title: National survey of practices to prevent health care-associated infections in Thailand: The role of prevention bundles.
abstract: BACKGROUND
  We evaluated the practices used in Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP).
  
  
  METHODS
  From January 1, 2014-November 30, 2014, we surveyed all Thai hospitals with an intensive care unit and at least 250 beds. The use of prevention practices for CAUTI, CLABSI, and VAP was assessed. High compliance (≥75%) with all components of the CLABSI and VAP prevention bundles were determined. CAUTI, CLABSI, and VAP infection rates before and after implementing infection control practices are reported. Multivariable regression was used to examine associations between infection prevention bundle compliance and infection rate changes.
  
  
  RESULTS
  Out of 245 eligible hospitals, 212 (86.5%) responded. A total of 120 (56.6%) and 115 hospitals (54.2%) reported ≥75% compliance for all components of the CLABSI and VAP prevention bundles, respectively, and 91 hospitals (42.9%) reported using ≥ 4 recommended CAUTI-prevention practices. High compliance with all of the CLABSI and VAP bundle components was associated with significant infection rate reductions (CLABSI, 38.3%; P < .001; VAP, 32.0%; P < .001). Hospitals regularly using ≥ 4 CAUTI-prevention practices did not have greater reductions in CAUTI (0.02%; P = .99).
  
  
  CONCLUSIONS
  Compliance with practices to prevent hospital infections was suboptimal. Policies and interventions promoting bundled approaches may help reduce hospital infections for Thai hospitals.
authors.affiliation: Department of Medicine, Thammasat University, Pathumthani, Thailand. Electronic address: anapisarn@yahoo.com.
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.affiliation: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: David
authors.initials: D
authors.lastname: Ratz
authors.affiliation: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: M Todd
authors.initials: MT
authors.lastname: Greene
authors.affiliation: Department of Medicine, Thammasat University, Pathumthani, Thailand.
authors.forename: Thana
authors.initials: T
authors.lastname: Khawcharoenporn
authors.affiliation: Schools of Medicine and Public Health, University of North Carolina, Chapel Hill, NC.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016134:Organizational Policy; D064872:Patient Care Bundles; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D018805:Sepsis / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013785:Thailand; D014552:Urinary Tract Infections
keywords: Bloodstream infection; Catheter-associated urinary tract infection; Cross-contamination; Patient safety; Ventilator-associated pneumonia