preventing HAIs protects patients and preserves precious healthcare resources and staff capacity.

Enhanced Environmental Cleaning and Disinfection

Routine cleaning alone is not enough. While proper use of traditional chemical disinfectants (like bleach or quaternary ammonium compounds) can eliminate pathogens on contact, they have no lasting effect once applied – meaning a surface can be recontaminated within hours after a wipe-down. Studies show that standard cleaning significantly reduces surface microbes at the moment of cleaning but has no persistent activity; as soon as staff and patients re-enter a cleaned room, microbes begin accumulating again. High-touch objects are notorious for rapid recontamination. Therefore, hospitals have turned to enhanced disinfection technologies and protocols to supplement manual cleaning. These innovations aim to thoroughly eliminate pathogens in the environment and prevent the reseeding of bacteria in patient rooms, thereby breaking the HAI transmission cycle.

Ultraviolet-C Light (UV-C) Disinfection

Ultraviolet-C devices emit germicidal light (around 254 nm wavelength) that inactivates bacteria, viruses, and fungi by damaging their DNA/RNA. UV-C “no-touch” systems are used after cleaning a room to disinfect the environment further. Clinical studies indicate that adding UV-C disinfection can reduce certain HAI rates. An analysis reported about an 18% lower incidence of hospital-onset multidrug-resistant organism infections when UV-C was used in addition to standard room cleaning (Sun et al., 2023). In one large multi-hospital study, an enhanced terminal room cleaning protocol with UV-C was associated with a 19% reduction in infections due to hardy bacteria like Acinetobacter and Klebsiella on the wards using UV, whereas no significant change occurred in control wards without UV (Anderson et al., 2017). These findings suggest UV-C can help eradicate residual pathogens that survive manual cleaning, thereby lowering the risk of transmission to the next patient. Best practices for UV-C room disinfection include placing the device in multiple positions (or using multiple emitters) to ensure UV light reaches all surfaces and running the machine for sufficient time to deliver a lethal dose to microorganisms.

There are some limitations: UV-C’s effectiveness is highly dependent on line-of-sight exposure – the light does not penetrate into shaded areas, under clutter, or through organic soil. Any dirt or dust on a surface can shield microbes from UV, so UV-C is not a replacement for physical cleaning. UV devices also require the room to be unoccupied (since UV can damage eyes/skin), which means they can only be used during room turnover or terminal cleaning when patients and staff are out. Despite these caveats, many hospitals have reported meaningful pathogen reductions by incorporating UV-C. Facilities that deploy UV-C after routine cleaning have observed lower contamination on surfaces and fewer infections with UV-sensitive organisms such as C. difficile and VRE (Boyce et al., 2008; Sun et al., 2023). The evidence supports UV-C as a valuable adjunct for environmental disinfection, particularly in high-risk areas like ICUs or isolation rooms.

Hydrogen Peroxide Vapor Systems

Hydrogen peroxide vapor (HPV) is another “no-touch” decontamination technology. Specialized machines disperse a concentrated vapor of hydrogen peroxide (often augmented with silver ions) into a sealed room, achieving uniform disinfection of all surfaces – even nooks and crevices that wiping may miss. Research demonstrates that HPV can essentially sterilize rooms and dramatically reduce pathogen transmission. In a notable hospital study, before HPV treatment, 25.6% of sampled room surfaces tested positive for C. difficile spores versus 0% after HPV decontamination (Boyce et al., 2008). Correspondingly, the incidence of C. difficile infection on high-risk wards fell by approximately 44% after implementing routine HPV room fogging (Boyce et al., 2008). These results, published in a CDC-sponsored study, provide compelling evidence that whole-room hydrogen peroxide fumigation can break the chain of transmission for tough spores and multidrug-resistant organisms. HPV is especially useful for terminal disinfection of rooms that housed patients with highly contagious pathogens (e.g. norovirus, C. difficile, Acinetobacter). It ensures that the next patient to occupy the room is not exposed to their predecessor’s germs.

Like UV, HPV has practical limitations: Because hydrogen peroxide vapor is hazardous to inhale at the concentrations used, the room must be completely sealed and vacated during the process. A single room’s decontamination cycle is time-intensive – often taking several hours for the vapor to disperse, dwell, and then aerate back to safe levels. This leads to room downtime, which can be operationally challenging for busy units. Thus, HPV is typically reserved for targeted use (e.g., outbreak control or post-discharge deep cleaning of isolation rooms) rather than daily cleaning of all rooms. Best practices for HPV include scheduling it for times when rooms or units can be taken offline (such as immediately after patient discharge or when an entire ward can be rotated out) and verifying the process efficacy with biological indicators. Despite the logistical hurdles, hospitals using HPV have reported marked reductions in environmental bioburden and infection rates, particularly for C. difficile, which is notoriously difficult to eradicate with conventional cleaning (Boyce et al., 2008). HPV provides a level of disinfection beyond what manual methods achieve, making it a powerful tool in the infection prevention arsenal.

Antimicrobial Surfaces and Materials

Another proactive approach is upgrading high-touch surfaces to materials with intrinsic antimicrobial properties. The rationale is to continuously suppress microbial contamination on surfaces between cleanings. The most well-studied example is the use of copper and copper-alloy surfaces. Copper (and its alloys like brass or bronze) exhibits rapid contact-killing of microbes: when bacteria or viruses land on copper, the metal releases ions that disrupt cell membranes and DNA, leading to microbial death. A landmark randomized trial in ICU rooms demonstrated the benefit of this approach – patient rooms outfitted with copper-alloy bed rails, tray tables, IV poles, and other fixtures had a 58% lower HAI rate compared to standard rooms (incidence 0.034 vs 0.081 HAIs per patient, p = 0.013) (Salgado et al., 2013). In other words, patients in rooms with copper surfaces acquired infections at roughly half the rate of those with traditional surfaces. This multi-hospital trial provides high-quality evidence that passive antimicrobial surfaces can translate into real reductions in infection risk (beyond just reducing contamination on surfaces) (Salgado et al., 2013). Copper’s biocidal effect is continuous and does not rely on human action – it keeps killing bacteria 24/7, significantly lowering the baseline bioburden between cleaning rounds. Studies have found that copper-coated surfaces in active hospital rooms have far lower microbial counts than controls (often >80% lower). It is important to note that antimicrobial surfaces complement but do not replace routine cleaning; for instance, dirt or biofilm buildup can impair copper’s efficacy, so regular cleaning is still needed to remove soil or organic matter.

Beyond copper, other antimicrobial materials and surface coatings are being explored. Surfaces impregnated with silver or polymer materials with built-in antimicrobial agents are in use. Even the air handling system can contribute – advanced ventilation with HEPA filtration (high-efficiency particulate air filters) in HVAC systems continuously removes bacteria, fungal spores, and virus-laden droplets from the air, preventing them from settling on surfaces. Many modern hospital operating rooms and transplant units require HEPA-filtered air for this reason, as it has been credited with near-elimination of certain airborne infections (for example, invasive Aspergillus infections in bone marrow transplant patients have been virtually eliminated in centers with HEPA-filtered rooms). By combining no-touch disinfection technologies like UV-C or HPV with antimicrobial surfaces and improved air filtration, healthcare facilities create layered defenses in the environment. The best practice is to treat these technologies as supplements to, not replacements for, standard cleaning protocols – when used together, they can achieve a more thorough and sustained reduction in pathogens in the hospital environment.

Persistent Antimicrobial Coatings

Given that cleaned surfaces begin accumulating microbes again almost immediately as people circulate, a major focus in infection control research has been long-lasting antimicrobial coatings that continuously kill germs for extended periods. The vision is to apply a product to surfaces (such as a spray, paint, or polymer coating) that remain active for days, weeks, or even months, providing residual protection between regular cleanings. Several persistent antimicrobial coatings have been tested in hospitals in recent years, and early results are promising.

One study evaluated a durable organosilane-based coating applied to high-touch surfaces across multiple units in two hospitals. This coating bonds to surfaces and creates microscopic spikes that mechanically destroy microbes on contact. Over the year following application, the units with the antimicrobial coating saw a 36% reduction in HAI rates (combining MRSA and other MDRO bloodstream infections plus C. difficile infections) compared to the prior year, while control units without the coating saw no significant change in HAI rates (Ellingson et al., 2020). The difference was statistically significant, indicating that the coating likely contributed to the infection reduction. Environmental cultures confirmed the coating’s efficacy: treated surfaces experienced approximately a 75–79% drop in total bacterial colony counts relative to baseline after the coating was applied (Ellingson et al., 2020). The percentage of surfaces positive for clinically relevant pathogens in the coated units also fell significantly. These findings suggest that continuously active surface coatings can significantly and sustainably reduce bioburden and interrupt transmission if the coating remains effective.

However, durability and maintenance of these coatings are key considerations. Some products may lose potency over time due to routine cleaning, abrasion, or chemical interactions. For instance, a randomized trial in an emergency department found that a long-acting antimicrobial coating on stretcher rails achieved strong initial reductions in bacteria, but after 6 months, the effect had waned as the coating wore off, illustrating that reapplication might be necessary to maintain continuous protection. Thus, hospitals adopting persistent antimicrobial treatments should monitor surface efficacy (e.g. periodic swab cultures or using surrogate markers) and reapply coatings at recommended intervals.

The Role of Kismet Clean in  Providing Long-lasting Surface Protection

Among the most promising innovations in persistent antimicrobial protection is Kismet’s innovative mediated cerium oxide technology.  Now available in Kismet Clean, this is a next-generation surface protection technology designed to address the challenges of maintaining continuous microbial suppression in high-touch hospital environments. Unlike conventional cleaners that only temporarily reduce bioburden, Kismet Clean offers prolonged, self-activating protection, reducing contamination levels between routine maintenance cleanings.

Kismet Clean harnesses the cleaning power of hydrogen peroxide only in the presence of bacteria, viruses, and fungi.  Pilot studies have shown up to a 90% reduction in aerobic bacteria on Kismet Clean treated surfaces.  These studies were in real-world healthcare settings, where surfaces treated with Kismet Clean experienced dramatic reductions in bioburden compared to untreated surfaces. Studies have shown that treated surfaces—such as privacy curtains, triage chairs, and sharps disposal box lids—harbored significantly fewer colony-forming units (CFUs) than their uncoated counterparts. For example:

One of the key advantages of Kismet Clean is that it does not require frequent reapplication. While many antimicrobial coatings degrade over time, Kismet’s technology functions more as a catalyst for the hydrogen peroxide production.   As long as the technology is on the surface it will continue to produce hydrogen peroxide in the presence of pathogens. Making it particularly valuable for high-touch surfaces that are difficult to disinfect, such as patient room fixtures, bed rails, call buttons, and shared medical equipment.

Kismet Clean does not replace traditional infection control measures but amplifies their effectiveness by reducing the microbial load between cleanings. By integrating Kismet Clean into a hospital’s environmental hygiene protocols, healthcare facilities can achieve a more comprehensive, layered defense against HAIs, reducing the risk of transmission without increasing staff workload.

As research continues to evolve, persistent antimicrobial coatings—especially those with self-activating properties like Kismet Clean—represent a paradigm shift in hospital disinfection strategies. When combined with standard cleaning and disinfecting protocols, and robust hand hygiene compliance, these long-lasting surface coatings provide an added layer of protection against HAI risks in ways traditional methods alone cannot achieve. Innovations like Kismet Clean are setting a new standard of cleaning for hospitals and healthcare facilities.

Hand Hygiene and Compliance Monitoring

Proper hand hygiene is the single most important behavior for preventing HAIs. The vast majority of HAIs originate from the transmission of microbes by hands – either via healthcare workers’ hands carrying pathogens between patients, or via the patient’s own flora being introduced at a vulnerable site (e.g. during a catheter insertion). The World Health Organization estimates that proper hand hygiene could prevent up to 50% of avoidable infections acquired in healthcare settings (WHO, 2009). In other words, a large fraction of HAIs are avoidable through the simple act of hand washing with soap or using alcohol-based hand sanitizer at key moments.

Despite its importance, compliance with hand hygiene protocols is notoriously inconsistent. In many hospitals (even in high-resource settings), observational studies have found that, on average, hand hygiene compliance hovers around 40–70% (WHO, 2009), meaning that healthcare workers clean their hands only about half the time they should. In some settings, baseline compliance rates are even lower. Without targeted interventions, global studies have found typical compliance around 40% or less (WHO, 2009), indicating that healthcare providers often perform hand hygiene only a fraction of the times they ought to. Therefore, improving hand hygiene adherence among doctors, nurses, and all healthcare personnel is a top priority in HAI prevention efforts.

Decades of research and quality improvement initiatives have shown that sustained improvements in hand hygiene directly correlate with reductions in infection rates. Structured training and feedback are proven strategies for raising hand hygiene compliance. This includes regularly educating staff on proper technique (following WHO’s “Five Moments for Hand Hygiene” and CDC guidelines), making alcohol-based sanitizer readily accessible at point-of-care, and fostering an institutional culture where hand hygiene is critical to patient care. Many hospitals implement multimodal hand hygiene improvement programs – combining education, reminders, performance data feedback, and infrastructure improvements (like more sinks or sanitizer dispensers) – to drive behavior change. Hospitals that implement such structured programs have consistently observed higher compliance and corresponding drops in infection rates (Allegranzi et al., 2013). When adopted in a hospital setting, the WHO’s multimodal hand hygiene improvement strategy significantly increased hand hygiene compliance and was associated with reduced HAIs (Allegranzi et al., 2013).

Peer accountability can further reinforce habits. Some institutions encourage a “just culture” of safety where staff members feel empowered to remind colleagues to perform hand hygiene if they observe missed opportunities. A simple prompt – “I noticed you didn’t gel your hands when you entered that room – please do so now” – can reset expectations in the moment. In one study, installing an electronic reminder system plus a structured peer accountability process led to roughly a 40% improvement in hand hygiene adherence, with a corresponding decline in HAIs (BioVigil, 2021). Technology can assist these efforts: electronic hand hygiene monitoring systems can provide real-time feedback (e.g. flashing badges or chimes that remind staff to sanitize upon room entry/exit) and track compliance rates by individual or unit. When combined with active encouragement and feedback, these systems have shown significant boosts in compliance.

The best results come from a bundle of hand hygiene interventions: making the desired action as easy as possible (e.g. placing sanitizer dispensers at every bedside and room entrance), providing continuous education and frequent visual reminders (posters, screen savers, badges), monitoring compliance (through direct observation or electronic systems), and giving staff feedback on performance. Hospitals can achieve sustained high compliance by creating an environment where hand cleaning is simple, expected, and visibly monitored. The payoff is tangible – numerous reports document that when hand hygiene rates climb, infection rates fall in tandem (Allegranzi et al., 2013; WHO, 2009). In some cases, major hand hygiene campaigns have dramatically lowered HAI rates, validating Nightingale’s 19th-century assertion that handwashing saves lives.

Clean hands save lives. Investing in hand hygiene promotion is one of the most cost-effective HAI prevention measures available, and it underpins all other infection control efforts.

Antimicrobial Stewardship Programs (ASPs)

The overuse and misuse of antibiotics in hospitals can drive the emergence of drug-resistant organisms, which in turn cause difficult-to-treat infections. Antimicrobial stewardship programs (ASPs) aim to optimize the use of antibiotics to improve patient outcomes and reduce resistance. Importantly, effective antibiotic stewardship has a direct infection prevention benefit. By curbing unnecessary antibiotic exposure, hospitals can reduce the incidence of certain HAIs (especially those caused by opportunistic or resistant bacteria).

Restricting high-risk antibiotics (like fluoroquinolones and certain cephalosporins) can dramatically cut C. difficile infection rates since those drugs predispose patients to C. diff by wiping out protective gut flora. One hospital that instituted a robust stewardship program saw C. difficile cases plummet from 94 in one year to just 13 by the fourth year post-intervention – an 86% reduction in C. diff infections. In the same study, ventilator-associated pneumonia and central-line bloodstream infection rates also declined in the years after stewardship began, likely because of fewer invasive infections with drug-resistant organisms (as overall bacterial burden and resistance in the hospital dropped). These data underscore that antibiotic stewardship is infection prevention: if fewer highly resistant bugs exist in the hospital ecosystem, there will be fewer opportunistic and hard-to-treat HAIs.

Successful ASPs are typically multidisciplinary, involving infectious disease physicians or pharmacists who review antibiotic orders and guide optimal therapy. Common interventions include prospective audit-and-feedback (where the stewardship team reviews ongoing antibiotic cases and suggests modifications or de-escalation), formulary restrictions (requiring approval to use certain broad-spectrum or high-cost antibiotics), and development of local treatment guidelines to encourage appropriate antibiotic choices. Education of prescribers is also central – clinicians need to know about local resistance trends and the rationale behind stewardship recommendations. Many hospitals implement simple policies like requiring pharmacy or ID approval for prescribing specific broad-spectrum antibiotics; this alone can curtail the overuse of the drugs most strongly associated with resistance.

The benefits of stewardship extend beyond infection rates. Multiple studies have documented significant cost savings due to reduced drug expenditures when unnecessary antibiotics are eliminated. For instance, a group of four hospitals in Saudi Arabia reported a 28% drop in antibiotic costs in the first year of their ASP (over $1.5 million saved over a few years) while simultaneously cutting HAIs – a welcome side effect of doing the right thing for patient safety. Importantly, ASPs often work synergistically with other infection control measures. A comprehensive meta-analysis (Baur et al., 2017) found that stewardship programs were even more effective at reducing infections when paired with robust hand hygiene and infection control interventions. In some studies, stewardship plus a hand-hygiene campaign yielded an even larger reduction in certain resistant infections than stewardship alone.

Best practices for ASPs include obtaining strong administrative support (leadership endorsement and resources), tracking metrics (antibiotic usage rates, resistance patterns, and HAI rates) to measure impact, and providing regular feedback to clinicians on their performance. Modern ASPs may leverage clinical decision support systems in the electronic health record – in alert to prompt an “antibiotic time-out” after 48 hours so the team can reassess ongoing therapy once culture results are available (nudging physicians to narrow or stop antibiotics if appropriate). The bottom line is that by reducing unnecessary antibiotics, hospitals combat the global threat of antimicrobial resistance and see immediate local benefits in the form of lower HAI rates and improved patient outcomes. Stewardship is truly a win-win for both public health and individual hospitals, and it has become a required element of hospital accreditation in many countries, given its proven value. The literature shows that well-designed ASPs can significantly reduce infection rates – in one meta-analysis, antibiotic stewardship interventions led to a 51% reduction in infections by multidrug-resistant Gram-negatives, a 37% reduction in MRSA infections, and a 32% reduction in C. difficile infections (Baur et al., 2017)​. Such results illustrate the powerful role of antimicrobial stewardship as a preventive strategy against HAIs.

Education, Training, and Safety Culture

While technology and protocols are crucial, the foundation of HAI prevention is a strong safety culture and an educated, vigilant staff. All the best practices described – hand hygiene, careful device use, environmental cleaning, stewardship, etc. – ultimately depend on healthcare workers executing them consistently. Thus, ongoing education and training of staff at all levels is essential. Regular in-servicing on infection prevention practices (for example, annual competencies on central line care or proper urinary catheter management) helps reinforce the “why” and “how” of HAI prevention. Some hospitals conduct hand hygiene workshops, device insertion simulation training, or multidisciplinary safety drills to keep skills sharp.

Many high-performing hospitals have championed a “zero preventable infections” mindset – that even one avoidable HAI is too many – and empower every staff member to speak up or take action to maintain safety. Simple culture interventions, like encouraging staff to ask, “Is there anything I can do to reduce infection risk?” during patient care rounds, keep prevention on everyone’s mind. Some institutions have even implemented reward programs or friendly competitions for units with exemplary hand hygiene or low infection rates to incentivize engagement.

An educated and empowered workforce is the linchpin of HAI prevention. Technology and policies set the stage, but it’s the people who must perform the proper actions every single time. By training staff, reinforcing positive behaviors, and nurturing a culture where infection prevention is everyone’s responsibility, hospitals create an environment where infections struggle to take hold – fulfilling the ultimate goal of patients healing without harm.

Conclusion

Preventing healthcare-associated infections requires an orchestrated, proactive approach spanning technology, processes, and people. These include enhanced environmental cleaning protocols (with innovations like UV-C light and hydrogen peroxide vapor), continuous surface protection delivered in products like Kismet Clean, strict hand hygiene enforcement and compliance monitoring, robust airborne precautions (improved ventilation and UV air disinfection), optimal use of personal protective equipment and barrier methods, judicious antibiotic use through stewardship programs, advanced surveillance and analytics for early warning, and ongoing staff education coupled with a strong safety culture. Each of these strategies is backed by scientific evidence. Importantly, these interventions are synergistic – no single measure can eliminate HAIs on its own, but together they form a robust defense. Hospitals that have embraced comprehensive infection prevention bundles have achieved striking reductions in HAI rates, in some cases approaching zero infections in intensive care units for months on end. The results translate to safer patient care, shorter hospital stays, lives saved, and lower costs.

It must be acknowledged that the fight against HAIs is ongoing. Pathogens evolve, healthcare procedures become more complex, and new challenges (like emerging viruses or increasing antimicrobial resistance) continue to arise. Therefore, continuous innovations and adaptations are necessary. With diligent application of the strategies outlined above and an institutional culture prioritizing infection prevention, the long-standing goal of “zero preventable infections” comes closer into view. Hospitals leveraging advanced, persistent antimicrobial surface protection experience lower pathogen loads, reduced transmission risks, and improved patient outcomes.

Kismet Clean offers a next-generation approach to continuous environmental hygiene, reducing surface contamination between routine cleanings without increasing staff workload. By integrating Kismet Clean’s self-activating technology into cleaning and disinfecting protocols, facilities can establish an amplified layer of protection against HAIs.

Partner with Kismet Technologies to implement cutting-edge, research-backed antimicrobial solutions. Contact us today to explore how Kismet Clean can seamlessly enhance existing hygiene protocols as part of your overall efforts to reduce HAIs.

🔗 Visit Kismet Clean Products to Learn More

References

Allegranzi, B., et al. (2013). Successful implementation of the WHO multimodal hand hygiene improvement strategy in a university hospital: a step-wise approach. Infection Control & Hospital Epidemiology, 34(5), 419–425. (Demonstrates improved hand hygiene compliance and reduced HAIs with a structured WHO hand hygiene strategy)

Baur, D., Gladstone, B. P., et al. (2017). Effect of antibiotic stewardship on the incidence of infection and colonization with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infectious Diseases, 17(9), 990–1001. (Meta-analysis showing significant reductions in MRSA, multidrug-resistant Gram-negatives, and C. difficile infections with stewardship programs)

Boyce, J. M., Havill, N. L., et al. (2008). Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infection Control & Hospital Epidemiology, 29(8), 723–729. (HPV “fogging” eradicated C. diff from surfaces and reduced C. diff infection rates by ~44%)

Centers for Disease Control and Prevention (CDC). (2019). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved from CDC.gov. (Provides definitions of contact, droplet, and airborne transmission and recommended precautions)

Centers for Medicare & Medicaid Services (CMS). (2019). Hospital-Acquired Conditions (HAC) Reduction Program.Retrieved from CMS.gov. (Describes Medicare payment policy of 1% reimbursement penalty for worst 25% hospitals in HAC rates)

Ellingson, K. D., Pogreba-Brown, K., Gerba, C. P., & Elliott, S. P. (2020). Impact of a Novel Antimicrobial Surface Coating on healthcare-associated infections and environmental bioburden at two urban hospitals. Clinical Infectious Diseases, 71(8), 1807–1813. (Application of a persistent organosilane coating led to a 36% decline in HAIs and ~75–79% reduction in surface bacteria in coated units)

Escombe, A. R., et al. (2009). Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmission. PLoS Medicine, 6(3), e1000043. (In a Guinea pig model, upper-room UVGI reduced TB transmission by ~70%)

Fakih, M. G., et al. (2021). Non-compliance with central line insertion practices and subsequent risk of central line–associated bloodstream infection. Infection Control & Hospital Epidemiology, 42(9), 1029–1035. (Found ~28% increase in CLABSI rates when sterile insertion protocols were not followed consistently)

Guerrero, D. M., et al. (2012). Clostridium difficile infection in a surgical inpatient unit: the importance of environmental contamination. Infection Control & Hospital Epidemiology, 33(5), 517–519. (Highlighted transmission of C. difficile via contaminated bedding and equipment, contributing to prolonged stays and higher costs)

Harris, A. D., et al. (2013). Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA, 310(15), 1571–1580. (BUGG study: Using gloves and gowns for all patient contact in ICUs reduced MRSA acquisition by ~40% without adversely affecting patient care)

Johnston, C. P., et al. (2007). Outbreak management and implications of a nosocomial norovirus outbreak. Clinical Infectious Diseases, 45(5), 534–540. (Case study of a hospital norovirus outbreak causing 105 staff illnesses, temporary closure to admissions, and >$650k in costs)

Klevens, R. M., et al. (2007). Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Reports, 122(2), 160–166. (Estimated 1.7 million HAIs and ~98,987 associated deaths in U.S. hospitals, highlighting HAIs as a leading cause of preventable mortality)

Magill, S. S., et al. (2018). Changes in prevalence of healthcare-associated infections in U.S. hospitals. New England Journal of Medicine, 379(18), 1732–1744. (Reported that on any given day, ~3.2% of patients have an HAI – roughly 1 in 31 patients – based on 2015 data)

Ohl, M., et al. (2012). Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. American Journal of Infection Control, 40(10), 904–906. (Found 92% of privacy curtains tested were contaminated within one week, including MRSA and VRE)

Page, L. (2010, July 23). Hospital-Acquired Infections by the Numbers. Becker’s Hospital Review. (Compiled statistics on HAIs, noting ~7 HAI-related lawsuits per hospital per year at $1.5M each, and that 27 states mandate public reporting of HAIs)

Pennsylvania Health Care Cost Containment Council (PHC4). (2012). The Impact of Healthcare-Associated Infections in Pennsylvania, 2010. Harrisburg, PA: PHC4 Report. (Statewide data showing HAI patients had 21.9-day average stays vs 5.0 days for others, and 41.9% were readmitted within 30 days vs 16.3% for others)

Salgado, C. D., et al. (2013). Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infection Control & Hospital Epidemiology, 34(5), 479–486. (Randomized trial: Copper-alloy surfaces in ICU rooms led to a 58% reduction in HAI rate among patients)

Shek, K., et al. (2018). Rate of contamination of hospital privacy curtains in a burns/plastics unit: a longitudinal study. American Journal of Infection Control, 46(9), 1019–1021. (Found 87.5% of curtains tested positive for MRSA by day 14 and 100% by day 21, highlighting the need for frequent changing of curtains)

Stone, P. W. (2009). Economic burden of healthcare-associated infections: an American perspective. Expert Review of Pharmacoeconomics & Outcomes Research, 9(5), 417–422. (Estimated the direct annual cost of treating HAIs in the U.S. ranges from $28.4 billion to $45 billion)

Sun, Y., Wu, Q., Liu, J., & Wang, Q. (2023). Effectiveness of ultraviolet-C disinfection systems for reduction of multidrug-resistant organism infections in healthcare settings: A systematic review and meta-analysis. Epidemiology & Infection, 151, e149. (Meta-analysis of 9 studies: UV-C room disinfection was associated with an ~18% reduction in Gram-negative rod infections (IRR 0.82) and overall contributes to lower MDRO infection rates)

Breaking the Chain of Infection

Healthcare-associated infections (HAIs) remain a pervasive threat to patient safety and hospital outcomes. In U.S. hospitals alone, the CDC estimates that about 1 in 31 patients contracts an HAI during their care (Magill et al., 2018). These infections range from surgical site infections and pneumonias to bloodstream and urinary tract infections, often involving drug-resistant organisms. HAIs not only cause direct patient harm but also prolong hospital stays and increase mortality. A landmark analysis estimated that HAIs add $28.4 to $45 billion in excess healthcare costs annually in the United States and contribute to nearly 99,000 deaths per year, making them one of the top causes of preventable mortality (Stone, 2009; Klevens et al., 2007). Beyond clinical outcomes, high HAI rates create operational and financial burdens for healthcare facilities – including regulatory penalties, higher resource utilization, and reputational damage in quality-of-care rankings. They strain healthcare operations by requiring additional treatments, isolation measures, and extended bed occupancy. Preventing HAIs is, therefore, paramount for both patient safety and effective hospital management.

Stopping these infections requires more than routine cleaning and disinfecting; it demands a proactive, multilayered approach woven into every facet of care. The following evidence-based strategies – from advanced disinfection technologies to data-driven interventions – can effectively break the chain of infection while improving hospital hygiene and safety.

How HAIs Spread: Common Transmission Pathways

Hospital-acquired infections can originate from invasive procedures or exposure within the hospital environment. Understanding how HAIs spread is essential for implementing effective prevention strategies. HAIs generally arise through one of three sources:

  • Iatrogenic Infections – Result from invasive medical procedures such as catheter insertions, surgical interventions, or mechanical ventilation. For example, studies have shown that catheter-associated bloodstream infections (CLABSIs) increase by about 28% when sterile protocols are not strictly followed (Fakih et al., 2021).
  • Nosocomial Infections – Acquired due to environmental exposure in hospitals, including contaminated medical devices, patient bedding, or healthcare workers’ hands. For instance, Clostridioides difficile (C. diff) spores can spread through contaminated bedding and improperly sanitized equipment, leading to prolonged hospital stays and increased treatment costs (Guerrero et al., 2012).
  • Exogenous Infections – Stem from external contaminants entering the hospital environment. High-touch surfaces such as privacy curtains, bed rails, doorknobs, and call buttons serve as reservoirs for harmful microbes. Studies show that privacy curtains become rapidly contaminated; one study found 87.5% of curtains tested positive for MRSA by day 14 and 100% by day 21 after hanging (Shek et al., 2018)​, underscoring the need for frequent changing or cleaning of such items.

In terms of modes of transmission, HAIs spread primarily through four key routes – surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated UTIs – which together account for roughly 75% of HAIs in acute-care hospitals (Magill et al., 2018). These infections can result from medical interventions (iatrogenic causes) or person-to-person and environmental spread (nosocomial transmission). Nosocomial spread occurs via several pathways:

  • Contact Transmission: The most common route. It occurs when healthcare workers’ hands, gloves, or instruments transfer pathogens from one patient to another. For example, a nurse’s hands can pick up Staphylococcus aureus from one patient and carry it to another. Many antibiotic-resistant bacteria (like MRSA and VRE) are predominantly spread by contact, underscoring the critical need for strict hand hygiene and glove use (CDC, 2019).
  • Droplet Transmission: Droplet spread happens when an infected person’s coughs or sneezes release respiratory droplets that travel a short distance (generally a few feet) before falling out of the air (CDC, 2019). These droplets do not remain airborne over long distances but can directly infect nearby individuals or contaminate surfaces. Common respiratory pathogens like influenza, SARS-CoV-2, adenovirus, Bordetella pertussis (whooping cough), Neisseria meningitidis, and RSV are transmitted via droplets (CDC, 2019). In healthcare settings, droplet precautions (e.g. masks and private rooms) are used to block this route of HAI spread (CDC, 2019).
  • Airborne Transmission: Airborne spread involves much smaller particles (<5 µm) that can remain suspended in the air and travel longer distances (CDC, 2019). Organisms like Mycobacterium tuberculosis (TB), varicella zoster (chickenpox), and measles virus are transmitted this way. These pathogens may infect people even without close contact, as infectious droplet nuclei can circulate through ventilation systems. Hospitals use Airborne Infection Isolation Rooms with specialized negative-pressure ventilation and require N95 respirators for staff to prevent airborne HAIs (CDC, 2019). Although there are few true airborne diseases, they pose high outbreak potential inwards if not adequately contained.
  • Fomite Transmission: Fomites are inanimate objects or surfaces that can carry infectious agents. Pathogens on surfaces can transfer to patients when surfaces are touched and not adequately disinfected. For example, if not thoroughly cleaned, C. difficile spores can survive up to 5 months on hospital room surfaces. High-touch objects are a significant reservoir: one study noted that about 92% of hospital privacy curtains were contaminated with potentially pathogenic bacteria (including MRSA) within one week of being hung (Ohl et al., 2012). This highlights how fomites can sustain transmission if cleaning is infrequent or inadequate.

By recognizing these transmission pathways, healthcare providers can tailor interventions (e.g. hand hygiene, airborne isolation, aggressive environmental cleaning) to break each link in the chain of infection.

The Cost and Consequences of HAIs

Beyond patient morbidity and mortality, HAIs impose extensive financial and operational burdens on healthcare systems. The consequences include prolonged hospitalizations, high treatment costs, regulatory penalties, legal liability, and strain on staff and resources. Below we examine these impacts:

Extended Hospital Stays and Readmissions

Patients who develop an HAI often require substantially longer inpatient stays. A Pennsylvania statewide analysis found that patients with an HAI had an average hospital stay of 21.9 days, compared to just 5.0 days for patients without an HAI (Pennsylvania Health Care Cost Containment Council [PHC4], 2012). Such prolonged hospitalization increases exposure risk to other complications and ties up hospital beds. HAIs also drive up rehospitalizations – the same analysis showed that 41.9% of HAI patients were readmitted within 30 days, versus only 16.3% of patients without an HAI (PHC4, 2012). This nearly three-fold increase in 30-day readmission rates reflects the downstream complications and recovery challenges associated with hospital-acquired infections. Each additional day or readmission due to an HAI represents care that could have been avoided with adequate prevention.

Financial Costs and Medicare Penalties

Financially, hospital-acquired infections are enormously expensive. The CDC estimates that annual direct medical costs of HAIs range from $28.4 billion to $45 billion in the U.S. (Stone, 2009)​pmc.ncbi.nlm.nih.gov, reflecting expenses like antibiotics, additional surgeries, extended ICU care, and other treatments. On a per-case basis, complex infections can be very costly – one analysis found that a single central line-associated bloodstream infection costs around $45,000, a ventilator-associated pneumonia about $40,000, and a surgical site infection over $20,000 in added expenses. In contrast, even a “minor” catheter-associated UTI can add nearly $1,000 (Scott, 2009). These are costs that insurers increasingly will not cover. Medicare, for instance, no longer reimburses hospitals for certain preventable HAIs, which it deems “avoidable complications” (Centers for Medicare & Medicaid Services [CMS], 2019). Under Medicare’s Hospital-Acquired Condition (HAC) Reduction Program, the worst-performing 25% of hospitals (those with the highest infection and complication rates) incur a 1% penalty on their total Medicare reimbursements (Advisory Board, 2020)​ advisory.com. In Fiscal Year 2020, 786 U.S. hospitals – including several major academic centers – faced these financial penalties due to high infection rates (Advisory Board, 2020). Such policies put hospitals under economic pressure to invest in infection prevention or risk losing significant revenue.

Litigation and Liability Risks

Hospitals may also bear substantial legal costs from HAIs. Preventable infections can lead to malpractice lawsuits if patients or their families claim negligence. According to an analysis in Becker’s Hospital Review, a typical large hospital faces around 7 HAI-related lawsuits per year, with an average settlement of $1.5 million per case – totaling an estimated $10.5 million in potential liability annually (Page, 2010) beckershospitalreview.com. Now that 27 U.S. states require public reporting of hospital infection rates, the number of legal actions is expected to rise as consumers become more aware of facility-specific infection data (Page, 2010)​ beckershospitalreview.com. In addition to settlement payouts, these lawsuits bring added costs in legal fees and can damage a hospital’s reputation, indirectly impacting revenue. The growing legal exposure provides a strong incentive for hospitals to reduce their HAI rates aggressively.

Resource Strain and Staffing Challenges

Every HAI event commands considerable hospital resources and can exacerbate staffing challenges. Infected patients often require isolation rooms, dedicated equipment, enhanced cleaning protocols, and one-on-one nursing care – which diverts healthcare workers and supplies from other needs. This can be incredibly taxing in units that are already short-staffed. Outbreaks of highly transmissible infections amplify the burden dramatically, sometimes sidelining healthcare workers themselves. A published case study of a nosocomial norovirus outbreak in a U.S. hospital documented 105 staff members falling ill, leading to acute staffing shortages and a temporary freeze on new patient admissions (Johnston et al., 2007). The same outbreak incurred about $650,000 in costs due to lost productivity and intensive decontamination efforts (Johnston et al., 2007)​ pmc.ncbi.nlm.nih.gov. Even smaller-scale HAIs force hospitals to spend extra on protective gear, lab tests, and extended cleaning protocols. Infection control departments must continually monitor cases, train staff, and conduct audits – a significant operational effort. All of these demands, from arranging coverage for sick nurses to closing units for deep cleaning, illustrate how HAIs can strain hospital operations and contribute to workforce burnout. In contrast, preventing HAIs protects patients and preserves precious healthcare resources and staff capacity.

Enhanced Environmental Cleaning and Disinfection

Routine cleaning alone is not enough. While proper use of traditional chemical disinfectants (like bleach or quaternary ammonium compounds) can eliminate pathogens on contact, they have no lasting effect once applied – meaning a surface can be recontaminated within hours after a wipe-down. Studies show that standard cleaning significantly reduces surface microbes at the moment of cleaning but has no persistent activity; as soon as staff and patients re-enter a cleaned room, microbes begin accumulating again. High-touch objects are notorious for rapid recontamination. Therefore, hospitals have turned to enhanced disinfection technologies and protocols to supplement manual cleaning. These innovations aim to thoroughly eliminate pathogens in the environment and prevent the reseeding of bacteria in patient rooms, thereby breaking the HAI transmission cycle.

Ultraviolet-C Light (UV-C) Disinfection

Ultraviolet-C devices emit germicidal light (around 254 nm wavelength) that inactivates bacteria, viruses, and fungi by damaging their DNA/RNA. UV-C “no-touch” systems are used after cleaning a room to disinfect the environment further. Clinical studies indicate that adding UV-C disinfection can reduce certain HAI rates. An analysis reported about an 18% lower incidence of hospital-onset multidrug-resistant organism infections when UV-C was used in addition to standard room cleaning (Sun et al., 2023). In one large multi-hospital study, an enhanced terminal room cleaning protocol with UV-C was associated with a 19% reduction in infections due to hardy bacteria like Acinetobacter and Klebsiella on the wards using UV, whereas no significant change occurred in control wards without UV (Anderson et al., 2017). These findings suggest UV-C can help eradicate residual pathogens that survive manual cleaning, thereby lowering the risk of transmission to the next patient. Best practices for UV-C room disinfection include placing the device in multiple positions (or using multiple emitters) to ensure UV light reaches all surfaces and running the machine for sufficient time to deliver a lethal dose to microorganisms.

There are some limitations: UV-C’s effectiveness is highly dependent on line-of-sight exposure – the light does not penetrate into shaded areas, under clutter, or through organic soil. Any dirt or dust on a surface can shield microbes from UV, so UV-C is not a replacement for physical cleaning. UV devices also require the room to be unoccupied (since UV can damage eyes/skin), which means they can only be used during room turnover or terminal cleaning when patients and staff are out. Despite these caveats, many hospitals have reported meaningful pathogen reductions by incorporating UV-C. Facilities that deploy UV-C after routine cleaning have observed lower contamination on surfaces and fewer infections with UV-sensitive organisms such as C. difficile and VRE (Boyce et al., 2008; Sun et al., 2023). The evidence supports UV-C as a valuable adjunct for environmental disinfection, particularly in high-risk areas like ICUs or isolation rooms.

Hydrogen Peroxide Vapor Systems

Hydrogen peroxide vapor (HPV) is another “no-touch” decontamination technology. Specialized machines disperse a concentrated vapor of hydrogen peroxide (often augmented with silver ions) into a sealed room, achieving uniform disinfection of all surfaces – even nooks and crevices that wiping may miss. Research demonstrates that HPV can essentially sterilize rooms and dramatically reduce pathogen transmission. In a notable hospital study, before HPV treatment, 25.6% of sampled room surfaces tested positive for C. difficile spores versus 0% after HPV decontamination (Boyce et al., 2008). Correspondingly, the incidence of C. difficile infection on high-risk wards fell by approximately 44% after implementing routine HPV room fogging (Boyce et al., 2008). These results, published in a CDC-sponsored study, provide compelling evidence that whole-room hydrogen peroxide fumigation can break the chain of transmission for tough spores and multidrug-resistant organisms. HPV is especially useful for terminal disinfection of rooms that housed patients with highly contagious pathogens (e.g. norovirus, C. difficile, Acinetobacter). It ensures that the next patient to occupy the room is not exposed to their predecessor’s germs.

Like UV, HPV has practical limitations: Because hydrogen peroxide vapor is hazardous to inhale at the concentrations used, the room must be completely sealed and vacated during the process. A single room’s decontamination cycle is time-intensive – often taking several hours for the vapor to disperse, dwell, and then aerate back to safe levels. This leads to room downtime, which can be operationally challenging for busy units. Thus, HPV is typically reserved for targeted use (e.g., outbreak control or post-discharge deep cleaning of isolation rooms) rather than daily cleaning of all rooms. Best practices for HPV include scheduling it for times when rooms or units can be taken offline (such as immediately after patient discharge or when an entire ward can be rotated out) and verifying the process efficacy with biological indicators. Despite the logistical hurdles, hospitals using HPV have reported marked reductions in environmental bioburden and infection rates, particularly for C. difficile, which is notoriously difficult to eradicate with conventional cleaning (Boyce et al., 2008). HPV provides a level of disinfection beyond what manual methods achieve, making it a powerful tool in the infection prevention arsenal.

Antimicrobial Surfaces and Materials

Another proactive approach is upgrading high-touch surfaces to materials with intrinsic antimicrobial properties. The rationale is to continuously suppress microbial contamination on surfaces between cleanings. The most well-studied example is the use of copper and copper-alloy surfaces. Copper (and its alloys like brass or bronze) exhibits rapid contact-killing of microbes: when bacteria or viruses land on copper, the metal releases ions that disrupt cell membranes and DNA, leading to microbial death. A landmark randomized trial in ICU rooms demonstrated the benefit of this approach – patient rooms outfitted with copper-alloy bed rails, tray tables, IV poles, and other fixtures had a 58% lower HAI rate compared to standard rooms (incidence 0.034 vs 0.081 HAIs per patient, p = 0.013) (Salgado et al., 2013). In other words, patients in rooms with copper surfaces acquired infections at roughly half the rate of those with traditional surfaces. This multi-hospital trial provides high-quality evidence that passive antimicrobial surfaces can translate into real reductions in infection risk (beyond just reducing contamination on surfaces) (Salgado et al., 2013). Copper’s biocidal effect is continuous and does not rely on human action – it keeps killing bacteria 24/7, significantly lowering the baseline bioburden between cleaning rounds. Studies have found that copper-coated surfaces in active hospital rooms have far lower microbial counts than controls (often >80% lower). It is important to note that antimicrobial surfaces complement but do not replace routine cleaning; for instance, dirt or biofilm buildup can impair copper’s efficacy, so regular cleaning is still needed to remove soil or organic matter.

Beyond copper, other antimicrobial materials and surface coatings are being explored. Surfaces impregnated with silver or polymer materials with built-in antimicrobial agents are in use. Even the air handling system can contribute – advanced ventilation with HEPA filtration (high-efficiency particulate air filters) in HVAC systems continuously removes bacteria, fungal spores, and virus-laden droplets from the air, preventing them from settling on surfaces. Many modern hospital operating rooms and transplant units require HEPA-filtered air for this reason, as it has been credited with near-elimination of certain airborne infections (for example, invasive Aspergillus infections in bone marrow transplant patients have been virtually eliminated in centers with HEPA-filtered rooms). By combining no-touch disinfection technologies like UV-C or HPV with antimicrobial surfaces and improved air filtration, healthcare facilities create layered defenses in the environment. The best practice is to treat these technologies as supplements to, not replacements for, standard cleaning protocols – when used together, they can achieve a more thorough and sustained reduction in pathogens in the hospital environment.

Persistent Antimicrobial Coatings

Given that cleaned surfaces begin accumulating microbes again almost immediately as people circulate, a major focus in infection control research has been long-lasting antimicrobial coatings that continuously kill germs for extended periods. The vision is to apply a product to surfaces (such as a spray, paint, or polymer coating) that remain active for days, weeks, or even months, providing residual protection between regular cleanings. Several persistent antimicrobial coatings have been tested in hospitals in recent years, and early results are promising.

One study evaluated a durable organosilane-based coating applied to high-touch surfaces across multiple units in two hospitals. This coating bonds to surfaces and creates microscopic spikes that mechanically destroy microbes on contact. Over the year following application, the units with the antimicrobial coating saw a 36% reduction in HAI rates (combining MRSA and other MDRO bloodstream infections plus C. difficile infections) compared to the prior year, while control units without the coating saw no significant change in HAI rates (Ellingson et al., 2020). The difference was statistically significant, indicating that the coating likely contributed to the infection reduction. Environmental cultures confirmed the coating’s efficacy: treated surfaces experienced approximately a 75–79% drop in total bacterial colony counts relative to baseline after the coating was applied (Ellingson et al., 2020). The percentage of surfaces positive for clinically relevant pathogens in the coated units also fell significantly. These findings suggest that continuously active surface coatings can significantly and sustainably reduce bioburden and interrupt transmission if the coating remains effective.

However, durability and maintenance of these coatings are key considerations. Some products may lose potency over time due to routine cleaning, abrasion, or chemical interactions. For instance, a randomized trial in an emergency department found that a long-acting antimicrobial coating on stretcher rails achieved strong initial reductions in bacteria, but after 6 months, the effect had waned as the coating wore off, illustrating that reapplication might be necessary to maintain continuous protection. Thus, hospitals adopting persistent antimicrobial treatments should monitor surface efficacy (e.g. periodic swab cultures or using surrogate markers) and reapply coatings at recommended intervals.

The Role of Kismet Clean in  Providing Long-lasting Surface Protection

Among the most promising innovations in persistent antimicrobial protection is Kismet’s innovative mediated cerium oxide technology.  Now available in Kismet Clean, this is a next-generation surface protection technology designed to address the challenges of maintaining continuous microbial suppression in high-touch hospital environments. Unlike conventional cleaners that only temporarily reduce bioburden, Kismet Clean offers prolonged, self-activating protection, reducing contamination levels between routine maintenance cleanings.

Kismet Clean harnesses the cleaning power of hydrogen peroxide only in the presence of bacteria, viruses, and fungi.  Pilot studies have shown up to a 90% reduction in aerobic bacteria on Kismet Clean treated surfaces.  These studies were in real-world healthcare settings, where surfaces treated with Kismet Clean experienced dramatic reductions in bioburden compared to untreated surfaces. Studies have shown that treated surfaces—such as privacy curtains, triage chairs, and sharps disposal box lids—harbored significantly fewer colony-forming units (CFUs) than their uncoated counterparts. For example:

One of the key advantages of Kismet Clean is that it does not require frequent reapplication. While many antimicrobial coatings degrade over time, Kismet’s technology functions more as a catalyst for the hydrogen peroxide production.   As long as the technology is on the surface it will continue to produce hydrogen peroxide in the presence of pathogens. Making it particularly valuable for high-touch surfaces that are difficult to disinfect, such as patient room fixtures, bed rails, call buttons, and shared medical equipment.

Kismet Clean does not replace traditional infection control measures but amplifies their effectiveness by reducing the microbial load between cleanings. By integrating Kismet Clean into a hospital’s environmental hygiene protocols, healthcare facilities can achieve a more comprehensive, layered defense against HAIs, reducing the risk of transmission without increasing staff workload.

As research continues to evolve, persistent antimicrobial coatings—especially those with self-activating properties like Kismet Clean—represent a paradigm shift in hospital disinfection strategies. When combined with standard cleaning and disinfecting protocols, and robust hand hygiene compliance, these long-lasting surface coatings provide an added layer of protection against HAI risks in ways traditional methods alone cannot achieve. Innovations like Kismet Clean are setting a new standard of cleaning for hospitals and healthcare facilities.

Hand Hygiene and Compliance Monitoring

Proper hand hygiene is the single most important behavior for preventing HAIs. The vast majority of HAIs originate from the transmission of microbes by hands – either via healthcare workers’ hands carrying pathogens between patients, or via the patient’s own flora being introduced at a vulnerable site (e.g. during a catheter insertion). The World Health Organization estimates that proper hand hygiene could prevent up to 50% of avoidable infections acquired in healthcare settings (WHO, 2009). In other words, a large fraction of HAIs are avoidable through the simple act of hand washing with soap or using alcohol-based hand sanitizer at key moments.

Despite its importance, compliance with hand hygiene protocols is notoriously inconsistent. In many hospitals (even in high-resource settings), observational studies have found that, on average, hand hygiene compliance hovers around 40–70% (WHO, 2009), meaning that healthcare workers clean their hands only about half the time they should. In some settings, baseline compliance rates are even lower. Without targeted interventions, global studies have found typical compliance around 40% or less (WHO, 2009), indicating that healthcare providers often perform hand hygiene only a fraction of the times they ought to. Therefore, improving hand hygiene adherence among doctors, nurses, and all healthcare personnel is a top priority in HAI prevention efforts.

Decades of research and quality improvement initiatives have shown that sustained improvements in hand hygiene directly correlate with reductions in infection rates. Structured training and feedback are proven strategies for raising hand hygiene compliance. This includes regularly educating staff on proper technique (following WHO’s “Five Moments for Hand Hygiene” and CDC guidelines), making alcohol-based sanitizer readily accessible at point-of-care, and fostering an institutional culture where hand hygiene is critical to patient care. Many hospitals implement multimodal hand hygiene improvement programs – combining education, reminders, performance data feedback, and infrastructure improvements (like more sinks or sanitizer dispensers) – to drive behavior change. Hospitals that implement such structured programs have consistently observed higher compliance and corresponding drops in infection rates (Allegranzi et al., 2013). When adopted in a hospital setting, the WHO’s multimodal hand hygiene improvement strategy significantly increased hand hygiene compliance and was associated with reduced HAIs (Allegranzi et al., 2013).

Peer accountability can further reinforce habits. Some institutions encourage a “just culture” of safety where staff members feel empowered to remind colleagues to perform hand hygiene if they observe missed opportunities. A simple prompt – “I noticed you didn’t gel your hands when you entered that room – please do so now” – can reset expectations in the moment. In one study, installing an electronic reminder system plus a structured peer accountability process led to roughly a 40% improvement in hand hygiene adherence, with a corresponding decline in HAIs (BioVigil, 2021). Technology can assist these efforts: electronic hand hygiene monitoring systems can provide real-time feedback (e.g. flashing badges or chimes that remind staff to sanitize upon room entry/exit) and track compliance rates by individual or unit. When combined with active encouragement and feedback, these systems have shown significant boosts in compliance.

The best results come from a bundle of hand hygiene interventions: making the desired action as easy as possible (e.g. placing sanitizer dispensers at every bedside and room entrance), providing continuous education and frequent visual reminders (posters, screen savers, badges), monitoring compliance (through direct observation or electronic systems), and giving staff feedback on performance. Hospitals can achieve sustained high compliance by creating an environment where hand cleaning is simple, expected, and visibly monitored. The payoff is tangible – numerous reports document that when hand hygiene rates climb, infection rates fall in tandem (Allegranzi et al., 2013; WHO, 2009). In some cases, major hand hygiene campaigns have dramatically lowered HAI rates, validating Nightingale’s 19th-century assertion that handwashing saves lives.

Clean hands save lives. Investing in hand hygiene promotion is one of the most cost-effective HAI prevention measures available, and it underpins all other infection control efforts.

Antimicrobial Stewardship Programs (ASPs)

The overuse and misuse of antibiotics in hospitals can drive the emergence of drug-resistant organisms, which in turn cause difficult-to-treat infections. Antimicrobial stewardship programs (ASPs) aim to optimize the use of antibiotics to improve patient outcomes and reduce resistance. Importantly, effective antibiotic stewardship has a direct infection prevention benefit. By curbing unnecessary antibiotic exposure, hospitals can reduce the incidence of certain HAIs (especially those caused by opportunistic or resistant bacteria).

Restricting high-risk antibiotics (like fluoroquinolones and certain cephalosporins) can dramatically cut C. difficile infection rates since those drugs predispose patients to C. diff by wiping out protective gut flora. One hospital that instituted a robust stewardship program saw C. difficile cases plummet from 94 in one year to just 13 by the fourth year post-intervention – an 86% reduction in C. diff infections. In the same study, ventilator-associated pneumonia and central-line bloodstream infection rates also declined in the years after stewardship began, likely because of fewer invasive infections with drug-resistant organisms (as overall bacterial burden and resistance in the hospital dropped). These data underscore that antibiotic stewardship is infection prevention: if fewer highly resistant bugs exist in the hospital ecosystem, there will be fewer opportunistic and hard-to-treat HAIs.

Successful ASPs are typically multidisciplinary, involving infectious disease physicians or pharmacists who review antibiotic orders and guide optimal therapy. Common interventions include prospective audit-and-feedback (where the stewardship team reviews ongoing antibiotic cases and suggests modifications or de-escalation), formulary restrictions (requiring approval to use certain broad-spectrum or high-cost antibiotics), and development of local treatment guidelines to encourage appropriate antibiotic choices. Education of prescribers is also central – clinicians need to know about local resistance trends and the rationale behind stewardship recommendations. Many hospitals implement simple policies like requiring pharmacy or ID approval for prescribing specific broad-spectrum antibiotics; this alone can curtail the overuse of the drugs most strongly associated with resistance.

The benefits of stewardship extend beyond infection rates. Multiple studies have documented significant cost savings due to reduced drug expenditures when unnecessary antibiotics are eliminated. For instance, a group of four hospitals in Saudi Arabia reported a 28% drop in antibiotic costs in the first year of their ASP (over $1.5 million saved over a few years) while simultaneously cutting HAIs – a welcome side effect of doing the right thing for patient safety. Importantly, ASPs often work synergistically with other infection control measures. A comprehensive meta-analysis (Baur et al., 2017) found that stewardship programs were even more effective at reducing infections when paired with robust hand hygiene and infection control interventions. In some studies, stewardship plus a hand-hygiene campaign yielded an even larger reduction in certain resistant infections than stewardship alone.

Best practices for ASPs include obtaining strong administrative support (leadership endorsement and resources), tracking metrics (antibiotic usage rates, resistance patterns, and HAI rates) to measure impact, and providing regular feedback to clinicians on their performance. Modern ASPs may leverage clinical decision support systems in the electronic health record – in alert to prompt an “antibiotic time-out” after 48 hours so the team can reassess ongoing therapy once culture results are available (nudging physicians to narrow or stop antibiotics if appropriate). The bottom line is that by reducing unnecessary antibiotics, hospitals combat the global threat of antimicrobial resistance and see immediate local benefits in the form of lower HAI rates and improved patient outcomes. Stewardship is truly a win-win for both public health and individual hospitals, and it has become a required element of hospital accreditation in many countries, given its proven value. The literature shows that well-designed ASPs can significantly reduce infection rates – in one meta-analysis, antibiotic stewardship interventions led to a 51% reduction in infections by multidrug-resistant Gram-negatives, a 37% reduction in MRSA infections, and a 32% reduction in C. difficile infections (Baur et al., 2017)​. Such results illustrate the powerful role of antimicrobial stewardship as a preventive strategy against HAIs.

Education, Training, and Safety Culture

While technology and protocols are crucial, the foundation of HAI prevention is a strong safety culture and an educated, vigilant staff. All the best practices described – hand hygiene, careful device use, environmental cleaning, stewardship, etc. – ultimately depend on healthcare workers executing them consistently. Thus, ongoing education and training of staff at all levels is essential. Regular in-servicing on infection prevention practices (for example, annual competencies on central line care or proper urinary catheter management) helps reinforce the “why” and “how” of HAI prevention. Some hospitals conduct hand hygiene workshops, device insertion simulation training, or multidisciplinary safety drills to keep skills sharp.

Many high-performing hospitals have championed a “zero preventable infections” mindset – that even one avoidable HAI is too many – and empower every staff member to speak up or take action to maintain safety. Simple culture interventions, like encouraging staff to ask, “Is there anything I can do to reduce infection risk?” during patient care rounds, keep prevention on everyone’s mind. Some institutions have even implemented reward programs or friendly competitions for units with exemplary hand hygiene or low infection rates to incentivize engagement.

An educated and empowered workforce is the linchpin of HAI prevention. Technology and policies set the stage, but it’s the people who must perform the proper actions every single time. By training staff, reinforcing positive behaviors, and nurturing a culture where infection prevention is everyone’s responsibility, hospitals create an environment where infections struggle to take hold – fulfilling the ultimate goal of patients healing without harm.

Conclusion

Preventing healthcare-associated infections requires an orchestrated, proactive approach spanning technology, processes, and people. These include enhanced environmental cleaning protocols (with innovations like UV-C light and hydrogen peroxide vapor), continuous surface protection delivered in products like Kismet Clean, strict hand hygiene enforcement and compliance monitoring, robust airborne precautions (improved ventilation and UV air disinfection), optimal use of personal protective equipment and barrier methods, judicious antibiotic use through stewardship programs, advanced surveillance and analytics for early warning, and ongoing staff education coupled with a strong safety culture. Each of these strategies is backed by scientific evidence. Importantly, these interventions are synergistic – no single measure can eliminate HAIs on its own, but together they form a robust defense. Hospitals that have embraced comprehensive infection prevention bundles have achieved striking reductions in HAI rates, in some cases approaching zero infections in intensive care units for months on end. The results translate to safer patient care, shorter hospital stays, lives saved, and lower costs.

It must be acknowledged that the fight against HAIs is ongoing. Pathogens evolve, healthcare procedures become more complex, and new challenges (like emerging viruses or increasing antimicrobial resistance) continue to arise. Therefore, continuous innovations and adaptations are necessary. With diligent application of the strategies outlined above and an institutional culture prioritizing infection prevention, the long-standing goal of “zero preventable infections” comes closer into view. Hospitals leveraging advanced, persistent antimicrobial surface protection experience lower pathogen loads, reduced transmission risks, and improved patient outcomes.

Kismet Clean offers a next-generation approach to continuous environmental hygiene, reducing surface contamination between routine cleanings without increasing staff workload. By integrating Kismet Clean’s self-activating technology into cleaning and disinfecting protocols, facilities can establish an amplified layer of protection against HAIs.

Partner with Kismet Technologies to implement cutting-edge, research-backed antimicrobial solutions. Contact us today to explore how Kismet Clean can seamlessly enhance existing hygiene protocols as part of your overall efforts to reduce HAIs.

🔗 Visit Kismet Clean Products to Learn More

References

Allegranzi, B., et al. (2013). Successful implementation of the WHO multimodal hand hygiene improvement strategy in a university hospital: a step-wise approach. Infection Control & Hospital Epidemiology, 34(5), 419–425. (Demonstrates improved hand hygiene compliance and reduced HAIs with a structured WHO hand hygiene strategy)

Baur, D., Gladstone, B. P., et al. (2017). Effect of antibiotic stewardship on the incidence of infection and colonization with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infectious Diseases, 17(9), 990–1001. (Meta-analysis showing significant reductions in MRSA, multidrug-resistant Gram-negatives, and C. difficile infections with stewardship programs)

Boyce, J. M., Havill, N. L., et al. (2008). Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infection Control & Hospital Epidemiology, 29(8), 723–729. (HPV “fogging” eradicated C. diff from surfaces and reduced C. diff infection rates by ~44%)

Centers for Disease Control and Prevention (CDC). (2019). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved from CDC.gov. (Provides definitions of contact, droplet, and airborne transmission and recommended precautions)

Centers for Medicare & Medicaid Services (CMS). (2019). Hospital-Acquired Conditions (HAC) Reduction Program.Retrieved from CMS.gov. (Describes Medicare payment policy of 1% reimbursement penalty for worst 25% hospitals in HAC rates)

Ellingson, K. D., Pogreba-Brown, K., Gerba, C. P., & Elliott, S. P. (2020). Impact of a Novel Antimicrobial Surface Coating on healthcare-associated infections and environmental bioburden at two urban hospitals. Clinical Infectious Diseases, 71(8), 1807–1813. (Application of a persistent organosilane coating led to a 36% decline in HAIs and ~75–79% reduction in surface bacteria in coated units)

Escombe, A. R., et al. (2009). Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmission. PLoS Medicine, 6(3), e1000043. (In a Guinea pig model, upper-room UVGI reduced TB transmission by ~70%)

Fakih, M. G., et al. (2021). Non-compliance with central line insertion practices and subsequent risk of central line–associated bloodstream infection. Infection Control & Hospital Epidemiology, 42(9), 1029–1035. (Found ~28% increase in CLABSI rates when sterile insertion protocols were not followed consistently)

Guerrero, D. M., et al. (2012). Clostridium difficile infection in a surgical inpatient unit: the importance of environmental contamination. Infection Control & Hospital Epidemiology, 33(5), 517–519. (Highlighted transmission of C. difficile via contaminated bedding and equipment, contributing to prolonged stays and higher costs)

Harris, A. D., et al. (2013). Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA, 310(15), 1571–1580. (BUGG study: Using gloves and gowns for all patient contact in ICUs reduced MRSA acquisition by ~40% without adversely affecting patient care)

Johnston, C. P., et al. (2007). Outbreak management and implications of a nosocomial norovirus outbreak. Clinical Infectious Diseases, 45(5), 534–540. (Case study of a hospital norovirus outbreak causing 105 staff illnesses, temporary closure to admissions, and >$650k in costs)

Klevens, R. M., et al. (2007). Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Reports, 122(2), 160–166. (Estimated 1.7 million HAIs and ~98,987 associated deaths in U.S. hospitals, highlighting HAIs as a leading cause of preventable mortality)

Magill, S. S., et al. (2018). Changes in prevalence of healthcare-associated infections in U.S. hospitals. New England Journal of Medicine, 379(18), 1732–1744. (Reported that on any given day, ~3.2% of patients have an HAI – roughly 1 in 31 patients – based on 2015 data)

Ohl, M., et al. (2012). Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. American Journal of Infection Control, 40(10), 904–906. (Found 92% of privacy curtains tested were contaminated within one week, including MRSA and VRE)

Page, L. (2010, July 23). Hospital-Acquired Infections by the Numbers. Becker’s Hospital Review. (Compiled statistics on HAIs, noting ~7 HAI-related lawsuits per hospital per year at $1.5M each, and that 27 states mandate public reporting of HAIs)

Pennsylvania Health Care Cost Containment Council (PHC4). (2012). The Impact of Healthcare-Associated Infections in Pennsylvania, 2010. Harrisburg, PA: PHC4 Report. (Statewide data showing HAI patients had 21.9-day average stays vs 5.0 days for others, and 41.9% were readmitted within 30 days vs 16.3% for others)

Salgado, C. D., et al. (2013). Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infection Control & Hospital Epidemiology, 34(5), 479–486. (Randomized trial: Copper-alloy surfaces in ICU rooms led to a 58% reduction in HAI rate among patients)

Shek, K., et al. (2018). Rate of contamination of hospital privacy curtains in a burns/plastics unit: a longitudinal study. American Journal of Infection Control, 46(9), 1019–1021. (Found 87.5% of curtains tested positive for MRSA by day 14 and 100% by day 21, highlighting the need for frequent changing of curtains)

Stone, P. W. (2009). Economic burden of healthcare-associated infections: an American perspective. Expert Review of Pharmacoeconomics & Outcomes Research, 9(5), 417–422. (Estimated the direct annual cost of treating HAIs in the U.S. ranges from $28.4 billion to $45 billion)

Sun, Y., Wu, Q., Liu, J., & Wang, Q. (2023). Effectiveness of ultraviolet-C disinfection systems for reduction of multidrug-resistant organism infections in healthcare settings: A systematic review and meta-analysis. Epidemiology & Infection, 151, e149. (Meta-analysis of 9 studies: UV-C room disinfection was associated with an ~18% reduction in Gram-negative rod infections (IRR 0.82) and overall contributes to lower MDRO infection rates)