The Lowbury Lecture. The United States approach to strategies in the battle against healthcare-associated infections, 2006: transitioning from benchmarking to zero tolerance and clinician accountability.

Approximately 2,000,000 healthcare-associated infections (HAIs) annually occur in US healthcare facilities and lead to approximately 60,000 90,000 deaths and cost $17 29 billion dollars. Such HAIs are an equal, if not more common problem, worldwide. Many evidence-based HAI prevention guidelines exist. However, despite knowing what to do, the challenge remains of getting clinicians to comply with these recommendations. In the USA, a variety of forces, including the public and legislators, are demanding HAI prevention. This is illustrated by the Consumers Union's effort to get legislation in every state for public HAI rate reporting. In addition, a number of profit-making and non-profit-making organizations have initiated major HAI prevention interventions. At least three common themes for these interventions exist. First, no single intervention prevents any HAI; rather a "bundle" approach, using a package of multiple interventions based on evidence provided by the infection control community and implemented by a multidisciplinary team is the model for successful HAI prevention. Second, benchmarking is inadequate and a culture of zero tolerance is required. Third, a culture of accountability and administrative support is required. Such interventions have illustrated that much greater levels of HAI prevention can be accomplished than ever estimated in the past. Implementation of evidence-based HAI prevention interventions should be a high priority for all healthcare facilities to reduce preventable HAIs to the greatest extent possible.