Reduce Health Care-associated Infections Research Articles

"Clean care is safer care": correct handwashing in the prevention of healthcare associated infections.

In 2005, WHO developed the campaign "Clean care is safer care", aiming at the reduction of Healthcare Associated Infections (HCAI) through the worldwide promotion of appropriate hand hygiene practices. Adherence to these practices presently ranges from 5 to 81% (average 40%). Aim of the study was the evaluation of healthcare workers (HCWs) adherence to the application of WHO guidelines on the hand hygiene and the possible impact on HCAI reduction. First, some wards at highest HCAI risk were identified. Then, direct observational survey was conducted to evaluate the behaviour of the different HCW categories. Six-hundred-twenty-eight HCWs were observed: 519 nurses (68 in training), 109 physicians (63 in training). Survey analysis highlighted that compliance with handwashing was higher in post care practices (59.6%) than before (55.1%). Some HCWs performed handwashing in both cases. Only in 30.6% of cases HCWs observed the handwashing technique suggested by the guidelines. In 70.4% they wore gloves during procedures in which it was possible to have contact with potentially infectious material, but they did not change them before caring for a new patient in 64% of cases. The survey confirms the international data, showing a low compliance with hand hygiene practices by the HCWs and the need to promote a correct handwashing based on respect of the international guidelines.

Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review.

Infants in the neonatal intensive care unit are highly susceptible to healthcare associated infections (HAI), with a substantial impact on mortality, morbidity and healthcare costs. Effective skin disinfection with topical antiseptic agents is an important intervention in the prevention or reduction of HAI. A wide array of antiseptic preparations in varying concentrations and combinations has been used in neonatal units worldwide. In this article we have reviewed the current evidence of a preferred antiseptic of choice over other agents for topical skin disinfection in neonates. Chlorhexidine (CHG) appears to be a promising antiseptic agent; however there exists a significant concern regarding the safety of all agents used including CHG especially in preterm and very low birth weight infants. There is substantial evidence to support the use of CHG for umbilical cord cleansing and some evidence to support the use of topical emollients in reducing the mortality in infants born in developing countries. Well-designed large multicentre randomized clinical trials are urgently needed to guide us on the most appropriate and safe antiseptic to use in neonates undergoing intensive care, especially preterm infants.

Reducing health care-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance

Reducing health care-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance

Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices

Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices

Healthcare reform after MERS outbreak: progress to date and next steps

To avoid a future catastrophic event like the recent Middle East respiratory syndrome (MERS) outbreak, we must reform our health system based on an objective and thorough review of the outbreak. A little over a year after the outbreak, this paper aims to evaluate the current status of the government's effort to reform our health system across the three following areas: 1) infectious disease emergency preparedness and response; 2) an organized healthcare system for infectious diseases; and 3) hospital preparedness for healthcare-associated infections. In spite of the substantial organizational changes of the Korea Centers for Disease Control (CDC) responsible for infectious disease emergency preparedness and response, the Korea CDC has not shown significant improvement in its competence and organizational commitment in the face of recent infectious disease threats such as Zika virus and cholera. So far, the Korean government has not announced an implementation plan for establishing an organized healthcare system for infectious diseases. To reduce healthcare associated infections, the Korean government implemented major changes in the hospital infection control system, emergency medical service system, and enhanced nursing system. Because the most extensive reform occurred around reducing healthcare-associated infections in hospitals, we need to evaluate the impact of the entire reform effort in a near future. Because the effort to reform our health system remains ongoing, we also need to continue to observe the progress of reform to ensure the avoidance of a future catastrophic event like the recent MERS outbreak.

Impact of implementation of the World Health Organization multimodal hand hygiene improvement strategy in a teaching hospital in Taiwan

Hand hygiene (HH) is considered to be the most simple, rapid, and economic way to prevent health care-associated infection (HAI). However, poor HH compliance has been repeatedly reported. Our objective was to evaluate the impact of implementing the updated World Health Organization (WHO) multimodal HH guidelines on HH compliance and HAI in a tertiary hospital in Taiwan. We conducted a before-and-after interventional study during 2010-2011. A multimodal HH promotion campaign was initiated. Key strategies included providing alcohol-based handrub dispensers at points of care, designing educational programs tailored to the needs of different health care workers, placement of general and individual reminders in the workplace, and establishment of evaluation and feedback for HH compliance and infection rates. Overall HH compliance increased from 62.3% to 73.3% after 1year of intervention (P<.001). The rate of overall HAI decreased from 3.7% to 3.1% (P<.05), urinary tract infection rate decreased from 1.5% to 1.2% (P<.05), and respiratory tract infection rate decreased from 0.53% to 0.35% (P<.05). This campaign saved an estimated $940,000 and 3,564 admission patient days per year. The WHO multimodal HH guidelines are feasible and effective for the promotion of HH compliance and are associated with the reduction of HAIs.

Performance management of Clostridium difficile infection in hospitals – The carrot or stick approach?

Public and political pressure for healthcare quality indicator monitoring, specifically healthcare-associated infection (HAI) has intensified the debate regarding the merits of public reporting and target setting as policy approaches. This paper reviews the evidence for these approaches with a focus on HAI, including Clostridium difficile infection (CDI).Healthcare key performance indicators (KPIs) and associated targets have been used widely with little evaluation. While targets are associated with some HAI reductions including CDI, as their control is multi-factorial, it is likely that reductions are due to numerous, concurrent control measures. Targets may help tackle organizational-wide issues that require high level management engagement and have contributed to the increased access and influence of infection control teams. HAI public reporting has also gained traction and is mandatory in many countries despite little scientific evaluation. CDI is one of the KPIs used but there is little consensus as to the best KPI for public reporting. Countries without public reporting have also seen improvements. Using indicator-based strategies rather than evidence-based ones risk improving the KPI but not necessarily quality of care. ‘Bottom-up’ approaches focussing on quality improvement and innovation generated by front line staff are seen as a lever for sustainable change. Positive deviance, where the resourcefulness and problem solving abilities of staff is harnessed, enables ‘bottom-up’ changes with process and outcome improvements. As implementation of best practice in healthcare is dependent on behavioural and cultural change, it is most likely that a combination of ‘top-down’ and ‘bottom-up’ approaches are required for sustainable improvement. This combined approach was used to improve staff influenza vaccination rates.Regulation may initially direct the spot-light onto infection control needs but true sustainable HAI reduction will only be fostered with concurrent cultural and behavioural shifts in practice and ownership of the HAI burden across clinical, policy and management domains. It will be interesting if this approach will be increasingly used by policy makers, however, irrespective it is clear that there is a need for rigorous evaluation of our HAI policy approaches from this point forward.

The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey.

The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation. A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states. Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%). Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states.

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.

Antimicrobial Stewardship from Policy to Practice: Experiences from UK Antimicrobial Pharmacists

Antimicrobial stewardship in the UK has evolved dramatically in the last 15 years. Factors driving this include initial central funding for specialist pharmacists and mandatory reductions in healthcare-associated infections (particularly Clostridium difficile infection). More recently, the introduction of national stewardship guidelines, and an increased focus on stewardship as part of the UK five-year antimicrobial resistance strategy, have accelerated and embedded developments. Antimicrobial pharmacists have been instrumental in effecting changes at an organizational and national level. This article describes the evolution of the antimicrobial pharmacist role, its impact, the progress toward the actions listed in the five-year resistance strategy, and novel emerging areas in stewardship in the UK.

Targeted Assessment for Prevention of Healthcare-Associated Infections: A New Prioritization Metric.

To develop a method for calculating the number of healthcare-associated infections (HAIs) that must be prevented to reach a HAI reduction goal and identifying and prioritizing healthcare facilities where the largest reductions can be achieved. Acute care hospitals that report HAI data to the Centers for Disease Control and Prevention's National Healthcare Safety Network. METHODS :The cumulative attributable difference (CAD) is calculated by subtracting a numerical prevention target from an observed number of HAIs. The prevention target is the product of the predicted number of HAIs and a standardized infection ratio goal, which represents a HAI reduction goal. The CAD is a numeric value that if positive is the number of infections to prevent to reach the HAI reduction goal. We calculated the CAD for catheter-associated urinary tract infections for each of the 3,639 hospitals that reported such data to National Healthcare Safety Network in 2013 and ranked the hospitals by their CAD values in descending order. Of 1,578 hospitals with positive CAD values, preventing 10,040 catheter-associated urinary tract infections at 293 hospitals (19%) with the highest CAD would enable achievement of the national 25% catheter-associated urinary tract infection reduction goal. The CAD is a new metric that facilitates ranking of facilities, and locations within facilities, to prioritize HAI prevention efforts where the greatest impact can be achieved toward a HAI reduction goal.

Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance

ObjectiveTo describe the epidemiology of healthcare-associated infections (HAI) in hospitals participating in the German national nosocomial infections surveillance system (KISS). MethodThe epidemiology of HAI was described for the surveillance components for intensive care units (ITS-KISS), non-ICUs (STATIONS-KISS), very low birth weight infants (NEO-KISS) and surgical site infections (OP-KISS) in the period from 2006 to 2013. In addition, risk factor analyses were performed for the most important infections of ICU-KISS, NEO-KISS and OP-KISS. ResultsData from a total of 3,454,778 ICU patients from 913 ICUs, 618,816 non-ICU patients from 142 non-ICU wards, 53,676 VLBW from 241 neonatal intensive care units (NICU) and 1,005,064 surgical patients from operative departments from 550 hospitals were used for analysis. Compared with baseline data, a significant reduction of primary bloodstream infections (PBSI) and lower respiratory tract infections (LRTI) was observed in ICUs with the maximum effect in year 5 (or longer participation) (incidence rate ratio 0.60 (CI95 0.50–0.72) and 0.61 (CI95 0.52–0.71) respectively). A significant reduction of PBSI and LRTI was also observed in NEO-KISS when comparing the baseline situation with the 5th year of participation (hazard ratio 0.70 (CI95 0.64–0.76) and 0.43 (CI95 0.35–0.52)). The effect was smaller in operative departments after the introduction of OP-KISS (OR 0.80; CI95 0.64–1.02 in year 5 or later for all procedure types combined). Due to the large database, it has not only been possible to confirm well-known risk factors for HAI, but also to identify some new interesting risk factors like seasonal and volume effects. ConclusionsParticipating in a national surveillance system and using surveillance data for internal quality management leads to substantial reduction of HAI. In addition, a surveillance system can identify otherwise not recognized risk factors which should – if possible – be considered for infection control management and for risk adjustment in the benchmarking process.

Reflection on observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia

Within the Australian public health care system, an observation model is used to assess hand hygiene practice in health care workers, culminating in a publicly available healthcare service performance indicator. The intent of this study was for the results to inform the development of a strategy to support individual auditors and local sustainability of the hand hygiene auditing program. This qualitative study used a values clarification tool to gain an understanding of the experiences of hand hygiene auditors. The methodology involved qualitative interpretation of focus group discussions to identify the enablers and barriers to successful performance of the auditors' role. Twenty-five participants identified congruous themes of the need for peer and managerial support, improved communication and feedback, and consideration for succession planning. There was consistency in the participants' most frequently identified significant barriers in undertaking the role. Hand hygiene auditors take pride in their role and work toward the goal of reducing health care-associated infections by having a part to play in improving hand hygiene practices of all staff members. Important themes, barriers, and enablers were identified in this study. This research will be of interest nationally and globally, considering the dearth of published information on the experience of hand hygiene auditors. This study provides evidence of the need to support individual hand hygiene auditors.

Cleaning Hospital Room Surfaces to Prevent Health Care-Associated Infections: A Technical Brief.

The cleaning of hard surfaces in hospital rooms is critical for reducing health care-associated infections. This review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. Studies examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci were included. Eighty studies were identified-76 primary studies and 4 systematic reviews. Forty-nine studies examined cleaning methods, 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation. Only 5 studies were randomized, controlled trials, and surface contamination was the most commonly assessed outcome. Comparative effectiveness studies of disinfecting methods and monitoring strategies were uncommon. Future research should evaluate and compare newly emerging strategies, such as self-disinfecting coatings for disinfecting and adenosine triphosphate and ultraviolet/fluorescent surface markers for monitoring. Studies should also assess patient-centered outcomes, such as infection, when possible. Other challenges include identifying high-touch surfaces that confer the greatest risk for pathogen transmission; developing standard thresholds for defining cleanliness; and using methods to adjust for confounders, such as hand hygiene, when examining the effect of disinfecting methods.

Good infection control practice: protecting the patient

This article will examine environmental cleanliness, surface cleaning, hand hygiene and how we have a responsibility to ensure that all our staff, patients and visitors are confident that we are doing all we can to reduce health care-associated infections

A primer on on-demand polymerase chain reaction technology

Efforts to reduce health care-associated infections (HAIs) have grown in both scale and sophistication over the past few decades; however, the increasing threat of antimicrobial resistance and the impact of new legislation regarding HAIs on health care economics make the fight against them all the more urgent. On-demand polymerase chain reaction (PCR) technology has proven to be a highly effective weapon in this fight, offering the ability to accurately and efficiently identify disease-causing pathogens such that targeted and directed therapy can be initiated at the point of care. As a result, on-demand PCR technology has far-reaching influences on HAI rates, health care outcomes, hospital length of stay, isolation days, patient satisfaction, antibiotic stewardship, and health care economics. The basics of on-demand PCR technology and its potential to impact health care have not been widely incorporated into health care education and enrichment programs for many of those involved in infection control and prevention, however. This article serves as a primer on on-demand PCR technology and its ramifications.

Effects of fluoroquinolone restriction (from 2007 to 2012) on Clostridium difficile infections: interrupted time-series analysis

Antimicrobial stewardship is a key component in the reduction of healthcare-associated infections, particularly Clostridium difficile infection (CDI). We successfully restricted the use of cephalosporins and, subsequently, fluoroquinolones. From an endemically high level of >280 cases per year in 2007-08, the number of CDIs reduced to 72 cases in 2011-12. To describe the implementation and impact of fluoroquinolone restriction on CDI. This was an interrupted time-series analysis pre and post fluoroquinolone restriction for 60 months based on a Poisson distribution model. In June 2008, fluoroquinolone consumption halved to about 5 defined daily doses (DDD) per 100 occupied bed-days (OBD). This was followed by a significant fall in CDI number [rate ratio (RR): 0.332; 95% confidence interval (CI): 0.240-0.460] which remained low over the subsequent months. Subsequently, fluoroquinolone consumption was further reduced to about 2 DDD/100 OBD in June 2010 accompanied by further reduction in CDI rate (RR: 0.394; 95% CI: 0.199-0.781). In a univariate Poisson model the CDI rate was associated with fluoroquinolone usage (RR: 1.086; 95% CI: 1.077-1.094). We conclude that in an environment where cephalosporin usage is already low, the reduction in fluoroquinolone usage was associated with an immediate, large, and significant reduction in CDI cases.

The impact of hand hygiene in the primary care: to go beyond the hospital setting

Scientific evidence shows that hand hygiene is an easy and efficient practice in the reduction of healthcare associated infection, contributing to a decrease in morbidity and mortality. World Health Organization (WHO) “SAVE LIVES: Clean Your Hands” (SL-CYH) is still very centered in the hospital/ long term care settings.

Is your antiseptic effective against clinical multidrug-resistant microorganisms? A chlorhexidine digluconate formulation demonstrates efficacy even in lower concentrations

Managing Healthcare-associated Infections (HAI) and multidrug-resistant Microorganisms (MDRO) is a daily challenge in hospitals. Universal decolonization by daily bathing with impregnated cloths can result in a reduction of HAIs.

Hand hygiene multimodal strategy and the decrease on central line-associated bloodstream infection in a Brazilian neonatal intensive care unit

Hand hygiene (HH) is the most important strategy to reduce healthcare associated infection. Central line associated bloodstream infection (CLABSI) is the most frequent and severe infection in the Neonatal intensive care unit (NICU).