Review
Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus

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Summary

Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37 000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate use of guidelines; education and training; auditing; surveillance and feedback; multimodal and multidisciplinary prevention programmes that include behavioural change; engagement of champions; and positive organisational culture. These components comprise manageable and widely applicable ways to reduce health-care-associated infections and improve patients' safety.

Introduction

Health-care-associated infections (HAIs) affect millions of patients worldwide every year.1, 2 In the European Union (EU) alone, the estimated number of HAIs is 4 544 100 annually, leading directly to around 37 000 deaths and 16 million extra days of hospital stay.3 Several evidence-based practice guidelines have been published in the past decade4, 5, 6, 7, 8, 9, 10, 11, 12 but, despite evidence suggesting that good practice strategies are sufficient, hospitals struggle to comply.13, 14, 15, 16, 17 The systematic review and evidence-based guidance on organisation of hospital infection control programmes (SIGHT) was funded by the European Centre for Disease Prevention and Control. Our objective was to provide evidence-based guidance on the organisation of infection-control programmes in hospitals. In particular, the review aimed to identify the most effective and generally applicable elements of acute-care infection-control and prevention programmes and to identify indicators of structure and process for monitoring. In contrast to more procedure-focused recommendations, we address mainly management and organisational features.

Section snippets

Methods

The systematic review was done according to the PRISMA guidelines18 at three participating institutions (University of Geneva Hospitals, Geneva, Switzerland; Imperial College London, London, UK; and University Hospital of Freiburg, Freiburg, Germany). We separated this project into two work packages: first, a systematic review to identify elements for the organisation of infection-prevention programmes in hospitals and, second, the selection from these of key components, assessment of their

Results

Our search yielded 47 948 titles and abstracts and an additional 131 were added through cross-referencing. 92 articles were eligible for data extraction and analysis (figure 2, table 1, appendix).15, 16, 17, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96,

Discussion

This broad systematic review identified a range of structural, organisational, and management components that are crucial to effective implementation of infection-control programmes in hospitals. Additionally, these components were put into a user's perspective by providing context about implementation and EU-wide applicability.

The formal proportion of one infection-control nurse per 250 hospital beds was established more than 30 years ago.17 However, hospital settings have changed, and expert

Conclusions

Infection prevention and control is a priority for patients' safety and should involve HCWs at all levels and be part of the hospital organisation as a whole.132 Staffing must be adequate to meet task requirements without leading to excessive workload. For prevention purposes, hospital infection-control programmes need to translate the key components into workable documents and programmes that take the local context into account. Programmes should be planned by multidisciplinary groups, take

Search strategy and selection criteria

These are described in detail in the Methods section.

This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on Feb 23, 2015

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    Further contributors are listed in the Acknowledgments section

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