Educating the infection control team - past, present and future. A British prespective

Effectiveness of Infection Control Teams in Reducing Healthcare-Associated Infections: A Systematic Review and Meta-Analysis

The infection control team (ICT) ensures the implementation of infection control guidelines in healthcare facilities. This systematic review aims to evaluate the effectiveness of ICT, with or without an infection control link nurse (ICLN) system, in reducing healthcare-associated infections (HCAIs). We searched four databases to identify randomised controlled trials (RCTs) in inpatient, outpatient and long-term care facilities. We judged the quality of the studies, conducted meta-analyses whenever interventions and outcome measures were comparable in at least two studies, and assessed the certainty of evidence. Nine RCTs were included; all were rated as being low quality. Overall, ICT, with or without an ICLN system, did not reduce the incidence rate of HCAIs [risk ratio (RR) = 0.65, 95% confidence interval (CI): 0.45-1.07], death due to HCAIs (RR = 0.32, 95% CI: 0.04-2.69) and length of hospital stay (42 days vs. 45 days, p = 0.52). However, ICT with an ICLN system improved nurses' compliance with infection control practices (RR = 1.17, 95% CI: 1.00-1.38). Due to the high level of bias, inconsistency and imprecision, these findings should be considered with caution. High-quality studies using similar outcome measures are needed to demonstrate the effectiveness and cost-effectiveness of ICT.

Status of infection prevention and control capacity in Korean hospitals: implications for disaster response and pandemic preparedness

OBJECTIVES

This study aims to explore the association of hospital infection prevention and control (IPC) structure (i.e. a dedicated IPC team and/or IPC committee) and IPC capacity in Korean hospitals, as well as its implications in the response and preparedness to COVID-19.

STUDY DESIGN

This was a cross-sectional study using data collected through a nationwide survey.

METHODS

Participating hospitals completed an online questionnaire. Participation was voluntary. The survey questionnaire was developed by the government in consultation with IPC experts. The questionnaire was distributed to 2108 hospitals, including both acute and long-term care hospitals. The independent variables were the presence of an IPC team and/or IPC committee. The dependent variables were IPC activities and capacity measures, which were based on the World Health Organisation (WHO) recommendations on the core components in IPC.

RESULTS

A total of 1442 hospitals completed the survey. Hospitals with IPC structures conducted significantly more IPC activities in all outcome measures compared with hospitals without IPC structures, with the exceptions of monitoring hand hygiene and screening for infectious diseases that showed non-significant differences. Hospitals with IPC structures showed a significant difference in performance in IPC risk assessment, operating outbreak response teams and appraisal of hospital IPC policies compared with hospitals without IPC structures.

CONCLUSIONS

The presence of a dedicated IPC team and IPC committee was associated with increased IPC activities and IPC capacity. Hospitals with IPC teams and IPC committees showed strong implementation of planning, appraisal, resource management and outbreak response, indicating that strengthening IPC structures within hospitals is the key to more effective IPC and disaster response.

Infection control teams for reducing healthcare-associated infections in hospitals and other healthcare settings: a protocol for systematic review

INTRODUCTION

Healthcare-associated infections (HCAIs) are a worldwide problem. Infection control in hospitals is usually implemented by an infection control team (ICT). Initially, ICTs consisted of doctors, nurses, epidemiologists and microbiologists; then, in the 1980s, the infection control link nurse (ICLN) system was introduced. ICTs (with or without the ICLN system) work to ensure the health and well-being of patients and healthcare professionals in hospitals and other healthcare settings, such as acute care clinics, community health centres and care homes. No previous study has reported the effects of ICTs on HCAIs. This systematic review aims to assess the effectiveness of ICTs with or without the ICLN system in reducing HCAIs in hospitals and other healthcare settings.

METHODS AND ANALYSIS

We will perform a comprehensive literature search for randomised controlled trials in four databases: PubMed, Embase, CINAHL and the Cochrane Library. The primary outcomes are: patient-based/clinical outcomes (rate of HCAIs, death due to HCAIs and length of hospital stay) and staff-based/behavioural outcomes (compliance with infection control practices). The secondary outcomes include the costs to the healthcare system or patients due to extended lengths of stay. Following data extraction, we will assess the risk of bias by using the Cochrane Effective Practice and Organization of Care risk of bias tool. If data can be pooled across all the studies, we will perform a meta-analysis.

ETHICS AND DISSEMINATION

We will use publicly available data, and therefore, ethical approval is not required for this systematic review. The findings will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

CRD42020172173.

Developing a model to assess optimum infection control workforce in acute care settings

BACKGROUND

Little research has been completed to assess the numbers of infection prevention and control personnel employed or optimal size and composition of infection control teams.

METHODS

Acute national health hospital organizations in England were requested to provide information about the numbers of infection prevention and control personnel employed and weekly hours contributed by each occupational group under the United Kingdom's Freedom of Information legislation. The relationship between capacity of the infection prevention and control workforce, size of the inpatient population, and routinely collected surveillance data for health care-associated infection were explored.

RESULTS

There were 137 (85%) National Health Service (NHS) hospital organizations that responded. The number of infection prevention and control nurses ranged from 1-16 per organization. A total of 46 (33.6%) reported that they received no clinical microbiology sessions, and for 11 (8%) input was inadequate. An antibiotic pharmacist was reported to be employed in 107 (78.1%) organizations. Few infection prevention and control teams reported receiving the following: 1. managerial support, 2. being represented on committees where decisions about resource allocation were made, or 3. assistance with administration.

CONCLUSION

Despite the priority that infection prevention and control have received in the United Kingdom over the last 10 years, many infection prevention and control teams appear underresourced.

Development and validation of tools for assessing use of personal protective equipment in health care

BACKGROUND

Incorrect use of personal protective equipment (PPE) may lead to the spread of infectious agents among health care workers and patients. Although novel education programs show promise, there is no standard evaluation for the competencies developed during training.

METHODS

A Delphi methodology was used in which checklist and global rating items for evaluating the performance of PPE skills involving gloves, gowns, masks, eye protection, and hand hygiene were generated and iteratively distributed to a panel of experts. The panel rated the importance of each item until agreement was reached, and the relevant items were used to form the Tools for Assessment of PPE Skills (TAPS), comprising 3 checklist sections (hand hygiene, donning, and doffing) and a global rating scale. Newly trained and experienced PPE users participated in experiments to evaluate the reliability, construct validity, and responsiveness of TAPS.

RESULTS

TAPS demonstrated interobserver reliability, and its global rating scale differentiated the performance of newly trained users and experienced users and was sensitive to changes in performance over time.

CONCLUSIONS

Pending further validation studies, the TAPS may facilitate the development and evaluation of educational programs to support learning and retention of PPE skills, leading to enhanced patient and health care worker safety.

Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches

BACKGROUND

Current approaches in the control of methicillin-resistant Staphylococcus aureus (MRSA) in the large tertiary referral hospital have not been universally successful.

METHODS

The trend of MRSA rates and their relationship with stepwise implementation of preventive strategies in Tokai University Hospital during a 76-month period from September 1998 to December 2004, was retrospectively analyzed with a quasi-experimental design.

RESULTS

Implementation of strategies including a feedback process with case and epidemic reporting, an infection control team and office, and a preventive guideline for MRSA did not result in reduction in monthly MRSA rates in the hospital, as analyzed with Shewhart u charts. When infection control link nurses were organized and their activities became full-scale, there appeared significant reduction in arithmetic mean of the monthly rates of MRSA from 6.3% to 5.0% in June 2002. Meanwhile the mean values for monthly counts of new MRSA cases also dropped in 15 of 25 wards/units in June 2002, as analyzed with Exponentially Weighted Moving Average charts. Concurrently, there was a significant increase (17.3%) in the monthly consumption of handwashing liquid plain soap. Thereafter the MRSA rates remained low for 2 years within three standard deviations.

CONCLUSIONS

The sustained reduction of MRSA rates in the hospital can be related to introduction of the infection control link-nurse system on the basis of continuous enforcement of basic and multidisciplinary approaches such as hand-hygiene compliance.

The role of the infection control link nurse

Link nurses act as a link between their own clinical area and the infection control team. Their role is to increase awareness of infection control issues in their ward and motivate staff to improve practice. It is essential that they receive training from the infection control team to ensure their competence. They have been shown to be of value to Trusts by improving clinical ward audit scores, helping infection control nurses implement policies and collecting data on hospital-acquired infections. In some hospitals, however, there are operational difficulties for link nurse schemes including high turnover of staff and insufficient time for training and monitoring their effectiveness.

Perceptions of physicians on infection control activities in Turkish hospitals: a cross-sectional survey

BACKGROUND

Most countries practice some form of infection control (IC) to minimize hospital-acquired infections. There is still considerable diversity in IC activities in Turkey. Little is known about practical issues and perceptions of physicians regarding IC in Turkey.

METHODS

The authors developed an 11-item questionnaire addressing questions on IC activities. Physicians attending a national infection control meeting (n = 285) were asked to participate.

RESULTS

The response rate was 86%. Respondents from nonuniversity teaching hospitals stated a higher involvement in IC. Physicians from university hospitals were in greater need of IC training.

CONCLUSIONS

Academic hospitals are particularly concerned with IC. Domains such as surveillance of endemic hospital infections, specific preventive protocols, antibiotics policy, and staff education should be addressed by IC committees. IC is well established in Turkey, but there is still a long way to go to reach the standards found in developed countries.