The 2nd National Action Plan for Prevention and Control of Healthcare-Associated Infections (2023–2027)

Abstract

On April 12, the Korea Disease Control and Prevention Agency unveiled ‘The 2nd National Action Plan for the Prevention and Control of Healthcare-Associated Infections (2023–2027).’ This initiative aims to foster a safer healthcare environment against infections by addressing the shortcomings of ‘The 1st National Action Plan for the Prevention and Control of Healthcare-Associated Infections (2018–2022),’ and establishing an enhanced national-level infection prevention and control system, reflecting the changed conditions in medical settings since coronavirus disease 2019.

Key messages

① What is known previously?

Effective control of healthcare-associated infections requires a comprehensive national-level management system, coupled with necessary environmental development and infection control practices by healthcare workers.

② What new information is presented?

‘The 2nd National Action Plan for Prevention and Control of Healthcare-Associated Infections’ broadens Korea Disease Control and Prevention Agency’s focus from a system centered on acute care hospitals to one that also includes small and medium-sized hospitals and long-term care hospital.

③ What are implications?

While overall healthcare-associated infection rates are declining in the Republic of Korea, plans should be developed for areas with inadequate management to ensure the protection of healthcare service users. Implementing an appropriate evaluation and support system is crucial.

Introduction

Healthcare-associated infections (HAIs) can develop in patients, guardians, visitors, and staff of medical institutions during various medical procedures such as hospitalization, examination, and courses of treatment. Essentially, these are new infections that manifest while individuals are undergoing medical care, infections that were not initially present upon hospital admission. Common HAIs include bloodstream infections, urinary tract infections, and ventilator-associated pneumonia [1]. The occurrence of HAIs contributes to an increase in patient mortality and fatality rates. Additionally, both individual patients and medical system bear an increased burden, evident in escalated medical costs due to extended hospitalization and limited treatment options due to limitations on available antibiotics. In the Republic of Korea (ROK), specific policies have been pursued in a segmented manner to address these issues, including ‘The 1st Master Plan for Infectious Disease Prevention and Control (2013–2017),’ ‘The Establishment of a Consultative Committee on Measures against HAIs (2015),’ and ‘The Implementation of National Action Plan on Antimicrobial Resistance (2016).’ However, frequent incidents of cluster infections, such as the mass deaths of newborns due to contaminated injections in 2017 and cluster outbreaks of sepsis associated with propofol in 2018, underscore the need for comprehensive, nationwide measures to address HAIs holistically. Consequently, ‘The 1st National Action Plan for the Prevention and Control of HAIs (2018–2022)’ was established in 2018.

Body

The incidence of major HAIs in ROK has been decreasing due to persistent efforts such as the establishment of National Action Plan, continuous expansion of the scope of management, and dissemination of detailed guidelines [2]. In intensive care units, the incidence of HAIs decreased from 4.83 cases per 1,000 days of hospital stay in 2012 to 2.72 cases in 2022. However, since 2020, awareness of infection control in ROK has increased due the coronavirus disease 2019 (COVID-19) pandemic, necessitating the need for a national policy that encompasses institutions vulnerable to infection control, such as small and medium-sized and long-term care hospitals. Accordingly, the Korea Disease Control and Prevention Agency (KDCA) announced ‘The 2nd National Action Plan for Prevention and Control of Healthcare-Associated Infections (2023–2027)’ to present the direction of a stronger infection control policy reflecting the changed conditions in medical settings since COVID-19 (April 12, 2023).

Under the 1st National Action Plan, the KDCA has broadened the scope of infection control by extending the criteria for establishing infection control rooms and designating infection control personnel (now applicable to hospital-level medical institutions with more than 100 beds, compared to the previous threshold of 150 beds). The foundation of the infection control system has been expanded by including more organizations and widening the surveillance areas of the Korean National Healthcare-associated Infections Surveillance System. Additionally, a network has been established to provide technical support and guidance on infection control to small and medium-sized hospitals that lack infection control resources. Collaboration among relevant ministries has strengthened compensation measures, such as the establishment of the ‘Operating Room Patient Safety Management Fee.’ Furthermore, the evaluation has been enhanced by introducing appropriateness evaluation for neonatal intensive care units.

However, despite the success of the 1st National Action Plan, the current level of infection control is insufficient to protect healthcare service recipients in the changed environment since COVID-19 (Figure 1).

Figure 1. Limitations of the 1st National Action Plan and Direction of the 2nd National Action Plan.

HAI=healthcare-associated infection.

Accordingly, the KDCA collaborated with infection control experts to establish a committee dedicated to promoting the development of countermeasures. This committee, jointly with the experts, promoted the establishment of the 2nd National Action Plan based on the results of the performance evaluation and surveys on the 1st National Action Plan. Consequently, intending to minimize blind spots in infection control, the KDCA, collaborated with relevant ministries with relevant resources—such as the Ministry of Health and Welfare and the Ministry of Environment—to establish 12 key tasks organized in 4 promotion strategies. The details are discussed below (Figure 2).

Figure 2. The 2nd National Action Plan for Prevention and Control of Healthcare-Associated Infections (2023–2027).

HAI=healthcare-associated infection; IPC=infection prevention and control.

First, our focus is on enhancing the medical institutions’ facilities and environmental management systems. Given that medical institutions are frequently accessed by high-risk groups, such as critically ill and immunocompromised patients, external factors to strengthen the protection of high-risk areas for infections should be enhanced. We aim to strengthen facility standards in high-risk areas, including negative pressure isolation rooms and single rooms in intensive care units, and to establish specific ventilation standards for reducing the spread of infection within medical facilities prone to infections. Additionally, based on the results of the surveys on infection control in medical institutions, we plan to create a safe injection administration environment by preparing medication-related guidelines suitable for the actual situation of small and medium-sized and long-term care hospitals and clinic-level medical institutions. Additionally, in collaboration with the Ministry of Environment, we plan to discuss the revision of guidelines for the separate disposal of medical waste, ensuring an efficient response in the event of new infectious diseases and improving the implementation of medical waste disposal.

Second, we will expand the foundation of the infection control system and strengthen infection control competencies. Effective infection control programs and systems can reduce HAIs by more than 30% [3]. According to the 2018 National Survey on Healthcare-Associated Infections, Medical institutions with infection control systems showed 90% of checking infection occurrences rate, 85% of infection control activities rate, 96% of checking disinfection and sterilization of medical device. However, medical institutions without infection control systems showed 73% in checking infection occurrences rate, 60% in infection control activities rate, 81% in checking disinfection and sterilization of medical device [4]. Therefore, we will expand the obligation to operate infection control rooms, establish an infection control committee, designate infection control personnel, and distribute specific guidelines for the practice of infection control rooms to support them in playing a critical role in infection control in medical institutions. Additionally, we aim to strengthen the statutory infection control education system for previous workers at medical institutions and reduce blind spots in management by expanding training to non-medical personnel such as caregivers and cleaners. We will review it to strengthen the competencies of prospective healthcare professionals through systematic infection control education from the undergraduate curriculum. Collaborating with related ministries, we plan to promote the enhancement of infection control competencies of related occupations, such as nursing assistants, to strengthen the implementation of infection control in clinic-level medical institutions. Additionally, we have newly designated and operated ‘Healthcare-Associated Infection Prevention and Control Week’ to raise awareness of the importance of and improve infection control practices among the public [5]. By raising awareness of infection control among administrators of medical institutions, we plan to spread enhanced awareness of the importance of infection control to all medical workers.

Third, we will expand the surveillance system for HAIs and enhance the evaluation and reward system for infection control activities of medical institutions. We aim to improve surveillance indicators to expand the scope of surveillance from the existing acute hospital-centered surveillance system to infections in long-term care hospitals and clinic-level medical institutions frequently used by the public. We will promote improvements in the infection control area of various medical institution evaluations, such as accreditation, appropriateness, and medical quality evaluations. As part of the 2nd National Action Plan, a separate long-term care hospital infection prevention and control fee was established last July to accommodate the unique characteristics of long-term care hospitals, which are differentiated from acute care hospitals. We plan to operate an appropriate compensation system for infection control activities.

Fourth, we will reform the response system for HAIs. Since there are no separate tools for inspection of the infection control activities of medical institutions under the current system, we intend to establish a system for checking and communicating the infection control activities of medical institutions regularly through cooperation with local governments. Additionally, the KDCA, which oversees HAI control, will secure the authority to implement HAI prevention tasks under the law to perform efficient infection control. Additionally, to strengthen the management of healthcare-associated infectious diseases such as Carbapenem-resistant Enterobacterales (CRE) infection, which has a high risk of transmission in medical institutions, we plan to distribute standard scenarios for responding to multidrug-resistant bacteria outbreaks and strengthen support for epidemiological investigations to local government officials. Lastly, to prevent the transmission of CRE infection to medical institutions and communities, which is continuously increasing in ROK, we plan to establish and operate a strengthened CRE response system by analyzing and referring to successful cases of responding to CRE infections in ROK and other countries.

Conclusion

Through under the 2nd National Action Plan, the KDCA aims to promote infection control practices, such as increasing the establishment rate of infection control rooms in medical institutions and optimizing the operation of infection control personnel. Furthermore, we plan to expand the participation of small and medium-sized and long-term care hospitals in infection control efforts. Through this, we aim to suppress the rise in the incidence of central line-associated bloodstream infection in intensive care units and reduce the number of patients with CRE infections.

While effective national management policies and active efforts of medical institutions can prevent HAIs, neglecting management may lead to a resurgence of these infections at any time. Globally, HAIs have been increasing annually [6]. The US Centers for Disease Control and Prevention reported an increase in healthcare-associated infectious diseases in 2021 compared to 2020 due to the impact of COVID-19, necessitating active control measured in each country [7]. In May 2022, in its resolution of the 75th World Health Assembly, World Health Organization urged countries to develop infection control action plans to ensure that all people who use or provide health services are safe from infection and manage them with measurable indicators and reminded of the importance of HAI control [8]. Following this international trend, we will actively implement the 2nd National Action Plan and promote creating a safe medical environment from infection through communication with stakeholders such as the medical community. More detailed information on ‘The 2nd National Action Plan for the Prevention and Control of Healthcare-Associated Infections (2023–2027)’ can be found on the ‘KDCA website (https://www.kdca.go.kr/).’