Monitoring Adherence to Health Care Practices that Prevent Infection
Hospitals and other healthcare facilities have infection control and prevention policies and procedures. However, do they know if all healthcare providers understand and are consistently complying? The California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program developed tools for measuring healthcare worker adherence to care practices critical to prevent infections. Each hospital, skilled nursing facility, and outpatient clinic should develop a plan to regularly monitor staff adherence to evidence-based infection prevention practices. Feedback of adherence monitoring results to frontline staff can increase compliance and prevent HAI.
We present 20 adherence monitoring tools for measuring care practices, including contact precautions, environmental cleaning, hand hygiene, invasive device use, perioperative care, blood glucose monitoring, injection safety, hemodialysis care, and reprocessing reusable devices. Suggestions for using the tools:
Covert observations (e.g., using “secret shoppers”) are more effective than overt observations for assessing routine, typical care. Monitoring by a known designated staff member, such as the infection preventionist, may result in inflated adherence percentages.
When using an adherence monitoring tool, repeat the measurements at regular intervals to assess improvement over time. Sharing performance data that demonstrates improvement over time is important to gain frontline support for infection prevention interventions.
Encourage competition between units to achieve higher adherence percentages.
Calculating adherence percentage
The method used to calculate the adherence percentage is the same for each adherence monitoring tool. On the form, you will sum the number of correct practices observed and divide by the total number of observations (and multiple by 100).
Reduction of C. difficile and other multi-drug resistant organisms (MDRO) requires strict adherence to contact precautions and proper use of personal protective equipment. Use this tool to determine if staff members are correctly adhering to contact precautions practices. Feedback of results to staff has been shown to increase adherence to these practices.
Pathogens are transmitted in healthcare settings when contaminated surfaces and equipment are not adequately cleaned and disinfected between patients. Use this tool to measure how well staff members are adhering to appropriate environmental cleaning and disinfection practices. Feedback of results to staff has been shown to increase adherence to these practices.
Regular monitoring with feedback of results to staff can improve hand hygiene adherence. Use this tool to identify gaps and opportunities for improvement. Monitoring may be performed in any type of patient care location.
Central Line Adherence Monitoring
A central line associated bloodstream infection (CLABSI) may occur due to breaches in technique during line insertion or lapses in infection prevention practices when accessing and maintaining the line. We provide three central-line adherence monitoring tools for direct observation of 1) the central line insertion process, 2) central line medication administration and dressing changes, and 3) the condition of the central line dressing and tubing.
Surgical Site Infections (SSI) - Operating Room Environment
Use these tools to measure adherence to evidence-based practices known to reduce SSI in the operating room and perioperative settings. Monitoring may be performed in any operating room setting, including hospitals, ambulatory surgery centers, and outpatient clinics.
Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update Anderson, D.J., et al, Infection Control and Hospital Epidemiology,Vol. 35, No. 6 (June 2014), pp. 605-627
Indwelling Urinary Catheter Maintenance Practices
The best ways to prevent a catheter associated urinary tract infections (CAUTI) are to avoid use of indwelling catheter unless absolutely necessary and to remove catheters as quickly as possible after insertion. Use this tool to observe the conditions of urinary catheters in use, and to identify gaps and opportunities for improvement.
Blood Glucose Monitoring
Incorrect use of or failing to properly disinfect blood glucose meters places patients at risk for bloodborne pathogen infections. Use this tool to observe blood glucose monitoring practices and identify gaps and opportunities for improvement. Monitoring may be performed in any type of patient care location where blood glucose is monitored.
Injection safety is a basic expectation in patient care, and includes safe handling of medications and using each needle and syringe for only one patient one time. Use this tool to measure adherence to safe injection practices in any type of location where medication is prepared or provided to patients. Adherence monitoring will help to identify areas for potential harm to patients or healthcare workers.
Use these hemodialysis tools to measure adherence to dialysis care practices that are important for the prevention of bloodstream infections and access site infections.
Many areas of the healthcare facility may be performing device reprocessing. These adherence monitoring tools may be used in any area where device reprocessing, or high-level disinfection or sterilization of reusable devices are performed. Select the monitoring tool that best applies to the reprocessing area being observed.
For questions, suggestions, or an accessible version of these tools, please email HAIProgram@cdph.ca.gov.