Keywords
Nosocomial infections
Healthcare‐associated infections
Infection control guidelines
Antimicrobial stewardship
Hand hygiene
AGREE II
Implementation framework
Healthcare‐associated infections
Infection control guidelines
Antimicrobial stewardship
Hand hygiene
AGREE II
Implementation framework
How to Cite
Ademi, A., Qyra, S., Dika-Haxhirexha, F., Dogjani, A., Biberaj, P., & Haxhirexha, K. (2025). Contemporary Guidelines for the Treatment and Prevention of Nosocomial Infections: Critical Analysis and Practical Perspectives. Albanian Journal of Trauma and Emergency Surgery, 9(2), 1869 - 1876. https://doi.org/10.32391/ajtes.v9i2.483
Abstract
Introduction: Nosocomial infections remain a significant threat to patient safety worldwide, driving morbidity, mortality, and escalating healthcare costs. Despite comprehensive guidelines from the WHO, CDC, and ECDC, variability in recommendations and persistent implementation gaps impede optimal uptake.
Objective: To critically assess current international and regional standards for preventing and controlling healthcare‐associated infections (HAIs) and to propose feasible, context‐specific strategies for local implementation that empower healthcare professionals to reduce infection rates meaningfully.
Material and Methods: We conducted a systematic review of key HAI prevention and management guidelines published between 2013 and 2023. The methodological quality of each document was evaluated using the AGREE II instrument.
Results: All guidelines converge on essential measures: rigorous hand hygiene, standardized environmental disinfection protocols, and robust antimicrobial stewardship programs. However, antibiotic regimens for routine HAIs (e.g., catheter‐associated urinary tract infections) differ markedly, and few guidelines offer clear pathways for implementation in facilities constrained by staffing, equipment, or medication shortages. Interviewees cited critical challenges, including insufficient staffing levels, inconsistent training quality, limited diagnostic capacity, and underdeveloped surveillance systems.
Conclusions: Harmonization of core recommendations is needed to reduce clinician confusion. We propose a practical implementation framework. Tailoring global best practices to local realities promises improved compliance, optimized resource use, and a significant reduction in nosocomial infection burden.
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4. Cassini, A., Plachouras, D., Eckmanns, T., Abu Sin, M., Blank, H. P., Ducomble, T., ... & Suetens, C. (2016). The burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modeling study. PLoS medicine, 13(10), e1002150. https://doi.org/10.1371/journal.pmed.1002150
5. Kollef, M. H., Micek, S. T., Hampton, N., Doherty, J. A., & Kumar, A. (2012). Septic shock attributed to healthcare-associated infections versus community-acquired infections: risk factors, outcomes, and healthcare resource use. Critical Care Medicine, 40(12), 396–401. https://doi.org/10.1097/CCM.0b013e31825bee2b
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7. Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4), 305–315. https://doi.org/10.1016/j.jhin.2009.04.019
8. Vincent, J. L., Sakr, Y., Singer, M., Martin-Loeches, I., Machado, F. R., Marshall, J. C., & Finfer, S. (2020). Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA, 323(15), 1478–1487. https://doi.org/10.1001/jama.2020.2717
9. Wisplinghoff, H., Bischoff, T., Tallent, S. M., Seifert, H., Wenzel, R. P., & Edmond, M. B. (2004). Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clinical Infectious Diseases, 39(3), 309–317. https://doi.org/10.1086/421946
10. Pfaller, M. A., & Diekema, D. J. (2007). Epidemiology of Invasive Candidiasis: A Persistent Public Health Problem. Clinical Microbiology Reviews, 20(1), 133–163. https://doi.org/10.1128/CMR.00029-06
11. Griffith, D. E., Aksamit, T., Brown-Elliott, B. A., Catanzaro, A., Daley, C., Gordin, F., & Wallace Jr, R. J. (2007). An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. American Journal of Respiratory and Critical Care Medicine, 175(4), 367–416. https://doi.org/10.1164/rccm.200604-571ST
12. European Centre for Disease Prevention and Control. (2018). Healthcare-associated infections: Surgical site infections – Annual Epidemiological Report for 2016. https://www.ecdc.europa.eu/en/publications-data
13. Magill, S. S., O’Leary, E., Janelle, S. J., Thompson, D. L., Dumyati, G., Nadle, J., & Fridkin, S. K. (2018). Changes in prevalence of healthcare-associated infections in US hospitals. New England Journal of Medicine, 379(18), 1732–1744. https://doi.org/10.1056/NEJMoa1801550
14. Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Reports, 122(2), 160–166. https://doi.org/10.1177/003335490712200205
15. Rosenthal, V. D., Al-Abdely, H. M., El-Kholy, ... & International Nosocomial Infection Control Consortium (INICC). (2016). International Nosocomial Infection Control Consortium (INICC) report, data summary of 50 countries for 2007–2012. Infection Control & Hospital Epidemiology, 37(11), 1329–1345. https://doi.org/10.1017/ice.2016.160
16. Dudeck, M. A., Weiner, L. M., Allen-Bridson, K., Malpiedi, P. J., Peterson, K. D., Pollock, D. A., & Sievert, D. M. (2013). National Healthcare Safety Network (NHSN) Report, Data Summary for 2011. American Journal of Infection Control, 41(4), 286–300. https://doi.org/10.1016/j.ajic.2013.01.002
17. David, M. Z., & Daum, R. S. (2010). Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clinical Microbiology Reviews, 23(3), 616–687. https://doi.org/10.1128/CMR.00081-09
18. Vincent, J. L., Rello, J., Marshall, J., & EPIC II Group of Investigators. (2009). International study of the prevalence and outcomes of infection in intensive care units. JAMA, 302(21), 2323–2329. https://doi.org/10.1001/jama.2009.1754
19. Sievert, D. M., Ricks, P., & Fridkin, S. (2013). Antimicrobial-resistant pathogens associated with healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network at the CDC, 2009–2010. Infection Control & Hospital Epidemiology, 34(1), 1–14. https://doi.org/10.1086/668770
20. Tumbarello, M., Repetto, …& Cauda, R. (2007). Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality. Epidemiology & Infection, 135(5), 847–853. https://doi.org/10.1017/S0950268806007542
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22. Hejazi, A., & Falkiner, F. R. (1997). Serratia marcescens. Journal of Medical Microbiology, 46(11), 903–912. https://doi.org/10.1099/00222615-46-11-903
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