Reduce Health Care-associated Infections Research Articles

Healthcare-associated infections must stop: a breakthrough project aimed at reducing healthcare-associated infections in an intensive-care unit

BackgroundHealthcare-associated infections are a problem for the Swedish healthcare system. In order to reduce the risk of acquiring healthcare-associated infections, the intensive-care unit attended a breakthrough project in 2004–2005, with...

Effects of Electronic Monitoring on Hand Hygiene Adherence and Healthcare-Associated Infections

Despite monitoring of hand hygiene (HH) practices, Infection Preventionists (IP) at Facility A have not seen significant improvement in HH rates or reduction in healthcare-associated infections (HAI) through HH enhancement policies. Limitations of monitoring HH hygiene practices and adherence rates are generally derived from a snapshot view, fraught with bias, and difficult to validate. For these reasons and to improve patient outcomes, Facility A approved implemented an electronic hand hygiene monitoring system (EHHMS) in one unit.

Systems Initiatives Reduce Healthcare-Associated Infections: A Study of 22,928 Device Days in a Single Trauma Unit

Systems Initiatives Reduce Healthcare-Associated Infections: A Study of 22,928 Device Days in a Single Trauma Unit

“Somebody else’s problem?” Staff perceptions of the sources and control of meticillin-resistant Staphylococcus aureus

Meticillin-resistant Staphylococcus aureus (MRSA) is endemic within the United Kingdom health care sector. Recent campaigns to reduce health care-associated infection have rested on increasing staff accountability and ownership of the problem and its solutions. However, the existence of reservoirs of colonization in the community now creates ambiguity about sources, which may undermine preventative strategies. The theoretical framework of causal attribution was applied to explore staff biases in perceptions and effects on infection control behaviors on both sides of the hospital/care home interface. Forty-four staff from 1 acute care hospital and 53 staff from 6 care homes estimated prevalence, risk, and sources of MRSA. Focus groups (6 care home and 8 hospital) were used to elicit group perceptions. Staff tended to attribute the causes of MRSA to external (not self) human factors including patient risk factors and poor infection control practices of others. Teams tend to attribute their "successes" in infection control to dispositional attributions (good team policy and performance) and attribute "lapses" to situational factors (client group, patient movement, work pressures). Variations in information needs, ownership, and infection control practices could be addressed by better interorganizational working and support for staff teams to assess their own responses to the problem.

Project: Clean Sweep Reducing Healthcare-associated Infections, Employee Absenteeism, Healthcare Cost and Hospital Readmissions in a Long Term Care Facility

Project: Clean Sweep Reducing Healthcare-associated Infections, Employee Absenteeism, Healthcare Cost and Hospital Readmissions in a Long Term Care Facility

Getting to Zero: New Resources Aim to Reduce Health Care-Associated Infections

Getting to Zero: New Resources Aim to Reduce Health Care-Associated Infections

Establishing nurse-led ventilator-associated pneumonia surveillance in paediatric intensive care

Preventing ventilator-associated pneumonia (VAP) is one of the Department of Health 'Saving Lives' initiatives. Whereas morbidity and mortality from VAP is well-documented in adults, it is poorly studied in children. We describe the establishment of a nurse-led VAP surveillance programme as part of an overall drive for patient safety and healthcare-associated infection reduction. All children admitted to a tertiary referral paediatric intensive care unit over a four-month period were studied. VAP was defined as pneumonia occurring >48 h post intubation. Diagnostic criteria were: (i) radiological: new/progressive infiltrates, consolidation or cavitation on chest X-ray; (ii) clinical: > or = 3 of new onset purulent bronchial secretions, leucopaenia or leucocytosis, core temperature > or = 38.5 degrees C or < or = 36 degrees C without other cause, significant positive respiratory culture or culture from another relevant site of infection. A flow diagram and teaching programme was developed for bedside nurses to facilitate investigations of suspected VAP. The nurse in charge collected data daily at midnight until 24h post extubation, discharge or death. Suspected cases of VAP were referred to infection control for secondary verification. A total of 158 intubated children were admitted over four months with 58 excluded (ventilated <24 h). Full data were obtained on all 100 children. VAP incidence was 5.6 per 1000 ventilator-days. We report successful introduction of a nurse-led VAP surveillance programme. Data acquisition in this study was dependent on nursing workload, however, and placed a significant time burden on the study leads. Although a relatively low VAP rate was demonstrated, VAP bundles with automated surveillance are being introduced.

Healthcare workers’ uniforms: roles, types and determining policy

Demonstrating reductions in healthcare-associated infection has become a political and clinical priority in the NHS. A plethora of strategies have received the attention of evidence-based practice, one of which is the healthcare worker's uniform and the extent to which it may be implicated in the transmission of infection. Although existing evidence suggests that this risk is low, public opinion believes that such a correlation exists. However, it is difficult for researchers to quantify the level of risk, and organizations should be wary about developing uniform policies based on tenuous infection control evidence. Although professional standards dictate that healthcare workers perform their duties in a well-groomed, appropriately attired manner, it is infection control that should underpin an organization's uniform policy; patients should be well-informed and reassured by this.

PTH-068 Development of nurse led paracentesis service

<h3>Introduction</h3> Patients (Pts) with chronic liver disease who have refractory or diuretic resistant ascites require regular paracentesis. Previously this resulted in urgent admission via the medical take leading to inconvenience for the patient and additional work for the admitting team. Pts admitted for paracentesis had an average length of stay of 6.4 days. The Hepatology Nurse Specialist (HCNS)-lead outpatient (OP) paracentesis service was initiated in November 2007 which intended to reduce the frequency of hospital admissions for ascites drainage and the length of stay as an inpatient. The service aims to improve the Pts9 quality of life and to reduce healthcare associated infection. We report the outcome of the first 2 years of the service. <h3>Methods</h3> Pts are referred to the HCNS from the Hepatology ward, or consultant clinics. The HCNS initiates regular Pt contact to monitor blood tests and weight. On admission HCNS reviews the Pt and their blood results. The amount of ascites drained is recorded ensuring frequency of drainage is optimised. It is possible for two-three Pts to access OP paracentesis service each week, which is planned to fit around Pts9 commitments. Following drainage HCNS remains in contact with Pts to establishing a pattern of drainage planned 2–3 months in advance giving Pts control over admissions, preventing adhoc admissions via A&amp;E. <h3>Results</h3> 18 Patients on the hepatology OP paracentesis database; 16 analysed (2 unavailable) 95 paracentesis admissions over 18 mths since service initiation; 73.6% Pts used the outpatient paracentesis service and remained an inpatient for 8 h; 26.3% were admitted as inpatients due to decompensation. The mean time interval between drains was 22 days. Average 8500 mls drained per episode. Disease progression required some hospital admissions, as Pts became more unwell requiring interventions or palliation not offered by the OP paracentesis service or community care. Adhoc emergency admissions required longer admission and caused distress. Planned paracentesis allowed Pts to have control of their admissions. Pts are at lower risk of hospital-acquired infection. Pts and families felt supported by the service, being rapidly able to access assessment and assistance from HCNS. 70 admissions were avoided by having a daycase procedure. Admissions to the ward increased with disease progression. <h3>Conclusion</h3> Our nurse-led OP paracentesis service avoided 70 hospital admissions over a 2-year period and reduced Pts stay in hospital from an average of 6.4 days to 8 h. Regular large volume paracentesis was successful. Planned admissions are more acceptable for both Pts and staff. Service flexibility gives the Pts more control of their admissions and improves their quality of life.

Systems Initiatives Reduce Healthcare-Associated Infections: A Study of 22,928 Device Days in a Single Trauma Unit

"Implementation research" promotes the systematic conversion of evidence-based principles into routine practice to improve the quality of care. We hypothesized a system-based initiative to reduce nosocomial infection would lower the incidence of ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and bloodstream infection (BSI). From January 2006 to April 2008, 7,364 adult trauma patients were admitted, of which 1,953 (27%) were admitted to the trauma intensive care unit and comprised the study group. Tight glycemic control was maintained using a computer algorithm for continuous insulin administration based on every 2-hour blood glucose testing. Centers for Disease Control and Prevention definitions of nosocomial infections were used. Evidence-based infection reduction strategies included the following: a VAP bundle (spontaneous breathing, Richmond Agitation-Sedation Scale, oral hygiene, bed elevation, and deep vein thrombosis/stress ulcer prophylaxis), UTI (expert insertion team and Foley removal/change at 5 days), and BSI (maximum barrier precautions, chlorhexidine skin prep, line management protocol). An electronic dashboard identified the at-risk population, and designated auditors monitored the compliance. Infection rates (events per 1,000 device days) were measured over time and compared annually using Fisher's exact test. The study group had 22,928 device exposure days: 6,482 ventilator days, 9,037 urinary catheter days, and 7,399 central line days. Patient acuity, demographics, and number of device days did not vary significantly year-to-year. Annual infection rates declined between 2006 and 2008, and decreases in UTI and BSI rates were statistically significant (p < 0.05). These decreases pushed UTI and BSI rates below Centers for Disease Control and Prevention norms. Over 28 months, a systems approach to reducing nosocomial infection rates after trauma decreased nosocomial infections: UTI (76.3%), BSI (74.1%), and VAP (24.9%). Our experience suggests that infection reduction requires (1) an evidence-based plan; (2) MD and staff education/commitment; (3) electronic documentation; and (4) auditors to monitor and ensure compliance.

From expert-driven to user-oriented communication of infection control guidelines

Currently, infection control guidelines in hospitals and other health care institutions are more expert-driven than user-oriented. In order to enhance the usability of the expert-driven guideline format, we developed a website for the communication of existing guidelines that better fit the practical information needs of health care workers (HCWs). We employed a user-centered design process that involved two studies. In the initial study, 28 HCWs were asked to solve tasks using existing, paper-based infection control guidelines. In order to detect their strategies and problems, the participants were asked to think aloud. Usability problems occurred due to poorly structured information, insufficient quality of information, and a mismatch between experts’ and HCWs’ vocabulary. To overcome these shortcomings, three design principles were applied for communicating infection control guidelines: better navigation (the guidelines should be searchable in several ways); multimodality (the guidelines should not be presented as text only), and action-orientation (the guidelines should be presented as HCWs’ behaviors). A website was developed to meet these principles. In the second study, the same 28 HCWs completed tasks identical to those of the first study while thinking aloud, but this time using the website. The percentage of correctly completed tasks increased and the mean time for task completion decreased significantly. Also, respondents were more satisfied with the website than the paper-based guidelines. The number of problems due to poor information quality and a mismatch in vocabulary declined, although the number of structural problems increased. This can probably be explained by the fact that the navigation structure was user-generated (using Card Sort), in contrast to a standardized answer format based on common usability principles. Overall, we found that involving HCWs in the development process is important to create a sense of ownership and to foster the implementation of the guidelines, which might eventually result in compliance and reduce health care-associated infections. This paper outlines concrete steps for how to involve HCWs in the design process.

Reduction in Intraoperative Bacterial Contamination of Peripheral Intravenous Tubing Through the Use of a Novel Device

Hand hygiene is a vital intervention to reduce health-care associated infections, but compliance remains low. The authors hypothesized that improvements in intraoperative hand hygiene compliance would reduce transmission of bacteria to surgical patients and reduce the incidence of postsurgical healthcare-associated infections. The authors performed a controlled before-and-after study over 2 consecutive months. One hundred fourteen operative cases were enrolled. Two predesignated sites on the anesthesia machine were selected, decontaminated, and cultured via aseptic technique. These sites and the peripheral intravenous stopcock were cultured again after completion of the surgery. The treatment phase used a novel personal hand-decontamination device capable of recording hand-decontamination events. There were no significant differences in patient location, age, or case duration and procedure type between groups. Use of the Sprixx GJ device (Harbor Medical Inc., Santa Barbara, CA) increased hourly hand decontamination events by 27-fold as compared with baseline rates (P < 0.002; 95% confidence interval, 3.3-13.4). Use of the device was associated with a reduction in contamination in the anesthesia work area and peripheral intravenous tubing. Intravenous tubing contamination was identified in 32.8% of cases in the control group versus 7.5% in the treatment group (odds ratio, 0.17; 95% confidence interval, 0.06-0.51; P < 0.01). Healthcare-associated infections rates were reduced in the device group (3.8%) as compared with the control group (17.2%) (odds ratio, 0.19; 95% confidence interval, 0.00-0.81; P = 0.02). Improved hand hygiene compliance through the use of a novel hand sanitation strategy reduces the risk of intraoperative bacterial transmission. The intervention was associated with a reduction in healthcare-associated infections.

Infection prevention and control in general practice

Reducing healthcare-associated infections is a priority for the NHS. This article highlights infection prevention and control expectations for nurses working in general practice. Careful attention to detail and following recommended guidelines are good professional practice - protecting patients from infection and the practice from potential litigation.

Hospital Tap Water

AbstractAccepted as our most reliable weapon in battle to reduce health care-associated infections, hospital tap water has also been recognized as the most overlooked, important, and controllable source of HAI. Peer-reviewed literature has demonstrated that hospital tap water contains microbia

Evidence‐based algorithms for diagnosing and treating ventilator‐associated pneumonia

Ventilator-associated pneumonia (VAP) is widely recognized as a serious and common complication associated with high morbidity and high costs. Given the complexity of caring for heterogeneous populations in the intensive care unit (ICU), however, there is still uncertainty regarding how to diagnose and manage VAP. We recently conducted a national collaborative aimed at reducing health care-associated infections in ICUs of hospitals operated by the Hospital Corporation of America (HCA). As part of this collaborative, we developed algorithms for diagnosing and treating VAP in mechanically ventilated patients. In the current article, we (1) review the current evidence for diagnosing VAP, (2) describe our approach for developing these algorithms, and (3) illustrate the utility of the diagnostic algorithms using clinical teaching cases. This was a descriptive study, using data from a national collaborative focused on reducing VAP and catheter-related bloodstream infections. The setting of the study was 110 ICUs at 61 HCA hospitals. None. We assembled an interdisciplinary team that included infectious disease specialists, intensivists, hospitalists, statisticians, critical care nurses, and pharmacists. After reviewing published studies and the Centers for Disease Control and Prevention VAP guidelines, the team iteratively discussed the evidence, achieved consensus, and ultimately developed these practical algorithms. The diagnostic algorithms address infant, pediatric, immunocompromised, and adult ICU patients. We present practical algorithms for diagnosing and managing VAP in mechanically ventilated patients. These algorithms may provide evidence-based real-time guidance to clinicians seeking a standardized approach to diagnosing and managing this challenging problem.

Reducing healthcare associated infections by adopting a proactive, preventive approach

An increase in Clostridium difficile associated diarrhoea, rapidly rising MRSA bacteraemias and new cases of healthcare associated MRSA colonisation prompted the Royal Wolverhampton Hospitals NHS Trust to review and reform their infection control priorities. The aim was to reduce healthcare associated infections and reach the Department of Health MRSA bacteraemia target for the Trust. By changing the emphasis from a reactive ‘infection control’ approach to a more proactive ‘infection prevention’ outlook; improving ward to board accountability; and implementing a number of infection prevention initiatives, the number of cases of hospital acquired infections due to Clostridium difficile, MRSA and Acinetobacter baumannii within the Trust have been effectively reduced.

New measures to reduce HCAIs.

The Department of Health has outlined a package of measures to help reduce healthcare associated infections (HCAIs) in hospitals.

Underresourced Hospital Infection Control and Prevention Programs: Penny Wise, Pound Foolish?

To estimate the cost of healthcare-associated infections (HAIs) in a network of 28 community hospitals and to compare this sum to the amount budgeted for infection control programs at each institution and for the entire network. We reviewed literature published since 1985 to estimate costs for specific HAIs. Using these estimates, we determined the costs attributable to specific HAIs in a network of 28 hospitals during a 1-year period (January 1 through December 31, 2004). Cost-saving models based on reductions in HAIs were calculated. Twenty-eight community hospitals in the southeastern region of the United States. The weight-adjusted mean cost estimates for HAIs were $25,072 per episode of ventilator-associated pneumonia, $23,242 per nosocomial blood stream infection, $10,443 per surgical site infection, and $758 per catheter-associated urinary tract infection. The median annual cost of HAIs per hospital was $594,683 (interquartile range [IQR], $299,057-$1,287,499). The total annual cost of HAIs for the 28 hospitals was greater than $26 million. Hospitals budgeted a median of $129,000 (IQR, $92,500-$200,000) for infection control; the median annual cost of HAIs was 4.6 (IQR, 3.4-8.0) times the amount budgeted for infection control. An annual reduction in HAIs of 25% could save each hospital a median of $148,667 (IQR, $74,763-$296,861) and could save the group of hospitals more than $6.5 million. The economic cost of HAIs in our group of 28 study hospitals was enormous. In the modern age of infection control and patient safety, the cost-control ratio will become the key component of successful infection control programs.

Improving Infection Control, Prevention, and Surveillance: Using the Electronic Health Record (EHR) in a 370-Bed Acute Care Hospital

ISSUE: Surveillance is used to prevent and/or reduce the frequency of healthcare-associated infections (HAIs) by monitoring patients during and after care in combination with continuous improvement in procedures and practices that relate to factors which have been causing or might cause infections (Moore, 2006). The reduction and prevention of HAIs is a time-consuming process requiring data analysis, infection control rounds, ongoing staff and patient education, and concurrent and retrospective review of medical records. Using available resources wisely allow infection control and prevention department staff to improve processes in identifying HAIs, patients with multi-drug resistant organisms, reportable diseases, clusters or outbreaks of infections, and other unusual occurrences. Using our new electronic health record (EHR) should improve the timeliness of infection control, prevention, and surveillance activities by streamlining access to epidemiological significant and legible information.

Improving the Compliance and Knowledge of Standard Precautions in a Large University Hospital

BACKGROUND/OBJECTIVES: Improving the compliance of standard precautions (SP) is one of the most important ways to reduce healthcare associated infections, but also the most difficult to achieve. We provided education to healthcare workers (HCW) about SP when we provided a standard precautions guideline in September 2004. We assessed the knowledge and compliance with SP among HCW in a large university hospital using a questionnaire.