Changes in health care-associated infection prevention practices in Japan: Results from 2 national surveys

• Published in: American journal of infection control 2019-01, Vol.47 (1), p.65-68
• Main Authors: Sakamoto, Fumie, Asano, Keiko, Sakihama, Tomoko, Saint, Sanjay, Greene, M. Todd, Patel, Payal, Ratz, David, Tokuda, Yasuharu
• Format: Article
• Language: English
• Subjects: Catheter-Related Infections - epidemiology; Catheter-Related Infections - prevention & control; CAUTI; CLABSI; Cross-Sectional Studies; Device-associated infection; Hospitals; Humans; Infection Control - methods; Infection Control - organization & administration; Infection prevention; Japan - epidemiology; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - prevention & control; Sepsis - epidemiology; Sepsis - prevention & control; Urinary Tract Infections - epidemiology; Urinary Tract Infections - prevention & control; VAP
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2018.06.015

•National surveys in 2012 and 2016 show that many recommended practices to prevent common health care-associated infections are underused in Japanese hospitals.•Since 2012, the Japanese health care payment system has adopted an incentive system that financially rewards hospitals that have certain organizational structures in place to prevent health care-associated infections.•Continued institutional governance and rewards for hospitals for adopting and sustaining an organizational culture that prioritizes quality improvement and safety have the potential to improve use of health care-associated infection prevention practices in Japan. A national survey conducted in 2012 revealed that the rates of regular use of many evidence-based practices to prevent device-associated infections were low in Japanese hospitals. We conducted a second survey 4 years later to evaluate changes in infection prevention practices. Between July 2016 and January 2017, the instrument used in a survey of Japanese hospitals in 2012 was sent to 1,456 Japanese hospitals. The survey assessed general hospital and infection prevention program characteristics and use of practices specific to preventing catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). Independent sample chi-square tests were used to compare prevention practice rates between the first and second surveys. A total of 685/971 (71%) and 940/1,456 (65%) hospitals responded to the first and second surveys, respectively. For CAUTI, only use of bladder ultrasound scanners (11.1%-18.1%; P < .001) increased. For CLABSI, use of chlorhexidine gluconate for insertion site antisepsis (18.5%-41.1%; P < .001), antimicrobial dressing with chlorhexidine (3.4%-7.1%; P = .001), and central line insertion bundle (22.9%-33.0%; P < .001) increased. For VAP, use of semirecumbent positioning of patients (65.0%-72.3%; P = .002), sedation vacation (31.5%-41.6%; P < .001), oscillating/kinetic beds (4.7%-8.6%; P = .002), and a collective VAP prevention bundle (24.8%-34.8%; P < .001) increased. Fewer than 50% of Japanese hospitals reported conducting CAUTI and VAP surveillance. Collaborative approaches and stronger incentives promoting infection prevention efforts may be warranted to further increase use of most evidence-based practices to reduce common health care-associated infections in Japan.