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HAI prevention policies don’t guarantee clinician adherence

Thursday January 30, 2014
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ICUs in the U.S. show uneven compliance with infection prevention policies, according to a study.

In what was described as the largest study of its kind, researchers from Columbia University in New York City collaborated with the CDC to undertake a nationwide survey of 1,534 ICUs at 975 hospitals as part of the larger Prevention of Nosocomial Infections and Cost Effectiveness Refined study.

The survey inquired about the implementation of 16 prescribed infection prevention measures at point-of-care and clinician adherence to these policies for the prevention of central line-associated bloodstream infections, ventilator-associated pneumonia and catheter-associated urinary tract infections. These are among the most common infections acquired by critical care patients.

According to the survey results, published in the February issue of the American Journal of Infection Control, hospitals have more policies in place to prevent CLABSI and VAP than CAUTI.

The presence of infection control policies to prevent CLABSI ranged from 87% to 97% depending on the measure being counted; the presence of policies for VAP ranged from 69% to 91%; and policies for CAUTI lagged behind with only 27% to 68% of ICUs reporting prevention policies.

The use of a checklist for CLABSI insertion practices was reported by the vast majority of hospitals (92%), while the use of a ventilator bundle checklist was reported by fewer hospitals (74%).

“Evidence-based practices related to CAUTI prevention measures have not been well implemented,” the authors wrote. “These findings are surprising, given that CAUTI is the most frequent healthcare-associated infection. Clearly, more focus on CAUTI is needed, and dissemination and implementation studies to inform how best to improve evidence-based practices should be helpful.”

In adhering to policies, many hospital ICUs fell short, according to the survey. Adherence to prevention policies ranged from 37% to 71% for CLABSI, 45% to 55% for VAP and 6% to 27% for CAUTI.

“Establishing policies does not ensure clinician adherence at the bedside,” the authors wrote. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.”

The survey also assessed structure and resources of infection prevention and control programs, evaluating characteristics such as staffing, use of electronic surveillance systems and proportion of infection preventionists with certification.

Many healthcare-associated infections occur in the ICU setting and are associated with an invasive device such as central line, ventilator or indwelling urinary catheter. At any given time, about 1 in 20 inpatients has an infection related to hospital care. The estimated annual costs associated with HAIs in the U.S. are up to $33 billion, according to the news release.

The American Journal of Infection Control is the official publication of the Association for Professionals in Infection Control and Epidemiology.


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