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Original research
What US hospitals are currently doing to prevent common device-associated infections: results from a national survey
  1. Sanjay Saint1,2,
  2. Michael Todd Greene1,2,
  3. Karen E Fowler1,
  4. David Ratz1,
  5. Payal K Patel2,3,
  6. Jennifer Meddings1,2,4,
  7. Sarah L Krein1,2
  1. 1 Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
  2. 2 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
  3. 3 Division of Infectious Diseases, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
  4. 4 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
  1. Correspondence to Dr Sanjay Saint, University of Michigan, Ann Arbor, MI 48109, USA; saint{at}med.umich.edu

Abstract

Background Despite focused initiatives to reduce device-associated infection among hospitalised patients, the practices US hospitals are currently using are unknown. We thus used a national survey to ascertain the use of several established and novel practices to prevent device-associated infections.

Methods We mailed surveys to infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017. Our survey asked about the use of practices to prevent three common device-associated infections: catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP). Using sample weights, we estimated the percentage of hospitals reporting regular use of each practice. We also conducted multivariable regression to determine associations between selected hospital characteristics (eg, perceived support from leadership) and use of CAUTI, CLABSI and VAP prevention practices.

Results The response rate was 59%. Several practices are reportedly used in over 90% of US hospitals: aseptic technique during indwelling urethral catheter insertion and maintenance (to prevent CAUTI); maximum sterile barrier precautions during central catheter insertion and alcohol-containing chlorhexidine gluconate for insertion site antisepsis (to prevent CLABSI); and semirecumbent positioning of the patient (to prevent VAP). Antimicrobial devices are used in the minority of hospitals for these three device-associated infections.

Conclusions We provide an updated snapshot of the practices US hospitals are currently using to prevent device-associated infections. Compared with previous studies using a similar design and questions, we found that the use of recommended practices increased in US hospitals, especially for CAUTI prevention.

  • infection control
  • hospital
  • nosocomial infection
  • patient safety

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjqs-2018-009111

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    Footnotes

    • Contributors Concept and design: SS, MTG, KEF and SLK; data acquisition: SS, KEF, JM and SLK. Data analysis: MTG and DR. Data interpretation: all authors; drafting of the manuscript: SS, MTG and KEF; critical revision of the manuscript: all authors; obtained funding: SS and SLK.

    • Funding This project was supported by the Blue Cross Blue Shield of Michigan Foundation grant 2413.II and the US Department of Veterans Affairs (VA), including a VA National Center for Patient Safety funded Patient Safety Center of Inquiry. Dr Krein was also supported by a VA Health Services Research and Development Service Research Career Scientist award (RCS 11-222).

    • Disclaimer The study sponsors had no role in the design or conduct of the study; the collection, management, analysis and interpretation of the data; of the preparation, review or approval of the manuscript.

    • Competing interests SS reports receiving honoraria for lectures and teaching related to the prevention of hospital-acquired infection and serving on the medical advisory boards for Doximity (a social networking site for physicians) and Jvion (a health care technology company). JM reports receiving honoraria for lectures and teaching related to prevention and value-based policies involving catheter-associated urinary tract infection and hospital-acquired pressure ulcers. SS and JM hold a provisional US patent on a technology to improve aseptic placement of urinary catheters, which was not part of this study.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.