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Infection preventionists agree on best practices

Sunday February 3, 2013
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There is general agreement among hospital infection preventionists about which practices have weak or strong evidence supporting their use to prevent healthcare-associated infection, according to a study.

Furthermore, IPs with certification in infection prevention and control are two to three times more likely to perceive the evidence behind certain infection prevention practices as strong, compared with their non-certified peers, researchers reported in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology.

The study was conducted to understand how those who lead infection prevention activities perceive the strength of evidence behind practices aimed at preventing device- and procedure-associated infections and lessening the risk of cross-transmission of microorganisms in healthcare facilities.

A research team led by Sanjay Saint, MD, MPH, of the VA Ann Arbor & University of Michigan Medical School, collected survey responses from infection prevention personnel at 478 U.S. hospitals to determine the perceived strength of evidence behind 28 of the most common hospital infection prevention practices.

The following practices were perceived by 90% or more of the respondents as having strong evidence to support their use: alcohol-based hand rub, aseptic urinary catheter insertion, chlorhexidine for antisepsis prior to central venous catheter insertion, maximum sterile barriers during central venous catheter insertion, avoiding the femoral site for central venous catheter insertion, and semi-recumbent positioning of patients on ventilators.

Conversely, practices with the weakest perceived evidence were routine central catheter changes, using silver-coated endotracheal tubes for ventilator-associated pneumonia, nitrofurazone-releasing urinary catheters and the use of antimicrobials in the urinary catheter drainage bag.

"The perceived strength of evidence among infection prevention personnel across the country generally tracked with the actual strength of evidence for various practices that have been reported in evidence-based guidelines," Saint said in a news release.

The research team further examined the perceptions of evidence supporting practice use between certified and non-certified IPs. Compared with their non-certified counterparts, CIC IPs were more likely to perceive the strength of evidence as strong for a number of infection prevention practices, including regular interruption of sedation for VAP patients, nurse-initiated urinary catheter discontinuation to prevent catheter-associated urinary tract infection, and antimicrobial stewardship programs.

"Understanding the impact of board certification on the effectiveness of an infection prevention program is imperative," said Russell Olmstead, MPH, CIC, a study-co-author. "This study adds to mounting evidence that suggests that CIC [status] may lead to greater evidence-based practice, which may result in the reduction of both healthcare-associated infections and hospital costs."

Certification in infection prevention and control is the centerpiece of a new competency model developed by APIC to advance the profession. The content areas of the model correspond to the core competencies as defined by the Certification Board of Infection Control and Epidemiology.

The study is available at www.ajicjournal.org/article/S0196-6553%2812%2901269-2/fulltext.


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