A setting used to treat sudden, often unexpected, urgent or emergent episodes of injury and illness that can lead to death or disability without rapid intervention. The term acute care encompasses a range of clinical health care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care, and short-term inpatient stabilization.

An alcohol-based preparation designed for application to the hands to inactivate microorganisms and/or temporarily suppress their growth. Such preparations may contain one or more types of alcohol and other active ingredients with excipients and humectants.

Major antimicrobial resistance surveillance systems focus on data from invasive isolates. According to the European Antimicrobial Resistance Surveillance Network (https://ecdc.europa.eu/en/publications-data/earsnet-reporting-protocol-2017) and the USA National Healthcare Safety Network (https://www.cdc.gov/nhsn/pdfs/pscmanual/11pscaurcurrent.pdf), eligible specimens to identify invasive isolates include cerebrospinal fluid and blood specimens.

Carbapenem resistance among Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa may be due to a number of mechanisms. Some strains may be innately resistant to carbapenems, while others contain mobile genetic elements (for example, plasmids, transposons) that result in the production of carbapenemase enzymes (carbapenemases), which break down most beta-lactam antibiotics, including carbapenems. Frequently, CP genes are co-located with other resistance genes, which can result in cross-resistance to many other antibiotic drug classes (1–3). Thus, while carbapenem-resistant strains of these pathogens are frequently CP (CP-Enterobacteriaceae [CPE], CP-A. baumannii, CP-P. aeruginosa), they may have other carbapenem resistance mechanisms that make them equally difficult to treat and manage clinically. Thus, the term “carbapenem-resistant Enterobacteriaceae” includes all strains that are carbapenem-resistant, including CPE. For this reason, infection and prevention control actions should focus on all strains of carbapenem-resistant Enterobacteriaceae, A. baumannii and P. aeruginosa, regardless of their resistance mechanism. Adequate infection prevention and control measures are essential in both outbreak and endemic settings (4).

The practice of grouping together patients who are colonized or infected with the same organism in order to confine their care to one area and prevent contact with other susceptible patients. Cohorts are created based on clinical diagnosis, microbiological confirmation with available epidemiology and the mode of transmission of the infectious agent. Cohorting is defined according to the United States Centers for Disease Control and Prevention (CDC) Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007 (5).

Measures intended to prevent the transmission of infectious agents, which are spread by direct or indirect contact with the patient or the patient environment. These include: ensure appropriate patient placement; use of personal protective equipment, including gloves and gowns; limit the transport and movement of patients; use disposable or dedicated patient-care equipment; and prioritize the cleaning and disinfection of rooms. Contact precautions are defined according to the CDC Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007 (5).

An approach used to assess the quality of a body of evidence and to develop and report recommendations.

For the purpose of these guidelines, a health care facility includes any type of acute care facility, secondary or tertiary care facilities, long-term care facilities and rehabilitation centres.

An infection occurring in a patient during the process of care in a hospital or other health care facility, which was not present or incubating at the time of admission. Health care-associated infections can also appear after discharge.

The proportion of patients with one or more active health care-associated infections at a given time point.

The number of new cases of health care-associated infections occurring during a certain period in a population at risk.

WHO Member States are grouped into four income groups (low, lower-middle, upper-middle and high) based on the World Bank list of analytical income classification of economies for the fiscal year, which is based on the Atlas gross national income per capita estimates (released annually in July). For the current 2017 fiscal year, low-income economies are defined as those with a gross national income per capita of US$ 1005 or less in 2016; middle-income economies are those with a gross national income per capita of more than US$ 1045, but less than US$ 12 235; high-income economies are those with a gross national income per capita of US$ 12 236 or more. (Lower-middle-and upper-middle-income economies are separated at a gross national income per capita of US$ 4125.)

A multimodal strategy comprises several elements or components (three or more; usually five) implemented in an integrated way with the aim of improving an outcome and changing behaviour. It includes tools, such as bundles and checklists, developed by multidisciplinary teams that take into account local conditions. The five most common components include: (1) system change (availability of the appropriate infrastructure and supplies to enable infection prevention and control good practices); (2) education and training of health care workers and key players (for example, managers); (3) monitoring infrastructures, practices, processes, outcomes and providing data feedback; (4) reminders in the workplace/communications; and (5) culture change within the establishment or the strengthening of a safety climate. It is important to note the distinction between a multimodal strategy and a bundle. A bundle is an implementation tool aiming to improve the care process and patient outcomes in a structured manner and is often used as an operational tool in the context of multimodal strategies. Multimodal strategies are a more comprehensive implementation approach.

Patients should be placed in single-patient rooms when available. When single rooms are in short supply, patients who are infected or colonized with the same resistant pathogen can be placed in the same room together (cohorted). Adapted definition according to the CDC Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007 (5).

Contains the patient and his/her immediate surroundings. This typically includes all inanimate surfaces that are touched by or in direct physical contact with the patient, such as the bed rails, bedside table, bed linen, infusion tubing, bedpans, urinals and other medical equipment. It also contains surfaces frequently touched by health care workers during patient care, such as monitors, knobs and buttons, and other “high frequency” touch surfaces. This is according to the definition included in the WHO guidelines on hand hygiene in health care (6). Contamination is also likely in toilets and associated items (7).