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I NT E RV I E W Efforts Aim to Create an Infection-Free Hospital Environment Hospital-associated infections are a major public health concern across the nation. The U.S. Centers for Disease Control and Prevention estimates that on any given day, one in 25 hospital patients has at least one infection associated with their care or the hospital environment, and approximately 75,000 patients die each year as a result. At UCLA, continuously evaluated efforts to adopt and implement the best possible prevention practices are led by infectious disease experts Zachary Rubin, MD, and Daniel Uslan, MD. What are the aspects unique to a hospital environment that put people at risk for infection? Dr. Rubin: Part of it is the medical technology. Infections can occur when patients are being supported by artificial equipment that bypasses the normal immune system. For instance, a patient may be placed on a ventilator that can bypass our ability to get rid of secretions, allowing some of the bacteria that are living in Zachary Rubin, MD, and Daniel Uslan, MD UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) the mouth and the upper airway to get down to the lower lungs and cause pneumonias. Central venous catheters are large IVs that get placed through the skin into central veins, which opens up the possibility that bacteria from the skin or from the outside can get into the bloodstream. And the same is true with surgery; any time you open up a sterile site, there’s the possibility that bacteria from the skin or from outside can get in. What has changed over the years to make infection prevention more challenging for hospitals? Dr. Rubin: Patients in hospitals have been getting sicker, partly because of healthcare’s success in keeping people alive who would not have survived even 20 or 30 years ago. Many of these patients who are surviving longer have impaired immune systems and are thus more vulnerable to catching infections. We