Infection prevention practices in Swedish emergency departments: results from a cross-sectional survey

Healthcare-associated infections (HAIs) are a leading cause of preventable morbidity and mortality. Emergency departments (EDs) are a potential source of HAIs as they are the site for large volumes of patients in tight quarters and often focus on immediate life threats over prevention. We aimed to estimate the extent to which Swedish EDs have adopted evidence-based measures to prevent HAIs. The second aim was to identify predictors of high hand hygiene compliance.

We developed a survey on the basis of an instrument used in a US survey in 2011. We modified the survey to reflect Swedish ED practice, and emailed it to ED directors between February and April 2012. We calculated proportions, odds ratios, and 95% confidence intervals, and used logistic regression to adjust for independent variables.

We received responses from 59 of Sweden's 72 EDs (82%). Thirty-nine percent of EDs participate in a project to improve hand hygiene compliance. Staff hand hygiene compliance rates were audited at least monthly in 45% of EDs. Forty-three percent reported a compliance rate of 80% or more. The only independent predictor of greater than 80% hand hygiene compliance was auditing compliance frequently - at least monthly (odds ratio 6.3, 95% confidence interval 1.7-24, P=0.01). A majority of Swedish EDs (58%) have a written policy for the appropriate use of urinary catheters. Twenty-one percent participate in a project to reduce catheter-associated urinary tract infections.

A minority of Swedish EDs are participating in projects to address hand hygiene and catheter-associated urinary tract infection. Frequent auditing of hand hygiene compliance may improve compliance rates.