Table 4 Interventions reported in the literature to improve guideline compliance and the corresponding ambiguity type targeted
StudyTarget healthcare-associated infectionsInterventionsResultsAmbiguity type
Berenholtz et al44Ventilator-associated pneumoniaEducational sheet for nursesPercentage of ventilator days during which patients received all the care required by the ventilator-associated pneumonia bundle increased significantlyExpectation
In-services for nurses
Instruction to residents and fellows during daily lectures
A standardised checklist (daily goals form) to ensure that physicians wrote the orders required by the ventilator-associated pneumonia bundleTask
Cocanour et al48Ventilator-associated pneumoniaReal-time feedback to intensive-care unit staff on compliance with the ventilator-associated pneumonia bundleVentilator-associated pneumonia rate decreased significantlyExpectation
Helman et al46Ventilator-associated pneumoniaStandardised order addressing the head of the bed greater than 30° guidelineCompliance improved significantlyTask
An organised nurse and physician education programmeCompliance improved significantlyExpectation
Berenholtz et al45Central venous catheter-related bloodstream infectionsWeb-based training module for physiciansCentral venous catheter-related bloodstream infection rates decreased significantlyExpectation
Lectures for nurses and physicians
Central venous catheter insertion cartMethod
An item about whether any lines could be removed was added to the daily goals formTask
Nurses were empowered to stop procedures if guidelines were not followed.Responsibility
Shannon et al49Central venous catheter-related bloodstream infectionsEach infection occurrence examined to its root cause as close as possible to receipt of a positive laboratory test valueCentral venous catheter-related bloodstream infection rates decreased significantlyExpectation
Multidisciplinary training exercise to trainees using patient simulators
Wall et al47Central venous catheter-related bloodstream infectionsReal-time feedback to ICU staff on complianceCentral venous catheter-related bloodstream infection rates decreased significantlyExpectation
Vogelzang et al50Surgical site infectionsComputerised decision support system for supporting the tight glucose control guidelineCompliance significantly improvedMethod
Goetz et al51Catheter-associated urinary tract infectionsFeedback of unit level catheter-associated urinary tract infection rates to nursing staffCatheter-associated urinary-tract infection rates decreased significantlyExpectation

  • ICU, intensive care unit.