Addressing Inequities in Healthcare-Associated Infections (HAIs)

Black, Latinx, Asian, and Indigenous people experience higher rates of healthcare-associated infections (HAIs) than white people in the United States.

A 2016 review of more than 79,000 adults hospitalized with acute cardiovascular disease, pneumonia, or major surgery found that 5.0% of Asian patients and 4.6% of Hispanic patients experienced catheter-associated urinary tract infections (CAUTIs), compared to 3.2% of non-Hispanic white patients.

A 2018 study that examined methicillin-resistant Staphylococcus aureus infections (MRSA) between 2005 and 2014 found that Black patients had higher incidence rates of hospital-onset MRSA than white patients (6.21 per 100,000 vs. 2.94 per 100,000), with Black people 3.2 times more likely to suffer infection than similarly aged white people.

A 2021 review of literature notes that “most studies suggest that minoritized patients experience higher rates of HAIs compared to their white counterparts.” Hospitals and healthcare facilities that are serious about decreasing HAIs must acknowledge and address existing inequities.

Factors Contributing to Inequities in HAI Prevention

Healthcare inequities have multiple causes, including conscious and unconscious bias and unequal access to healthcare that’s often the result of historic segregation and limited socioeconomic opportunities. The two factors that are most relevant to racial and ethnic inequities in HAIs are unconscious bias and funding disparities:

Unconscious bias

According to the University of San Francisco’s Office of Diversity and Outreach, unconscious biases are “social stereotypes about certain groups of people that individuals form outside their own conscious awareness.” These thoughts are often based on inaccurate historical ideas, such as the idea that Black people feel less pain than white people. (A 2016 study of 222 white medical students found that half of them “endorsed false beliefs about biological differences between blacks and whites” and were less likely to perceive pain in Black patients.)

Research has found that unconscious bias contributes to “longstanding patterns of unequal treatment, including minoritized patients receiving less attention from nurses…” This unequal treatment may contribute to an increased prevalence of HAIs in certain populations.

Funding disparities

Safety-net hospitals, which provide services to a substantial share of vulnerable patients regardless of their ability to pay, care for a higher proportion of racial and ethnic minorities than non-safety net hospitals. These hospitals also typically have fewer financial resources. Researchers believe that “the under-sourcing of safety-net hospitals may directly contribute to racial/ethnic inequities in HAIs.”

Government rules that financially penalize hospitals for high HAI rates may exacerbate the situation. Though these rules are intended to incentivize the actions necessary to decrease HAIs, decreased payments to facilities that care for the greatest proportions of socioeconomically disadvantaged patients make it difficult to provide the care and resources necessary to adequately prevent HAIs.

Take Action to Decrease HAI Inequities

The CDC, Leapfrog Group, and Association for Professionals in Infection Control and Epidemiology (APIC) have all recently expressed an intention to address healthcare inequities, including racial disparities in healthcare-associated infections.

Steps you can take now to decrease HAI inequities include:

1. Measure and monitor HAIs. 

At present, most hospitals and healthcare facilities track HAIs but do not disaggregate data by race and ethnicity. Without this information, it’s impossible to determine the extent and prevalence of inequities in HAI infections. Accurate information is essential to understand the problem, identify root causes, and develop targeted solutions.

2. Invest in innovative technologies.

A 2021 article in Current Infectious Diseases Report states that “uptake of innovative technologies may assist in mitigating HAI inequities. For example, the implementation of an electronic hand hygiene voice reminder system in a rural health system showed significant improvement of hand hygiene within 6 months and concomitant significant reduction in HAIs.”

Electronic hand hygiene systems that provide information about clinical workflow can also help clinicians detect – and correct, if necessary – patterns of movement. Systems that provide insight into clinical workflow will help you determine if staff visit certain patient rooms less often, which may help you address unconscious bias.

3. Increase diversity and inclusion efforts.

Enhancing diversity and inclusion in the healthcare workforce is key to combating healthcare inequities. Additional research funding is also needed to determine root causes and effective solutions for HAI equities; efforts must also be undertaken to ensure that minority scholars are granted access to this research funding.

Consistent, dedicated attention is necessary to address disparities in healthcare-associated infections.