Organization Of Infection Control Research Articles

Implications of deduplication on the detection rates of multidrug-resistant organism (MDRO) in various specimens: insights from the hospital infection surveillance program

BackgroundCurrently, different guidelines recommend using different methods to determine whether deduplication is necessary when determining the detection rates of multidrug-resistant organisms (MDROs). However, few studies have investigated the effect of deduplication on MDRO monitoring data. In this study, we aimed to investigate the influence of deduplication on the detection rates of MDROs in different specimens to assess its impact on infection surveillance outcomes.MethodsSamples were collected from hospitalized patients admitted between January 2022 and December 2022; four types of specimens were collected from key monitored MDROs, including sputum samples, urine samples, blood samples, and bronchoalveolar lavage fluid (BALF) samples. In this study, we compared and analysed the detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CRECO), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and methicillin-resistant Staphylococcus aureus (MRSA) under two conditions: with and without deduplication.ResultsWhen all specimens were included, the detection rates of CRKP, CRAB, CRPA, and MRSA without deduplication (33.52%, 77.24%, 44.56%, and 56.58%, respectively) were significantly greater than those with deduplication (24.78%, 66.25%, 36.24%, and 50.83%, respectively) (all P < 0.05). The detection rates in sputum samples were significantly different between samples without duplication (28.39%, 76.19%, 46.95%, and 70.43%) and those with deduplication (19.99%, 63.00%, 38.05%, and 64.50%) (all P < 0.05). When deduplication was not performed, the rate of detection of CRKP in urine samples reached 30.05%, surpassing the rate observed with deduplication (21.56%) (P < 0.05). In BALF specimens, the detection rates of CRKP and CRPA without deduplication (39.78% and 53.23%, respectively) were greater than those with deduplication (31.62% and 42.20%, respectively) (P < 0.05). In blood samples, deduplication did not have a significant impact on the detection rates of MDROs.ConclusionDeduplication had a significant effect on the detection rates of MDROs in sputum, urine, and BALF samples. Based on these data, we call for the Infection Prevention and Control Organization to align its analysis rules with those of the Bacterial Resistance Surveillance Organization when monitoring MDRO detection rates.

Influences of Prevention Knowledge Regarding Catheter-associated Urinary Tract Infection (CAUTI), Workplace Learning, and Recognition of Infection Control Organization Culture on the Prevention Performance of CAUTI among Long-term Care Hospitals Nurses

Influences of Prevention Knowledge Regarding Catheter-associated Urinary Tract Infection (CAUTI), Workplace Learning, and Recognition of Infection Control Organization Culture on the Prevention Performance of CAUTI among Long-term Care Hospitals Nurses

Influence of nanocrystalline cerium dioxide on antigens of non-specific protection of quails

Intensive poultry farming technologies are closely linked to a variety of environmental, technological, feed and biological stressors, which tend to negatively affect their productivity and immune defenses. In the pathogenesis of such detrimental effects, the leading role belongs to the overproduction of oxygen free radicals - oxidative stress. The latter activates a number of transcription factors, including Nrf-2 and Nf-kB, which modulate the antioxidant defense network and participate in the organization of infection control. NDC is able to reduce the activation of Nf-kB and thus maintain antioxidant balance, but the response of the immune system to this factor is insufficiently studied. The aim of our work is to investigate the effect of NDC on the antigen of non-specific immunity of quails by adding it to drinking water. The object of study were the quail of the Pharaoh breed, experimental and control groups formed at the age of one day on the principle of analogues. The birds were kept in cages with free access to food and water. Quails of the experimental group in drinking water was added to the feed additive Nanocerium at a dose of 8.6 mg per liter of drinking water. This additive is an aqueous dispersion of NDC with an average nanoparticle size of 2-7 nm. The average weight of quails at the end of the experiment (56 days) in the experimental group was 20.2 g greater than in the control. Morphometric studies of the thymus, bursa and spleen showed no effect of NDC on the central and peripheral immune systems. Morphological parameters of the blood were within the physiological norm, but in the experimental group the number of erythrocytes and hemoglobin content were higher. The leukocyte count showed an increase in the leukocyte count (according to Garkavi LH) in the experimental group. Humoral performance was identical in both groups. Studies of cellular defense indicate no effect on the phagocytic function of peripheralblood cells. Functional and metabolic activity under the influence of NDC in the spontaneous test probably did not differ and increased in the stimulated. Therefore, quails that received nanocerium feed additive with water had a higher immunoresistance. Key words: birds, nanocerium, morphometry, thymus, natural immunity, morphological parameters of blood, hematopoiesis, humoral immunity, cellular immunity, hematological parameters. Accepted abbreviations: NDC – nanocrystalline cerium dioxide, ROS – reactive oxygen species, Nf-kB – nuclear factor - kV, Nrf-2 – nuclear factor - erythroid 2 and related factor 2.

Factors related to the accurate application of NHSN surveillance definitions for CAUTI and CLABSI in Texas hospitals: A cross-sectional survey

Previous studies indicate variability in the accurate application of National Healthcare Safety Network surveillance criteria with limited data on possible contributing factors. In this cross-sectional, convenience sampled web-based survey sent to members of Texas infection prevention and control organizations, training, experience, and time spent on surveillance was collected and assessed including 2 case studies. Our results indicate correct identification of catheter-associated urinary tract infection (CAUTI) and central line-associated bloodstream infection (CLABSI) criteria may be associated with 2019 National Healthcare Safety Network training (CAUTI: aOR = 0.17, 95% CI: 0.04, 0.80; CLABSI: aOR = 0.45, 95% CI: 0.045, 4.56) and increased years of infection prevention experience (CAUTI: aOR = 1.35, 95% CI: 0.42, 4.33; CLABSI: aOR = 1.23, 95% CI: 0.24, 6.38). Routinely performing more hours of surveillance may increase accuracy of CLABSI identification, but not CAUTI.

Interest in Working as an Infection Prevention and Control Nurse and Perception of This Position by Nursing Students-Results of a Pilot Study.

Background: The results of several studies in the area of infection control in Poland are disturbing. The situation may be shaped by many factors. However, the key factor for effective infection prevention and control is dedicated personnel, especially infection prevention and control nurses (IPCN). Nevertheless, based on the available published data and the authors’ experience, in many Polish hospitals infection control is not sufficiently appreciated by managers, it is consequently underfunded, and treated by medical staff as a nuisance. This may influence the nurses willingness to work as IPCN. The aim of the study was to assess the nursing students’ perception of the work of IPCN and their interest in employment in this position, as well as the potential reasons for choosing this particular specialization. Materials and methods: The study was conducted using the authors’ anonymous questionnaire conducted among nursing students of three Polish universities. The questionnaire was prepared by a panel of experts working in the field of infection control, including nurses working both as academic teachers and infection control nurses in hospitals. The design of the questionnaire was based on the authors’ own experience, knowledge, and exchanging information with the practitioners in infection control in Poland. The reliability of the questionnaire was confirmed by the Cronbach alpha test. The raw alpha values and 95% CI for two main questions concerning opinion were: 0.76 (0.72–0.81) and 0.69 (0.63–0.75). Results: The study was conducted among 253 students, mostly women (98%) of full-time (31.4%) and extramural (68.6%) studies. The age range of the respondents was 20–58 years, median = 26 years, IQR = 19 years. To the key item in the questionnaire, i.e., “Would you like to work as an IPCN?”, 84.6% (214 respondents; first group) of the respondents answered “no” and 15.4% (39 respondents, second group) answered “yes”. The results revealed no significant differences between the two groups concerning the position responsibilities and appreciation by other medical staff. Additionally, for respondents willing to work as ICPN the most important issues were the influence on patient safety, expected salary, and possibility of professional development; for the respondents from the other group the most important issue was lack of contact with patients. The results concerning the students’ opinion on the perception of IPCN by medical personnel proved to be peculiar. About 80% of the respondents confirmed the IPCNs’ key role in ensuring patient and personnel safety, while only 31.6% declared their high standing in the hospital hierarchy. Conclusions: The obtained results indicate the necessity of thorough studies on the organization and structure of infection control in Polish hospitals, with a particular emphasis on building a positive perception of IPCNs by medical staff, as well as implementing an education campaign on infection control in the hospital environment.

The use of personal protective equipment in clinical ophthalmology during corona virus disease-2019: a review of international guidelines and literature.

The use of nonpharmaceutical interventions can prevent viral spread in COVID-19 pandemic and PPE forms a crucial part of this strategy. However, there are discrepancies in existing guidelines and a lack of consensus among ophthalmic communities. This review aims to identify general consensus and provides recommendation of PPE for most common ophthalmological scenarios. With a global shortage of PPE, extended use and reuse strategies are also discussed. In this review, guidelines and resources were selected, based on a three-tier process. The first-tier resources were from international infection control organizations. The second-tier resources were from ophthalmological professional associations and colleges. The third-tier resources involved a PubMed search using the keywords 'COVID-19; coronavirus; personal protective equipment' performed on 1 May 2020. Non-English guidelines and literatures were excluded. On the basis of our methodology, we included a total of 30 documents, including 5 resources from tier 1, 14 resources from tier 2 and 15 from tier 3. Different levels of protection are necessary. Whenever performing an aerosol generating procedure, maximum protection should be ensured, this includes FFP3 respirator, fluid resistant gown, goggles or face-shield and disposable gloves. Similar protection should be used for handling COVID-19-positive/suspected case but the use of FFP2 respirator is acceptable. During routine outpatient clinic in cases of negative triage, it is recommended to use ASTM III surgical mask, plastic apron, disposable gloves and eye protection with goggles or face-shield. Lastly, patients should be encouraged to wear surgical masks whenever possible.

Selected aspects of the knowledge and practice concerning hand hygiene guidelines in the context of infection control structures in hospitals and long-term care facilities - findings of a questionnaire survey.

Hand hygiene (HH) is the simplest and the most fundamental means of hospital-acquired infection (HAI) prevention in both hospitals and long-term care facilities (LTCFs) which differ as to their structure, organization and epidemiology. The objective of this study was to evaluate the knowledge of, and attitudes towards, compliance with the HH guidelines by medical staff of LTCFs and hospitals, in the context of infection control organization. The study was carried out among medical staff of LTCFs and hospitals using an anonymous questionnaire designed by the authors. The questionnaire was composed of 22 questions. Among 237 healthcare workers from LTCFs and hospitals (51.5% vs. 48.5%), the vast majority were women (97.5% vs. 94.8%), who were nurses (86.9% vs. 91.3%) with 21-30 years of experience (28.5% vs. 44.3%). The respondents, both working in hospitals and in LTCFs, declared that there was some surveillance of HAIs in their workplace - 78.8% vs. 87.8%, respectively, p = 0.082. However, the respondents from LTCFs significantly more often than those working in hospitals declared the lack of HAI registration (12.3% vs. 0.9%, p = 0.002), as well as the lack of surveillance of multidrug-resistant microorganisms (16.4% vs. 4.3%, p = 0.010). Although the knowledge of WHO HH guidelines was declared by over 90% of the respondents, only about 70% of them (with no significant difference between both types of facilities) properly indicated the 5 moments of HH. The results of the study indicate that the organizational conditions and practice of HH in LTCFs and hospitals present some differences. Therefore, there is a need for observational studies concerning HH in the context of the structure and organization of infection control, as they are necessary for the development and implementation of effective programs to improve the situation in this field. Med Pr. 2020;71(5):531-7.

Organization of infection control in the Orenburg region in 1941– 1945: article dedicated to the 75th anniversary of the Great Victory

Risk of the spread of acute contagious infections at the front has sharply increased with the beginning of the Great Patriotic War of 1941–1945, as a result of which the problem of ensuring sanitary and epidemic wellbeing, including the home front, has been put forward. The issue of preventing the spread of infectious diseases was developed in the war period on the home front, by a group of scientists from the city of Chkalov as well. An important role was given to solving the problem of production of bactericides, improving the production of vaccines and serums, research to increase their immune properties, reduce reactivity, etc. Three institutes of epidemiology and microbiology functioned in the city of Chkalov (now Orenburg) in wartime: Smolensky, Chkalovsky and Ukrainian institute named after I. I. Mechnikov.

COVID-19 - what should anaethesiologists and intensivists know about it?

Over the past three months, the world has faced an unprecedented health hazard. The World Health Organization has announced a pandemic infection with an unknown species of coronavirus called SARS-CoV-2. Spreading mainly through the droplet route, the virus causes mild symptoms in the majority of cases, the most common being: fever (80%), dry cough (56%), fatigue (22%) and muscle pain (7%); less common symptoms include a sore throat, a runny nose, diarrhea, hemoptysis and chills. A life-threatening complication of SARS-CoV-2 infection is an acute respiratory distress syndrome (ARDS), which occurs more often in older adults, those with immune disorders and co-morbidities. Severe forms of the infection, being an indication for treatment in the intensive care unit, comprise acute lung inflammation, ARDS, sepsis and septic shock. The article presents basic information about etiology, pathogenesis and diagnostics (with particular emphasis on the importance of tomocomputer imaging), clinical picture, treatment and prevention of the infection. It goes on to emphasize the specific risks of providing anesthesiology and intensive care services. Due to the fact that effective causal treatment is not yet available and the number of infections and deaths increases day by day, infection prevention and strict adherence to recommendations of infection control organizations remain the basis for fighting the virus.

THE EVALUATION OF FUNCTIONING OF PRIVATE MEDICAL INSTITUTIONS IN THE REPUBLIC OF TAJIKISTAN

Introduction. The analysis of the problem of functioning of private medical institutions is dictated by a number of circumstances related to dramatic increasing of number of private medical services providers in Tajikistan during last years and also by danger of occurrence of medical practice of improper quality. Material and methods. The study included analysis of functioning of 681 private medical services providers according data of the Service of State Monitoring of Medical Activities and Social Defense of the Ministry of Health and Social Defense of Population of the Republic of Tajikistan. The evaluation of their activities was implemented using questionnaires covering all aspects of private medical institutions. Results. Among total sampling of private medical services providers, 325 (47.7%) are corporate bodies, 55 (8.1%) - branches of institutions of corporate bodies and 301 (44.2%) physical persons. In the private medical sector operate 3666 individuals and out of them 1559 physicians, 1234 paramedical personnel and 873 general service and supportive personnel. The analysis of distribution of private medical services providers according licensed activities established that the highest percentage had multi-field institutions (207 or 30.3%), stomatological services (200 or 29.4%) and ultra-sound diagnostic (88 or 12.9%). According the results of analysis established violations personnel of the Service of State Monitoring of Medical Activities and Social Defense, within the framework of authority, in 567 cases applied penalties and out of them vindictive damages in 43.2% of cases, suspending of illegal private practice in 31.2% of cases, disregard of legal requirements in the area of traditional medicine in 13.6% of cases and temporary suspending of functioning of institution in 11.6% of cases. Conclusion. To ameliorate functioning of private medical institutions of the Republic of Tajikistan a support is needed of further development of normative legal base with simultaneous support of private medical institutions with necessary normative materials. Also increasing of expenses of institutions to clinical security and amelioration of organization and quality of infection control are required.

Infection control bundles in intensive care: an international cross-sectional survey in low- and middle-income countries

In low- and middle-income countries (LMICs), the burden of healthcare-associated infections (HCAIs) is not known due to a lack of national surveillance systems, standardized infection definitions, and paucity of infection prevention and control (IPC) organizations and legal infrastructure. To determine the status of IPC bundle practice and the most frequent interventional variables in LMICs. A questionnaire was emailed to Infectious Diseases International Research Initiative (ID-IRI) Group Members and dedicated IPC doctors working in LMICs to examine self-reported practices/policies regarding IPC bundles. Responding country incomes were classified by World Bank definitions into low, middle, and high. Comparison of LMIC results was then made to a control group of high-income countries (HICs). This survey reports practices from one low-income country (LIC), 16 middle-income countries (MICs) (13 European), compared to eight high-income countries (HICs). Eighteen (95%) MICs had an IPC committee in their hospital, 12 (63.2%) had an annual agreed programme and produced an HCAI report. Annual agreed programmes (87.5% vs 63.2%, respectively) and an annual HCAI report (75.0% vs 63.2%, respectively) were more common in HICs than MICs. All HICs had at least one invasive device-related surveillance programme. Seven (37%) MICs had no invasive device-related surveillance programme, six (32%) had no ventilator-associated pneumonia prevention bundles, seven (37%) had no catheter-associated urinary tract infection prevention bundles, and five (27%) had no central line-associated bloodstream infection prevention bundles. LMICs need to develop their own bundles with low-cost and high-level-of-evidence variables adapted to the limited resources, with further validation in reducing infection rates.

Association of national and hospital factors to hospitals' alcohol-based handrub consumption in Europe: results of the European PROHIBIT study

ObjectivesHand hygiene is considered the most effective way to reduce the transmission of (multidrug-resistant) organisms and to prevent healthcare-associated infections. Hand rubbing with alcohol-based handrub (AHR) has become the reference standard for hand hygiene. Data on AHR consumption are easy to obtain and can serve as an approximation for hand hygiene compliance. As described earlier, AHR consumption varies among European hospitals. In the current study the role of various hospital and country indicators for AHR consumption is analysed. MethodsAs part of the European Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project hospital-based data on infection prevention and control (IPC) structure and organization and hospital-wide AHR consumption were obtained from acute care hospitals. National indicators such as income, public health expenditure, national hand hygiene campaigns, IPC training and the six Hofstede dimensions were identified. Univariable and multivariable linear regression analyses using generalized linear models were performed to estimate the association between AHR consumption and indicators at both hospital and country levels. ResultsData from 232 hospitals from 22 European countries were analysed. Multivariate risk factor analysis showed independent associations between AHR consumption and private and university-affiliated hospitals (multiplicative effect, 95% CI: 1.76, 1.21–2.55; and 1.39, 1.17–1.64, respectively), high-income countries (3.61, 2.94–4.43), and countries offering national curricula for the training of IPC nurses (3.77, 2.32–6.13). However, no cultural dimension was independently associated with AHR consumption. ConclusionCountry indicators such as high-income, national training on IPC, and hospital type and status are positively associated with AHR consumption in Europe.

Positioning and change in a hospital ward

PurposeThis paper focuses on communication about hygiene in a hospital ward and with the relevant infection control organization. The purpose of this paper is to examine the function of the hygiene coordinator as a key change agent and the communicative challenges and role conflicts implied in her practice. The author suggests strategies for improving communication on hygiene on ward level.Design/methodology/approachThe empirical material consists of interviews and recordings of communicative events in relation to a breakout of dangerous bacteria in the ward. Change communication is used as a contextualizing frame of understanding, and positioning theory and analysis are applied to shed light upon the core challenges of communicating as a change agent when the coordinator’s professional position and collegial relations do not support it.FindingsIt is shown how these challenges are connected to positional dilemmas regarding professional hierarchies and collegial relations. In order to have the hygiene coordinator gain authority and achieve empowerment in her function, additional documentation and training are needed, and communication efforts between the department management and the hygiene coordinator need strengthening. Furthermore, the hygiene area should be connected to the hospital’s overarching purpose of saving lives.Originality/valueThese findings point to the importance of taking communication on the departmental level into consideration in relation to change strategies, and they highlight the centrality of strategic positioning practices in a work environment which is organized in professional groups and according to distributed responsibilities.

Exploring the context for effective clinical governance in infection control.

Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance. A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework. Three hundred surveys were returned. IPs appear well equipped at an individual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources. Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements.

Organization of infection control in European hospitals

The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) survey was initiated to investigate the status of healthcare-associated infection (HCAI) prevention across Europe. This paper presents the methodology of the quantitative PROHIBIT survey and outlines the findings on infection control (IC) structure and organization including management's support at the hospital level. Hospitals in 34 countries were invited to participate between September 2011 and March 2012. Respondents included IC personnel and hospital management. Data from 309 hospitals in 24 countries were analysed. Hospitals had a median (interquartile range) of four IC nurses (2-6) and one IC doctor (0-2) per 1000 beds. Almost all hospitals (96%) had defined IC objectives, which mainly addressed hand hygiene (87%), healthcare-associated infection reduction (84%), and antibiotic stewardship (66%). Senior management provided leadership walk rounds in about half of hospitals, most often in Eastern and Northern Europe, 65% and 64%, respectively. In the majority of hospitals (71%), sanctions were not employed for repeated violations of IC practices. Use of sanctions varied significantly by region (P < 0.001), but not by countries' healthcare expenditure. There is great variance in IC staffing and policies across Europe. Some areas of practice, such as hand hygiene, seem to receive considerably more attention than others that are equally important, such as antibiotic stewardship. Programmes in IC suffer from deficiencies in human resources and local policies, ubiquitous factors that negatively impact on IC effectiveness. Strengthening of IC policies in European hospitals should be a public health priority.

P211: Organization and scope of infection control in Polish hospitals. First results of the pan-european prohibit survey

The PROHIBIT Prevention of Hospital Infections by Intervention and Training survey was initiated to obtain data on practices on HAI prevention and to identify enabling factors or barriers to compliance with evidence-based recommendations.

Building global partnerships in infection prevention: A report from APIC Badger and the Nairobi Infection Control Nurses Chapter

An international partnership between Wisconsin and Kenya was established after a serendipitous meeting with a newly formed infection control organization in Nairobi, Kenya, the Nairobi Infection Control Nurses Chapter (NICNC). Establishment of a sister chapter partnership between a Wisconsin Association for Professionals in Infection Control and Epidemiology chapter (APIC Badger) and the NICNC provided an opportunity to share resources. Although there are many barriers to developing infection prevention and control programs in Kenya, some needs can be met through such partnerships.

A European survey of nosocomial infection control and hospital-acquired pneumonia prevention practices

We aimed to examine organizational, structural and routine infection control measures provided by European ICUs and staff practices in ventilator-associated pneumonia prevention in relation with current recommendations. European ICU staffs were invited to complete a web-based 20 closed-item questionnaire. 675 nurses and 886 physicians from 13 countries answered the questionnaire. Median number of respondents per country was 118.0 (64.5-155.5). Availability and organizational aspects of infection control revealed wide variations between countries. Among them, single-patient rooms was the aspect with the lowest availability (median availability 38%), but the largest variation ranging from 15 to 84%. Self-reported median adherence rate to recommendations was 72% (34.5-83.0) with a strong correlation between nurses and physicians responses (r²=0.96; p<0.0001). Sub-glottic drainage (31%), and infrequent ventilatory-circuit change (24%) were the measures with the lowest adherence rate whereas preferential use of oral intubation (90%) and of NIV (84%) and use of HMEs (82%) were the three with the highest rate. Organization of infection control was consistently self-reported. Disparities among countries were more frequent for specific actions regarding airway management, and even moreso for controversial issues (subglottic drainage, closed-suction systems). This European survey shows a 72% overall adherence rate to VAP prevention measures; with strong agreements between physician and nurses but considerable differences among countries for availability and organization aspects of infection control, providing healthcare authorities with figures for future programs.

Nurses’ views of infection control organization in regional hospitals of Latvia

Every nurse can play a significant role in minimizing the risk of healthcare-associated infections, especially, if she use care guidelines and nursing protocols in patients care. The aim of the study to investigate the nurses’ views of infection control organization in 10 regional hospitals of Latvia. The qualitative research method as structured interview (n = 36) was used. The most common reasons for failures of infection control in nurses’ views were referred to the lack of guidelines and patient care documentation, and to the lack of availability of equipment, particularly for hand decontamination, gloves-wearing and safe collection of sharp instruments/objects, and to the lack of availability of work wear. The most common reasons why nurses break the rules of the infection control were overload and the lack of knowledge. Conclusions. Obtained results reflect problem areas in patients’ care from the nurses’ views and necessity for improvement of infection control organization.

Patient safety and healthcare-associated infection

Healthcare-associated infection (HCAI) has become a major patient safety issue in National Health Service (NHS) hospitals. The UK has an HCAI prevalence rate of 8.2% which equates to an annual incidence of approximately 300000 patients (Hospital Infection Society, 2007). HCAI is a safety issue because it is associated with increased morbidity and mortality as well as increased healthcare costs (National Audit Office (NAO), 2009). In 2000, the NAO identified cultural change as a requirement if the NHS is to get a grip of infection prevention and control. This article has taken a 'conceptual culture of safety model' that has been previously described in the literature and applied it to the organization of infection control. It is clear that while there are many areas of good practice, in relation to infection prevention and control, there is still much to do if the NHS is to invoke the type of paradigm shift that will result in a mature sustainable safety culture.