Korean J healthc assoc Infect Control Prev.  2022 Dec;27(2):153-161. 10.14192/kjicp.2022.27.2.153.

Pilot Study of Healthcare-associated Infections Surveillance System in Long-term Care Facilities

• Kim SR
• Cha KS
• Kim JY
• Oh BR
• Yoo HM
• Cho NH
• Choi JR
• Choi JY
• Han SH
• Ga H
• Lee MS

• KMID: 2537076
• DOI: http://doi.org/10.14192/kjicp.2022.27.2.153

Abstract

Background
In Korea, the older population is increasing rapidly, and the number of longterm care facilities (LTCFs) are also increasing to meet the need . LTCFs are institutions that provide medical practice to patients who need long-term hospitalization. In LTCFS, a high risk of infection or spread of infection is present in terms of the clinical characteristics of inpatients and the structural aspects of the institutions. This study is a pilot investigation of the hand hygiene and prevention surveillance system for urinary tract infections (UTIs) in LTCFs.
Methods
A total of 20 LTCFs participated in the study. The status of hand hygiene and UTIs’ prevention intervention in the LTCFs was checked, and the collected data were analyzed to determine indicators such as hand hygiene compliance rate, indwelling urinary catheter usage ratio, UTIs’ rate, and UTIs’ prevention compliance rate.
Results
From October 2020 to March 2021, the total hand hygiene compliance rate of participating institutions was 86.7%. The UTIs’ rate was 0.22 cases per 1,000 days, and the indwelling urinary catheter-associated UTIs’ rate was 0.78 cases per 1,000 catheter-days. The compliance rate of indwelling urinary catheter maintenance was 88.3-99.8%, where the compliance rate of fixing the indwelling urinary catheter was marked the lowest and that of keeping the urine bag below the bladder, marked the highest.
Conclusion
This study provides the basic data for determining the continuous operation of the surveillance system. Additionally, the standardized indicators, which were calculated from the operation of the surveillance system, will help plan future healthcare-associated infection prevention projects for LTCFs.

Keyword

Hand hygiene; Healthcare-associated infections; Infection control; Long-term care; Urinary tract infections

Reference

1. Statistics Korea. Major population indicators (sex ratio, population growth rate, population structure, dependency ratio, etc.) /nationwide. https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1BPA002&checkFlag=N. Updated on 9 December 2021.

2. Statistics Korea. Status of long-term care facilities by city and province. https://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=DT_MIRE01&vw_cd=MT_ZTITLE&list_id=354_MT_DTITLE&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=MT_ZTITLE. Updated on 27 October 2022.

3. Park MW, Park KH, Cho J, Park HY, Kwon IH, Yeo WH, et al. 2014; Characteristics of geriatric trauma patients transferred from long-term care hospitals: a propensity score matched analysis. J Korean Soc Emerg Med. 25:312–7.

4. Kang JH, Lee HC. 2015; A study on the status of infection control and effect of infection education: comparison with social welfare facility and hospital. Public Policy Rev. 29:107–35.

5. Heudorf U, Boehlcke K, Schade M. 2012; Healthcare-associated infections in long-term care facilities (HALT) in Frankfurt am Main, Germany, January to March 2011. Euro Surveill. 17:20256. DOI: 10.2807/ese.17.35.20256-en. PMID: 22958607.

6. Kim SY, Kim JH, Yu KH, Kwon KH, Jung S, Shin JH, et al. 2009; The clinical features and hospital courses of patients admitted to a geriatric hospital: analysis of 600 registered cases. Dement Neurocogn Disord. 8:28–36.

7. Nicolle LE. 2009; Urinary tract infections in the elderly. Clin Geriatr Med. 25:423–36. DOI: 10.1016/j.cger.2009.04.005. PMID: 19765490.

8. Choi HH, Jeoung S. 2012; The correlation between immobility and UTI in the patients at a nursing hospital. Med J Chosun Univ. 37:149–54.

9. Lai CC, Lee CM, Chiang HT, Hung CT, Chen YC, Su LH, et al. 2017; Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan. J Microbiol Immunol Infect. 50:464–70. DOI: 10.1016/j.jmii.2017.01.006. PMID: 28711430.

10. Association for Professionals in Infection Control. 2015. Guide to hand hygiene programs for infection prevention. Association for Professionals in Infection Control and Epidemiology;Washington, DC: p. 70. DOI: 10.1016/j.jmii.2017.01.006.

11. WHO Patient Safety. 2009. A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. World Health Organization;Geneva: p. 48. DOI: 10.1016/j.jmii.2017.01.006.

12. Korea Disease Control. 2014. Guideline for hand hygiene in healthcare facilities. Korea Disease Control and Prevention Agency;Cheongju: p. 58. DOI: 10.1016/j.jmii.2017.01.006.

13. Korean National Healthcare-associated Infections Surveillance system. KONIS system. http://konis.cafe24.com/xe/. Updated on 9 December 2022.

14. McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, et al. 1991; Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 19:1–7. DOI: 10.1016/0196-6553(91)90154-5. PMID: 1902352.

15. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, et al. 2012; Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 33:965–77. DOI: 10.1086/667743. PMID: 22961014. PMCID: PMC3538836.

16. Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, et al. 2008; SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol. 29:785–814. DOI: 10.1086/592416. PMID: 18767983. PMCID: PMC3319407.

17. Ministry of Health. Medical treatment law. https://www.lawnb.com/Info/ContentView?sid=L000001788. Updated on 24 September 2021.

18. Ministry of Health. Medical treatment law enforcement regulations. https://www.lawnb.com/Info/ContentView?sid=L000007863. Updated on 14 September 2022.

19. Korean Association of Infection Control Nurses. 2012. Text of infection control. 2nd ed. Hyeonmoonsa;Seoul: p. 792.

20. Jeong SY, Kim OS, Choi JH, Lee SJ. 2018; Infection control tasks, difficulties, and educational needs of infection control practitioners in long term care facilities in Korea. Health Soc Welf Rev. 38:331–62. DOI: 10.15709/hswr.2018.38.3.331.

21. Lee MS. 2021. Operation of the nationwide surveillance system for healthcare associated infection. KyungHee University;Seoul: p. 732. DOI: 10.15709/hswr.2018.38.3.331.

22. Lee YK, Shin HH. 2017; A feasibility study of hand hygiene status in Korea hospitals. J Korea Inst Healthc Archit. 23:9–17.

23. Oh HS. 2015; Hand hygiene compliance of healthcare workers in a children's hospital. Pediatr Infect Vaccine. 22:186–93. DOI: 10.14776/piv.2015.22.3.186.

24. Cho HJ, Hong YH. 2020; A study on the knowledge and performance status for healthcare- associated infection control and prevention in caregivers. Korean J healthc assoc Infect Control Prev. 25:29–39. DOI: 10.14192/kjicp.2020.25.1.29.

25. Han MH, Choi SE. 2020; Factors influencing care workers' intention of implementing hand hygiene in long-term care hospitals. J Korean Acad Community Health Nurs. 31:375–83. DOI: 10.12799/jkachn.2020.31.3.375.

26. Health Insurance Review. Medical cost by national health insurance. https://repository.hira.or.kr/handle/2019.oak/2540. Updated on February 2021.

27. Jeong SY, Choi J, Kim JY, Ga H. 2020; Development and application of a surveillance method for healthcare-associated infections in long-term care hospitals in Korea. Ann Geriatr Med Res. 24:274–81. DOI: 10.4235/agmr.20.0067. PMID: 33389974. PMCID: PMC7781959.

28. Pennsylvania Patient Safety Authority. 2016. Pennsylvania patient safety authority annual report 2015. Pennsylvania Patient Safety Authority;Harrisburg: p. 98.

29. Palms DL, Mungai E, Eure T, Anttila A, Thompson ND, Dudeck MA, et al. 2018; The National Healthcare Safety Network Long-term Care Facility Component early reporting experience: January 2013-December 2015. Am J Infect Control. 46:637–42. DOI: 10.1016/j.ajic.2018.01.003. PMID: 29478758.