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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3050 — What VA and Non-VA Hospitals are Doing to Prevent Hospital-Acquired Infection: 2005 to 2009

Krein SL (VA Ann Arbor HSR&D COE), Kowalski CP (VA Ann Arbor HSR&D COE), Hofer TP (VA Ann Arbor HSR&D COE), Saint S (VA Ann Arbor HSR&D COE)

Objectives:
Hospital-acquired infection (HAI) is common, costly, and potentially life-threatening. In 2005 there was substantial variability in the use of HAI prevention practices among hospitals and whether recent initiatives to reduce HAI have led to an increase in the use of preventive practices is unknown. Therefore, we sought to examine current use of infection prevention practices by VA and non-VA hospitals and assess trends in the use of various practices between 2005 and 2009.

Methods:
We surveyed infection preventionists at a national random sample of U.S. hospitals and all VA hospitals in both 2005 and 2009 and asked about the regular use of practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI).

Results:
In 2005, significantly more VA hospitals reported using maximum barrier precautions (84% VA vs. 71% non-VA, P = .01) and chlorhexidine site antisepsis (91% VA vs. 69% non-VA, P < .001) to prevent CLABSI. In 2009, use of these practices was reported by >= 90% of VA and non-VA hospitals. Similarly, 89% of VA and 82% of non-VA hospitals reported use of semi-recumbent positioning to prevent VAP in 2005 compared to >= 95% in 2009. In both 2005 and 2009 the most frequently used practice to prevent CAUTI among VA hospitals was portable bladder ultrasound (49% in 2005 and 70% in 2009) compared with antimicrobial urinary catheters among non-VAs (30% in 2005 and 45% in 2009). Catheter reminders or stop-orders were used by 12% of VA and 9% of non-VA hospitals in 2005 but increased to 20% for both in 2009.

Implications:
Since 2005, there have been significant increases in the percentage of U.S. hospitals reporting use of key practices to prevent CLABSI, VAP, and CAUTI. Nonetheless, use of practices to prevent CAUTI remains low compared to those for preventing CLABSI and VAP among VA and non-VA hospitals.

Impacts:
Increased effort may be required in both VA and non-VA hospitals to increase the use of key practices for preventing CAUTI. Leveraging the VA’s computerized order entry system to remind physicians and nurses about the presence of a urinary catheter may be a useful method to prevent CAUTI.


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