Background: In addition to using individual evidence-based practices, bundled approaches to healthcare-associated infection (HAI) prevention have been shown to be effective. We evaluated the use of individual practices in Thai hospitals to prevent common HAI including catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) and examined the extent to which compliance with prevention bundles impact these infections.
Methods: From January 2014 - November 2014 we surveyed all hospitals in Thailand with an intensive care unit and at least 250 beds. The use of specific prevention practices for CAUTI, CLABSI, and VAP was assessed on a 5-point scale. Responses of 4 (almost always) or 5 (always) defined regular use. As a specific CAUTI bundle is not promulgated in Thailand, we examined the influence of regularly using at least 4 of 6 evidence-based CAUTI prevention practices. High compliance (75% or greater) for practicing all components of the CLABSI and VAP prevention bundles were assessed. CAUTI, CLABSI, and VAP infection rates before and after implementation of infection control practices were reported. Multivariable logistic regression, adjusting for several hospital and infection control characteristics, was used to examine associations between infection prevention bundle compliance and changes in infection rates.
Results: Of the 245 eligible hospitals, 212 (86.5%) responded to our survey. The Figure shows the distribution of regular use of several infection prevention practices. The 91 (43%) hospitals regularly using at least 4 CAUTI prevention practices did not have greater reductions in CAUTI compared to hospitals using less than 4 CAUTI prevention practices (p = 0.59). High compliance with all of the components of the CLABSI (120 (56.6%)) and VAP (115 (54.2%)) bundles was associated with infection rate reductions (CLABSI: 36.1%, 95% CI [23.1% - 49.0%], p<0.001; VAP: 31.2%, 95% CI [20.9% - 41.5%], p<0.001).
Conclusion: Individual recommended practices to prevent HAIs were used fairly infrequently in Thailand. Policies and interventions promoting bundled prevention approaches may help to effectively reduce HAI burden in Thai hospitals.
T. Greene, None
T. Khawcharoenporn, None
D. J. Weber, None
S. Saint, None