Hospital infection control programs: assessment of process and structure indicators

Giroti, Alessandra Lyrio Barbosa; Ferreira, Adriano Menis; Rigotti, Marcelo Alessandro; Sousa, Álvaro Francisco Lopes de; Frota, Oleci Pereira; Andrade, Denise de

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2017039903364 copy

Hospital infection control programs: assessment of process and structure indicators

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To assess hospital infection control committees in relation to structure and process indicators of hospital infection control programs.

Method

Descriptive, cross-sectional study conducted with hospital committees registered in the National Registry of Healthcare Facilities. Primary and secondary data collection was conducted through structured interview using validated instruments and verification of documents, respectively.

Results

Fourteen committees participated in the research. Mean values of conformity of 80.58% were evidenced for the technical-operational structure assessment indicator, 60.77% for the infection control and prevention operational guidelines indicator, 81.59% for the epidemiological surveillance system assessment indicator, and 63.44% for hospital infection control and prevention activities assessment indicator.

Conclusion

Among the four instruments applied to assess hospital infection control programs, only two presented results with more than 80.0% of conformity: those related to the epidemiological surveillance and technical-operational structure assessments.

Cross Infection; Infection Control; Patient Safety; Quality of Health Care; Health Services Research

PCET* indicator	Conformity		No conformity		Partial conformity

	n	%	n	%	n	%
The HICC is represented by, at least, members of the administration, nursing, and medical services.	14	100.0	-	-	-	-
There is a statute determining the operation of the HICC and/or hospital infection control services.	12	85.7	-	-	2	14.2
There are two higher education health professionals performing exclusive actions for HI control and prevention for every 200 beds; one of them is a nurse (associated or not).	8	57.1	6	42.8	-	-
The nurse works exclusively dedicated to the service for at least 6 hours a day.	10	71.4	4	28.5	-	-
There is another higher education professional working with exclusive dedication to the service for at least 4 hours a day.	8	57.1	6	42.8	-	-
The HICC conducts regular meetings with the participation of executive members and leaders.	12	85.7	2	14.2	-	-
There is microbiology and pathology lab support, own or outsourced.	14	100.0	-	-	-	-
There is a delimitated and exclusive physical space for the daily activities, files, etc. of the HICC or hospital infection control services.	9	64.2	5	35.7	-	-
There is availability of computerized resources for the activities developed by the HICC or hospital infection control services.	14	100.0	-	-	-	-
The administration provides statistical data (number of admissions, discharges, deaths, patients-day, etc.) for the production of HICC or hospital infection control services reports	12	85.7	2	14.2	-	-

Mean	80.7		17.8		1.4
Standard-deviation	17.1		18.2		4.5

PCDO indicator	Conformity		No conformity		Partial conformity

	n*	%	n	%	n	%
There is a recommendation for assessment and referral of accidents with sharp objects and other cases of exposure to biological material.	11	84.6	1	7.69	1	7.69
There are recommendations for the disposal of health care waste.	8	66.6	3	25.0	1	8.3
There are recommendations for respiratory infection control and prevention.	6	42.8	8	57.1	-	-
There are recommendations for urinary tract infection control and prevention.	5	35.7	8	57.1	1	7.14
There are recommendations for bloodstream infection control and prevention.	5	35.7	9	64.2	-	-
There are recommendations for surgical site infection control and prevention.	6	46.1	7	53.8	-	-
There is a recommendation for isolation of patients with infectious/contagious or immunosuppressive diseases.	11	78.5	3	21.4	-	-
There is a recommendation for the use of prophylactic antibiotics to prevent surgical site infections.	11	84.6	2	15.3	-	-
There is a standardization of germicides and antiseptics.	10	71.4	4	28.5	-	-
There is a recommendation of techniques for cleaning, disinfecting, and sterilizing materials and equipment.	8	57.1	6	42.8	-	-
There is a recommendation of hand hygiene technique.	13	92.8	1	7.1	-	-
There is a recommendation of the routine for cleaning and disinfection of surfaces.	11	78.5	2	14.2	1	7.1
There is a recommendation for washing and hygiene of clothes used in the institution.	3	21.4	10	71.4	1	7.1
There is a recommendation for the technique to collect material for cultivation.	4	28.5	8	57.1	2	14.2
There is a recommendation for dressing techniques and intervals of dressing changes.	9	81.8	2	18.1	-	-
There are recommendations for respiratory tract infection control and prevention.	6	42.8	8	57.1	-	-
There are recommendations for urinary tract infection control and prevention.	5	35.7	8	57.1	1	7.14

Mean	60.4		36.1		3.4
Standard deviation	23.5		22.3		4.6

PCVE indicator	Conformity		No conformity		Partial conformity

	n*	%	n	%	n	%
Epidemiological surveillance (global or per component) is conducted at determined intervals.	13	92.8	1	7.1	-	-
HI epidemiological surveillance is conducted through active search of cases	13	92.8	1	7.1	-	-
Active search of HI cases is conducted in higher risk units (ICU, nursery, burn units, etc.).	12	92.3	-	-	1	7.6
Monitoring, at regular intervals and with regular records, the microbiological results of cultures identifying strains or species of microorganisms, including resistant ones.	11	78.5	3	21.4	-	-
There are predetermined criteria for HI diagnosis.	13	92.8	1	7.1	-	-
Regular reports of the results of the epidemiological surveillance (endemic levels) are produced.	13	92.8	1	7.1	-	-
The reports analyze and notify any changes in the epidemiological profile (descriptive and/or graphical).	11	78.5	3	21.4	-	-
The reports correlate results with adopted control and prevention strategies (intervention).	5	35.7	9	64.2	-	-
The reports are regularly made available to the several sectors and leaders of the institution.	11	78.5	3	21.4	-	-
The reports are regularly made available to the concerning public bodies (managers).	12	85.7	2	14.2	-	-

Mean	82.0		17.1		0.7
Standard deviation	17.5		18.1		2.4

PCCP indicator	Conformity		No conformity		Partial conformity

	n*	%	n	%	n	%
Dialysis unit (I – D – R – C – O)	2	66.6	1	33.3	-	-
Blood bank (I – D – R – C – O)	3	50.0	3	50.0	-	-
Clinical analysis lab (I – D – R – C – O)	2	28.5	4	57.1	1	14.2
Pathological anatomy lab (I – D – R – C – O)	2	40.0	2	40.0	1	20.0
Hospitalization units (I – D – R – C – O)	13	92.8	1	7.1	-	-
Intensive care units (I – D – R – C – O)	8	88.8	1	11.1	-	-
Nursery (I – D – R – C – O)	2	40.0	3	60.0	-	-
Material and sterilization center (I – D – R – C – O)	9	69.2	3	23.0	1	7.6
Surgical center (I – D – R – C – O)	11	84.6	2	15.3	-	-
Emergency room (I – D – R – C – O)	7	77.7	2	22.2	-	-
Outpatient facility (I – D – R – C – O)	8	61.5	5	38.4	-	-
Pharmacy service (I – D – R – C – O)	8	57.1	6	42.8	-	-
Nutrition and diet services (I – D – R – C – O)	10	71.4	4	28.5	-	-
Participation in technical decisions for specification and acquisition of products and related products	8	57.1	4	28.5	2	14.2

Mean	63.2		32.7		4.0
Standard deviation	19.3		16.3		7.0

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Álvaro Francisco Lopes de Sousa. Avenida dos Bandeirantes, 3900 Campus Universitário – Bairro Monte Alegre CEP 14040-902 – Ribeirão Preto, SP, Brazil alvarosousa@usp.br