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Article
Publication date: 20 April 2012

William R. Jarvis

The purpose of this paper is to briefly review the history of healthcare‐associated infection (HAI) prevention programs in the USA since the early 1970s until today, and provide…

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Abstract

Purpose

The purpose of this paper is to briefly review the history of healthcare‐associated infection (HAI) prevention programs in the USA since the early 1970s until today, and provide suggestions how other countries (and Canada specifically) may learn from this experience to accelerate HAI prevention and patient safety improvements in their counties.

Design/methodology/approach

The paper is a narrative review of literature and personal experience.

Findings

US hospitals have had healthcare‐associated infection (HAI) prevention programs, including surveillance for selected HAIs, since the late 1960s‐early 1970s. Such programs began with active surveillance for HAIs based upon the Centers for Disease Control and Prevention's (CDCs) National Nosocomial Infections Surveillance (NNIS) system. This system included standardized definitions and surveillance protocols. Since the 1980s, the CDC has developed HAI prevention guidelines, with categorized recommendations for HAI prevention. In the early 2000s, the Institute of Medicine published a report outlining the harm caused by HAIs. This led to increased attention to HAI prevention by an increasingly wide variety of organizations. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) initiated HAI prevention efforts. Many studies documented the failure of hospitals to fully implement evidence‐based practices. The increased attention to HAIs and their morbidity and mortality led to media reports and ultimately an initiative by the Consumer's Union for mandatory reporting of HAI rates by hospitals in all states. Subsequently, the CMS introduced decreased reimbursement for the additional costs directly related to HAIs (and other critical incidents) and linkage of reimbursement levels to hospital HAI rates. Together, mandatory reporting and reduced reimbursement for HAIs has led hospital executives to focus more attention on infection control programs to decrease HAI rates. Progress on preventing HAIs seems to be related to standardizing evidence‐based HAI prevention bundles, mandatory reporting, and paying for performance (or not paying for preventable HAI complications). Given that voluntary HAI prevention programs have existed since the 1970s, it appears that regulation, reporting, and decreased reimbursement has resulted in more rapid implementation of HAI prevention programs and improved patient safety.

Practical implications

The different major activities enhancing HAI prevention in the USA are outlined in an historic context.

Originality/value

Understanding the history of progress in hospital infection control efforts provides an essential perspective for policy makers and for the interdisciplinary team required to evaluate HAI mandatory public reporting in a comprehensive manner.

Article
Publication date: 24 May 2018

Michael Canty and Edward Jerome St George

Surgical site infection (SSI) is a common complication in surgical practice. SSIs represent almost a fifth of healthcare-associated infections in Scotland, and have deleterious…

Abstract

Purpose

Surgical site infection (SSI) is a common complication in surgical practice. SSIs represent almost a fifth of healthcare-associated infections in Scotland, and have deleterious effects on mortality, morbidity, length of stay, and cost to the health service. SSIs in neurosurgery may be more consequential than in other specialities given the potentially devastating effects of central nervous system infection. The paper aims to discuss these issues.

Design/methodology/approach

In 2014, the authors became concerned about an anecdotal increase in infection rates in the authors’ unit. While national guidance on SSI surveillance existed in England and Scotland, the authors had no relevant procedures or policies in Glasgow, and began the process of establishing a surveillance programme. This was driven by clinicians but faced challenges due to a lack of involvement of the wider organisation in the early stages.

Findings

SSIs were initially reported via a form-filling system. This developed into an editable hospital intranet database, but still suffered from the problems of voluntary entries and under-reporting. Following the formal engagement of management structures and the funding of a surveillance nurse, the authors’ programme developed robustness, and resilience. With the advent of an SSI committee, the authors now have a well-established programme that ingrains SSI prevention in the collective learning and organisational memory of the authors’ unit.

Originality/value

Clinicians must lead on the development of these programmes, but long-term durability requires engagement and support from the wider organisation.

Details

International Journal of Health Governance, vol. 23 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

Article
Publication date: 1 August 1994

J.C.M. Sharp and W.J. Reilly

The frequency of reporting of foodborne infections of animal origin, inparticular salmonella, campylobacter and Escherichia coli (VTEC) hasincreased in recent years due to changes…

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Abstract

The frequency of reporting of foodborne infections of animal origin, in particular salmonella, campylobacter and Escherichia coli (VTEC) has increased in recent years due to changes in food production and processing methods in parallel with changes in eating habits and other social factors such as mass catering and the use of convenience foods. In contrast infections, primarily of human origin, in particular typhoid, paratyphoid and bacillary dysentery, are nowadays much less frequently associated with foodborne spread. Meanwhile, other “emerging” micro‐organisms of bacterial, viral and protozoal origin have increasingly frequently been reported with evidence of food or waterborne spread. Foodborne disease has also taken on an international dimension, highlighted by outbreaks associated with imported foods (e.g. cheese, chocolate, pate, etc.) and tourist groups. Presents a review of recent trends in foodborne infections.

Details

British Food Journal, vol. 96 no. 7
Type: Research Article
ISSN: 0007-070X

Keywords

Article
Publication date: 27 April 2010

David Birnbaum and Jude Van Buren

This paper aims to describe the history and growth of mandatory public reporting of healthcare‐associated infection rates and the philosophy and implementation of an…

Abstract

Purpose

This paper aims to describe the history and growth of mandatory public reporting of healthcare‐associated infection rates and the philosophy and implementation of an evidence‐based total‐quality‐oriented state government program and also to provide critical appraisal of recognized assumptions underlying this movement.

Design/methodology/approach

This paper provides a narrative review of pertinent evaluation research literature and the authors' own experience.

Findings

Washington is one of few states that hired experts in the subject area to develop its new program. It is one of the first exploring optimal ways to validate the rates reported, and one of very few taking evidence‐based approaches to all aspects of program design.

Practical implications

The work provides a model for less‐developed agencies to follow.

Originality/value

This is a new and unprecedented role for state health departments, but offers opportunities to raise standards of practice through continuous quality improvement approaches with hospital partners while regaining public trust through transparency. Weak evidence supporting fundamental assumptions, and failure of prior approaches, indicate that we must explore new paths rather than follow established ones.

Details

Clinical Governance: An International Journal, vol. 15 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 23 November 2010

Mahmud Hassan, Howard P. Tuckman, Robert H. Patrick, David S. Kountz and Jennifer L. Kohn

Hospital‐acquired infection (HAI) poses important health and financial problems for society. Understanding the causes of infection in hospital care is strategically important for…

1083

Abstract

Purpose

Hospital‐acquired infection (HAI) poses important health and financial problems for society. Understanding the causes of infection in hospital care is strategically important for hospital administration for formulating effective infection control programs. The purpose of this paper is to show that hospital length of stay (LOS) and the probability of developing an infection are interdependent.

Design/methodology/approach

A two‐equation model was specified for hospital LOS and the incidence of infection. Using the patient‐level data of hospital discharge in the State of New Jersey merged with other data, the parameters of the two equations were estimated using a simultaneous estimation method.

Findings

It was found that extending the LOS by one day increases the probability of catching an infection by 1.37 percent and the onset of infection increases average LOS by 9.32 days. The estimation indicates that HAI elongates LOS increasing the cost of a hospital stay.

Research limitations/implications

The findings imply that studies on cost of HAI that do not properly control for the simultaneity of these two variables, will result in a biased estimation of cost.

Originality/value

The study produces quantitative estimation of the extent of interdependency of hospital LOS and the probability of catching an infection.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 4 no. 4
Type: Research Article
ISSN: 1750-6123

Keywords

Article
Publication date: 20 April 2012

Bernard Black

Health‐care associated infections (HAIs) kill about 100,000 people annually; many are preventable. In response, 18 states currently require hospitals to publicly report their…

Abstract

Purpose

Health‐care associated infections (HAIs) kill about 100,000 people annually; many are preventable. In response, 18 states currently require hospitals to publicly report their infection rates and national reporting is planned. Yet there is limited evidence on the effects of public reporting on HAI rates, and none on what elements of a reporting plan affect its impact on HAI rates. The author aims to review here what little we know, emphasizing his own case study of Pennsylvania.

Design/methodology/approach

The paper contains a narrative description of empirical challenges in attributing changes in infection rates to the introduction of public reporting, and the author's own research findings from a case study of Pennsylvania using both infection rates estimated from administrative (billing) data (“inpatient rates”) and public reported rates.

Findings

Hospitals, faced with public HAI reporting, may respond both by reducing infection rates and through time‐inconsistent reporting (“gaming”). Both effects are likely to be stronger at hospitals with high reported rates, relative to peers. From 2003‐2008, Pennsylvania inpatient CLABSI rates dropped by 14 per cent, versus a 9 per cent increase in control states. The overall drop comes primarily from hospitals in the highest third of reported rates. Reported CLABSI rates fell much faster, by 40 per cent, from 2005 to 2007. This difference suggests time‐inconsistent reporting.

Practical implications

Much more research is needed before we can have confidence that public reporting affects HAI rates (and for which HAIs), or know how to design an effective reporting scheme. HAI reporting cannot yet be considered to be “evidence based.” National reporting mandates will foreclose the state experiments needed to address these questions.

Originality/value

What little we know about impact of public reporting on HAI rates comes in significant part from the case study of Pennsylvania described in this article.

Details

Clinical Governance: An International Journal, vol. 17 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 8 February 2008

David Birnbaum

The purpose of this paper is to confirm what program features potential students would view as incentives or disincentives toward enrolling in a unique self‐directed (distance…

393

Abstract

Purpose

The purpose of this paper is to confirm what program features potential students would view as incentives or disincentives toward enrolling in a unique self‐directed (distance) learning infectious disease control MPH (Master of Public Health) program currently being developed.

Design/methodology/approach

An internet discussion list announcement invited infection control professionals to participate in structured telephone interviews. This pilot study survey was conducted to confirm underlying assumptions about program features that might be viewed as incentives or disincentives by prospective students.

Findings

Responses were received from all regions of the USA except Alaska. Findings from 78 interviews confirm our underlying assumptions about delivery preferences, critical features, perceived value and reasonable cost for a self‐directed (distance) learning Infectious Disease Control MPH degree. Respondents clearly expressed a preference for distance education, but exhibited lack of familiarity with the various types and relative merits of different distance delivery modalities.

Originality/value

“Build it and they will come” has long been a widespread assumption in curriculum development. However, continuing education and advanced credentialing needs of health professionals can be better served by executive‐MBA‐style programs. One lesson from examining the experience of our academic MBA colleagues is to know your clients. This study uniquely confirms assumptions about the educational preferences of infection control professionals.

Details

Leadership in Health Services, vol. 21 no. 1
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 1 March 2005

Samantha Hogg, Nicola Baird, Judith Richards, Sean Hughes, John Nolan, Adrian Jones and Alison Holmes

To describe orthopaedic surgical site infection (SSI) surveillance models at two English pilot sites, and to review their effectiveness and integration into clinical governance.

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Abstract

Purpose

To describe orthopaedic surgical site infection (SSI) surveillance models at two English pilot sites, and to review their effectiveness and integration into clinical governance.

Design/methodology/approach

The different organisational models for orthopaedic SSI at two Trusts were examined and assessed.

Findings

Both sites recognised that regular feedback to clinical staff and clinical ownership are important determinants of success, and this was addressed by both models. Each site appointed a surveillance coordinator within the infection control service to oversee the programme, but tasked data collection to different staff groups directly involved with the care of orthopaedic patients. Feedback programmes to Clinical Governance Committees, clinical staff and managers were developed, reinforcing surveillance of SSI as a core component of surgical risk management and quality assurance, and an integral part of clinical governance. The pilots demonstrated the importance of a dedicated surveillance coordinator.

Practical implications

Infection following joint replacement surgery is associated with high morbidity and financial costs. In 2004 surveillance of orthopaedic SSI became mandatory in England. A description and assessment of these pilot sites will be of practical value to Trusts that must now implement SSI surveillance.

Originality/value

SSI surveillance is a corner‐stone of risk management and quality clinical care, yet little has been published on organisational frameworks needed for implementation, particularly in the context of clinical governance. This paper addresses these issues in describing and assessing the models at two English pilot sites.

Details

Clinical Governance: An International Journal, vol. 10 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 1 October 2006

Sile A. Creedon

The purpose of this research is to explore healthcare workers' infection control practices from a behavioural viewpoint. Major behavioural theories are explored. Findings from a…

3950

Abstract

Purpose

The purpose of this research is to explore healthcare workers' infection control practices from a behavioural viewpoint. Major behavioural theories are explored. Findings from a study which drew heavily from the PRECEDE theoretical framework are presented. The main purpose of this quasi‐experimental study was to observe health care workers' behavioural compliance with hand hygiene guidelines during patient care in an Intensive Care Unit in Ireland before (pre test) and after (post test) implementation of a multifaceted hand hygiene program. Health care workers' attitudes, beliefs and knowledge in relation to compliance with hand‐washing guidelines were also investigated.

Design/methodology/approach

Data were collected through non‐participant observation and survey methods. A convenience sample of nurses, doctors, physiotherapists and care assistants (n=73 observational subjects, n=62 questionnaire respondents) was used.

Findings

Data (n=314 observations, 62 questionnaires) were analysed descriptively and cross‐tabulated using Chi Square (Pearson's) and Mann Whitney statistical tests. Results revealed that a significant shift (32 per cent) occurred in health care workers' compliance with hand washing guidelines (pre‐test 51 per cent/post‐test 83 per cent, p<0.001) following the interventional hand hygiene program. Similarly, significant changes were also found in relation to health care workers' attitudes, beliefs and knowledge (p<0.05).

Originality/value

Findings from this paper are also of value to future researchers investigating any form of behavioural change. Recommendations from this study are that future research which aims to investigate behaviour should be underpinned by an appropriate theoretical framework. Only multifaceted interventions are justified.

Details

Clinical Governance: An International Journal, vol. 11 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

Book part
Publication date: 24 October 2019

Shreyas S. Limaye and Christina M. Mastrangelo

Healthcare-associated infections (HAIs) are a major cause of concern because of the high levels of associated morbidity, mortality, and cost. In addition, children and intensive…

Abstract

Healthcare-associated infections (HAIs) are a major cause of concern because of the high levels of associated morbidity, mortality, and cost. In addition, children and intensive care unit (ICU) patients are more vulnerable to these infections due to low levels of immunity. Various medical interventions and statistical process control techniques have been suggested to counter the spread of these infections and aid early detection of an infection outbreak. Methods such as hand hygiene help in the prevention of HAIs and are well-documented in the literature. This chapter demonstrates the utilization of a systems methodology to model and validate factors that contribute to the risk of HAIs in a pediatric ICU. It proposes an approach that has three unique aspects: it studies the problem of HAIs as a whole by focusing on several HAIs instead of a single type, it projects the effects of interventions onto the general patient population using the system-level model, and it studies both medical and behavioral interventions and compares their effectiveness. This methodology uses a systems modeling framework that includes simulation, risk analysis, and statistical techniques for studying interventions to reduce the transmission likelihood of HAIs.

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