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

Abstract

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. 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). 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. 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.