Identifying gaps in infection prevention practices may yield opportunities for improved patient safety, according to a survey.
Ascension Health, the nations largest nonprofit healthcare system with hospitals and related healthcare facilities in 23 states and Washington, D.C., conducted a 96-question survey of 71 member hospitals to evaluate infection control processes for catheter-associated urinary tract infections, central line-associated bloodstream infections, ventilator-associated pneumonia and surgical-site infections.
The survey questions addressed policies for placement and maintenance of devices, surgical procedures, evaluation of healthcare workers competencies and outcomes evaluation. Results were scheduled for publication in the November issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology.
The effort was undertaken as part of Ascension Healths participation as a Hospital Engagement Network in the Partnership for Patients program, a federally funded effort to help improve the quality, safety and affordability of healthcare for all Americans with a goal of decreasing preventable hospital-acquired conditions by 40% and hospital readmissions by 20%.
According to the survey results, the majority of hospitals had infection prevention policies in place for the use of devices, surgery, hand hygiene and multidrug-resistant organisms. However, only 28 of 71 (39.4%) reported having policies relating to antimicrobial stewardship, such as antimicrobial restrictions.
Practices to reduce device risk varied between hospitals. For example, the use of bladder scanners to assess for urinary retention was more available in medium and large hospitals compared with smaller ones. In addition, while more than three-quarters of hospitals had a nurse-driven protocol for determining need for a urinary catheter, only 26.8% of nurses and 11.3% of patient care technicians received annual training on how to properly place and maintain urinary catheters.
To reduce the risk of CLABSI, 94.4% of hospitals reported using an insertion checklist. However, according to the survey, only 59.2% used the checklist more than 90% of the time and only 40.8% provided annual training for nurses on placing and maintaining venous catheters. Very few hospitals used electronic reminders to help nurses (8.5%) and physicians (1.4%) evaluate catheter need.
Hospitals evaluated outcomes for CAUTI, CLABSI, VAP and SSI, with root-cause analysis predominantly occurring for cases of CLABSI and VAP. Surgeon-specific SSI rates, a tool that may be important in helping surgeons prioritize infection prevention efforts, were calculated and discussed with surgeons in only two-thirds of the hospitals.
We suggest that individual hospitals evaluate their policies, processes and practices prior to implementing interventions to establish a baseline for comparative purposes, to reduce infection and base their action on the gaps identified, the authors stated. We believe that identifying the gaps and addressing them as a system will help lead to marked improvements in safety for our patients.