Assessing Policies Versus Practices Utilizing the CDC Infection Control Assessment and Response Tool

Abstract

Background: The Infection Control Assessment and Response (ICAR) tool was developed by the CDC following the 2014 Ebola outbreak. Over a 3-year period, the CDC dispensed Funding: to all public health divisions in all 50 states to implement and promote the ICAR. The ICAR was developed as a self-assessment tool to evaluate policies, competencies, and practices across healthcare settings. The primary aim of the tool and associated Funding: was to guide quality improvement activities by addressing the identified gaps in infection prevention (IP). Independent of state funding, we sought to use the ICAR to evaluate whether there were differences in reported policies from observed practices related to hand hygiene (HH) and personal protective equipment (PPE) use in long-term care facilities (LTCFs), ambulatory surgical centers (ASCs), and outpatient pain clinics (OPCs). Methods: From November 2018 to August 2019, we conducted in-person ICAR assessments in 7 LTCFs in 3 states (Arizona, Utah, and Idaho), 2 ASCs in 2 states (Arizona, Indiana), and 5 OPCs in 1 state (Arizona). All on-site assessments were conducted with the ICAR tool by a board-certified infection preventionist. The paper form was converted to a mobile compatible digital audit tool utilizing Microsoft Forms on the Microsoft 365 platform. Once a survey was completed, it was sent to an Excel database and analyzed utilizing SPSS software. Results: All facilities (14 of 14, 100%) had a designated person responsible for coordinating and/or directing the IP program. Moreover, 4 of 7 LTCFs (57%), 2 of 2 ASCs (100%), and 5 of 5 OPCs (100%) reported having written IP policies that met evidence-based guidelines, regulations, or standards (eg, CDC/HICPAC). None of the 7 LTCFs (0%), 2 of 2 ASCs (100%), and none of the 5 OPCs (0%) reported active surveillance to monitor and document adherence to proper PPE selection and use. During direct observation of hand hygiene opportunities, compliance was 23% for LTCFs (7 of 31 opportunities), 37% for ASCs (7 of 19 opportunities), and (11 of 28 opportunities) 39% in OPCs. Conclusions: Our results indicate that the ICAR tool remains a useful resource for distinguishing between the reporting of IP polices from the actual implementation of evidence-based practices. Although all facilities had a designated role for IP and most had written evidence-based IP polices, this did not translate to the observation of recommended HH and PPE practices. By utilizing this tool, healthcare facilities can support their evidence-based IP polices and further promote patient safety by identifying and mitigating gaps in practices.Funding: NoneDisclosures: None