Have you ever noticed how a cold or flu can spread rapidly through a school or a workplace? Once an infection enters a limited-access institution like a school, close and constant contact increases the likelihood that others inside the institution will become infected. Hospitals face even more daunting infection control challenges than other limited-access institutions. While schools and sports teams can ask sick students and athletes to stay home, hospitals must invite sick residents in. Some patients may bring infectious bacteria in with them, and others may be more susceptible to infections because illness or injury has compromised their immune systems. Because hospital staff must attend to both types of patients, hospital workers and equipment are often unintentional conduits for the spread of infection.

Infection control in hospital settings is difficult, time-intensive, expensive, and unglamorous work. And though many hospitals want to improve infection control, the incentives they are currently getting send exactly the opposite message. Take staff hand-washing, for example. Installing additional hand-washing stations and strengthening hand-washing habits among doctors, nurses, and other hospital workers could be an attainable and effective strategy to reduce infection rates. But while Medicare and private insurers will pay for neither installing washing stations nor training hospital staff, both Medicare and private insurers will pay for antibiotics required to treat infections as they spread throughout the hospital. Thus hospitals have a financial incentive to allow the status quo to continue.

Medicare has begun to change those incentives, with restrictions on payments for infections the government considers avoidable. Still, it remains to be seen whether this change in policy will affect practice.


The UVA Medical Center has demonstrated over more than two decades that resistant infections can be controlled in hospitals. Despite their success and 14 studies reporting cost savings from active detection and isolation, many assume without data that attempting control this way would be too expensive. Read more about the UVA effort.