the catheter (without flushing it into the bloodstream) reduces the formation of biofilms. Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact transmission. Patient susceptibility Alongside reducing vectors for transmission, patient susceptibility to hospital-acquired infection needs to be considered. Factors which render patients at greater risk of infections include: Receipt of immunosuppressive medications such as glucocorticoids or immunosuppressive drugs as part of treatments for cancer, organ transplantation or autoimmune diseases Impaired immunity due to diseases such as haematological malignancy, primary immunodeficiency, HIV/AIDS or critical illness, including severe COVID-19 Presence of indwelling devices which breach natural defences, including endotracheal tubes, central venous catheters and urinary catheters. The use of antibiotics does not, itself, increase risk of hospital-acquired infections, but does contribute to the prevalence of Antimicrobial resistant organisms amongst patients with hospital-acquired infections Device-associated infections Given the association between invasive devices and hospital-acquired infections, specific terms are used to delineate such infections to allow for monitoring and prevention. Noted device-associated infections include ventilator-associated pneumonia, catheter-associated blood stream infections, catheter-associated urinary tract infections and device-associated ventriculitis. Surveillance for these infections is commonly undertaken and reported by bodies such as the European Centre for Disease Prevention and Control and Centers for Disease Control and Prevention. Prevention Controlling nosocomial infection is to implement QA/QC measures to the health care sectors, and evidence-based management can be a feasible approach. For those with ventilator-associated or hospital-acquired pneumonia, controlling and monitoring hospital indoor air quality needs to be on agenda in management, whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced. To reduce the number of hospital-acquired infections, the state of Maryland implemented the Maryland Hospital-Acquired Conditions Program that provides financial rewards and penalties for individual hospitals. An adaptation of the Centers for Medicare & Medicaid Services payment policy causes poor-performing hospitals to lose up to 3% of their inpatient revenues, whereas hospitals that are able to decrease hospital-acquired infections can earn up to 3% in rewards. During the program's first two years, complication rates fell by 15.26% across all hospital-acquired conditions tracked by the state (including those not covered by the program), from a risk-adjusted complication rate of 2.38 per 1,000 people in 2009 to a rate of 2.02 in 2011. The 15.26% decline translates into more than $100 million in cost savings for the health care system in Maryland, with the largest savings coming from avoidance of urinary tract