Infection Prevention Is Widely Practiced Across Veterans Affairs Hospitals

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Veterans Affairs hospitals adopted more infection prevention practices than non-VA hospitals.

Veterans Affairs (VA) hospitals adopted more infection prevention practices than non-VA hospitals between 2005 and 2017, according to study results published in JAMA Network Open.

Healthcare-associated infection (HAI) causes substantial harm, but is often preventable. As the largest integrated healthcare system in the United States, the Department of VA was an early adopter of HAI prevention policies and directives; however, it is unknown whether VA hospitals are continuing to these policies and use evidence-based practices surrounding HAI. The objective of this study was to evaluate changes over time in HAI prevention practices at VA facilities and the perception of the importance of HAI prevention among VA hospital leadership.

Therefore, researchers surveyed infection preventionists at every VA hospital across the United States every 4 years between 2005 and 2017 on practices they used to prevent common HAIs, such as catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). Participants were asked to indicate the frequency of their employment of various HAI prevention practices using a scale from 1 to 5, as well as the frequency they used antibiotic stewardship, if such programs were used at the facility. Participants were also asked about their perception regarding the level that hospital leadership regarded the importance of HAI prevention, using a scale of 1 to 4. A total of 320 surveys were completed between 2005 and 2017.

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Results revealed that the use of 12 different HAI prevention practices increased across VA hospitals. After 2013, between 92% (69 of 75) and 100% of VA hospitals reported using key HAI prevention practices for CLABSI and Clostridioides difficile infection. Though the rate of most HAI prevention practices for CAUTI increased over time, a lower percentage of hospitals reported regularly using these practices compared with other HAI prevention practices. 

In regards to CAUTI, there was an increase in the reported regular use of alternatives to urinary catheters, such as portable bladder ultrasonography for evaluation of postvoid residual (50% in 2005 vs 88% in 2017; P < .001 for trend) and condom catheters in men (46% in 2005 vs 64% in 2017, P = .02).

Measures to diminish the risk for HAI CLABSI also increased. Reports indicated that maximal sterile barrier precautions during insertion increased from 84% in 2005 to 97% in 2017 (P < .001) and antimicrobial dressing with chlorhexidine prior to line insertion also increased from 29% in 2005 to 96% in 2017 (P < .001).

In regards to VAP, the use of 5 prevention practices increased over time, including use of semi-recumbent positioning (89% in 2005 vs 97% in 2017; P =.007) and antimicrobial mouth rinse (33% in 2005 vs 92% in 2017; P <.001). No significant increases occurred with respect to use of early mobilization (81% in 2013 vs 82% in 2017; P =.88) and daily interruptions of sedation (85% in 2009 vs 87% in 2017; P =.66).

By 2017, 97% of VA hospitals reported having an antibiotic stewardship program, and 85% to 88% of infection preventionists perceived that hospital leaders considered HAI prevention of CAUTI, CLABSI, VAP, and C difficile infection of high importance.

Limitations to the results of the study included varied response rates across the years and the inclusion of only VA hospitals in the analysis. Not all survey questions were asked in all years, which may have led to some missed changes in HAI prevention over time. Further, the use of HAI prevention was self-reported and may not have reflected actual practices within hospitals.

The researchers concluded that among VA hospitals, areas for continued improvement of HAI prevention practices include those for CAUTI, some VAP practices, and diagnostic stewardship, and that the reported adoption of HAI prevention practices in VA hospitals is higher than that observed in non-VA hospitals.


Vaughn VM, Saint S, Greene MT, et al. Trends in health care-associated infection prevention practices in US Veterans Affairs hospitals from 2005 to 2017 [published online February 5, 2020]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2019.20464