Critical access hospitals struggle with infection prevention and control, especially when it comes to injection safety and preventing certain infections, according to findings presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology, or APIC.
“Lack of competency-based training programs and failure to perform audits and feedback appear to be recurrent themes in several domains,” Margaret Drake, MT(ASCP), CIC, health care-associated infection preventionist in the Nebraska Department of Health and Human Services, said in a news release.
According to Drake and colleagues, not much is known about infection control and prevention in critical access hospitals (CAHs), rural facilities with no more than 25 beds that are located at least 35 miles from other hospitals.
Using the CDC’s Infection Prevention and Control Assessment Tool, Drake and colleagues performed on-site assessments of 36 CAHs in Nebraska. To identify gap frequencies, they compiled 80 core questions representing best practice recommendations in 11 infection control domains. Factors studied included median number of beds, presence of infection control-trained infection preventionist and full-time equivalent of infection preventionist time per 25 beds spent on infection control activities.
The biggest gaps were seen in injection safety, central line-associated bloodstream infection prevention and catheter-associated urinary tract infection prevention, Drake and colleagues reported. However, they noted that there were important gaps in all infection control domains. After dividing CAHs based on gaps, they observed that top-performing CAHs implemented a median of 54 best practice recommendations compared with CAHs in the bottom quartile, which implemented a median of 29. Although the differences were not statistically significant, top-performing CAHs had a higher median number of beds (21 vs. 16), a higher median for full-time equivalent infection preventionist time per 25 beds (0.6 vs. 0.4) and a higher probability of having a trained infection preventionist (100% vs. 88.8%) compared with bottom quartile CAHs, Drake and colleagues reported.
They did observe some significant differences when gaps were individually analyzed. They found that CAHs with a competency-based training program for the reprocessing of semicritical equipment were more likely (96% vs. 69%; P <.05) to have a trained infection preventionist than CAHs without the program. These CAHs also had a higher median number of beds (23 vs. 16). CAHs where central venous catheter patients’ needs were assessed daily reported a higher median for full-time equivalent infection preventionist time per 25 beds (0.8 vs. 0.4, P <.05).
Drake and colleagues concluded that infection control practices at CAHs need improvement. They suggested that gaps in infection control and prevention can be reduced if infection preventionists are allotted more time for infection control activities. Education and training are important to rectifying these gaps, Drake noted.
“Injection safety is not unique to CAHs but [present] in all health care. Small hospitals generally have few patients with urinary catheters or central lines due to a low patient volume and they are not prioritizing competency for these devices,” Drake told Infectious Disease News. “ [Infection control practices are] important to practice so when there is a need, they are competent.” – by Marley Ghizzone
Drake M, et al. Abstract 1503. Presented at: APIC 2018; June 13-15, 2018; Minneapolis.
Disclosures: Drake reports no relevant financial disclosures.