Improving implementation of infection control guidelines to reduce nosocomial infection rates: pioneering the report card

SummaryBackgroundTwo detailed checklists were developed, based on published infection control guidelines, for daily use by infection control practitioners in departments and operating rooms.AimTo assess the impact of the checklists on nosocomial infection rates in three hospitals over the course of one year.MethodsThe checklists included 20 subheadings (±150 items). Project nurses conducted rounds in the study (but not control) departments; during each round, the nurses selected 15–20 items for observation, marked the checklists according to appropriateness of observed behaviour and provided on-the-spot corrective education. Rates of adherence to the checklist, antibiotic use, number of obtained and positive cultures, and positive staff hand and patient environment cultures were reported monthly as a report card to relevant personnel and administrators. The rate of nosocomial infections was determined in the first and last months.ResultsThe baseline nosocomial infection rate was similar in the study and control departments: 37/345 (11%) and 26/270 (10%) respectively. In the last month, the rate in the study department decreased to 16/383 (4%) (P < 0.01); in the control it decreased insignificantly to 21/248 (8%) (not significant). No significant trends were detected in the number of obtained cultures, positive cultures, or antibiotic use. Adherence to guidelines ranged from 75% to 94% between the hospitals (P < 0.001): the overall rate increased from 80% to 91% (P < 0.01).ConclusionsThe use of checklists during the conduct of infection control rounds, combined with monthly reports, was associated with a significant decrease in nosocomial infections in study departments.