Our study showed that the majority of HAI prevention practices implemented at our hospital can be monitored through regular ICTR. As a result of the ICTR and the assessment that followed, we found that the reasons behind underperformance in some infection control activities lie at the individual and organizational levels. Moreover, we identified a limitation of regular ICTR: some infection control activities are not applicable to patients and cannot be monitored through regular ICTR. Infection prevention practices associated with preventing breathing device-related infection and SSIs were found to be more difficult to monitor. Considering these findings, it is necessary to revise the protocol to ensure that all infection control activities can be practiced and monitored correctly in accordance with the manual.
Although several previous studies related to ICTR have been conducted, these studies investigated the benefits of incorporating leadership rounding into infection prevention and focused on the association between infection control activities with rounding and one specific type of infection. 2,4,5,6,8,9 These assessments indicated that ICTR was successful in the studied context; nonetheless, these studies lack a comprehensive perspective on the mechanisms of rounding. In contrast, our study evaluated monitoring of infection control activities based on the entire infection prevention protocol, with a grade-based assessment of infection control activities. Thus, we assessed 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 highlights the practices that require organizational decisions and changes beyond individual performance to result in improvement, i.e., we concluded that implementing improvements in linen and laundry management requires an additional budget.
Our 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 items that require monitoring, which is necessary for a structural improvement of the ICTR system. Although we could not validate the grounds for selecting each item because of the absence of previous studies, the list consists of items necessary for infection control, which the South Korean government also applies to assess medical institutions. Therefore, medical institutions can refer to our study in order to ensure compliance with the infection prevention accreditation criteria. Furthermore, our 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 may be required. For example, institutions may decide to designate one or two people to be 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 institution.
Despite several merits, our study has some limitations. First, this study was conducted in a single South Korean hospital. As every healthcare center has its own unique characteristics, the results obtained in this study may not be extrapolated to other hospitals. Second, notifying each department in advance about the schedule and inspection items may have resulted in a Hawthorne effect. Nonetheless, we expect to see improvements in infection control compliance rates providing we continue monitoring in the same fashion.
In this study, we investigated the challenges related to ICTR based on observed performance levels. Hospitals should focus on potentially inappropriate practices and revise the protocol to expand the functional scope of the ICTR once a problem has been identified. Furthermore, each medical institution should determine the interventions that can be implemented at an individual level and those that require additional organizational support.