Exploring the connection of health disparities and inequities with health care-acquired infections in North America: A scoping review of the literature.

Abstract

Background: Health care-associated infections (HAIs) pose a significant concern for patient safety, impacting one in 31 hospitalized patients in the United States. Traditional infection prevention strategies emphasize clinical and procedural factors. However, emerging evidence highlights the critical role of social determinants of health (SDOH). Factors such as race, ethnicity, socioeconomic status, insurance coverage, language barriers, disability, and other social disadvantages contribute to HAI disparities. Despite this increasing recognition, limited research has systematically examined these relationships. In response, the Association for Professionals in Infection Prevention and Epidemiology (APIC) established a Health Equity Committee to evaluate the impact of SDOH on HAIs and advance meaningful action.

Methods: A literature review was conducted to synthesize findings on the intersection of HAIs and SDOH. A comprehensive search strategy identified 16 relevant studies published between January 2014 and March 2024, focusing on catheter-associated urinary tract infections, central line-associated bloodstream infections, Clostridioides difficile infections, and surgical site infections.

Results: The findings revealed significant disparities in infection rates, readmission risks, and access to preventive measures. Black, Hispanic, and Asian patients experienced higher central line-associated bloodstream infections and catheter-associated urinary tract infections rates, particularly in pediatric populations. C difficile infections disproportionately affected individuals from disadvantaged neighborhoods and those insured through Medicare and Medicaid. Surgical site infections risks were higher among racial and ethnic minorities, especially in underserved areas with limited health care access. Additionally, hospitals serving socially vulnerable populations reported worse standardized infection ratios for HAIs yet were not consistently recognized in reimbursement penalties, highlighting systemic challenges in quality measurement.

Conclusions: To reduce HAI disparities, health care systems must adopt multifaceted approaches that include enhanced data collection, health equity-focused infection prevention strategies, and policy reforms that address SDOH-driven risks. Prioritizing longitudinal studies and systematic analyses will be essential in advancing equitable health care and improving patient outcomes across diverse populations.