Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T03:33:02.650Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving Patient Safety: Resource Availability and Application for Reducing the Incidence of Healthcare-Associated Infection

Published online by Cambridge University Press:  21 June 2016

Marly Christenson ,
John A. Hitt ,
Gordon Abbott ,
Edward J. Septimus  and
Nancy Iversen
Marly Christenson*
Affiliation:
VHA Mountain States, Denver, Colorado
John A. Hitt
Affiliation:
VHA Mountain States, Denver, Colorado Medical College of Georgia, Augusta, Georgia
Gordon Abbott
Affiliation:
VHA Central, Indianapolis, Indiana
Edward J. Septimus
Affiliation:
Memorial Hermann Healthcare System, Houston, Texas Billings Clinic, Billings, Montana
Nancy Iversen
Affiliation:
Billings Clinic, Billings, Montana
*
VHA Mountain States, LLC, 1401 17th Street, Suite 850, Denver, CO 80202 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

VHA Mountain States conducted a survey and analysis of infection control (IC) staffing resources, organizational structures, and clinical processes related to reducing the incidence of healthcare-associated infections (HAIs) in community healthcare facilities.

Methods.

Member participation was solicited for 2 study components. The first was a survey of demographic characteristics regarding the type and size of the facility and the structure and functions of IC departments. The second was an observational study of infection prevention practices related to general hand hygiene (GHH), ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), and catheter-related urinary tract infection (CRUTI).

Results.

A total of 31 not-for-profit community healthcare facilities submitted data; the number of beds in participating centers ranged from less than 50 beds (1 facility) to more than 500 beds (7 facilities). IC department staffing ranged from 0.3 to 5.0 full-time equivalents. There was a positive correlation between average daily census and IC staffing (r = .879; P<.001). Observational studies revealed that compliance with the use of alcohol-based hand rubs (77%) was significantly better than compliance with the use of soap and water (64%; P<.001). Seven (30%) of 23 organizations observed 90% or better compliance with VAP process measures; 7 of 27 (26%) observed 90% or better compliance with guidelines for preventing CRBSI; and 14 (56%) demonstrated proper placement of urinary drainage bags at least 90% of the time.

Conclusions.

There was variation in IC department structure and processes among the participating organizations. Infection prevention practices were inconsistent. These findings emphasize the need for more-effective implementation of current evidence-based recommendations for preventing HAIs and reducing the risk of harm to patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 3 , March 2006 , pp. 245 - 251
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kohn, L, Corrigan, J, Donaldson, M. To Err Is Human: Building a Safer Health System. Institute of Medicine report. Washington, DC: National Academy Press; 1999.Google Scholar
2.Page, A. Keeping Patients Safe: Transforming the Work Environment of Nurses. Committee on the Work Environment for Nurses and Patient Safety. Institute of Medicine. Washington, DC: National Academy Press; 2004.Google Scholar
3.Burke, JP. Infection control—a problem for patient safety. N Engl J Med 2003; 348:651–656.CrossRefGoogle ScholarPubMed
4.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994; 271:1598–1601.Google Scholar
5.Gerberding, JL. Hospital-onset infections: a patient safety issue. Ann Intern Med 2002; 137:665–670.Google Scholar
6.Jackson, M, Chiarello, LA, Gaynes, RP, Gerberding, JL. Nurse staffing and healthcare-associated infections: proceedings from a working group meeting. J Nurs Adm 2002; 32:314–322.Google Scholar
7.Scheckler, WE, Brimhall, D, Buck, AS, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1998; 19:114–124.Google Scholar
8.O'Boyle, C. The expanded role of the nurse in hospital epidemiology. In: Wenzel, R, ed. Prevention and Control of Nosocomial Infections, 4th ed. New York: Lippincott Williams & Wilkins; 2003:55–65.Google Scholar
9.O'Boyle, C, Jackson, M, Henley, SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control 2002; 30:321–333.Google Scholar
10.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Healthcare Infection Control Practices Advisory Committee. Society for Healthcare Epidemiology of America. Association for Professionals in Infection Control. Infectious Diseases Society of America. Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002; 23(12 Suppl): S3–S40.Google Scholar
11.The National Quality Forum. National Voluntary Consensus Standards for Hospital Care: an Initial Performance Measure Set. Washington, DC: The National Quality Forum; 2003.Google Scholar
12.Saint, S. Prevention of nosocomial urinary tract infections. In: Shojania, KG, Duncan, BW, McDonald, KM, Wachter, RM, eds. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. No. 01-E058. Evidence report/technology assessment no. 43. Rockville, MD: US Agency for Healthcare Research and Quality Publication; 2001:149–162.Google Scholar
13.Saint, S. Prevention of intravascular catheter–associated infections. In: Shojania, KG, Duncan, BW, McDonald, KM, Wachter, RM, eds. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. No. 01-E058. Evidence report/technology assessment no. 43. Rockville, MD: US Agency for Healthcare Research and Quality Publication; 2001:163–183.Google Scholar
14.Collard, HR, Saint, S. Prevention of ventilator-associated pneumonia. In: Shojania, KG, Duncan, BW, McDonald, KM, Wachter, RM, eds. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. No. 01-E058. Evidence report/technology assessment no. 43. Rockville, MD: US Agency for Healthcare Research and Quality Publication; 2001:185–203.Google Scholar
15.Berenholtz, SM, Dorman, T, Ngo, K, Pronovost, PJ. Qualitative review of intensive care unit quality indicators. J Crit Care 2002; 17:1–12.Google Scholar
16.O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2002; 23:759–769.Google Scholar
17.Pronovost, P, Berenholtz, S. A Practical Guide to Measuring Performance in the Intensive Care Unit. Vol. 2. Irving, TX: VHA Research Series; 2000.Google Scholar
18.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guidelines for preventing health-care-associated pneumonia, 2003. March 26, 2004. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm. Accessed October 19, 2004.Google Scholar
19.Wong, ES, Hooten, TM, Guidelines for prevention of catheter-associated urinary tract infections. Available at: http://www.cdc.gov/ncidod/dhqp/g1_catheter_assoc.html. Accessed March 12, 2004.Google Scholar
20.Bhende, S, Spangler, D. In vitro assessment of Chlorhexidine gluconate–impregnated polyurethane foam antimicrobial dressing using zone of inhibition assays. Infect Control Hosp Epidemiol 2004; 25:664–667.Google Scholar
21.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999; 130:126–130.Google Scholar
22.Pittet, D, Simon, A, Hugonnet, S, Pessoa-Silva, CL, Sauvan, V, Perneger, TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004; 141:1–8.Google Scholar