Effectiveness of comprehensive implementation of individualized bundling infection control measures for prevention of health care–associated infections in general medical wards

doi:10.1016/j.ajic.2010.09.017

American Journal of Infection Control

Volume 39, Issue 6, August 2011, Pages 471-476

https://doi.org/10.1016/j.ajic.2010.09.017 Get rights and content

Background

The prevalence of health care–associated infections (HAIs) in general medical wards at Siriraj Hospital in Bangkok, Thailand remains at 10% even after infection control measures were launched. The present study aimed to determine the effectiveness of comprehensive individualized bundling infection control measures in reducing HAIs and to identify the lowest possible rate of HAIs in general medical wards.

Methods

This was a cluster randomized controlled study conducted in 8 general medical wards (4 control wards and 4 intervention wards) at Siriraj Hospital. The patients hospitalized in the control wards received regular health care, as well as regular measures for preventing HAIs. The patients hospitalized in the intervention wards received additional measures. Each patient in the intervention wards was visited by the infection control team once a day until he or she left the hospital. The infection control team identified risk factors for developing HAI in each patient, coordinated with the local health care team to eliminate or minimize such risk factors, and encouraged responsible personnel to comply with the appropriate infection control measures for each patient.

Results

Between January and April 2009, there were 954 patients (9,650 hospitalization-days) in the intervention wards and 920 patients (9,777 hospitalization-days) in the control wards. The patient characteristics were comparable in the 2 groups. The prevalence of HAI was significantly lower in the intervention wards compared with the control wards (5.6% vs 9.2%; P = .003). Six episodes of HAI in patients in the intervention wards could have been avoided.

Conclusion

Comprehensive individualized bundling infection control measures were effective in reducing the prevalence of HAIs in general medical wards. The target overall prevalence of HAIs in general medical wards should not exceed 4.9%.

Section snippets

Methods

The study protocol was approved by Siriraj Hospital’s Institutional Review Board.

Results

Between January and April 2009, there were 954 patients (9,650 hospitalization-days) in the intervention wards and 920 patients (9,777 hospitalization-days) in the control wards. Characteristics of the patients in both groups are summarized in Table 1. The study cohort was 50% male, with a mean age of 60 years. The most common principal diagnoses were cardiopulmonary diseases, cerebrovascular diseases, chronic liver diseases, chronic renal diseases, cancer, and community-acquired infections.

Discussion

HAIs complicate 5%-10% of admissions in acute care hospitals in industrialized countries, compared with 25% in developing countries.⁵ The results of the International Infection Control Consortium (INICC) surveillance study between January 2003 and December 2008, in 173 ICUs involving 155,358 patients with 923,624 ICU-days in Latin America, Asia, Africa, and Europe, showed that although device utilization in developing countries’ ICUs was remarkably similar to that reported from US ICUs in the

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We evaluated the practices used in Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP).
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Citation Excerpt :
If the RRR of any intervention was ≥0.4, any intervention that cost <$23 per hospitalization day was superior to regular IC care. This study identified a relatively high cumulative incidence (23.30%) and incidence rate of HAIs (18.66 ± 44.19 per 1,000 hospitalization days) compared with the findings of previous studies.9,15-17 This could be the result of sicker patients in this study.
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A retrospective cohort study was conducted among hospitalized patients at Siriraj Hospital, Thailand. Results from the cohort were subsequently used to conduct cost-effective analysis (CEA) to compare the comprehensive implementation of individualized bundling infection control measures (IBICMs) with regular infection control care.
From February-May 2013, there were 515 hospitalizations (497 patients) with 7,848 hospitalization days. Cumulative incidence of HAIs was 23.30%, and the incidence rate of HAIs was 18.66 ± 44.19 per 1,000 hospitalization days. Hospital mortality among those with and without HAIs was 33.33% and 20.00%, respectively (P < .001). The adjusted cost attributable to HAIs was $704.72 ± $226.73 (P < .001). CEA identified IBICMs as a non-dominated strategy, with an incremental cost-effectiveness ratio of −$20,444.62 per life saved.
HAI is significantly related with higher hospital mortality, longer length of stay, and higher hospitalization costs. IBICMs were confirmed to be cost-effective at Siriraj Hospital. Implementing this intervention could improve care quality and save costs.
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The Thailand AMRCP Program has been producing local evidence of this sort in outpatient settings and in hospitalised patients and has been implementing infection control practices in hospitals. The programme has collected locally produced evidence on AMRCP, including on: promoting responsible antibiotic use for outpatients with upper respiratory infections, acute bronchitis, acute diarrhoea and fresh traumatic wounds [7–9]; drug use evaluation of controlled antibiotics for hospitalised patients [10]; and promoting comprehensive infection control practices in hospitals to minimise HAIs [11–14]. This evidence, in addition to international and global evidence, is incorporated in the AMRCP package.
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: Clinical Trial Registration Number: NCT00917319.

: Conflict of interest: None to report.

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Major articleEffectiveness of comprehensive implementation of individualized bundling infection control measures for prevention of health care–associated infections in general medical wards

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Hosp Infect

J Hosp Infect

J Hosp Infect

J Hosp Infect

Am J Infect Control

J Hosp Infect

J Hosp Infect

Am J Infect Control

Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients

J Formos Med Assoc

Prevalence and impacts of nosocomial infections in Thailand 2001

J Med Assoc Thai

Prevalence of nosocomial infection in Thailand, 2006

J Med Assoc Thai

Major article
Effectiveness of comprehensive implementation of individualized bundling infection control measures for prevention of health care–associated infections in general medical wards