Quality of the hospital infection control programs: an integrative review

To analyze the quality of health in relation to the components of structure, process, and outcome in actions for the prevention and control of infections.

Method:

An integrative literature review in the LILACS, Web of Science, Scopus, and SciELO databases. The time delimitation covered articles published between January 2009 and May 2019.

Results:

The final sample consisted of 10 articles published, mainly in Scopus (60%), and in Web of Science (30%). The structural elements varied among the study countries, suggesting opportunities for improvement of organizational characteristics and human resources. Regarding the process of the implemented routines, inconsistencies were found to comply with the guidelines. The result component was not emphasized among the studies included in the review.

Conclusion:

The quality of hospital infection control programs has yet to be improved among the health services, highlighting the need for investment in the structure, process, and outcome components.

Keywords
Hospital infection; Hospital infection control program; Quality of health care

Variables	n	%
Language
English	7	70.0
Portuguese	2	20.0
Spanish	1	10.0
Country of study
Africa	1	10.0
Germany	1	10.0
Australia	1	10.0
Brazil	2	20.0
Colombia	1	10.0
United States	1	10.0
Eurasia*	1	10.0
Netherlands	1	10.0
Iran	1	10.0
Journals
American Journal of Infection Control	1	10.0
BMJ Open	1	10.0
Colombia Médica	1	10.0
Infection, Disease and Health	1	10.0
International Journal for Quality in Health Care	1	10.0
Iranian Red Crescent Medical Journal	1	10.0
PLoS ONE	2	20.0
Revista da Escola de Enfermagem da USP	1	10.0
Public Health Magazine	1	10.0
Knowledge Area
Health	10	100.0

Author and year	Design and scenario	Methodological quality and level of evidence	Main highlights
Giroti et al, 20182020. Giroti ALB, Ferreira AM, Rigotti MA, Sousa ÁFL, Frota OP, Andrade D. Hospital infection control programs: assessment of process and structure indicators. Rev Esc Enferm USP. 2018;52:e03364. doi: https://doi.org/10.1590/s1980-220x2017039903364 https://doi.org/10.1590/s1980-220x201703...	Cross-sectional and descriptive n=14 (Health Care Services)	Score 9/10 (high); Level 6	The indicators referring to the technical-operational structure and the epidemiological surveillance system for infection had better compliance: 80.58% and 81.59%, respectively. However, the indicators on the operational guidelines and the prevention and control of infection were not satisfactory, showing that there is no uniformity in the routines implemented in hospitals.
Fletcher et al, 20172121. Fletcher TE, Gulzhan A, Ahmeti S, Al-Abri SS, Asik Z, Atilla A, et al. Infection prevention and control practice for Crimean-Congo hemorrhagic fever: a multi-center cross-sectional survey in Eurasia. PLoS One. 2017;12(9):e0182315. doi: https://doi.org/10.1371/journal.pone.0182315 https://doi.org/10.1371/journal.pone.018...	Cross-sectional, descriptive n = 23 (Health Services)	Score 9/10 (high); Level 6	The authors highlighted opportunities for improvement in relation to the structure, emphasizing the use of PPE, isolation for confirmed cases, and an adequate number of professionals. In addition, they recommended additional audits to guarantee the quality of the national programs.
Arefian et al, 20162222. Arefian H, Vogel M, Kwetkat A, Hartmann M. Economic evaluation of interventions for prevention of hospital acquired infections: a systematic review. PLoS One. 2016;11(1):e0146381. doi: https://doi.org/10.1371/journal.pone.0146381 https://doi.org/10.1371/journal.pone.014...	Systematic review n=27 (Studies)	Score 14/14; Level 5	Since 2009, the number of publications on HCRI prevention programs has increased; however, there has been no improvement in the quality of these studies. The authors reinforce the importance of making investments in the HICPs to reduce unnecessary expenses resulting from infectious events.
Mitchell et al, 20162323. Mitchell BG, Hall L, Halton K, MacBeth B, Gardner A. Time spent by infection control professionals undertaking healthcare associated infection surveillance: a multi-centred cross sectional study. Infect Dis Health. 2016;21(1):36-40. doi: https://doi.org/10.1016/j.idh.2016.03.003 https://doi.org/10.1016/j.idh.2016.03.00...	Cross-sectional, descriptive n = 40 (HICCs)	Score 9/10 (high); Level 6	In Australia, approximately 1,675 hours are spent on the HCRI surveillance process, which increases as the number of beds goes up. For the authors, the success of the surveillance program depends on the ability to provide information to those who can implement changes and act as an incentive for continuous team participation.
Van Mourik et al, 20152424. Van Mourik MSM, Van Duijn PJ, Moons KGM, Bonten MJM, Lee GM. Accuracy of administrative data for surveillance of healthcare-associated infections: a systematic review. BMJ Open. 2015;5:e008424. doi: https://doi.org/10.1136/bmjopen-2015-008424 https://doi.org/10.1136/bmjopen-2015-008...	Systematic review n = 35 (Studies)	Score 10/14; Level 5	In Africa, little has been invested in the HICP. Improper infrastructure, inadequate infection prevention practices, as well as lack of laboratory input negatively influence the indicators, generating underreporting.
Hernández-Gómez et al, 20152525. Hernández-Gómez C, Motoa G, Vallejo M, Blanco VM, Correa A, de la Cadena E, et al. Introduction of software tools for epidemiological surveillance in infection control in Colombia. Colomb Med (Cali) . 2015 [cited Aug 20 2019];46(2):60-5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536816/pdf/1657-9534-cm-46-02-00060.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Descriptive n = 23 (Health Services)	Score 9/10 (high); Level 6	Regarding the structure, it is necessary to increase the proportion of professionals per number of beds. In the process evaluation, it is highlighted that 65% perform the surveillance of HCRIs in a combined way (active and passive), using the NHSN criterion of the CDC, from the United States. The HCRI results are compiled into a specific software; however, it could achieve greater adherence to an active, standardized and prospective surveillance model.
Shojaee et al, 20142626. Shojaee J, Moosazadeh M. Determining the status quo of infection prevention and control standards in the hospitals of Iran: a case study in 23 Hospitals. Iran Red Crescent Med J. 2014;16(2):e14965. doi: https://doi.org/10.5812/ircmj.14695 https://doi.org/10.5812/ircmj.14695...	Cross-sectional, descriptive n = 23 (Health Services)	Score 9/10 (high); Level 6	Six sessions related to the HICP were evaluated: leadership and programming; program focus; isolation methods; health and hand protection techniques; improvement in safety and quality of patients and staff training, where most items presented adequate conditions, with compliance records above 77%, except for isolation methods (67.4%).
Stone et al, 20142727. Stone PW, Pogorzelska-Maziarz M, Herzig CT, Weiner LM, Furuya EY, Dick A, et al. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control. 2014;42(2):94-9. doi: https://doi.org/10.1016/j.ajic.2013.10.003 https://doi.org/10.1016/j.ajic.2013.10.0...	Cross-sectional, descriptive n = 3,374 (Health Services)	Score 10/10 (high); Level 6	The authors showed that there are few professionals working at the HICC with specific degrees and these are not consistent with the published guidelines. It is added that little time is invested in health education to prevent infection.
Friday et al, 20122828. Friday O, Edoja O, Osasu A, Chinenye N, Cyril M, Lovney K, et al. Assessment of infection control practices in maternity units in Southern Nigeria. Int J Qual Health Care. 2012;24(6):634-40. doi: https://doi.org/10.1093/intqhc/mzs057 https://doi.org/10.1093/intqhc/mzs057...	Cross-sectional Descriptive n = 63 (Health Services)	Score 8/10 (high); Level 6	About the structure, only 13% of the services had HICC, 52% of the locations had running water in 24 hours, few supplies were available for hand hygiene, and 11% still recycled gloves. Regarding the process component, 63% reported having infection control procedures and 33% said they had a training program.
Silva et al, 20112929. Silva CPR, Lacerda RA. Validation of a proposal for evaluating hospital infection control programs. Rev Saúde Pública. 2011;45(1):121-8. doi: https://doi.org/10.1590/S0034-89102010005000052 https://doi.org/10.1590/S0034-8910201000...	Methodological and descriptive study n = 50 (Health Services)	Score 8/10 (high); Level 6	The “structure” and “epidemiology” indicators showed 100% compliance for almost all the assessments. The greatest conformities, with statistical significance, were in the group of institutions with qualification or accreditation processes in health.

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author:
André Luiz Silva Alvim E-mail: andrealvim1@hotmail.com