Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
JAMA Netw Open. 2020 Feb 5;3(2):e1920464. doi: 10.1001/jamanetworkopen.2019.20464.
Health care-associated infection (HAI) is associated with substantial harm. To reduce HAI, the largest integrated health care system in the United States-the Veterans Health Administration-was an early adopter of infection prevention policies and initiatives. Whether these efforts translated into increased use of practices to prevent HAI in Veterans Affairs (VA) hospitals is unknown.
To evaluate changes over time in infection prevention practices and the perception of the importance of infection prevention to hospital leadership.
DESIGN, SETTINGS, AND PARTICIPANTS: For this survey study, every 4 years between 2005 and 2017, infection preventionists were surveyed at all VA hospitals on use of practices associated with common HAIs, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), and (beginning in 2013) Clostridioides difficile infection. Data analysis was performed from February 1, 2019, to July 1, 2019.
Reported regular use of key infection prevention practices and perceived importance of infection prevention to hospital leadership.
Between 2005 and 2017, 320 total surveys were completed with response rates ranging from 59% (73 of 124) in 2017 to 80% (95 of 119) in 2005. Use of 12 different infection prevention practices increased. Since 2013, 92% (69 of 75) to 100% of VA hospitals reported regular use of key infection prevention practices for C difficile infection and CLABSI. In contrast, adoption of many practices to prevent CAUTI, although increasing, have lagged. Despite reported increases in the use of some practices for VAP such as semirecumbent positioning (89% [79 of 89] in 2005 vs 97% [61 of 63] in 2017, P = .007 for trend) and subglottic secretion drainage (23% [19 of 84] in 2005 vs 65% [40 of 62] in 2017, P < .001), use of other key practices such as daily interruptions of sedation (85% [55 of 65] in 2009 vs 87% [54 of 62] in 2017, P = .66) and early mobilization (81% [52 of 64] in 2013 vs 82% [51 of 62] in 2017, P = .88) has not increased. Antibiotic stewardship programs are now reported in nearly every VA hospital (97% [71 of 73]); however, some hospitals report practices for microbiologic testing for HAIs (eg, 22% [16 of 72] report routine urine culture testing in 2017) that could also contribute to antibiotic overuse.
From 2005 to 2017, reported use of 12 different infection prevention practices increased in VA hospitals. Areas for continued improvement of infection prevention practices appear to include CAUTI, certain VAP practices, and diagnostic stewardship for HAI. The reported adoption of many infection prevention practices in VA hospitals was higher than in non-VA hospitals. As hospitals continue to merge and health systems become increasingly integrated, these successes could help inform patient safety broadly.
医疗保健相关感染（HAI）会造成严重危害。为了降低 HAI，美国最大的综合性医疗保健系统——退伍军人事务部（VA）——是预防感染政策和举措的早期采用者。尚不清楚这些努力是否转化为退伍军人事务部医院中预防 HAI 的实践的使用增加。
评估感染预防实践随时间的变化以及医院领导层对感染预防重要性的看法。
设计、地点和参与者：在这项调查研究中，2005 年至 2017 年期间每四年对所有退伍军人事务部医院的感染预防人员进行一次调查，调查内容包括与常见 HAI 相关的实践使用情况，包括中心静脉导管相关性血流感染（CLABSI）、导管相关性尿路感染（CAUTI）、呼吸机相关性肺炎（VAP）和（从 2013 年开始）艰难梭状芽孢杆菌感染。数据分析于 2019 年 2 月 1 日至 7 月 1 日进行。
报告的关键感染预防实践的定期使用情况以及医院领导层对感染预防的重视程度。
2005 年至 2017 年间共完成了 320 份总调查，答复率从 2017 年的 59%（73/124）到 2005 年的 80%（95/119）不等。使用了 12 种不同的感染预防实践方法。自 2013 年以来，92%（69/75）至 100%的退伍军人事务部医院报告定期使用关键感染预防措施预防艰难梭菌感染和 CLABSI。相比之下，尽管采用了许多预防 CAUTI 的做法，但仍存在滞后现象。尽管报告称用于预防 VAP 的某些做法（如半卧位）有所增加（2005 年为 89%[89/89]，2017 年为 97%[61/63]，趋势 P = 0.007）和亚声门下分泌物引流（2005 年为 23%[19/84]，2017 年为 65%[40/62]，P<0.001），但其他一些关键做法的使用（如每日中断镇静）并未增加（2009 年为 85%[55/65]，2017 年为 87%[54/62]，P=0.66）和早期动员（2013 年为 81%[52/64]，2017 年为 82%[51/62]，P=0.88）。现在几乎每个退伍军人事务部医院都报告了抗生素管理计划（97%[71/73]）；然而，一些医院报告了用于 HAI 微生物检测的做法（例如，2017 年有 22%[16/72]报告常规尿培养检测），这也可能导致抗生素过度使用。
2005 年至 2017 年期间，退伍军人事务部医院报告的 12 种不同感染预防实践的使用有所增加。感染预防实践持续改进的领域似乎包括 CAUTI、某些 VAP 做法和 HAI 的诊断管理。退伍军人事务部医院报告采用的许多感染预防做法的比例高于非退伍军人事务部医院。随着医院继续合并，医疗系统变得越来越一体化，这些成功经验可能有助于广泛地促进患者安全。
