Infection control interventions in small rural hospitals with limited resources: results of a cluster-randomized feasibility trial

Kurt B Stevenson,Grace Curry,Gregory J Stoddard,Stephan Harbarth,Katie Searle,Matthew H Samore,John M Boyce

doi:10.1186/2047-2994-3-10

Abstract

BackgroundThere are few reports on the feasibility of conducting successful infection control (IC) interventions in rural community hospitals.MethodsTen small rural community hospitals in Idaho and Utah were recruited to participate in a cluster-randomized trial of multidimensional IC interventions to determine their feasibility in the setting of limited resources. Five hospitals were randomized to develop individualized campaigns to promote HH, isolation compliance, and outbreak control. Five hospitals were randomized to continue with current IC practices. Regular blinded observations of hand hygiene (HH) compliance were conducted in all hospitals as the primary outcome measure. Additionally, periodic prevalence studies of patient colonization with resistant pathogens were performed. The 5-months intervention time period was compared to a 4-months baseline period, using a multi-level logistic regression model.ResultsThe intervention hospitals implemented a variety of strategies. The estimated average absolute change in “complete HH compliance” in intervention hospitals was 20.1% (range, 7.8% to 35.5%) compared to −3.1% (range −6.3% to 5.9%) in control hospitals (p = 0.001). There was an estimated average absolute change in “any HH compliance” of 28.4% (range 17.8% to 38.2%) in intervention hospitals compared to 0.7% (range −16.7 to 20.7%) in control hospitals (p = 0.010). Active surveillance culturing demonstrated an overall prevalence of MRSA carriage of 9.7%.ConclusionsA replicable intervention significantly improved hand hygiene as a primary outcome measure despite barriers of geographic distance and lack of experience with study protocols. Active surveillance culturing identified unsuspected reservoirs of MRSA colonization and further promoted IC activity.

Highlights

Significant investments in biomedical research have been made by the National Institutes of Health (NIH) and other funding agencies
We examine the feasibility of T3 research in small rural hospitals where limited resources present distinct challenges
During the time frames selected to determine the point-prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) by active surveillance culturing, those patients selected as candidates for providing surveillance cultures included any inpatient ≥18 years of age capable of giving informed consent

Summary

Introduction

Significant investments in biomedical research have been made by the National Institutes of Health (NIH) and other funding agencies Despite these efforts, much of the research has not “translated” into significant improvements of care at the patient and provider level [1,2]. Rural hospitals have typically been excluded because of small size, low patient census, and remote locations. These smaller facilities often struggle with inadequate financial resources and limited staff making full implementation of HH or infection control interventions appear less feasible [18,19]. There are limited published studies regarding rural IC quality improvement programs or rural healthcare worker (HCW) compliance with IC guidelines [20,21]. There are few reports on the feasibility of conducting successful infection control (IC) interventions in rural community hospitals

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Conclusion