What strategies should be implemented in a hospital to prevent infectious diseases as part of a quality improvement project?

Comprehensive Strategies for Hospital Infectious Disease Prevention in Quality Improvement Projects

A comprehensive multimodal approach that includes hand hygiene, contact precautions, environmental cleaning, education, isolation protocols, and antimicrobial stewardship is essential for preventing infectious diseases in hospitals.

Core Infection Prevention Strategies

Hand Hygiene

• Implement hand hygiene education programs with alcohol-based hand rubs as the preferred method for routine hand antisepsis 1
• Encourage healthcare workers to perform hand hygiene with alcohol-based hand rub before and after all patient contacts 1, 2
• Use soap and water when hands are visibly soiled with body fluids or excretions 1
• Monitor hand hygiene compliance and provide feedback to healthcare workers to achieve greater adherence 1, 3
• Prohibit the use of artificial nails among healthcare workers 1

Contact Precautions

• Implement contact precautions for all colonized patient encounters to reduce transmission risk 1
• Require healthcare workers to wear gloves and gowns before entering rooms of colonized/infected patients 1
• Promptly remove protective equipment after care and perform hand hygiene 1
• Audit adherence to contact precautions to ensure interventions are correctly performed 1

Patient Isolation and Cohorting

• Isolate colonized and infected patients in single rooms to reduce acquisition risk 1
• Monitor for potential adverse effects of isolation, including clinical complications from reduced contact with healthcare providers, decreased quality of life, and psychological effects 1
• Cohort patients with the same multidrug-resistant organisms in designated areas when single rooms are unavailable 1
• Consider cohorting staff to reduce transmission risk of resistant organisms 1

Environmental Cleaning and Disinfection

• Monitor cleaning performance to ensure consistent environmental cleaning 1
• Implement environmental cleaning procedures with audit and feedback mechanisms 1
• Specify in protocols which items require disinfection, which disinfectants to use, and frequency of cleaning 1
• Dedicate non-critical patient-care equipment to individual patients or cohorts infected/colonized with resistant organisms 1
• Consider vacating units for intensive cleaning during outbreaks 1
• Develop specific protocols for disinfection of endoscopes and respiratory equipment 1

Surveillance and Monitoring Systems

Active Surveillance

• Establish and maintain surveillance for airborne environmental diseases during construction, renovation, repair, and demolition activities 1
• Monitor for airborne infections in immunocompromised patients 1
• Periodically review facility's microbiologic, histopathologic, and postmortem data to identify additional cases 1
• Implement a program of active screening cultures at hospital admission followed by contact precautions to reduce colonization rates 1

Alert Systems

• Use alert codes to promptly identify patients already known to be colonized at hospital/ward admission 1
• Implement pre-emptive contact precautions for patients admitted from ICUs or wards with known cases of multidrug-resistant organisms 1
• Perform environmental sampling from surfaces that have been in contact with colonized or infected patients 1

Administrative and Educational Measures

Education Programs

• Conduct educational programs to ensure healthcare workers understand the epidemiological importance of infectious organisms, prevention strategies, and effective control measures 1
• Ensure regular multidisciplinary meetings to implement interventions, review adherence audit results, and provide feedback to all healthcare workers 1
• Use multimodal improvement strategies that include system change, education, monitoring, reminders, and culture change 1

Antimicrobial Stewardship

• Implement an antimicrobial stewardship program to reduce the spread of resistant organisms 1
• Plan interventions to restrict antibiotic usage 1
• Consider interventions that limit the use of specific antimicrobial agents based on patients' comorbidities 1

Construction-Related Infection Control

• Perform an Infection Control Risk Assessment (ICRA) before construction projects to define scope and need for barrier measures 1
• Determine if immunocompromised patients may be at risk for exposure to fungal spores from dust generated during construction 1
• Develop contingency plans to prevent exposures during construction activities 1
• Implement infection control measures for both external and internal demolition/construction activities 1

Implementation Framework

Quality Improvement Methodology

• Use the Plan-Do-Check-Act (PDCA) cycle for implementing and improving hand hygiene compliance 4
• Incorporate multidisciplinary approaches to promote increased use of alcohol-based handrubs 2
• Establish administrative support, including economic and human resources, to prevent and control transmission within healthcare facilities 1
• Include environmental personnel (estates, domestic, and janitorial representatives) in infection prevention and control infrastructure 1

Monitoring and Evaluation

• Measure compliance with hand hygiene and other infection control practices during routine patient care 3, 4
• Track nosocomial infection rates and attack rates of resistant organisms 3
• Monitor consumption of hand hygiene products as a surrogate marker for compliance 3, 5
• Conduct regular observational surveys to assess adherence to infection control protocols 3

Common Pitfalls and Challenges

• Poor compliance among physicians: Hand hygiene compliance often remains lower among doctors compared to nurses and nursing assistants 3
• Resource limitations: Failure to provide user-friendly hand hygiene equipment and staff shortages are predictors for noncompliance, especially in ICU settings 2
• Knowledge gaps: Lack of awareness of guidelines, failure to recognize hand hygiene opportunities during patient care, and underestimation of cross-transmission risks are barriers to good practices 2
• Inconsistent implementation: Infection control measures may be applied inconsistently across different hospital units or staff shifts 5

By implementing these comprehensive strategies as part of a quality improvement project, hospitals can significantly reduce healthcare-associated infections and improve patient outcomes.