Health Inequities Drive Higher Infection Risk for Spanish-Speaking Hospital Patients, Kaiser Permanente Data Show

Health Inequalities and HAIs APIC25

New research presented at the 2025 APIC Annual Conference and Expo, held in Phoenix, Arizona, from June 16 to 18, 2025, has spotlighted a troubling disparity in health care outcomes: Spanish-speaking patients are significantly more likely to contract health care-associated infections (HAIs) during hospital stays than English-speaking patients. According to data from Kaiser Permanente of Northern California, these disparities persist even when formal interpreter services are used.

The findings are based on a 5-year review of publicly reported infection data from 21 Northern California Kaiser Permanente hospitals. Between 2019 and 2023, the infection prevention team tracked 6,813 cases and analyzed the data to assess the relationship between language barriers and infection risk. Their analysis revealed that Spanish-speaking patients, as well as other non-English speakers, faced higher rates of several serious infections.

"It is essential that we keep raising our voices about the issue of inequities as a driving factor for some of our patients and communities being at risk for or getting infections,” said Cristine Lacerna, DNP, RN, MPH, FAPIC, CIC, senior regional director of infection prevention at Kaiser Permanente Northern California. “Highlighting these disparities is an act of infection prevention. The best thing infection preventionists can do to incorporate the issue of health equity in their program is to collect data. Show and highlight the problem objectively first."

Among the most concerning trends was an elevated risk of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) among Spanish-speaking adults. Additionally, surgical site infections (SSIs) increased in both adult and pediatric patients with limited English proficiency. These outcomes suggest that language and communication barriers may be critical but underrecognized contributors to infection vulnerability in acute care settings.

Further complicating the issue is the role of interpreter use. While hospitals routinely rely on professional interpreters to facilitate communication, the study found that the use of interpreters, whether formal or informal, was itself associated with an increased risk of infection. The risk was even higher when family members or friends served as interpreters. In these cases, patients faced increased odds not only for CLABSI, CAUTI, and SSIs but also for infections caused by Clostridioides difficile, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus.

The evidence points to a stark conclusion: language barriers and the inconsistent use of trained interpreters are not merely inconveniences; they are associated with measurable, adverse health outcomes. The data show that patients who are not proficient in English face a compounded risk, stemming both from communication challenges and from systemic health care inequities that have yet to be fully addressed.

These disparities underscore a broader issue in infection prevention: the need to incorporate social and demographic risk factors, including language and cultural background, into health care-associated infection mitigation strategies. The elevated infection risk among non-English speaking patients signals a gap in current infection control frameworks and calls for a reassessment of how preventive measures are applied across diverse patient populations.

The presentation emphasized that interpreting services, while necessary, are not sufficient to close this gap on their own. The increased infection rates, even with interpreter use, suggest that deeper, systemic issues may be at play, ranging from delays in care and misunderstanding of discharge instructions to limited comprehension of infection prevention protocols and postprocedural hygiene guidance. Informal interpreters, such as family members, may also lack the necessary training to accurately convey medical terminology or may be reluctant to ask clarifying questions, which can further exacerbate the risk.

Kaiser Permanente’s findings offer a data-driven starting point for infection preventionists and health care administrators to examine where communication-related inequities may be creating vulnerabilities in patient safety. As multilingual and multicultural populations continue to grow across the United States, hospitals must develop more robust approaches to identifying and addressing these disparities in real-time.

The research team behind the study emphasized the importance of ongoing data collection and analysis to understand the full scope of how language proficiency and cultural barriers influence infection outcomes. They also highlighted the importance of embedding health equity considerations into the design and implementation of infection control protocols, staffing strategies, and patient education materials.

The session, titled “Do Health Inequities Cause a Greater Risk of Healthcare-Associated Infections in Acute Care Settings?” is part of a growing body of work aiming to move infection prevention beyond standardized clinical procedures toward inclusive, equity-focused models of care. The data presented urges health care organizations to move beyond language access as a compliance issue and treat it as a patient safety priority.

As the health care system continues to navigate the intersection of infection prevention, health equity, and patient-centered care, this research marks a pivotal moment. It not only reveals gaps in the current system but also offers a path forward—one that demands innovation, policy reform, and deeper engagement with the diverse communities that hospitals serve.

“The reality of health inequities’ link to HAIs presents infection preventionists with an opportunity to not only better understand their impact on outcomes, but to identify disparities and how to mitigate them in all non-English speaking populations,” said APIC 2025 President Carol McLay, DrPH, MPH, RN, FAPIC, FSHEA, CIC.

PHHP 18 –“Do Health Inequities Cause a Greater Risk of Healthcare-associated Infections in Acute Care Settings?” is being presented from 2:15 PM to 2:35 PM MST on June 16, 2025, at the APIC Annual Conference and Expo in Phoenix, Arizona.