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Hospital intensive care units (ICUs) in the U.S. report a high level of infection prevention policies in place, but the numbers fall off sharply when actual adherence to the interventions are factored in, researchers report.
While that implies that some ICU patients are more protected on paper than in actual practice, the lead author of the study says the vast majority of health care workers are trying to “do the right thing” in a very challenging environment.
“I think we’re doing well with getting the policies in place, but we still have work to do to make sure the clinicians at the bedside can and do follow the policies,” says Pat Stone, PhD, FAAN, director of the Center for Health Policy at Columbia University School of Nursing. “We need to support them so they can comply every time. I’m not saying there are bad clinicians out there. It’s not easy to do the right thing all of the time.”
Stone and colleagues at Columbia collaborated with the Centers for Disease Control and Prevention to conduct a nationwide survey of 1,534 ICUs at 975 hospitals.1 The survey inquired about the implementation of 16 recommended infection prevention measures at point-of-care, and clinician adherence to these policies for the prevention of central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI). The three health care associated infections (HAIs) are among the most commonly acquired by ICU patients.
According to the survey, hospitals have more policies in place to prevent CLABSI and VAP, than CAUTI. However all three HAIs fell sharply when researchers asked about adherence to the policies.
"The CLABSI policies are pretty much getting out there and we know that the rates have been going down, but still the adherence (for all three HAIs) was about 50%,” Stone says. “We need to focus on how we can help the clinicians, both the nurses and doctors and decrease these infections. There is a whole science in human engineering to try to make the right thing the easiest thing to do.”
1. Stone PW, Monika Pogorzelska-Maziarz, Herzig CTA, et al. State of infection prevention in U.S. hospitals enrolled in the National Health and Safety Network. AJIC 2014;94-99
For more on this story see the March issue of Hospital Infection Control & Prevention