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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3012 — Adoption of Infection Prevention Practices by VA and Non-VA Hospitals

Author List:
Krein SL (Center for Practice Management and Outcomes Research)
Hofer TP (Center for Practice Management and Outcomes Research)
Kowalski C (Center for Practice Management and Outcomes Research)
Saint S (Center for Practice Management and Outcomes Research)

Objectives:
Device-related healthcare-associated infection is a common and costly patient safety problem. Unfortunately, there is no current information about which practices are used in U.S. hospitals to prevent the most common device-related infections. The purpose of this study was to describe the adoption of evidence-based infection prevention practices by VA and non-VA hospitals.

Methods:
We conducted a written survey of Infection Control Coordinators at 797 hospitals nationwide, 119 VA Medical Centers, and a national stratified random sample of non-VA hospitals. Respondents identified whether certain practices were used for the prevention of the three most common device-related infections: catheter-related urinary tract infection (UTI), central venous catheter-related infection, and ventilator-associated pneumonia (VAP). For this analysis we focus on 7 key prevention practices, 2 each related to UTI and VAP and 3 related to central venous catheters. We defined ”adoption” as using a practice always or almost always. Data analysis includes both descriptive and multivariable techniques.

Results:
Our response rate was 74%. Both VA and non-VA hospitals have adopted, on average, 3 of the 7 practices of interest. The percent of hospitals adopting at least one prevention practice within each domain were: for UTI, 21% of VAs compared to 36% of non-VAs; for central venous catheters, 99% of VAs vs. 92% of non-VAs; and, for VAP, 88% of VAs compared to 84% of non-VAs. VAs were less likely to use anti-infective urinary catheters, compared to non-VA hospitals (30% vs. 14%, p = .002), but were more likely to use maximum sterile barrier precautions (84% vs. 73%, p = .027) and chlorhexidine gluconate for antisepsis of the central venous catheter insertion site (91% vs. 74%, p = .001).

Implications:
While the number of infection prevention practices adopted is similar between VA and non-VA hospitals, there are several important differences in the types of practices being used.

Impacts:
Identifying and implementing strategies to encourage the use of proven infection prevention practices is a key issue in creating a safer patient environment. While adoption is an important and necessary first step, the degree to which certain practices are effectively implemented in order to decrease infection risk must also be examined.


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