All hospitals with valid responses | Hospitals that responded to both surveys | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Question | 1st survey (n = 678) | 2nd survey (n = 559) | P* | 1st survey (n = 437) | 2nd survey (n = 437) | P* | ||||
Number of staff | ||||||||||
Physician (full-time) | 75 | (47–128) | 80 | (48.5–137.5) | 0.237 | 80 | (50–140) | 81 | (50–137) | 0.805 |
Nurse (full-time) | 336 | (235–528.5) | 360 | (251–561) | 0.066 | 368 | (246–543) | 371 | (251–561) | 0.629 |
Laboratory technologist (full-time) | 23 | (16–34) | 24 | (17–36) | 0.107 | 24 | (17–36.5) | 24.5 | (17–37) | 0.819 |
Pharmacist (full-time) | 19 | (13–28) | 20 | (14–30) | 0.066 | 19 | (14–28) | 20 | (14–30) | 0.360 |
Dietitian | 5 | (4–8) | 5 | (4–8) | 0.097 | 5 | (4–8) | 6 | (4–8) | 0.370 |
Administrative staff | 52 | (32–86) | 53.5 | (32–87) | 0.611 | 56 | (33–87) | 56 | (33–89) | 0.718 |
Registered ICD (MD or PhD) | 2 | (1–4) | 3 | (2–4) | 0.139 | 3 | (2–4) | 3 | (2–4) | 0.322 |
We have an active ICT. | 674 | (99.4%) | 557 | (99.6%) | 0.843 | 436 | (99.8%) | 435 | (99.5%) | 0.607 |
Number of ICT member, crude | 10 | (8–16) | 11 | (7–16) | 0.103 | 11 | (8–17) | 11 | (7–17) | 0.530 |
Physician | 2.5 | (2–4) | 3 | (2–4) | 0.153 | 3 | (2–4) | 3 | (2–4) | 0.576 |
Nurse | 2 | (2–4) | 2 | (2–4) | 0.488 | 2 | (2–4) | 2 | (2–4) | 0.757 |
Pharmacist | 2 | (1–2) | 2 | (1–2) | 0.255 | 2 | (1–2) | 2 | (1–2) | 0.242 |
Laboratory technologist | 2 | (1–2) | 2 | (1–2) | 0.230 | 2 | (1–2) | 2 | (1–2) | 0.709 |
Dietitian | 0 | (0–0) | 0 | (0–0) | 0.910 | 0 | (0–0) | 0 | (0–0) | 0.948 |
Administrative staff | 1 | (0–2) | 1 | (0–1) | 0.969 | 1 | (0–2) | 1 | (1–2) | 0.926 |
Number of ICT member, full-time equivalent | 2.8 | (1.3–4.3) | 2.8 | (1.8–4) | 0.717 | 2.8 | (1.6–4.3) | 2.8 | (1.8–4.1) | 0.920 |
Physician | 2.5 | (2–4) | 3 | (2–4) | 0.951 | 3 | (2–4) | 3 | (2–4) | 0.830 |
Nurse | 0.8 | (0.8–1.3) | 0.8 | (0.8–1.3) | 0.675 | 0.8 | (0.8–1.3) | 0.8 | (0.8–1.3) | 0.693 |
Pharmacist | 0.5 | (0–0.8) | 0.5 | (0–0.8) | 0.725 | 0.5 | (0–0.8) | 0.5 | (0–0.65) | 0.531 |
Laboratory technologist | 0.5 | (0–0.8) | 0.5 | (0–0.5) | 0.953 | 0.5 | (0–1) | 0.5 | (0–0.8) | 0.931 |
Dietitian | 0 | (0–0) | 0 | (0–0) | 0.068 | 0 | (0–0) | 0 | (0–0) | 0.067 |
Administrative staff | 0 | (0–0.5) | 0 | (0–0.5) | 0.839 | 0 | (0–0.5) | 0 | (0–0.5) | 0.524 |
FTE per 100 beds | 0.7 | (0.4–1.0) | 0.7 | (0.4–1.0) | 0.918 | 0.7 | (0.4–1.0) | 0.7 | (0.4–1.0) | 0.918 |
We performed bacterial culture, identification, and susceptibility tests basically in our hospital. | 542 | (79.9%) | 466 | (83.4%) | 0.301 | 355 | (81.2%) | 367 | (84.0%) | 0.362 |
We participate in JANIS programs. | 647 | (95.4%) | 548 | (98.0%) | 0.025 | 426 | (97.5%) | 432 | (98.9%) | 0.219 |
Clinical laboratory division | 636 | (93.8%) | 536 | (95.9%) | 0.103 | 421 | (96.3%) | 422 | (96.6%) | 0.855 |
Antimicrobial-resistant bacterial infection division | 311 | (45.9%) | 288 | (51.5%) | 0.048 | 228 | (52.2%) | 235 | (53.8%) | 0.635 |
Surgical site infection division | 366 | (54.0%) | 324 | (58.0%) | 0.161 | 249 | (57.0%) | 259 | (59.3%) | 0.493 |
Intensive care unit division | 116 | (17.1%) | 88 | (15.7%) | 0.519 | 80 | (18.3%) | 74 | (16.9%) | 0.595 |
Neonatal intensive care unit division | 74 | (10.9%) | 64 | (11.4%) | 0.766 | 56 | (12.8%) | 51 | (11.7%) | 0.606 |
1. Organizational structure for nosocomial infection control | ||||||||||
The head of our hospital attends ICC almost every time. | 576 | (85.0%) | 473 | (84.6%) | 0.027 | 379 | (86.7%) | 369 | (84.4%) | 0.018 |
We have a comprehensive hospital infection control manual that can be used all around our hospital. | 677 | (99.9%) | 559 | (100.0%) | 0.364 | 437 | (100.0%) | 437 | (100.0%) | – |
We hold a workshop regarding countermeasures against hospital infection more than once a year. | 677 | (99.9%) | 559 | (100.0%) | 0.364 | 437 | (100.0%) | 437 | (100.0%) | – |
We have tools, such as the intranet and bulletin boards, to inform our staff of hospital infection-related matters. | 671 | (99.0%) | 556 | (99.5%) | 0.397 | 434 | (99.3%) | 436 | (99.8%) | 0.317 |
2. Activities of ICT | ||||||||||
We hold a regular ICT meeting. | 628 | (92.6%) | 534 | (95.5%) | 0.042 | 410 | (93.8%) | 416 | (95.2%) | 0.353 |
We provide consultation as an activity of the ICT. | 633 | (93.4%) | 516 | (92.3%) | 0.274 | 412 | (94.3%) | 407 | (93.1%) | 0.333 |
We have an AST (a member can work for both ICT and AST). | 542 | (79.9%) | 373 | (66.7%) | <.001 | 355 | (81.2%) | 305 | (69.8%) | <.001 |
We monitor the uses of antibiotics to assure their propriety. | 652 | (96.2%) | 544 | (97.3%) | 0.476 | 420 | (96.1%) | 431 | (98.6%) | 0.064 |
We intervene to assure appropriate uses of antibiotics. | 631 | (93.1%) | 527 | (94.3%) | 0.177 | 410 | (93.8%) | 415 | (95.0%) | 0.317 |
We have established criteria of interventions, such as their administration duration and selection, for patients administered antibiotics. | 466 | (68.7%) | 399 | (71.4%) | 0.589 | 304 | (69.6%) | 310 | (70.9%) | 0.691 |
We have criteria for the uses of anti-MRSA antibiotics. | 433 | (63.9%) | 361 | (64.6%) | 0.964 | 267 | (61.1%) | 278 | (63.6%) | 0.594 |
We record the used amount of anti-MRSA antibiotics. | 667 | (98.4%) | 554 | (99.1%) | 0.508 | 432 | (98.9%) | 432 | (98.9%) | 0.788 |
We have a reporting system (1st survey: “registration system”) for the use of anti-MRSA antibiotics. | 390 | (57.5%) | 542 | (97.0%) | <.001 | 259 | (59.3%) | 425 | (97.3%) | <.001 |
We have a preauthorization and/or restriction system for the use of anti-MRSA antibiotics. | 321 | (47.3%) | 208 | (37.2%) | <.001 | 206 | (47.1%) | 169 | (38.7%) | 0.035 |
We have criteria for the uses of broad-spectrum antibiotics such as carbapenems. | 355 | (52.4%) | 287 | (51.3%) | 0.369 | 217 | (49.7%) | 224 | (51.3%) | 0.305 |
We have a reporting system (1st survey: “registration system”) for the use of broad-spectrum antibiotics. | 391 | (57.7%) | 530 | (94.8%) | <.001 | 251 | (57.4%) | 415 | (95.0%) | <.001 |
We have a preauthorization and/or restriction system for the use of broad-spectrum antibiotics. | 258 | (38.1%) | 131 | (23.4%) | <.001 | 157 | (35.9%) | 111 | (25.4%) | 0.003 |
We record the used amount of broad-spectrum antibiotics. | 667 | (98.4%) | 550 | (98.4%) | 0.935 | 429 | (98.2%) | 431 | (98.6%) | 0.777 |
We have a reference system, such as the intranet of a booklet, for the antibiogram. | 562 | (82.9%) | 482 | (86.2%) | 0.238 | 371 | (84.9%) | 383 | (87.6%) | 0.499 |
We performed TDM for basically all cases. | 423 | (62.4%) | 362 | (64.8%) | 0.273 | 273 | (62.5%) | 287 | (65.7%) | 0.193 |
We record the vaccination proportion of employees who are HBsAg-negative. | 581 | (85.7%) | 485 | (86.8%) | 0.415 | 369 | (84.4%) | 378 | (86.5%) | 0.096 |
We perform IGRAs for employees who are in contact with tuberculosis patients. | 616 | (90.9%) | 503 | (90.0%) | 0.772 | 404 | (92.4%) | 397 | (90.8%) | 0.556 |
We record employees’ immunization statuses for measles, rubella, chickenpox, and mumps (2nd survey: “for all of measles, rubella, chickenpox, and mumps”). | 572 | (84.4%) | 340 | (60.8%) | <.001 | 371 | (84.9%) | 273 | (62.5%) | <.001 |
We have a manual and a reporting system of needle punctures and sharp object injuries. | 678 | (100.0%) | 559 | (100.0%) | – | 437 | (100.0%) | 437 | (100.0%) | – |
Needle puncture and sharp object injuries are reported to a relevant department, such as ICT. | 463 | (68.3%) | 391 | (69.9%) | 0.177 | 301 | (68.9%) | 307 | (70.3%) | 0.408 |
ICT and/or ICPs check the number of isolated antimicrobial-resistant organisms and other microorganisms that are relevant to infection control on a daily basis | 436 | (64.3%) | 357 | (63.9%) | 0.409 | 281 | (64.3%) | 286 | (65.4%) | 0.110 |
ICT and/or ICPs record the species and trends of isolated microorganisms on a type-of-sample and a ward-by-ward basis. | 636 | (93.8%) | 530 | (94.8%) | 0.142 | 413 | (94.5%) | 414 | (94.7%) | 0.257 |
We have a direct and fast reporting system to the doctor-in-charge, such as e-mail and telephone, when microorganisms are isolated from a sample that is supposed to be aseptic (e.g., a blood sample). | 653 | (96.3%) | 550 | (98.4%) | 0.068 | 422 | (96.6%) | 431 | (98.6%) | 0.088 |
We perform surveillance for surgical site infections. | 510 | (75.2%) | 446 | (79.8%) | 0.038 | 334 | (76.4%) | 355 | (81.2%) | 0.119 |
We perform surveillance for ventilator-associated pneumonia. | 238 | (35.1%) | 219 | (39.2%) | 0.254 | 162 | (37.1%) | 175 | (40.0%) | 0.422 |
We perform surveillance for central line-associated bloodstream infections. | 508 | (74.9%) | 440 | (78.7%) | 0.190 | 330 | (75.5%) | 351 | (80.3%) | 0.088 |
We perform surveillance for catheter-associated urinary tract infections. | 345 | (50.9%) | 310 | (55.5%) | 0.275 | 224 | (51.3%) | 258 | (59.0%) | 0.063 |
We perform active surveillance cultures. | 334 | (49.3%) | 273 | (48.8%) | 0.905 | 228 | (52.2%) | 219 | (50.1%) | 0.831 |
We have an established manual for outbreaks. | 637 | (94.0%) | 534 | (95.5%) | 0.370 | 417 | (95.4%) | 419 | (95.9%) | 0.947 |
3. Preventive measures by the route of infections | ||||||||||
We have a manual for the outbreak of tuberculosis. | 675 | (99.6%) | 559 | (100.0%) | 0.290 | 435 | (99.5%) | 437 | (100.0%) | 0.368 |
We have a manual for the outbreak of measles. | 623 | (91.9%) | 513 | (91.8%) | 0.175 | 398 | (91.1%) | 401 | (91.8%) | 0.222 |
We have a manual for the outbreak of chickenpox. | 612 | (90.3%) | 502 | (89.8%) | 0.161 | 393 | (89.9%) | 395 | (90.4%) | 0.222 |
We provide N95 masks at the outpatient emergency department and other outpatient departments. | 664 | (97.9%) | 551 | (98.6%) | 0.648 | 429 | (98.2%) | 432 | (98.9%) | 0.661 |
We put a surgical mask on patients with suspected airborne infections while transporting. | 677 | (99.9%) | 558 | (99.8%) | 0.361 | 436 | (99.8%) | 436 | (99.8%) | 0.368 |
Wearing an N95 mask is mandatory while entering the ward of a patient with suspected tuberculosis. | 676 | (99.7%) | 558 | (99.8%) | 0.680 | 436 | (99.8%) | 436 | (99.8%) | 1.000 |
We have a manual for the outbreak of influenza. | 674 | (99.4%) | 555 | (99.3%) | 0.736 | 435 | (99.5%) | 435 | (99.5%) | 1.000 |
Wearing a surgical mask while entering the ward of a patient with a droplet infection is instructed by a manual. | 671 | (99.0%) | 558 | (99.8%) | 0.152 | 432 | (98.9%) | 437 | (100.0%) | 0.081 |
We provide surgical masks in the wards of patients with droplet infections. | 589 | (86.9%) | 486 | (86.9%) | 0.716 | 374 | (85.6%) | 380 | (87.0%) | 0.336 |
We have a manual for cases in which MRSA is isolated from a patient. | 667 | (98.4%) | 551 | (98.6%) | 0.661 | 429 | (98.2%) | 433 | (99.1%) | 0.400 |
Wearing disposable gloves and a gown is mandatory while entering the ward of a patient with suspected contagious diseases. | 618 | (91.2%) | 508 | (90.9%) | 0.966 | 399 | (91.3%) | 401 | (91.8%) | 0.793 |
We provide alcohol-based hand sanitizers in all wards except for some special wards, such as the psychiatric ward. | 657 | (96.9%) | 546 | (97.7%) | 0.525 | 427 | (97.7%) | 428 | (97.9%) | 0.607 |
We provide alcohol-based hand sanitizers in all outpatient departments. | 624 | (92.0%) | 529 | (94.6%) | 0.151 | 404 | (92.4%) | 415 | (95.0%) | 0.224 |
4. Maintenance of medical equipment | ||||||||||
We adopt closed urine drainage systems. | 644 | (95.0%) | 544 | (97.3%) | 0.112 | 419 | (95.9%) | 426 | (97.5%) | 0.412 |
We do not change catheters without blockages or infections regularly. | 512 | (75.5%) | 418 | (74.8%) | 0.619 | 322 | (73.7%) | 323 | (73.9%) | 0.904 |
We have a manual for the maintenance of ventilators. | 583 | (86.0%) | 499 | (89.3%) | 0.221 | 376 | (86.0%) | 388 | (88.8%) | 0.424 |
We adopt closed tracheal suction systems. | 568 | (83.8%) | 476 | (85.2%) | 0.799 | 382 | (87.4%) | 381 | (87.2%) | 0.931 |
We use sterile water for humidifiers. | 658 | (97.1%) | 544 | (97.3%) | 0.120 | 428 | (97.9%) | 426 | (97.5%) | 0.311 |
We perform regular oral cleansing for intubated patients in approximately 100% of relevant cases. | 524 | (77.3%) | 425 | (76.0%) | 0.225 | 340 | (77.8%) | 333 | (76.2%) | 0.226 |
We have a manual for the maintenance of central line catheters. | 654 | (96.5%) | 542 | (97.0%) | 0.108 | 418 | (95.7%) | 425 | (97.3%) | 0.294 |
We insert central line catheters under maximal barrier precautions in approximately 100% of relevant cases. | 254 | (37.5%) | 210 | (37.6%) | 0.086 | 163 | (37.3%) | 167 | (38.2%) | 0.150 |
We prepare intravenous hyperalimentation admixtures on clean benches in approximately 100% of relevant cases. | 277 | (40.9%) | 225 | (40.3%) | 0.415 | 182 | (41.6%) | 175 | (40.0%) | 0.335 |
We use transparent dressings on the sites of catheter insertion to make them easy to inspect visually in approximately 100% of relevant cases. | 563 | (83.0%) | 486 | (86.9%) | 0.224 | 357 | (81.7%) | 380 | (87.0%) | 0.112 |
5. Standard precautions | ||||||||||
We instruct new employees in hand hygiene by practical training sessions for all professions. | 361 | (53.2%) | 290 | (51.9%) | 0.955 | 229 | (52.4%) | 222 | (50.8%) | 0.700 |
We evaluate the implementation of hand hygiene instructions of all wards at least once a year. | 603 | (88.9%) | 523 | (93.6%) | 0.018 | 389 | (89.0%) | 411 | (94.1%) | 0.028 |
We instruct new employees of all professions how to put on and remove PPE. | 532 | (78.5%) | 426 | (76.2%) | 0.638 | 347 | (79.4%) | 330 | (75.5%) | 0.255 |
We instruct all employees in PPE by practical training sessions every year. | 135 | (19.9%) | 107 | (19.1%) | 0.281 | 85 | (19.5%) | 80 | (18.3%) | 0.126 |
6. Wards | ||||||||||
We provide hand sanitizers at the entrance of all wards. | 656 | (96.8%) | 544 | (97.3%) | 0.407 | 426 | (97.5%) | 426 | (97.5%) | 0.593 |
All medical devices (e.g., thermometers, stethoscopes) of single isolation rooms are patient-dedicated. | 653 | (96.3%) | 529 | (94.6%) | 0.152 | 423 | (96.8%) | 414 | (94.7%) | 0.174 |
We check expiry dates of sterilized medical devices daily. | 638 | (94.1%) | 528 | (94.5%) | 0.949 | 415 | (95.0%) | 416 | (95.2%) | 0.987 |
We check expiry dates of unused medications. | 664 | (97.9%) | 551 | (98.6%) | 0.516 | 429 | (98.2%) | 430 | (98.4%) | 0.741 |
We have established guides for the expiry dates of opened medications. | 649 | (95.7%) | 542 | (97.0%) | 0.285 | 421 | (96.3%) | 422 | (96.6%) | 0.514 |
All wards have at least one infection control link nurse. | 669 | (98.7%) | 547 | (97.9%) | 0.535 | 432 | (98.9%) | 429 | (98.2%) | 0.571 |
7. ICU | ||||||||||
Medical professions do not change their shoes while entering ICU. | 548 | (80.8%) | 425 | (76.0%) | 0.123 | 363 | (83.1%) | 335 | (76.7%) | 0.037 |
Medical professions are not recommended to wear gowns while entering ICU. | 548 | (80.8%) | 425 | (76.0%) | 0.116 | 361 | (82.6%) | 337 | (77.1%) | 0.128 |
We have handwashing sinks at the entrance of ICU. | 397 | (58.6%) | 320 | (57.2%) | 0.085 | 259 | (59.3%) | 248 | (56.8%) | 0.107 |
We provide hand sanitizers at the entrance of ICU. | 549 | (81.0%) | 426 | (76.2%) | 0.114 | 362 | (82.8%) | 338 | (77.3%) | 0.095 |
We advise the patients’ families to use hand sanitizers or wash hands before and after entering ICU. | 545 | (80.4%) | 428 | (76.6%) | 0.016 | 362 | (82.8%) | 339 | (77.6%) | 0.066 |
8. Operating room | ||||||||||
We do not change stretchers while entering operating rooms. | 518 | (76.4%) | 449 | (80.3%) | 0.046 | 334 | (76.4%) | 352 | (80.5%) | 0.211 |
Medical professions do not change their shoes while entering operating rooms. | 395 | (58.3%) | 356 | (63.7%) | 0.102 | 263 | (60.2%) | 285 | (65.2%) | 0.299 |
We do not provide sticky mats at the entrance of operation rooms. | 670 | (98.8%) | 552 | (98.7%) | 0.734 | 434 | (99.3%) | 432 | (98.9%) | 0.715 |
We have established standards of surgical hand preparation. | 579 | (85.4%) | 492 | (88.0%) | 0.331 | 375 | (85.8%) | 381 | (87.2%) | 0.553 |
We do not recommend the use of a brush for surgical hand preparation. | 641 | (94.5%) | 534 | (95.5%) | 0.424 | 419 | (95.9%) | 420 | (96.1%) | 0.867 |
9. Prevention of postoperative infections | ||||||||||
We use electric clippers or depilatory creams for patients who need to remove their hair before surgery in all departments. | 651 | (96.0%) | 532 | (95.2%) | 0.572 | 420 | (96.1%) | 418 | (95.7%) | 0.271 |
We advise patients who can take a shower to take a shower on the night before or the morning of the day of surgery. | 638 | (94.1%) | 526 | (94.1%) | 0.865 | 410 | (93.8%) | 410 | (93.8%) | 0.478 |
We recommend the administration of prophylactic antibiotics 30 min to 1 h before the incision. | 640 | (94.4%) | 522 | (93.4%) | 0.582 | 421 | (96.3%) | 406 | (92.9%) | 0.710 |
We have manuals to establish the duration of prophylactic antibiotics administration in all departments. | 304 | (44.8%) | 266 | (47.6%) | 0.532 | 188 | (43.0%) | 214 | (49.0%) | 0.230 |
10. Management of food hygiene in hospitals | ||||||||||
We adopt dry kitchen systems for hospital meals. | 508 | (74.9%) | 453 | (81.0%) | 0.005 | 330 | (75.5%) | 356 | (81.5%) | 0.040 |
11. Management of medical waste | ||||||||||
We distinguish infectious waste from other waste and store it in a place inaccessible to non-authorized people. | 667 | (98.4%) | 546 | (97.7%) | 0.667 | 428 | (97.9%) | 427 | (97.7%) | 0.607 |
12. Cleaning, disinfection, and sterilization of instruments | ||||||||||
We do not pre-clean or pre-disinfect medical devices in wards. | 549 | (81.0%) | 463 | (82.8%) | 0.526 | 355 | (81.2%) | 368 | (84.2%) | 0.501 |
We clean and disinfect endoscopes in accordance with the manuals or check them regularly. | 582 | (85.8%) | 472 | (84.4%) | 0.498 | 375 | (85.8%) | 372 | (85.1%) | 0.885 |