infection control and hospital epidemiologyjuly 2012, vol. 33, no. 7
National Survey of Practices to Prevent Healthcare-Associated
Infections in Thailand: The Role of Safety Culture
Anucha Apisarnthanarak, MD;1M. Todd Greene, PhD, MPH;2,3Edward H. Kennedy, MS;3
Thana Khawcharoenporn, MD, MSc;1Sarah Krein, PhD, RN;2,3,4
Sanjay Saint, MD, MPH2,3,4
(CAUTI), central line–associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP), the 3 most common types
of healthcare-associated infection (HAI) in Thailand.
To evaluate hospital characteristics and practices used by Thai hospitals to prevent catheter-associated urinary tract infection
setting.Thai hospitals with an intensive care unit and 250 or more hospital beds
hospital characteristics and practices to prevent CAUTI, CLABSI, and VAP. Ordinal logistic regression was used to assess relationships
between hospital characteristics and use of prevention practices.
Between January 1, 2010, and October 31, 2010, research nurses collected data from all eligible hospitals. The survey assessed
most frequently reported prevention practice by infection was as follows: for CAUTI, condom catheters in men (47%); for CLABSI, avoiding
routine central venous catheter changes (85%); and for VAP, semirecumbent positioning (84%). Hospitals with peripherally inserted central
catheter insertion teams were more likely to regularly use elements of the CLABSI prevention bundle. Greater safety scores were associated
with regular use of several VAP prevention practices. The only hospital characteristic associated with increased use of at least 1 prevention
practice for each infection was membership in an HAI collaborative.
A total of 204 (80%) of 256 hospitals responded. Most hospitals (93%) reported regularly using alcohol-based hand rub. The
were used infrequently in Thailand. Policies and interventions emphasizing specific infection prevention practices, establishing a strong
institutional safety culture, and participating in collaboratives to prevent HAI may be beneficial.
While reported adherence to hand hygiene was high, many of the prevention practices for CAUTI, CLABSI, and VAP
Infect Control Hosp Epidemiol 2012;33(7):711-717
Affiliations: 1. Division of Infectious Diseases, Thammasat University Hospital, Pathumthani, Thailand; 2. University of Michigan Health System, Ann
Arbor, Michigan; 3. Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan; 4. Center for
Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Received November 14, 2011; accepted February 8, 2012; electronically published May 14, 2012.
? 2012 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2012/3307-0010$15.00. DOI: 10.1086/666330
Healthcare-associated infection (HAI) related to invasive
medical devices is a major threat to patient safety in both
developed and developing countries.1,2In developing coun-
tries, the risk of HAI has been estimated to be 2–20 times
higher than that in developed countries.3-7Because the po-
tential impact of HAI is perceived to be of minor importance
with respect to other healthcare priorities, hospital resources
are often diverted from infection control programs, especially
in low-resource countries where the annual per capita income
is less than US$1,500 or where less than 5% of the gross
national product is spent on health care.4This perception,
coupled with limited spending on HAI prevention in devel-
oping countries, can unfortunately lead to missed opportu-
nities for cost-effective healthcare interventions through in-
fection control measures in hospitals.
Thailand initiated its national commitment to improve pa-
tient safety in June 2007 after signing the pledge with the
World Health Organization (WHO) and joining with the
World Alliance for Patient Safety to campaign for patient
safety through the 2005–2006 Global Patient Safety Challenge
project “Clean Care Is Safer Care.” The primary focus of this
project was on the prevention of infections associated with
health care through the implementation of low-cost, simple,
and effective strategies, such as hand hygiene and evidence-
based practices to prevent HAI.8,9Despite the commitment
to the Global Patient Safety Challenge by the Thai govern-
preventing hai in thailand717
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