Hospital setting
This study was conducted at the Fifth People's Hospital of Chengdu City, which is a tertiary general hospital in Sichuan, China. The hospital has 51 clinical departments and 2188 bed spaces. In 2018, the hospital admitted 79,132 inpatients, 84,535 in 2019, 80,545 in 2020, 86,388 in 2021, and 90,394 in 2022. It serves over 2.6 million patients in outpatient settings annually.
Confirmation and identification of nosocomial infections
The Chinese diagnostic criteria for nosocomial infection are developed based on the WHO and the US CDC criteria and was published in the "Classification and Diagnosis Criteria for Nosocomial Infections" document. Nosocomial infection cases were collected Xinglin System, an internal infection monitoring system within the hospital. Clinical doctors report nosocomial infection cases to the Xinglin System, and dedicated staff from the infection control department verify these cases as hospital-acquired infections.
Nursing infection control inspector(NICI)
Organization of NICI
The NICI (Nursing Infection Control Inspector) consists of 5 groups, with each group comprising 1 instructor, 1 team leader, 1 key department inspector, and 6 members. The instructor is responsible for training, assessing, and supervising the members of the group. They oversee the quality of inspections conducted by their group. The team leader has the role of coordinating and allocating inspection tasks among the group members. They work closely with the group members to conduct inspections within clinical departments. Key Department Inspector is tasked with focusing on inspections within specific key departments. They ensure that infection control measures are effectively implemented in these crucial areas.
Selection and training of NICI
personnel were selected from ICLN team. ICLN from clinical departments took part in a hospital infection prevention and control knowledge-based examination followed by interviews. The selection was based on a composite score of both examination results (50%) and interview results (50%). The top 50 candidates were appointed by the hospital's infection management committee to form a dedicated INCI team. Training was then conducted using a combination of online and face to face methods. Online training involved recording training content as videos and making them available on the company's WeChat platform for unlimited access. External meetings were attended via online meeting platform. Face to face training included centralized INCI training within the hospital, covering topics such as standardized checklists and inspection methods. Additionally, selected individuals were sent to participate in national and provincial healthcare infection quality control management training conferences. One-on-one training was also provided for clinical practice.
Supervision methods and content:
During the implementation of NICI, we have developed multiple inspection methods. To reduce the subjective judgment of NICI and ensure the objectivity of the inspection results, we use standardized inspection forms, such as the WHO hand hygiene observation form, forms for catheter-related or ventilator-related infections, and measures for prevention of multidrug-resistant bacteria.
| Inspection method and content |
|---|
| Items | Content |
| Inspection method | Rolling inspection: The dedicated infection control inspectors are divided into 5 groups, with 9 members in each group, and a full-time infection control staff member as the group leader. The two division of the hospital and 36 departments are divided into 5 sections, and the inspection of each section is completed in one week. Each person is responsible for one day, including holidays, forming a rolling inspection model. Checklist inspection: Dedicated infection control inspectors conduct inspections according to standardized inspection item lists for hospital infections. Problem-oriented inspection: Problems discovered through various channels are subject to special inspections. These channels include ① Problems discovered during inspections by higher-level departments (provincial committees, municipal committees, municipal health committees, law enforcement units), and ② Encouraging clinical reporting of clustering cases by fever clinics, clinical reporting from the Xinglin Hospital Infection Monitoring system, etc. Closed-loop inspection: Dedicated infection control inspectors identify problems during daily inspections and follow up with a second inspection the next day to ensure the issue has been resolved. Joint inspection: Dedicated infection control inspectors organize and collaborate with medical affairs departments, quality control offices, and nursing departments to conduct joint inspections of infection prevention and control work. Self-inspection: Clinical departments conduct risk assessments, identify high-risk processes, and conduct self-inspections of these processes. Any identified problems are addressed with corrective measures. |
| Inspecting items | 1. Hand hygiene 2. Policy to prevent multi-drug resistant organisms 3. Implementation of ward disinfection and deep cleaning: using fluorescent markers 4. Bundle released by WHO) for preventing ventilator-associated pneumonia, catheter-related bloodstream infections, and catheter-associated urinary tract infections 5. Implementation of standard preventive measures 6. Implementation of aseptic techniques 7. Medical waste disposal: using medical waste bags inside medical waste bins, foot-operated medical waste bin lids, goose-neck tying, and timely transportation. |
| Training | 1. All hospital staff were trained, including cleaners and nursing staff. 2. Educational and promotional videos were recorded to teach basic knowledge of infection control . 3. On-site training includes the use of personal protective equipment and hand hygiene. |
Evaluation and Assessment of Work Quality
In terms of assessing work quality, deductions will be applied to NICI members with poor inspection quality, including unexplained absences (such as those related to practice or training), late submission of inspection reports, or failure to submit reports. This is done to ensure the active participation of all team members and the timely submission of reports. When the assessment score of an infection control inspector falls below 80 points, their work allowance for the current month will be suspended. This serves as an incentive mechanism to encourage inspectors to maintain a high level of performance. The annual assessment is conducted from five aspects, workload, work attitude, quality of evaluation, completion status, and supervisory skills. Based on the scores, outstanding inspectors are complimented, and underperforming inspectors may be phased out.
Data collection and management
Retrospective review of nosocomial infection cases from the Xinglin Nosocomial Infection Surveillance System from 2018 to 2022. Cases between January 1, 2018, and December 30, 2019 were defined as the pre-COVID-19 group, while cases between January 1, 2020, and December 30, 2022, were defined as the post-COVID-19 group. This project was approved by the ethics committee of the Cheng Du Fifth Hospital.
Statistical analysis
Analysis of patient data was performed using SPSS 25.0 statistical software. According to data classification, such as hospital infection. etc, the data were merged into one group from 2018 to 2019, and the data were merged into one group from 2020 to 2022. The distributed data were compared using the t-test, χ2-test, or exact probability method. The non-normal distribution data were compared using the Mann-Whitney U test. A P-value of less than 0.05 was considered statistically significant.