Wide dissemination of this Guideline was not sufficient to change practice. Only some hospitals had initiated multidisciplinary programs; practice change is unlikely without such multidisciplinary efforts and explicit administrative support.
The majority of staff members were familiar with the Centers for Disease Control and Prevention Hand Hygiene Guideline. Staff attitudes toward practice guidelines varied by type of ICU and by profession, and more positive attitudes were associated with significantly better self-reported guideline implementation. Because differences in staff attitudes might hinder or facilitate their acceptance and adoption of evidence-based practice guidelines, these results may have important implications for the education and/or socialization of ICU staff.
• Background Antibiotic misuse and noncompliance with infection control precautions have contributed to increasing levels of antimicrobial resistance in hospitals.
• Objectives To assess the extent to which resistance is monitored in infection control programs and to correlate resistance rates with characteristics of antimicrobial control policies, provider attitudes and practices, and systems-level indicators of implementation of the hand hygiene guideline of the Centers for Disease Control and Prevention.
• MethodsAn on-site survey of intensive care unit staff and infection control directors of 33 hospitals in the United States was conducted. The following data were collected: antimicrobial control policies; rates during the previous 12 months of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and ceftazidime-resistant Klebsiella pneumoniae; an implementation score of systems-level efforts to implement the guideline; staff attitudes toward practice guidelines; and observations of staff hand hygiene. Variables associated with resistance rates were examined for independent effects by using logistic regression.
• ResultsResistance rates for S aureus, enterococci, and K pneumoniae were 52.5%, 18.2%, and 16.0%, respectively. Ten (30.3%) hospitals had an antibiotic control policy. No statistically significant correlation was observed between staff attitudes toward practice guidelines, observed hand hygiene behavior, or having an antibiotic use policy and resistance rates. In logistic regression analysis, higher scores on measures of systems-level efforts to implement the guideline were associated with lower rates of resistant S aureus and enterococci (P=.046).
• Conclusions Organizational-level factors independent of the practices of individual clinicians may be associated with rates of antimicrobial resistance.
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