Healthcare associated infections (HAIs) are a major contributor to increased morbidity, mortality and hospital costs; and, the majority of these occur in intensive care units (ICUs) and many are associated with
insertion of an invasive device. Reducing HAIs is an important component of patient safety. Guided by
Donabedian’s theory of quality, in our parent study in 2007, we surveyed a sample of National Healthcare
Safety Network (NHSN) hospitals (n = 289, 66% response rate) and received cross-sectional data on
structures, processes and outcomes in 415 adult ICUs. We found few structural aspects (e.g., hospital
characteristics) to be associated with device associated HAI rates. We did find that intensity of processes was
varied; and, only when an ICU had 95% or greater compliance (e.g., Central Line Bundle elements) with
processes were the HAI rates decreased. This work represents a significant contribution to the field.
However, with increased HAIs caused by methicillin resistant Staphylococcus aureus (MRSA) and
Clostridium difficile (C. difficile), state mandated reporting of HAI growing from 3 states in 2004 to 36 states in
2009, and in the process of conducting our study, we have identified a number of gaps that our team is
uniquely positioned to inform. Additionally, 20 states now mandate reporting through use of the NHSN.
Because of this, as well as open enrollment, NHSN has quickly grown to 2,198 acute care hospitals.
P-NICER is a 3-year mixed methods study. The aims are 1) Use a descriptive exploratory approach to qualitatively describe the phenomena of infection prevention, surveillance, and control in hospitals; 2) Assess the impact of the intensity of infection control processes on device associated and organism specific HAI rates in adult and pediatric ICUs across the nation; and 3) Determine the impact of state regulated mandatory reporting on infection control processes and HAI rates. In Phase I, we will purposively sample 12 hospitals from the parent study and conduct in-depth interviews with various personnel (e.g., infection professionals and nurses). These narrative data will be analyzed using an iterative process to identify themes in Aim 1. In Phase II, we will refine our survey based upon the results of Phase I and our prior work. Then, in 2011 we will survey NHSN hospitals (n = 2,198) on intensity of infection control processes in ICUs and obtain up to 6 years (2006-2011) of ICU-specific NHSN HAI data from our respondents. The analytic strategies for Aims 2 and 3 include state of the art multivariate methods designed to minimize potential bias and address clustering of data. The results of this innovative study will inform bedside clinicians as well as policy makers across the nation.