Relationship of antimicrobial control policies and hospital and infection control characteristics to antimicrobial resistance rates.
BACKGROUND
Antibiotic misuse and noncompliance with infection control precautions have contributed to increasing levels of antimicrobial resistance in hospitals.


OBJECTIVE
To assess the extent to which resistance is monitored in infection control programs and to correlate resistance rates with characteristics of antimicrobial control policies, provider attitudes and practices, and systems-level indicators of implementation of the hand hygiene guideline of the Centers for Disease Control and Prevention.


METHODS
An on-site survey of intensive care unit staff and infection control directors of 33 hospitals in the United States was conducted. The following data were collected: antimicrobial control policies; rates during the previous 12 months of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and ceftazidime-resistant Klebsiella pneumoniae; an implementation score of systems-level efforts to implement the guideline; staff attitudes toward practice guidelines; and observations of staff hand hygiene. Variables associated with resistance rates were examined for independent effects by using logistic regression.


RESULTS
Resistance rates for S aureus, enterococci, and K pneumoniae were 52.5%, 18.2%, and 16.0%, respectively. Ten (30.3%) hospitals had an antibiotic control policy. No statistically significant correlation was observed between staff attitudes toward practice guidelines, observed hand hygiene behavior, or having an antibiotic use policy and resistance rates. In logistic regression analysis, higher scores on measures of systems-level efforts to implement the guideline were associated with lower rates of resistant S aureus and enterococci (P=.046).


CONCLUSIONS
Organizational-level factors independent of the practices of individual clinicians may be associated with rates of antimicrobial resistance.
Larson
Elaine L
EL
School of Nursing, Columbia University, New York, NY 10032, USA. ell23@columbia.edu
Quiros
Dave
D
Giblin
Tara
T
Lin
Susan
S
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D024881:Drug Resistance, Bacterial; D016983:Enterococcus; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000592:standards; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology; D007711:Klebsiella pneumoniae; D016015:Logistic Models; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D013211:Staphylococcus aureus; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D000900:Anti-Bacterial Agents