Vertical Versus Horizontal Infection Control Interventions

ABSTRACT

Healthcare-associated infections are a major burden on a nation's healthcare system and prevention has been an area of major focus. Several strategies have been used to minimize transmission of organisms including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and Candida auris. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently emerged as organism of epidemiologic importance, causing a pandemic and overwhelming healthcare facilities worldwide. Vertical strategies target a specific organism and include measures such as active surveillance cultures which may be followed by isolation or decolonization. In contrast, horizontal strategies aim to reduce infections caused by all microorganisms sharing a common means of transmission. Examples of horizontal measures include implementation of hand hygiene, universal decolonization, selective digestive tract decolonization, antimicrobial stewardship, and environmental cleaning. While there is no clear consensus over which strategies are most optimal in different settings, horizontal strategies are more likely to have a broader impact and are more cost-effective. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.