Quality improvement tools (PDCA cycle) enhances compliance to nosocomial infection preventive measures: experience of a medical-surgical ICU

Introduction

Although nosocomial infection rates are prospectively collected and widely known, little is known about compliance rates to preventive measures that are assumed to be implemented for nosocomial infection control. Monitoring and improving compliance rates to preventive measures can help maintain nosocomial infection rates within acceptable ranges and even prevent outbreaks.

Objectives

To evaluate compliance rates to institutional nosocomial infection preventive measures and the effect of a quality improvement strategy on compliance rates.

Methods

During two distinct periods (October 1998 and June 1999), compliance to specific nosocomial preventive measures related to respiratory, bloodstream and urinary infections (defined according to institutional guidelines) were recorded by direct patient observation and chart reviews. Compliance rates were discussed with the multidisciplinary team, and low-compliance practices were focused and re-emphasized after the first surveillance. Subsequent surveillance evaluated improvement of compliance rates.

Results

General compliance to selected nosocomial infection preventive measures improved from 75.5% during October 1998 to 87% during June 1999 (P < 0.05). Higher compliance rates were observed to preventive measures related to urinary infections (88-94%), catheter-related infections (75-89%) as well as to respiratory infections (67-76%). General compliance rates remained high in a further surveillance (85.7% in February 2000). Concomitantly with higher compliance practices, the ICU general nosocomial infection rate decreased from 27.7 infections/1000 patients/day in 1998 to 20.6 infections/1000 patients/day in 1999.

Conclusion

General compliance rates to nosocomial infection preventive measures is high in our ICU, with lower rates related to prevention of respiratory infections. Quality improvement tools, such as discussing low compliance rates and retraining the multi-disciplinary team, are useful to increase compliance rates. Higher compliance to preventive methods was associated with a decrease in the general nosocomial infection rate, although a causal relationship needs to be investigated.