The majority of HAI prevention practices could be monitored by regular ICTR. As a result of ICTR and the following assessment, we found that the reasons behind underperformance in some infection control activities lie at individual and organizational levels. Moreover, we identified a limitation of regular ICTR: some infection control activities are neither applicable to patients nor able to be monitored by ICTR. Infection prevention practices associated with breathing device-related infection, and SSIs were found to be more difficult to monitor. Considering these findings, it is necessary to revise the protocol, so that all infection control activities can be practiced and monitored correctly, in accordance with the manual.
The majority of the previous studies have investigated the benefits of leadership rounding incorporation to infection prevention [2, 4, 5, 7, 8]. Those studies focused on the association between infection control activities with rounding and one type of infection. Although these assessment indicated such approach was successful in the studied context, a lack of comprehensive perspective on the mechanisms of this success has been a limitation of the previous studies. The present study examined the monitoring of the entire infection prevention protocol, with a grade-based assessment of infection control activities. For this purpose, we checked all infection control activities related to a variety of infections, rather than focusing on one specific infection. As a result, we could delineate the functional coverage of ICTR monitoring and applicability of each infection prevention activity. Notably, this method of assessment spotlights the practices that require organizational decisions and changes beyond individual performance that are needed for improvement. For example, the present study identified that implementing improvements in linen and laundry management requires additional budget.
The present pilot study is the first study to specify items that require monitoring for hospital-associated infection control. To our knowledge, there is no previous study that suggests a comprehensive list of monitoring items requiring monitoring, which is necessary for structural improvement of the ICTR system. Though we could not suggest validity of grounds to select each item for absence of the previous study, the list consists of items necessary for infection control, which the Korean government also applies to assessment of medical institute. Therefore, medical institutes can refer to the present study in order to stick with the criteria of certification assessment. Furthermore, the present study distinguishes between items that can be monitored via organizational ICTR of a particular department and those that cannot. In case of the latter group, additional time and human resources or an alternative approach to monitoring might be required. For example, institutes might decide to designate one or two people as responsible for the entire monitoring process in a particular department, rather than sharing responsibility across departments. A suitable observation method should be determined given the specific circumstances of each medical institute.
Despite such merits, the present study has some limitations. In particular, this study’s lack of representativeness, associated with low diversity of the sampled population, is problematic. Samples were collected from a single Korean hospital; as such, the present study findings might not be generalizable to other hospitals.
In the present study, we investigated challenges to ICTR based on observed performance levels. Hospitals need to focus on potentially inappropriate practices, and, if a problem is found, revise the protocol to expand the functional scope of the ICTR. Furthermore, each medical institute should consider what interventions can be implemented at an individual level, and what problems require organizational support. Such activities allow healthcare settings to be better prepared against events such as the COVID-19 pandemic.