Model of Healthcare-Associated Infection Control in Primary Health Care Institutions: A Structural Equation Modeling

Abstract

The purpose of this study was to construct the model of organization system, management, training and surveillance in healthcare-associated infection prevention and control (IC) of primary health care institutions and identify its effect on patient safety and decreasing economic burden by standardizing IC. A cross-sectional survey was conducted with questionnaires. Data were collected from 268 primary health care institutions in Hubei province, China. Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling. The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels: root mean square error of approximation (RMSEA)=0.071; comparative fit index (CFI)=0.965; tucker–lewis index (TLI)=0.956; weighted root mean square residual (WRMR)=1.014. The model showed that organization system had a direct effect on management (β=0.311, P<0.01), and training (β=0.365, P<0.01). Management and training played an intermediary role that partially promoted organization system impact on surveillance. Results also showed that institutional factors such as the number of physicians, the number of nurses, the designated capacity of beds, the actual number of open beds and surgery trips had positive impacts on management (β=0.050, P<0.01; β=0.181, P<0.01; β=0.111, P<0.01; β=0.064, P<0.01; β=0.084, P=0.04) and training (β=0.21, P=0.03; β=0.050, P=0.02; β=0.586, P=0.01; β=–0.995, P=0.02; β=–0.223, P=0.03). In conclusion, the model of organization system, management, training and surveillance in IC of primary health care institutions is valuable for guiding IC practice.

References

[1] ZhangLThe Chinese State’s Retreat from Health: Policy and the Politics of Retrenchment, 2012

[2] HuS, TangS, LiuY, et al.. Reform of how health care is paid for in China: challenges and opportunities. Lancet, 2008, 372(9652): 1846

[3] TangS, MengQ, ChenL, et al.. Tackling the challenges to health equity in China. Lancet, 2008, 372(9648): 1493-1501

[4] ZhangD, UnschuldPU. China’s barefoot doctor: past, present, and future. Lancet, 2008, 372(9653): 1865

[5] LiX, LuJ, HuS, et al.. The primary health–care system in China. Lancet, 2017, 390(10112): 2584-2594

[6] HarriesAD, ZachariahR, TaylersmithK, et al.. Keeping health facilities safe: one way of strengthening the interaction between disease–specific programmes and health systems. Trop Med Int Health, 2010, 15(12): 1407-1412

[7] PittetD, AllegranziB, StorrJ, et al.. The Global Patient Safety Challenge 2005–2006: Clean Care is Safer Care. Int J Infect Dis, 2006, 10(6): 419-424

[8] ZaidiAK, HuskinsWC, ThaverD, et al.. Hospitalacquired neonatal infections in developing countries. Lancet, 2005, 365(9465): 1175-1188

[9] ZinggW, HolmesA, DettenkoferM, et al.. Hospital organisation, management, and structure for prevention of health–care–associated infection: a systematic review and expert consensus. Lancet Infect Dis, 2015, 15(2): 212-224

[10] HansenS, ZinggW, AhmadR, et al.. Organizing of infection control in European hospitals. J Hosp Infect, 2015, 91(4): 338-345

[11] National Health and Family Planning Commission. Regulation of Healthcare–Associated Infection Management (Chinese). 2006.

[12] Rodríguez–BañoJ, del ToroMD, López–MéndezJ, et al.. Minimum requirements in infection control. Clin Microbiol Infect, 2015, 21(12): 1072-1076

[13] YilmazG, AydinH, AydinM, et al.. Staff education aimed at reducing ventilator–associated pneumonia. J Med Microbiol, 20161378-1384

[14] MeneguetiMG, CaniniSR, Bellissimo–RodriguesF, et al.. Evaluation of nosocomial infection control programs in health services. Rev Lat Am Enfermagem, 2015, 23(1): 98-105

[15] AllegranziB, NejadSB, CombescureC, et al.. Burden of endemic health–care–associated infection in developing countries: systematic review and meta–analysis. Lancet, 2011, 377(9761): 228-241

[16] ChengVC, TaiJW, WongLM, et al.. Effect of proactive infection control measures on benchmarked rate of hospital outbreaks: An analysis of public hospitals in Hong Kong over 5 years. Am J Infect Control, 2015, 43(9): 965-970

[17] BeauducelA, HerzbergPY. On the Performance of Maximum Likelihood Versus Means and Variance Adjusted Weighted Least Squares Estimation in CFA. Struct Equ Modeling, 2006, 13(2): 186-203

[18] SchreiberJB, StageFK, KingJ, et al.. Reporting Structural Equation Modeling and Confirmatory Factor Analysis Results: A Review. J Educ Res, 2006, 99(6): 323-338

[19] HooperD, CoughlanJ, MullenMR. Structural equation modelling: Guidelines for determining model fit. Electronic J Business Res Methods, 2008, 6(1): 141-146

[20] BarrettP. Structural equation modelling: Adjudging model fit. Pers Individ Differences, 2007, 42(5): 815-824

[21] MamishiS, PourakbariB, TeymuriM, et al.. Management of hospital infection control in Iran: a need for implementation of multidisciplinary approach. Osong Public Health Res Perspect, 2014, 5(4): 179-186

[22] BedoyaG, DolingerA, RogoK, et al.. Observations of infection prevention and control practices in primary health care, Kenya. Bull World Health Organ, 2017

[23] BrusaferroS, ArnoldoL, CattaniG, et al.. Harmonizing and supporting infection control training in Europe. J Hosp Infect, 2015, 89(4): 351-356

[24] YeLP, ZhangXP, LaiXQ. Does Hospital Ownership Influence Hand Hygiene Compliance. J Huazhong Univ Sci Technolog Med Sci, 2017, 37(5): 787-794

[25] FlanaganE, ChopraT, ModyL. Infection control in alternative healthcare settings. Infect Dis Clin North, 2016, 30(3): 785-804

[26] BranniganE, MurrayE, HolmesA. Where does infection control fit into a hospital management structure. J Hosp Infect, 2009, 73(4): 392-396

[27] PadovezeM F C, KifferC, et al.. Structure for prevention of health care–associated infections in Brazilian hospitals: A countrywide study. Am J Infect Control, 2016, 44(1): 74-79

[28] ColindresCV, BryceE, Coral–RoseroP, et al.. Effect of effort–reward imbalance and burnout on infection control among Ecuadorian nurses. Int Nurs Rev, 2018, 2: 190-199

[29] CheemaAA, ScottAM, ShambaughKJ, et al.. Rebound in ventilator–associated pneumonia rates during a prevention checklist washout period. BMJ Qual Saf, 2011, 20(9): 811-817

[30] PrattM, KerrM, WongC. The impact of ERI, burnout, and caring for SARS patients on hospital nurses’ self-reported compliance with infection control. Can J Infect Control, 2009, 24(3): 167-172

[31] MurphyDM. Staffing and structure of infection prevention and control programs. Am J Infect Control, 2009, 37(5): 349-350

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