A recent study conducted by researchers from Columbia University and the Centers for Disease Control and Prevention (CDC) revealed that a large number of US hospital intensive care units (ICUs) have demonstrated uneven compliance with infection prevention policies. The findings were published in the February issue of the American Journal of Infection Control.
In the largest study of its kind, researchers undertook a nationwide survey of 1,534 ICUs at 975 hospitals as part of the larger Prevention of Nosocomial Infections and Cost Effectiveness Refined (P-NICER) study.
The survey inquired about the implementation of 16 prescribed infection prevention measures at point-of-care, and clinician adherence to these policies for the most common infections acquired by patients in ICUs. This included the prevention of ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI).
According to the study results, hospitals have more policies in place to prevent CLABSI and VAP, than CAUTI. The presence of infection control policies to prevent CLABSI ranged from 87 to 97 percent depending on the measure being counted; the presence of policies for VAP ranged from 69 to 91 percent; and policies for CAUTI lagged behind with only 27 to 68 percent of ICUs reporting prevention policies.
The use of a checklist for CLABSI insertion practices was reported by the vast majority of hospitals (92 percent), while the use of a ventilator bundle checklist was reported by fewer hospitals (74 percent).
“Evidence-based practices related to CAUTI prevention measures have not been well implemented,” the authors noted. “These findings are surprising, given that CAUTI is the most frequent healthcare-associated infection. Clearly, more focus on CAUTI is needed, and dissemination and implementation studies to inform how best to improve evidence-based practices should be helpful.”
What’s more, the study found that many hospital ICUs fell short in adhering to policies. Adherence to prevention policies ranged from 37 to 71 percent for CLABSI, 45 to 55 percent for VAP, and 6 to 27 percent for CAUTI.
“Establishing policies does not ensure clinician adherence at the bedside,” the authors added. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.”