Implementing change in infection control practice : an action research study in two intensive care units.

The increased emergence of bacterial resistance to antibiotics means that primary prevention of all hospital-acquired infections is essential, but ensuring that infection control practice is evidence-based requires reliable measurement of endemic hospital-acquired infections. The research sought to develop a comprehensive method for combining surveillance of infection with improved infection control by incorporating a problem solving approach within nursing process documentation. Prior to the research there was little evidence of nursing documentation of infection risk assessment, evaluation or outcomes monitoring. Development of the documentation matched the aspirations for a clear, objective complete system to support infection control care planning and audit. The documentation was designed to collect and collate only routine items of clinical information that the nurse at the bedside on an ICU would already know or be able to access in a very short time. The data items were successfully incorporated within the audit documentation for measuring incidence of each of the four site-specific infections. The system provided a framework for case-mix identification, case definitions, data collection and identification of indicators for measurement of ICU-acquired infection. It was shown to be feasible to incorporate the audit tool within routine documentation of clinical care. The method has potential application for surveillance of endemic hospital-acquired infections in a wide range of clinical specialities and could be adapted by others facing similar difficulties in determining priorities for monitoring and controlling endemic hospital-acquired infections within limited resources.