,  which researches and develops high-performance products, programs, and training for the infection prevention and commercial cleaning markets. 

George Clarke

For nearly 2 decades, the health care industry has cited the same sobering statistic: 1.7 million health care-associated infections (HAIs) and 99,000 deaths annually in the US. This translates to roughly 1 death every 5 minutes, 24/7, 365 days every year. Despite this staggering toll, these infections rarely make headlines, trigger emergency declarations, or appear prominently in national public health debates.

2007 analysis by R. Monina Klevens, DDS, and colleagues at the CDC, which relied largely on surveillance data from the late 1990s and early 2000s.

 Yet by any epidemiological definition, HAIs have quietly crossed a critical threshold: They are no longer episodic outbreaks or epidemics. They have become endemic.

But here is the sobering question: Do those numbers still reflect the reality based on present-day 

The epidemiological landscape has shifted dramatically. If anything, the burden of 

HAIs is probably significantly underestimated. Surveillance is not lacking; the risk environment has fundamentally changed.

When Kleven’s analysis was published, the pathogens of concern in acute care hospitals were materially different. Since then, health care facilities have faced challenges such as:

, a multidrug-resistant yeast that persists in the environment

Increased prevalence of multidrug-resistant 

Methicillin-resistant Staphylococcus aureus (MRSA)

Many of these organisms exhibit characteristics that were not fully appreciated or understood in earlier surveillance reports, including:

Resistance to commonly used disinfectants

Sublethal tolerance to disinfectant residues

In short, the microbial burden and pathogenicity in health care environments have not remained static; they have evolved considerably.

The Overlooked Reservoirs: Sinks, Drains, Toilets, and Floors

Mounting evidence implicates environmental reservoirs in hospitals as active sources of pathogen transmission. 

Sink drains, P-traps, faucet aerators, and toilet plumbing systems

 can harbor biofilms containing viruses, fungi, and multidrug-resistant bacteria. Biofilm is not simply surface contamination; it is a structured suit of armor (extracellular polymeric matrix) that:

Protects embedded organisms from disinfectants

Facilitates antibiotic-resistant gene transfer (quorum sensing)

Allows biofilm seeding into the surrounding patient care environments

Splash and aerosolization from contaminated drains can disseminate organisms to adjacent surfaces, medical equipment, and patient care zones. Likewise, toilet plume aerosolization can disperse microbes beyond the bowl, especially in high-use, shared facilities.

Floors have long been recognized as reservoirs of pathogens; however, the prevailing attitude, “what is on the floor stays on the floor,” has been shown to be clearly incorrect. Studies published within the last 10 years have shown that pathogens on the floor rapidly cross-contaminate above-floor surfaces throughout the patient care zone, where incidental hand contact can easily result in cross-contamination.

These reservoirs challenge a long-standing assumption: that environmental contamination is transient and superficial. In reality, many hospital surfaces are continuously being reseeded and contaminated. Researchers have determined that “If you’re not disinfecting for biofilm, you’re not disinfecting!”

Infection prevention programs have understandably emphasized 

. It is measurable, auditable, and intuitively linked to patient health and safety. Campaigns inspired by global initiatives from the World Health Organization, the Association for Professionals in Infection Prevention and Epidemiology, and the CDC have elevated adherence awareness. However, hand hygiene has become, in many institutions, the dominant intervention, all too often to the exclusion of environmental surface hygiene.

A clinician washes/sanitizes his or her hands

Then touches, for example, a contaminated bed rail, privacy curtain, stethoscope, call button, IV pump keypad, or 

HAI pathogen transfer occurs within seconds

Without rigorous proactive environmental surface hygiene and pathogen reservoir control, hand hygiene alone becomes a revolving door, an expensive, incomplete, and ineffective mitigation strategy. Hand hygiene is necessary; however, on its own, it is akin to the old Einstein anecdote: 

Doing the same thing over and over again and expecting a different result is the definition of insanity.

Several systematic factors suggest that legacy 

Not all infections are captured in surveillance. Many postdischarge infections go unreported.

Immunocompromised oncology and transplant patients, and an aging population

Resistant organisms prolong the length of stay, increase environmental shedding, and complicate eradication

Modern pathogens survive longer on dry surfaces and in plumbing systems than previously understood

Standard surface disinfection is rarely validated against mature biofilm reservoirs. Taken together, it is difficult to argue that a dataset (estimate) compiled from the 1990s HAIs fully reflects the microbial challenges hospitals face in 2026.

Centers for Medicare & Medicaid Services penalties

 investments are typically treated as an operational cost center rather than a risk-reduction strategy. If a 

HAI costs tens of thousands of dollars per case, and significantly more for resistant organisms, then insufficient environmental hygiene and control are clinical issues, and they are balance-sheet issues.

HAIs requires moving beyond an emphasis on a single intervention. An effective proactive strategy must include:

All departments enterprise wide must be involved

Rigorous environmental surface hygiene and validation

Biofilm-targeted interventions in plumbing systems

Engineering controls to reduce splash and aerosolization

Frequent disinfection and monitoring of high-touch surfaces

Integrated hand + environmental surface + water management processes

Ensuring that the products, tools, and disinfectants used address biofilm and spore-forming bacteria and fungi

Daily disinfection processes must be proactive, not reactive

Environmental service professionals must be educated and trained to perform their vital tasks and rewarded accordingly

Validation is vital to ensure all the required surfaces are disinfected

Hand hygiene remains a key component of any infection prevention program; however, hand hygiene alone, without including environmental hygiene, is a waste of time, money, and effort.

The health care industry continues to cite 1.7 million infections and 99,000 deaths per year as a historical benchmark.

: “On any given day, about 1 in 31 hospital patients has at least one health care-associated infection. Patients in the 2015 HAI Hospital Prevalence survey were at least 16% less likely than patients in the 2011 survey to have an HAI.” However, the number and virulence of microbial challenges have evolved, resistance has expanded, and environmental reservoirs are better understood.

If the pathogens, the reservoirs, and the risks have changed, then relying on legacy numbers and a single-point intervention does not align with present-day reality.

It is time to reassess not only how many infections are preventable, the impact on the bottom line, but also how prevention itself is defined and implemented.

Articles

Health care–associated infections (HAIs) remain underestimated, driven by evolving pathogens, environmental reservoirs, and biofilm persistence. Experts argue outdated data and overreliance on hand hygiene obscure the true, growing burden of preventable infections.

HAIs Are the Silent Endemic: Why the Numbers Don’t Add Up

Infection prevention and environmental hygiene

, if the hospital’s Infection Prevention (IP) department is the architect of infection prevention policy, then Environmental Services (EVS) workers interpret the blueprint and carry out the general procedures for buttressing the all-important barriers between the patients and disease. They share a common mission: to create and maintain a clean, safe, and sanitary environment for patients, staff, and visitors. Despite this, EVS and IP often operate as 2 separate silos in health care facilities—a suboptimal scenario for patient outcomes and the safety of staff and visitors, especially when it comes to preventable health care-associated infections (

 daily. A patient’s risk of acquiring a 

HAI can almost quadruple, depending on whether the prior room occupant was infected. Thorough cleaning and disinfection are crucial for minimizing 

HAIs. Unfortunately, this process, carried out by EVS departments and championed by IPs, is often underresourced. It is time to change how we value EVS and IP to reduce the extreme costs 

HAIs exact on patients and health care facilities.

HAIs on patient outcomes, finances, and public health

HAIs increased significantly during the COVID-19 pandemic. The average risk of 3 

 (MRSA), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI)—spiked to a 5-year high in hospitals during the COVID-19 pandemic and remain high.

Health care facilities aren’t dedicating enough resources to reduce 

HAIs because they lack a clear picture of the cost associated with such infections. Leading to prolonged hospital stays and increased costs for treatment, 

HAIs result in a significant financial burden. That’s not to mention the legal repercussions and reputational damage left in their wake.

HAIs costs US acute care hospitals $147 billion annually, making them a formidable challenge to the financial sustainability of health care institutions. A single MRSA infection can cost health care facilities up to $30,000. More complex infections, such as 

, may cost up to $203,000 per infection. Finally, many 

—are caused by antimicrobial-resistant organisms. The 

 considers antimicrobial resistance an urgent global public health threat.

HAIs in health care facilities will improve patient safety, reduce excess health care costs, and combat antimicrobial resistance and its complications.

Making the case for resources and funding

EVS and IP departments are at the frontlines of the battle to reduce 

HAIs. Despite their essential roles, they remain underfunded and lacking resources because they do not generate direct revenue. They face challenges ranging from limited staffing and obsolete equipment to insufficient training and outdated protocols. For example, approximately 

 of EVS employees report working in chronically understaffed positions with an average pay of just 

During the APIC (Association for Professionals in Infection Control and Epidemiology) 2023 Spring Leadership Forum, there was some discussion about the ongoing perception that IPs are not valued, though we did learn that they are increasingly being heard in the C-suite. IPs want to expand their influence, particularly on the financial side. They can do so by offering a clear view of the cost of 

Savvy health care facilities are taking a more holistic view of the impact of 

HAIs to assess the actual financial benefit of fully staffed and equipped IP and EVS departments. Such hospitals account for all the physical and medical services provided to the 

HAI patient, including the high cost of incremental patient days, additional support staff required, cost to treat, potential litigation costs, and harm to hospital goodwill. This reporting offers a more comprehensive perspective of the true cost savings—and bottom-line contribution—delivered by EVS and IP. Armed with this information, hospitals can make the case to fully fund and staff IP and EVS departments.

HAI prevention has been regarded as a soft cost or cost avoidance. An enterprise-wide, multimodal intervention approach needs to be adopted by the C-suite.

Benefits of merging IP with EVS in acute care hospitals

Going a step further, acute care hospitals should consider merging the expertise of IP with the diligence of EVS into one unified department. Beyond the immediate advantages of bolstering infection prevention measures, this collaboration opens avenues for demonstrating the financial impact of 

HAIs on health care institutions. By presenting a unified front, IP and EVS can showcase the cost-effectiveness of preventative measures, potentially securing more funding for vital resources, including adequate staffing, training, and the appropriate tools.

Merging IP with EVS in acute care hospitals would result in a reduction in 

HAIs, a decrease in costs, and an increase in patient satisfaction. The benefits are:

 and collaboration between EVS and IP result in a more cohesive approach to infection control and environmental surface processing.

and reduced duplication of efforts would yield cost savings and increased efficiency. Reducing penalties related to 

 scores requires sustained efforts in enhancing patient satisfaction and safety. By merging IP and EVS, health care facilities can improve their overall performance, reduce penalties, and provide a better experience for patients.

and sharing of knowledge and expertise, resulting in improved infection control measures. Training is not a 1-time event; hospitals should constantly reinforce process quality improvements while updating training as new hires are added.

Consistent processing (cleaning and disinfection) and infection prevention protocols 

for cleaning and disinfection across the many different patient care environments that are closely aligned with infection control guidelines. The result would be more effective programs and a reduction in

HAIs. Also, EVS and IP speaking as 1 voice will have greater influence throughout the hospital.

 and oversight of processes for disinfection and infection control measures, leading to improved quality control. Adopting advanced tools, hospitals can quickly and efficiently offer quality assurance monitoring, corrective actions, and education to improve results. Without regular daily monitoring, standards will decline.

for maintaining high hygiene and infection control standards, resulting in higher compliance with regulations and standards.

for staff members would improve knowledge and skills related to infection prevention and control.

HAIs on patient outcomes, hospital finances, and public health continues to mount, it is imperative to recognize the importance of EVS and IP departments while addressing their persistent lack of resources. Short-term thinking on cost savings must be replaced with recognizing that long-term infection prevention will create a much better patient environment. As a united front, IP and EVS can fortify defenses against 

HAIs and make a compelling case for the financial benefits of proactive infection prevention. Now is the time to invest in these critical “first-line-of-defense” health care workers and a future where patient safety, sustainability, financial stability, and public health are seamlessly interconnected.

Preventable health care-associated infections (pHAIs) cost US health care facilities up to $123 million per day. 


George Clarke

Articles

HAIs Are the Silent Endemic: Why the Numbers Don’t Add Up

The Case for Merging Environmental Services and Infection Prevention Departments in Hospitals