Gaming in infection control: A qualitative study exploring the perceptions and experiences of health professionals in Mongolia

Background: This study aimed to gain insight into the extent to which gaming is responsible for the underreporting of hospital-acquired infections (HAIs) in Mongolian hospitals, to identify gaming strategies used by health professionals, and to determine how gaming might be prevented. Methods: Eighty-seven health professionals, including policy- and hospital-level managers, doctors, nurses, and infection control practitioners, were recruited for 55 interviews and 4 group discussions in Mongolia in 2008. Results: All study participants were aware of gaming, which could occur via the following mechanisms: (1) doctors or nurses concealing HAI by overprescribing antibiotics or discharging patients early; (2) infection control practitioners failing to report HAI cases to hospital directors; and (3) hospital directors preventing reporting of HAI cases to the Ministry of Health. Gaming was consistently perceived to be a response to punitive performance evaluation by the Ministry of Health and penalization of hospitals and staff by the State Inspection Agency when HAIs were detected. Participants held divergent views regarding the best approach to reduce gaming, including excluding the current single indicator (ie, HAI rate) from the performance indicator list, developing multiple specific infection control indicators, improving the awareness of health managers regarding the causes of HAI, and increasing funding for infection control activities. Conclusion: Inclusion of the overall HAI rate in the targeted performance indicator set and the strict control and penalization of hospitals with reported HAI cases are factors that have contributed to gaming, which has resulted in deliberate, extreme underreporting of HAIs in Mongolian hospitals. Copyright © 2011 by the Association for Professionals in Infection. Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Perceptions of healthcare professionals regarding the main challenges and barriers to effective hospital infection control in Mongolia: a qualitative study

Background: It is not fully understood why healthcare decision-makers of developing countries often give low priority to infection control and why they are unable to implement international guidelines. This study aimed to identify the main perceived challenges and barriers that hinder the effective implementation of infection control programmes in Mongolia.Methods: In 2008, qualitative research involving 4 group and 55 individual interviews was conducted in the capital city of Mongolia and two provincial centres.Results: A total of 87 health professionals participated in the study, including policy and hospital-level managers, doctors, nurses and infection control practitioners. Thematic analysis revealed a large number of perceived challenges and barriers to the formulation and implementation of infection control policy. These challenges and barriers were complex in nature and related to poor funding, suboptimal knowledge and attitudes, and inadequate management. The study results suggest that the availability of infection control policy and guidelines, and the provision of specific recommendations for low-resource settings, do not assure effective implementation of infection control programmes.Conclusions: The current infection control system in Mongolia is likely to remain ineffective unless the underlying barriers and challenges are adequately addressed. Multifaceted interventions with logistical, educational and management components that are specific to local circumstances need to be designed and implemented in Mongolia. The importance of international peer support is highlighted

Positive deviance as a strategy to prevent and control bloodstream infections in intensive care

OBJECTIVE To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. METHOD An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. RESULTS In 90 days, 188 actions were observed, of these, 36.70% (n=69) were related to catheter dressing. In 81.15% (n=56) of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. CONCLUSION Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care.OBJETIVO Describir la aplicación del Positive Deviance como estrategia en la prevención y control de la infección de corriente sanguínea. MÉTODO Estudio de intervención realizado en la Unidad de Cuidados Intensivos de un hospital universitario, con los miembros de los equipos de enfermería y médico, de junio a diciembre de 2014. Fueron aplicados los cuatro pasos de la metodología Positive Deviance: Definir, Determinar, Descubrir y Dibujar. RESULTADOS En 90 días 188 acciones fueron observadas; de estas, 36,70% (n=69) estaban relacionadas con los apósitos de los catéteres. En el 81,15% (n=56) de esos apósitos, el empleo del bastoncillo estéril para la realización de la antisepsia del sitio de inserción del catéter y de su placa de fijación fue la acción de mayor adhesión. CONCLUSIÓN El Positive Deviance ayudó la implantación de propuestas de mejorías de proceso laboral y el desarrollo del equipo para los problemas identificados en el cuidado con el catéter venoso central.OBJETIVO Descrever a aplicação do Positive Deviance como estratégia na prevenção e no controle da infecção de corrente sanguínea. MÉTODO Estudo de intervenção realizado na Unidade de Terapia Intensiva de um hospital universitário, com os membros das equipes de enfermagem e médica, de junho a dezembro de 2014. Foram aplicados os quatro passos da metodologia Positive Deviance: Definir, Determinar, Descobrir e Desenhar. RESULTADOS Em 90 dias 188 ações foram observadas, destas, 36,70% (n=69) estavam relacionadas aos curativos dos cateteres. Em 81,15% (n=56) desses curativos, o uso da haste flexível estéril para realização da antissepsia do local de inserção do cateter e de sua placa de fixação foi a ação de maior adesão CONCLUSÃO O Positive Deviance auxiliou na implementação de propostas de melhorias de processo de trabalho e no desenvolvimento da equipe para os problemas identificados no cuidado com o cateter venoso central