Process surveillance in ICU to increase adherence of staffs' infection prevention behavior

Background: Preventing health care associated infections (HAIs) is critical to reduce morbidity and mortality for ICU patients. According to the Japanese Nosocomial Infection Surveillance (JANIS) data in 2006, a HAI rate was 7.5% and the mortality rate for patients with HAIs was significantly higher than those without HAIs at ICU. Although many issues of infection control can be countered by technology (gloves, sharps covers, air exchanges), none of these aids work without constant vigilance on the part of healthcare workers. Therefore, in this study monitoring in ICU staffs’ infection prevention behavior was to identify which part of infection prevention measures were challenged to actually perform.

Objective: Process surveillance was performed in ICU to identify the staffs’ infection prevention behavior.

Methods: Infection prevention behavior of health care workers was observed in ICU at a university hospital in Japan for 5 days. Observed behavior was as followed: hand hygiene practice and use of Personal Protective Equipment (PPE) at contacting body substances such as blood, respiratory suction, and preparing and starting IVs.

Results: 1) Hand hygiene practice: Total of 222 events was observed. Before care, adherence rate of hand hygiene was 50.9% and after care it was 41.9%. This was statistically significant (P< 0.05). Fig. 1 showed the difference of hand hygiene adherence by infection prevention behavior. 2) Respiratory suction: Twenty seven events were observed and wearing goggles or face shields did not take place at all, whereas rate of wearing gloves were 92.6%. 3) Wearing gloves: When suctioning, the adherence rate of wearing gloves was 92.6%, drawing blood and IV administration was 79.3%, and handling body substances was 67.7%.

Conclusions: Conducting the process surveillance on infection prevention behavior of ICU staffs was very helpful to identify what are real issues at ICU. Results showed the adherence rate of hand hygiene after the care, wearing goggles or face shields at respiratory suction, and wearing gloves at handling body substances were low. The result of this study was provided to the staffs. Because of the busy environment at ICU, the focused educational interventions should be provided and it seemed to be effective. We will continue to develop an action research based on this result in the future.