Abstract
BackgroundNosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs.ObjectiveTo develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources.MethodsAn evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test.ResultsTwo rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions.Discussion/ConclusionThis study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.
Highlights
Nosocomial infections (NIs), known as healthcare associated infections (HCAIs), are infections acquired during an episode of care in a healthcare facility [1]
This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control
NIs place a significant burden on patients and hospital staff as they result in medical complications, prolonged hospital stays, high rates of morbidity and mortality, and reduced quality of life; they place a significant burden on healthcare systems as they result in extra costs related to the extended hospitalization or readmission of patients, patient’s care-related expenses and costs involved in limiting further contagion [3,4,5,6,7]
Summary
Nosocomial infections (NIs), known as healthcare associated infections (HCAIs), are infections acquired during an episode of care in a healthcare facility [1]. These infections are directly related to care and are considered among the most common and preventable adverse events [2]. In the province of Quebec, the Comitedes infections nosocomiales du Quebec (CINQ) estimated, based on American studies, that the annual number of NIs reached somewhere between 80,000 and 90,000 patients in 2005, with an estimated mortality rate of between 1 and 10% [10]. Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs.
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