Conditions · Infectious and tropical diseases

Healthcare-associated infections (CLABSI, CAUTI, VAP) !

Infections people catch while receiving care, often through a catheter, a ventilator or surgery. Most are preventable with hand hygiene and care bundles.

Updated 2026-11-01

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What it is

Infections that were not present or incubating on admission and appear during or after healthcare, usually 48 hours or more after admission. The main device-associated ones are central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI) and ventilator-associated pneumonia (VAP).

Who gets it

Healthcare-associated infections affect a significant share of hospitalised patients worldwide, more in intensive care and in low- and middle-income countries. In Colombia they are called IAAS (infecciones asociadas a la atención en salud) and device-associated infections, antibiotic use and resistance are under national surveillance by the Instituto Nacional de Salud.

Causes

Skin flora and S. aureus (including MRSA) and coagulase-negative staphylococci on central lines
Enterobacterales, Pseudomonas, enterococci and Candida in catheter-associated urinary infection
Pseudomonas, Acinetobacter, Klebsiella and S. aureus in ventilator-associated pneumonia
Clostridioides difficile after antibiotic exposure
Multidrug-resistant organisms transmitted on hands, equipment and surfaces

Risk factors

Invasive devices and their duration: central venous catheters, urinary catheters, endotracheal tubes
Intensive care stay, surgery and prolonged hospitalisation
Older age, immunosuppression, diabetes and malnutrition
Poor hand hygiene and breaks in aseptic technique
Supine position, heavy sedation and aspiration in ventilated patients
Broad-spectrum antibiotic use

Pathophysiology

Devices bypass natural barriers: a central line connects skin to blood, a urinary catheter opens the bladder to perineal flora, and an endotracheal tube lets contaminated oropharyngeal secretions leak past the cuff into the lower airway. Bacteria form biofilms on device surfaces, where they are protected from host defences and antibiotics, and then seed the bloodstream, bladder or lungs.

Classification

Central line-associated bloodstream infection (CLABSI)
Catheter-associated urinary tract infection (CAUTI)
Ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia
Surgical site infection: superficial, deep or organ/space
Clostridioides difficile infection

Symptoms and signs

New fever or hypothermia in a hospitalised patient
CLABSI: fever, chills, redness or pus at the line site, chills after flushing the line
CAUTI: fever, suprapubic or flank pain, cloudy urine, delirium in older adults
VAP: new purulent secretions, worsening oxygenation and new infiltrate on chest imaging
Wound redness, discharge or dehiscence in surgical site infection
Diarrhoea after antibiotics in C. difficile infection

Diagnosis

Clinical: New signs of infection 48 hours or more after admission or after a device was placed, with no other source. Surveillance definitions (such as those used by national programmes) differ from bedside clinical diagnosis but share the same core criteria.
Tests: Paired blood cultures (one from the line and one peripheral) for CLABSI; urine culture taken from the catheter sampling port, not the bag, for CAUTI; lower respiratory secretions (tracheal aspirate or bronchoalveolar lavage) for VAP; C. difficile toxin or PCR testing on unformed stool. Inflammatory markers and lactate support assessment of severity.
Imaging: Chest radiography or CT for a new infiltrate in VAP; ultrasound or CT to look for collections, abscesses or infected thrombi; echocardiography in S. aureus or persistent bacteraemia.

Differential diagnosis

Asymptomatic bacteriuria or colonisation of the device
Atelectasis, pulmonary oedema, ARDS or pulmonary embolism in ventilated patients
Drug fever, thrombophlebitis or transfusion reaction
Non-infectious postoperative inflammation

Goal of treatment

Treat the infection with appropriate antibiotics and source control (often device removal), and above all prevent new cases with hand hygiene, bundles and early removal of devices that are no longer needed.

Treatment

Procedure: Remove or replace the infected device when possible: central line removal in most CLABSI, catheter change or removal in CAUTI, drainage of surgical collections.
Medical: Empirical antibiotics chosen from local resistance patterns and the patient's risk of MDRO, then narrowed to culture results; specific therapy for C. difficile.
Follow-up: Prevention bundles. Central lines: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, preferred insertion site, daily review and hub disinfection. Urinary catheters: insert only when indicated, aseptic insertion, closed drainage with the bag below the bladder, daily review and early removal. Ventilators: head of bed raised 30 to 45 degrees, daily sedation interruption and weaning trials, oral care and subglottic secretion management.
Conservative: Institutional measures: active surveillance and reporting of IAAS rates, staff training, environmental cleaning and antibiotic stewardship.

Complications

Sepsis and septic shock
Infective endocarditis, septic thrombophlebitis and metastatic infection
Pyelonephritis and urosepsis
Prolonged ventilation and intensive care stay
Selection and spread of multidrug-resistant organisms
Increased cost and mortality

Prognosis

Healthcare-associated infections lengthen hospital stays and raise mortality, especially bloodstream infection and VAP in critically ill patients. Many are preventable: well-applied bundles and surveillance programmes have markedly reduced their rates.

Prevention

Hand hygiene at the WHO five moments
Insertion and maintenance bundles for central lines, urinary catheters and ventilators
Daily review of every device and removal as soon as it is no longer needed
Perioperative measures to prevent surgical site infection
Antibiotic stewardship and isolation of MDRO carriers

Test yourself

Think of the answer, then tap the question to see it.

What time frame usually defines an infection as healthcare-associated?

Onset 48 hours or more after admission (or after device placement), not present or incubating on admission.

What is the single most effective measure to prevent healthcare-associated infections?

Hand hygiene at the five moments of care.

Where should a urine sample be taken from a patient with an indwelling catheter?

From the catheter's sampling port using aseptic technique, never from the drainage bag.

What bed position is part of the ventilator-associated pneumonia bundle?

Head of the bed raised 30 to 45 degrees, unless contraindicated.

What is the most effective way to prevent CAUTI?

Avoid unnecessary urinary catheters and remove them as soon as they are no longer needed.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: About HAIs | HAIs | CDC (Centers for Disease Control and Prevention (CDC), 2024); Fichas y Protocolos | INS (Instituto Nacional de Salud (Colombia), 2025).

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Representative model, for educational purposes only.

Urinary bladder highlighted on the Durgical 3D model