Documentation of Adherence To Infection Prevention Best Practice in Patient Records – A Mixed-Methods Investigation

Abstract

Background Healthcare-associated infections remain a preventable cause of patient harm in healthcare. Full documentation of adherence to evidence-based best practices for each patient can support monitoring and promotion of infection prevention measures. Thus, we reviewed the extent, nature, and determinants of the documentation of infection prevention (IP) standards in patients with HAI. Methods We reviewed the electronic patient records (EMRs) of patients included in four annual point-prevalence studies 2013-2016 who developed a device- or procedure-related HAI (catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated infection (VAP), surgical site infection (SSI)). We examined the documentation quality of mandatory preventive measures published as institutional IP standards. Additionally, we undertook semi-structured interviews with healthcare providers and a two-step inductive (grounded theory) and deductive (Theory of Planned Behaviour) content analysis. Results Of overall 2972 surveyed patients, 249 patients developed 272 healthcare-associated infections (8.4%). Of these, 116 patients met the inclusion criteria, classified as patients with CAUTI, CLABSI, VAP, SSI in 21 (18%), 7 (6%), 10 (9%), 78 (67%) cases, respectively. We found a documentation of the IP measures in electronic medical records (EMR) in 432/1308 (33%) cases. Documentation of execution existed in the study patients’ EMR for CAUTI, CLABSI, VAP, SSI, and overall, in 27/104 (26%), 26/151 (17%), 46/122 (38%), 261/931 (28%), and 360/1308 (28%) cases, respectively, and documentation of non-execution in 2/104 (2%), 3/151 (2%), 0/122 (0%), 67/931 (7%), and 72/1308 (6%) cases, respectively. Healthcare provider attitude, subjective norm, and perceived behavioural control indicated reluctance to document IP standards. Conclusions EMRs rarely included conclusive data about IP standards adherence. Documentation had to be established indirectly through data captured for other reasons. It can be projected that a mandatory institutional documentation protocol and technically automated documentation would be necessary to alleviate this shortcoming in patient safety documentation.