These are described in detail in the Methods section.
ReviewHospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus
Introduction
Health-care-associated infections (HAIs) affect millions of patients worldwide every year.1, 2 In the European Union (EU) alone, the estimated number of HAIs is 4 544 100 annually, leading directly to around 37 000 deaths and 16 million extra days of hospital stay.3 Several evidence-based practice guidelines have been published in the past decade4, 5, 6, 7, 8, 9, 10, 11, 12 but, despite evidence suggesting that good practice strategies are sufficient, hospitals struggle to comply.13, 14, 15, 16, 17 The systematic review and evidence-based guidance on organisation of hospital infection control programmes (SIGHT) was funded by the European Centre for Disease Prevention and Control. Our objective was to provide evidence-based guidance on the organisation of infection-control programmes in hospitals. In particular, the review aimed to identify the most effective and generally applicable elements of acute-care infection-control and prevention programmes and to identify indicators of structure and process for monitoring. In contrast to more procedure-focused recommendations, we address mainly management and organisational features.
Section snippets
Methods
The systematic review was done according to the PRISMA guidelines18 at three participating institutions (University of Geneva Hospitals, Geneva, Switzerland; Imperial College London, London, UK; and University Hospital of Freiburg, Freiburg, Germany). We separated this project into two work packages: first, a systematic review to identify elements for the organisation of infection-prevention programmes in hospitals and, second, the selection from these of key components, assessment of their
Results
Our search yielded 47 948 titles and abstracts and an additional 131 were added through cross-referencing. 92 articles were eligible for data extraction and analysis (figure 2, table 1, appendix).15, 16, 17, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96,
Discussion
This broad systematic review identified a range of structural, organisational, and management components that are crucial to effective implementation of infection-control programmes in hospitals. Additionally, these components were put into a user's perspective by providing context about implementation and EU-wide applicability.
The formal proportion of one infection-control nurse per 250 hospital beds was established more than 30 years ago.17 However, hospital settings have changed, and expert
Conclusions
Infection prevention and control is a priority for patients' safety and should involve HCWs at all levels and be part of the hospital organisation as a whole.132 Staffing must be adequate to meet task requirements without leading to excessive workload. For prevention purposes, hospital infection-control programmes need to translate the key components into workable documents and programmes that take the local context into account. Programmes should be planned by multidisciplinary groups, take
Search strategy and selection criteria
This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on Feb 23, 2015
References (132)
- et al.
Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis
Lancet
(2011) - et al.
Infection control measures to limit the spread of Clostridium difficile
Clin Microbiol Infect
(2008) - et al.
The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study
Soc Sci Med
(2010) - et al.
Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care
Lancet
(2000) - et al.
Effectiveness of a hospital-wide programme to improve compliance with hand hygiene
Lancet
(2000) - et al.
Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review
Lancet Infect Dis
(2012) - et al.
Using peer feedback to improve handwashing and glove usage among Thai health care workers
Am J Infect Control
(2000) - et al.
Improving implementation of infection control guidelines to reduce nosocomial infection rates: pioneering the report card
J Hosp Infect
(2012) - et al.
Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis
Am J Kidney Dis
(2001) - et al.
The associations between organizational culture and knowledge, attitudes, and practices in a multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus
Am J Infect Control
(2012)
Reduction of surgical site infections after Caesarean delivery using surveillance
J Hosp Infect
Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections
J Hosp Infect
An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms
Int J Med Inform
The CLABs collaborative: a regionwide effort to improve the quality of care in hospitals
Jt Comm J Qual Patient Saf
Dissemination of the CDC's hand hygiene guideline and impact on infection rates
Am J Infect Control
A comprehensive hand hygiene approach to reducing MRSA health care-associated infections
Jt Comm J Qual Patient Saf
Impact of a five-year surveillance of central venous catheter infections in the REACAT intensive care unit network in France
J Hosp Infect
Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina
Am J Infect Control
Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina
Am J Infect Control
Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system
J Hosp Infect
Handwashing in healthcare workers: accessibility of sink location does not improve compliance
J Hosp Infect
Benchmarking of urinary tract infection rates: experiences from the intensive care unit component of the German national nosocomial infections surveillance system
J Hosp Infect
Propagation of methicillin-resistant Staphylococcus aureus due to the overloading of medical nurses in intensive care units
J Hosp Infect
Bed occupancy and overcrowding as determinant factors in the incidence of MRSA infections within general ward settings
J Hosp Infect
Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit
J Hosp Infect
Impact on hand hygiene compliance following migration to a new hospital with improved resources and the sequential introduction of World Health Organization recommendations
Am J Infect Control
A new approach to improving hand hygiene practice in an inner city acute hospital in Australia
Healthc Infect
A survey on handwashing practices and opinions of healthcare workers
J Hosp Infect
The power of vivid experience in hand hygiene compliance
J Hosp Infect
Health-care-associated infection in Africa: a systematic review
Bull World Health Organ
Annual epidemiological report on communicable diseases in Europe
Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals
Infect Control Hosp Epidemiol
Strategies to prevent Clostridium difficile infections in acute care hospitals
Infect Control Hosp Epidemiol
Strategies to prevent catheter-associated urinary tract infections in acute care hospitals
Infect Control Hosp Epidemiol
Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International clinical practice guidelines from the Infectious Diseases Society of America
Clin Infect Dis
Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America
Clin Infect Dis
Strategies to prevent ventilator-associated pneumonia in acute care hospitals
Infect Control Hosp Epidemiol
Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009
J Gen Intern Med
Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee
MMWR Recomm Rep
Guidelines for the prevention of intravascular catheter-related infections
Am J Infect Control
The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals
Am J Epidemiol
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration
BMJ
Country and lending groups
Behavior change strategies to influence antimicrobial prescribing in acute care: a systematic review
Clin Infect Dis
Delphi method
Patient safety begins with proper planning: a quantitative method to improve hospital design
Qual Saf Health Care
Integrated audit as a means to implement unit protocols: a randomized and controlled study
J Eval Clin Pract
The Feedback Intervention Trial (FIT)—improving hand-hygiene compliance in UK healthcare workers: a stepped wedge cluster randomised controlled trial
PLoS One
Use of simulation-based education to reduce catheter-related bloodstream infections
Arch Intern Med
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Further contributors are listed in the Acknowledgments section