The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Buetti N, Marschall J, Drees M, et al. Infect Control Hosp Epidemiol. 2022;43:553-569.
Central line-associated bloodstream infections (CLABSI) are a target of safety improvement initiatives, as they are common and harmful. This guideline provides an update on recommended steps for organizations to support the implementation of CLASBI reduction efforts.
Bearman G, Doll M, Cooper K, et al. Curr Infect Dis Rep. 2019;21:2.
Hospital-acquired infections contribute to patient morbidity and mortality. This review examines efforts to prevent hospital-acquired infections and found that despite reported improvements, some infections are not preventable. Data inconsistency, implementation incompleteness, and lack of executive oversight hinder improved understanding and prevention of hospital-acquired infections.
Munoz-Price S, Bowdle A, Johnston L, et al. Infect Control Hosp Epidemiol. 2018:1-17.
This expert guidance provides recommendations to help health care facilities develop policies for preventing health care–associated infections in the operating room. The authors build on existing anesthesia safety practices to outline specific actions for infection prevention and control.
Pay-for-performance strategies have been employed to reduce medical errors and improve care quality. This review examines the impact of financial incentives on occurrence of hospital-acquired infections. The authors suggest hospital administrators partner with clinicians and infection control experts to develop evidence-based policies and guidelines to prevent infections in their organizations.
Krein SL, Mayer J, Harrod M, et al. JAMA Intern Med. 2018;178:1016-1057.
Infection control precautions including use of personal protective equipment (PPE) are critical for preventing transmission of infections within health care settings. This direct observation study observed frequent failures in use of PPE, including entering rooms without using PPE at all, PPE process mistakes, and slips in properly executing PPE use. The authors suggest that given the wide range of failures, a variety of strategies are needed to improve use of PPE.
Birnbach DJ, Rosen LF, Fitzpatrick M, et al. J Infect Public Health. 2015;8:570-4.
Major efforts have focused on improving hospital employee hand hygiene as a way to decrease the spread of disease to hospitalized patients. This observational study found more than 60% of visitors to an intensive care unit did not disinfect their hands prior to entering a patient's room, with some carrying bacteria that could be dangerous for critically ill patients.
Munoz-Price LS, Banach DB, Bearman G, et al. Infect Control Hosp Epidemiol. 2015;36:747-758.
This expert guidance provides recommendations to help hospitals develop policies to reduce the spread of health care–associated infections by individuals visiting patients in isolation. The authors discuss contact precautions and outline specific conditions where these suggestions should be employed.
Munoz-Price S, Patel Z, Banks S, et al. Infect Control Hosp Epidemiol. 2014;35:717-20.
Hand hygiene rates remain disappointingly low among physicians and nurses, despite appropriate handwashing being an essential factor in preventing health care–associated infections. In this study, installing a hand sanitizer dispenser on the anesthesia machine resulted in only a limited increase in the frequency of hand sanitization by anesthesiologists.
Birnbach DJ, Rosen LF, Fitzpatrick M, et al. Anesth Analg. 2015;120:848-52.
This randomized trial found that a protocol requiring anesthesiologists to wear two pairs of sterile gloves during intubations—with the outer pair removed immediately afterward—was associated with a lower rate of operating room contamination.
Sharp D, Palmore T, Grady C. Infect Control Hosp Epidemiol. 2014;35:307-9.
Engaging patients in health care–acquired infection (HAI) prevention, such as asking providers about hand hygiene compliance, has shown promise. This commentary recommends providing patients with information about infection risks and hospital policies as additional areas to involve patients in reducing HAIs.
Bearman G, Bryant K, Leekha S, et al. Infect Control Hosp Epidemiol. 2014;35:107-21.
This guidance examined literature and hospital policies around how health care staff clothing can contribute to health care–associated infections (HAIs). The investigators reveal patients' and health care workers' perceptions regarding clinician attire and recommend research to improve understanding about its potential to spread pathogens.
Thom KA, Li S, Custer M, et al. Am J Infect Control. 2014;42:139-43.
Central line–associated bloodstream infections (CLABSIs) cause substantial morbidity and mortality. Efforts to combat these complications include implementation of checklists and—perhaps more importantly—the enhancement of safety culture. Despite the widespread success of these interventions, some institutions continue to experience CLABSI rates that are above national benchmarks. This study describes the introduction of a unit-based quality nurse dedicated to preventing CLABSIs within a surgical intensive care unit (ICU) at an academic medical center. The quality nurse helped to educate staff about health care–associated infections and prevention strategies. The nurse also provided immediate, direct feedback to staff regarding their compliance with best practices. The average CLABSI rate decreased significantly, even after adjusting for multiple factors including reduction in CLABSI rates in other adult ICUs. A unit-based quality nurse may prove to be a powerful adjunct to the current available tools for reducing these costly infections.