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The article aims to globally illuminate and inform the healthcare delivery systems of the potential value of integrated care pathways (ICPs) application to the management and control of infection in the hospital setting

An analysis of recent pertinent literature (1993‐2004) is given, preceded by a broad overview of both the subjects of infection control and ICPs.

There are scanty examples of ICPs applied to infection control albeit successfully with demonstrable merits which include improvements in the quality and cost of care. However, there is a lack of robust studies on the subject which warrants further research.

Infection control is a major challenge to all healthcare providers seeking practical solutions. This source article may stimulate further informed debate to curb the problem of hospital acquired infection (HAI) which remains a major cause of morbidity and mortality despite all the great advancement in medicine.

The purpose of this explanatory case study is to explain the implementation of interprofessional, multitiered lean daily management (LDM) and to quantitatively report its impact on hospital safety.

This case study explained the framework for LDM implementation and changes in quality metrics associated with the interprofessional, multitiered LDM, implemented at Saint Francis Hospital and Medical Center (SFHMC) at the end of 2018. Concepts from lean, Total Quality Management (TQM) and high reliability science were applied to develop the four tiers and gemba rounding components of LDM. A two-tailed t-test analysis was utilized to determine statistical significance for serious safety events (SSEs) comparing the intervention period (January 2019–December 2019) to the baseline period (calendar years 2017 and 2018). Other quality and efficiency metrics were also tracked.

LDM was associated with decreased SSEs in 2019 compared to 2017 and 2018 (p ≤ 0.01). There were no reportable central line-associated blood stream infection (CLABSI) or catheter-associated urinary tract infection (CAUTI) for first full calendar quarter in the hospital's history. Hospital-acquired pressure injuries were at 0.2 per 1,000 patient days, meeting the annual target of <0.5 per 1,000 patient days. Outcomes for falls with injury, hand hygiene and patient experience also trended toward target. These improvements occurred while also observing a lower observed to expected length of stay (O/E LOS), which is the organizational marker for hospital’s efficiency.

LDM may contribute greatly to improve safety outcomes. This observational study was performed in an urban, high-acuity, low cost hospital which may not be representative of other hospitals. Further study is warranted to determine whether this model can be applied more broadly to other settings.

LDM can be implemented quickly to achieve an improvement in hospital safety and other health-care quality outcomes. This required a redistribution of time for hospital staff but did not require any significant capital or other investment.

As hospital systems move from a volume-based to value-based health-care delivery model, dynamic interventions using LDM can play a pivotal role in helping all patients, particularly in underserved settings where lower cost care is required for sustainability, given limited available resources.

While many hospital systems promote organizational rounding as a routine quality improvement process, this study shows that a dynamic, intense LDM model can dramatically improve safety within months. This was done in a challenging urban environment for a high-acuity population with limited resources.

Many approaches on the economic aspect of hospital acquired infections (HAIs) have two major limitations: first, the lack of distinction between resources attributable to the management of HAI and resources absorbed by the main clinical problem for which the patient was hospitalized, and second, the lack of an adequate method for calculating the relative costs. These assume that the resources used by HAI can be determined by measuring the extra days of length of days (LOS) of infected patients versus non‐infected patients and attribute to extra‐LOS a value to the mean total cost. The aim of the article is to test a cost‐modelling method that could overcome these limitations by applying the appropriateness evaluation protocol to the medical charts of patients with hospital‐acquired symptomatic urinary tract infection (UTI) or sepsis, and by using cost‐centre accounting.

The paper explains and tests a model for calculating costs of HAIs.

The data analysis showed that it is not always true that infections protract LOS: five out of 25 sepsis cases have extra‐LOS and eight out of 25 UTI cases have extra‐LOS, while the cases of sepsis that arose in surgery ward and intensive care units and urinary tract infections in ICU are without prolongation of LOS. The data analysis also showed that, using the mean total cost, the three cases of sepsis in the general surgery and the six in the ICU did not incur costs, nor did the two cases of UTI in ICU, so that they appear to be infections at zero cost. Moreover, the weight of the cost for the bed, or for the diagnostic services, or for the pharmacological treatment, varied widely depending on the site of the HAI and the ward where the patient was hospitalized.

The method can be applied in any hospital.

The purpose of this study is to analyze the use of a team‐based organizational structure for the purpose of improving the quality of the services provided by the health care system. More specifically, the research aims to investigate the efficiency of a cross‐functional team‐based structure in regard to improving knowledge‐sharing and hereby reducing hospital‐acquired infections (i.e. health‐care associated infections) caused by insufficient hand hygiene.

The findings are drawn from interviews, observations, and desk research conducted in a large Danish university hospital. The paper has applied a case study methodology using grounded theory and has approached the analysis by employing a holistic view.

The paper identifies the necessity for educating the hygiene teams in regard to team processes. Professional knowledge of proper hygiene behavior is to be combined with knowledge of procurement, processes of change, and teamwork in such a manner that the members of the hygiene teams can implement these tools effectively.

The study is based on a small sample. The context and process imposed constraints and the findings are context specific; this has implications for the application of the findings to other settings.

Knowledge about proper hand washing is not enhanced through written policies and procedures.

The paper offers insight into means of enhancing hygiene standards by the integration of organizational processes and change with knowledge and knowledge transfer within a hospital.

Hospitals are responsible for protecting the well-being of their patients and staff. To do so, accurate information is needed for the hospital to make appropriate decisions and allocate resources efficiently. This study aims to describe the implementation process of a surveillance system to reduce hospital-acquired infection (HAI) reporting errors in the maternity unit of a district hospital in Rwanda.

The team adapted an evidence-based tool to identify and report HAI, provided training to staff and distributed reporting responsibilities equally between the maternity staff to improve accuracy in HAI reporting.

The intervention successfully reduced the reporting discrepancy of HAI from 6.5 to 1.9 per cent: p < 0.05.

This case study described the implementation process of a surveillance system using strategic problem solving to reduce HAI reporting errors. The results can inform hospitals in similar settings of the steps to follow to implement a cost-neutral HAI surveillance system to reduce reporting errors. The accurate data will enable the hospital to take corrective measures to address HAI in the future.

The results will inform hospitals in similar settings of steps to follow to implement a cost-neutral HAI surveillance system using the SPS approach to reduce reporting errors.

This chapter discusses the potential role of geographic information systems (GIS) for infection control within the hospital system. The chapter provides a brief overview of the role of GIS in public health and reviews current work applying these methods to the hospital setting. Finally, it outlines the potential opportunities and challenges for adapting GIS for use in the hospital setting for infection prevention. A targeted literature review is used to illustrate current use of GIS in the hospital setting. The discussion of complexity was compiled using the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Challenges and opportunities were then extracted from this exercise by the authors. There are multiple challenges to implementation of a Hospital GIS for infection prevention, mainly involving the domains of technology, organization, and adaptation. Use of a transdisciplinary approach can address many of these challenges. More research, specifically prospective, reproducible clinical trials, needs to be done to better assess the potential impact and effectiveness of a Hospital GIS in real-world settings. This chapter highlights a powerful but rarely used tool for infection prevention within the hospital. Given the importance of reducing hospital-acquired infection rates, it is vital to identify relevant methods from other fields that could be translated into the field of hospital epidemiology.

The next month or two behind us and this decade will have passed, to merge in the drab background of the post‐war years, part of the pattern of frustration, failure and fear. The ‘swinging sixties’ some called it, but to an older and perhaps slightly jaundiced eye, the only swinging seemed to be from one crisis to another, like the monkey swinging from bough to bough in his home among the trees; the ‘swingers’ among men also have their heads in the clouds! In the seemingly endless struggle against inflation since the end of the War, it would be futile to fail to see that the country is in retreat all the time. One can almost hear that shaft of MacLeodian wit christening the approaching decade as the ‘sinking seventies’, but it may not be as bad as all that, and certainly not if the innate good sense and political soundness of the British gives them insight into their perilous plight.

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.

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.

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.

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.

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

Improving healthcare quality has become a worldwide effort. Strategic problem solving (SPS) is one approach to improve quality in healthcare settings. This case study aims to illustrate the process of applying the SPS approach in implementing a quality improvement project in a referral hospital.

A project team was formed to reduce the hospital-acquired infection (HAI) rate in the neonatology unit. A new injection policy was implemented according to the root cause identified.

The HAI rate decreased from 6.4 per cent pre-intervention to 4.2 per cent post-intervention. The compliance of performing the aseptic injection technique significantly improved by 60 per cent.

This case study illustrated the detailed application of the SPS approach in establishing a quality improvement project to address HAI and injection technique compliance, cost-effectively. Other departments or hospitals can apply the same approach to improve quality of care.

This study helps inform other hospitals in similar settings, the steps to create a quality improvement project using the SPS approach.

Post-cesarean wound infection (PCWI) is a common post-operative complication that can negatively affect patients and health systems. Poor hand hygiene practice of health care professionals is a common cause of PCWI. This case study aims to describe how strategic problem solving was used to introduce an alcohol-based hand rub in a district hospital in Rwanda to improve hand hygiene compliance among health care workers and reduce PCWI.

Pre- and post-intervention study design was used to address the poor hand hygiene compliance in the maternity unit. The hospital availed an alcohol-based hand rub and the team provided training on the importance of hand hygiene. A chart audit was conducted to assess the PCWI, and an observational study was used to assess hand hygiene compliance.

The intervention successfully increased hand hygiene compliance of health care workers from 38.2 to 89.7 per cent, p < 0.001, and was associated with reduced hospital-acquired infection rates from 6.2 to 2.5 per cent, p = 0.083.

This case study describes the implementation process of a quality improvement project using the eight steps of strategic problem solving to introduce an alcohol-based hand rub in a district hospital in Rwanda. The intervention improved hand hygiene compliance among health care workers and reduced PCWI using available resources and effective leadership skills.

The results will inform hospitals with similar settings of steps to create an environment that enables hand hygiene practice, and in turn reduces PCWI, using available resources and strategic problem solving.