First step to reducing infection risk as a system: evaluation of infection prevention processes for 71 hospitals.
BACKGROUND
Hospitals can better focus their efforts to prevent health care-associated infections (HAIs) if they identify specific areas for improvement.


METHODS
We administered a 96-question survey to infection preventionists at 71 Ascension Health hospitals to evaluate opportunities for the prevention of catheter-associated urinary tract infection, central line-associated bloodstream infection, ventilator-associated pneumonia, and surgical site infection.


RESULTS
Seventy-one (100%) infection preventionists completed the survey. The majority of hospitals had established policies for urinary catheter placement and maintenance (55/70, 78.6%), central venous catheter maintenance (68/71, 95.8%), and care for the mechanically ventilated patient (62/66, 93.9%). However, there was variation in health care worker practice and evaluation of competencies and outcomes. When addressing device need, 55 of 71 (77.5%) hospitals used a nurse-driven evaluation of urinary catheter need, 26 of 71 (36.6%) had a team evaluation for central venous catheters on transfer out of intensive care, and 53 of 57 (93%) assessed daily ventilator support for continued need. Only 19 of 71 (26.8%) hospitals had annual nursing competencies for urinary catheter placement and maintenance, 29 of 71 (40.8%) for nursing venous catheter maintenance, and 38 of 66 (57.6%) for appropriate health care worker surgical scrubbing.


CONCLUSIONS
We suggest evaluating infection prevention policies and practices as a first step to improvement efforts. The next steps include implementing spread of evidence-based practices, with focus on competencies and feedback on performance.
Department of Infection Prevention and Control, St. John Hospital and Medical Center, Detroit, MI; Wayne State University School of Medicine, Detroit, MI. Electronic address: Mohamad.Fakih@stjohn.org.
Mohamad G
MG
Fakih
Michelle
M
Heavens
Carol J
CJ
Ratcliffe
Ann
A
Hendrich
D055499:Catheter-Related Infections / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D006302:Health Services Research / Q000379:methods; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D018805:Sepsis / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014481:United States; D014552:Urinary Tract Infections / Q000517:prevention & control*
Device infection; Prevention; Survey