Infection Control Today

FEB 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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Page 19 of 44

19 January/February 2019 ICT Continued from page 18 Only 21 percent of hospitals signifi cantly improved their clinical work environments over the past decade; most made no improvements and 7 percent experienced deteriorating work environments. The survey is a wake-up call for hospitals, especially since close to 30 percent of nurses gave their hospital an unfavorable grade on infection prevention. "Ours is a panel study where we have tracked infection prevention grades over a decade comparing each hospital's infection prevention scores to its own baseline," says Aiken. "Only in hospitals that signifi cantly improved work environments did infections grades improve signifi cantly. These results thus show a causal relationship between improving nurse staffi ng and clinical work environments and improved infection control. We know that recommended clinical care bundles are successful in preventing central line infections, but research shows the bundles must be fully implemented 95 percent of the time. In poor work environments, nothing can be assured at 95 percent fi delity, and hence infections continue." Hospitals that signifi cantly improved their care environments experienced much greater improvements in patient safety indicators and implementing a culture of patient safety than hospitals that did not improve clinical care environments as recommended by the National Academy of Medicine. Hospitals in which the work environment worsened exhibited a 25 percent decrease in the percentage of nurses saying that patient safety is a top priority of management. Despite aggressive healthcare reform initiatives, pay-for-performance strategies and quality improvement campaigns, improvement is sluggish in many healthcare systems. "Nurse staffing and quality of work environments are not reportable on Hospital Compare or the equivalents in nursing homes and home care and thus institutions do not identify investments in nursing as safety interventions or infection prevention inter- ventions," Aiken explains. "We recommend that the Centers for Medicare and Medicaid Services (CMS) requires Medicare providers to submit patient to nurse ratios and the National Quality Forum endorsed PES-NWI to hospital compare so that institutions than benchmark themselves and consumers could have greater access to important information that will help keep them safe." Aiken recommends interventions that poor-performing hospitals must make to improve: "Hospitals that are performing poorly on infection prevention should improve their nurse staffi ng and work environments," she says. "The prevention of costly infections would offset the costs of adding more nurses. And improving clinical work environments is a low-cost intervention to prevent infections; it primarily involves greater engagement of all clinicians in hospital decision-making and creating a blame-free culture that is foundational to a learning organization." Aiken continues, "Increasing staf f engagement in decision-making is key to improving clinical work environments and fostering interprofessional communication and collaboration. Our research shows that hospitals with good work environments have higher functioning interdisciplinary teams. The Magnet Recognition program is highly evidence-based and has developed a blueprint for successfully transforming institutions to engage staff and those engaged staff help implement innovations that improve care. Magnet is not just for nurses but improves outcomes of all who work in hospitals and their patients." Co-authors of the paper include Douglas M. Sloane, PhD; Hilary Barnes, PhD, CRNP; Jeannie Cimiotti, PhD; Olga F. Jarrín, PhD, RN; and Matthew D. McHugh, PhD, RN, all CHOPR Senior Fellows. This research was funded by the National Institute of Nursing Research, National Institutes of Health and the Robert Wood Johnson Foundation. Ò Despite good science showing how to prevent healthcare-associated infections, our study f nds that almost one-third of bedside care nurses give their hospitals unfavorable grades on infection prevention. — Linda Aiken, PhD, RN feature I nfection Control Today invited its readers to participate in an anonymous, online survey designed to elicit infection preven- tionists' perspectives on key issues within the profession such as workload, present and future challenges, as well as program needs and areas for improvement. This updates survey fi ndings from June 2017. This year, almost 68 percent of respondents say they are excited about the future of the profession, up from up from 56 percent among surveyed individuals in 2017. Regarding how competent IPs feel, almost 87 percent of respondents this year feel they have mastered their jobs, compared to 85 percent two years ago. Almost 94 percent of respondents this year say they enjoy their work as IPs, compared to 91 percent in 2017. Overall, at least among respondents, it appears that IPs are continuing to blossom in their profession and many have a continued positive take on what the fi eld can accomplish. Here's a look at the entire survey fi ndings: Continued on page 20 Many IPs Still Engaged, Feeling Positive About Their Profession, ICT Survey Indicates

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