National survey of practices to prevent health care-associated infections in Thailand: The role of prevention bundles

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HIGHLIGHTSSeveral recommended practices to prevent health care-associated infections are used infrequently in hospitals across Thailand.Infrastructure and organizational factors, such as involvement in health care-associated infection prevention collaboratives and leadership support for infection control, are associated with greater use of infection prevention practices.Bundling prevention practices and ensuring a high compliance level to bundled approaches may be effective strategies for targeting common health care-associated infections in Thailand.Background:We evaluated the practices used in Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP).Methods:From January 1, 2014-November 30, 2014, we surveyed all Thai hospitals with an intensive care unit and at least 250 beds. The use of prevention practices for CAUTI, CLABSI, and VAP was assessed. High compliance (≥75%) with all components of the CLABSI and VAP prevention bundles were determined. CAUTI, CLABSI, and VAP infection rates before and after implementing infection control practices are reported. Multivariable regression was used to examine associations between infection prevention bundle compliance and infection rate changes.Results:Out of 245 eligible hospitals, 212 (86.5%) responded. A total of 120 (56.6%) and 115 hospitals (54.2%) reported ≥75% compliance for all components of the CLABSI and VAP prevention bundles, respectively, and 91 hospitals (42.9%) reported using ≥ 4 recommended CAUTI-prevention practices. High compliance with all of the CLABSI and VAP bundle components was associated with significant infection rate reductions (CLABSI, 38.3%; P < .001; VAP, 32.0%; P < .001). Hospitals regularly using ≥ 4 CAUTI-prevention practices did not have greater reductions in CAUTI (0.02%; P = .99).Conclusions:Compliance with practices to prevent hospital infections was suboptimal. Policies and interventions promoting bundled approaches may help reduce hospital infections for Thai hospitals.

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