06 Feb The VA Has Increased Infection Prevention Practices, But Still Room for Improvement
MedicalResearch.com Interview with:
Valerie Vaughn MD, MSc
Assistant Professor of Medicine; Hospital Medicine
VA Ann Arbor Healthcare System and
University of Michigan Medical School
MedicalResearch.com: What is the background for this study?
Response: Health care-associated infection are a major patient safety problem. Fortunately, they can often be prevented through key practices. The Department of Veterans Affairs has been an early adopters of these key strategies through a combination of policies, directives, and initiatives which have aimed to reduce health care-associated infection. No one had previously looked across infections to see whether key infection prevention practices are being used in the VA.
MedicalResearch.com: What are the main findings?
Response: We survey all VA hospitals between 2005 and 2017 and found an increase in 12 different infection prevention practices. Notably, over 90% of VA hospitals report regular use of key infection prevention practices related to Clostridioides difficile infection and central line-associated bloodstream infection. Despite these gains, there are still critical areas for improve, including catheter-associated urinary tract infection, ventilator-associated pneumonia, and diagnostic stewardship for health care-associated infections.
MedicalResearch.com: What should readers take away from your report?
Response: The VA has successful increased the use of infection prevention practices—especially those related to CLABSI and CDI. This really demonstrates how concerted national efforts can improve patient safety. Other health care systems and hospital networks should seek to learn from these successes as they seek to improve reduce health care-associate infection.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Interestingly, we found that most hospitals continue to lack good diagnostic stewardship practices to reduce unnecessary microbiologic testing related to health care-associated infection. Inappropriate testing can lead to false positives which may lead to inappropriate antibiotic use and patient harm. Further studies need to identify best practices to diagnose health care-associated infection which balance the risk of missing diagnoses with the risk of over-diagnosing infections.
I have no disclosures. This work was supported by a U.S. Department of Veterans Affairs (VA) National Center for Patient Safety funded Patient Safety Center of Inquiry. Dr. Krein was also supported by a VA Health Services Research and Development Service Research Career Scientist award [RCS 11-222].
Vaughn VM, Saint S, Greene MT, et al. Trends in Health Care–Associated Infection Prevention Practices in US Veterans Affairs Hospitals From 2005 to 2017. JAMA Netw Open. 2020;3(2):e1920464. doi:10.1001/jamanetworkopen.2019.20464
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