Purpose The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety. Design/methodology/approach An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives. Findings The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses' active involvement and medical staff engagement in QI with improved patient care and physicians' active involvement and medical staff engagement with greater patient safety. Practical implications There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI. Originality/value QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

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Important challenges were identified in pandemic planning: one quarter of hospitals did not have a plan, few plans were tested, key players were not involved, plans were frequently incomplete, funding was inadequate, and small and rural hospitals were especially disadvantaged. If these problems are not addressed, the result may be increased morbidity and mortality when a virulent influenza pandemic hits.

Canadian infection control programs in 2005 continued to fall short of expert recommendations for human resources and surveillance and control activities. Meanwhile, nosocomial MRSA rates more than doubled between 1999 and 2005, and hospitals reporting new nosocomial VRE cases increased 77% over the same period. Although investments have been made toward infection control programs in Canadian acute care hospitals, the rapid rise in ICP positions has not yet translated into marked improvements in surveillance and control activities. In the face of substantial increases in ARO rates in Canada, continued efforts to train ICPs and support hospital infection control programs are necessary.

Surveillance and control activities were associated with MRSA and CDAD rates and the presence of VRE. Surveillance and control activities might be especially beneficial in large and teaching hospitals.

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Identifying factors associated with the ubiquitous inappropriate prescribing of antibiotics for upper respiratory tract infections (URTIs) will help develop effective interventions and decrease antimicrobial resistance. Surveys were mailed to family physicians in Ontario, Canada. The survey assessed antibiotic prescribing for URTIs and a wide range of influences on antibiotic decisions. Multivariate models of inappropriate prescribing were generated. 316 of 544 (58%) family physicians completed surveys. Associated with self-reported antibiotic prescribing for acute bronchitis were patients with obligations (OR 2.1; 95% CI, 1.2-3.6), physicians with positive antibiotic use attitudes (OR 2.1; 95% CI, 1.1-3.9), satisfaction antibiotics best for patients (OR 1.5; 95% CI, 1.1-2.1), and knowledgeable patients (OR 0.5; 95% CI, 03-0.8). Associated with antibiotic prescribing for influenza were patients with obligations (OR 2.2; 95% CI, 1.2-3.8), patients thought to be seeking antibiotics (OR 1.4; 95% CI, 1.1-1.9), and attending university and profession sponsored courses (OR 0.7; 95% CI, 0.4-1.0). Associated with not prescribing first line antibiotics for acute sinusitis were pharmaceutical industry influence (OR 2.0; 95% CI, 1.1-3.3), solo practice (OR 2.0; 95% CI, 1.1-5.0), and recommending rest and simple analgesics (OR 0.5; 95% CI, 0.3-0.8). Associated with not prescribing first line antibiotics for streptococcal pharyngitis were pharmaceutical industry influence (OR 1.7; 95% CI, 1.3-2.5), physician age (OR 1.6; 95% CI, 1.3-2.1), and perceived importance of clinical guidelines (OR 0.6; 95% CI, 0.4-0.8). Health care workers should be informed of the influence of perceived patient motivation and the pharmaceutical industry on antibiotic use for URTIs and these insights included in interventions targeting inappropriate antibiotic prescribing.