Gaming in infection control: A qualitative study exploring the perceptions and experiences of health professionals in Mongolia

Ider, Bat-Erdene; Adams, Jon; Morton, Anthony; Whitby, Michael; Clements, Archie

doi:10.1016/j.ajic.2010.10.033

Cited by 8 publications

(9 citation statements)

References 24 publications

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“…The current official infection control statistics of Mongolia, which show the annual prevalence of HCAI being 0.01–0.05%, is the only available report for health professionals of Mongolia [18]. Our recent studies showed that these MoH statistics were a drastic under-estimate of true burden of HCAIs in Mongolian hospitals, masking infection control problems from decision makers [15,19]. Yet, other statistics on hand-hygiene compliance, occupational exposure and infection levels, antibiotic usage and resistance, and financial burden of HCAIs are not available for decision makers.…”

Section: Discussionmentioning

confidence: 99%

“…The traditional approach of policy makers to infection control, which is characterised by the excessive penalization of reported HCAI cases, led to various types of gaming including excessive antibiotic prophylaxis [15]. …”

Section: Discussionmentioning

confidence: 99%

“…cross-referenced) between participant groups. The issues of gaming (fraudulent reporting, manipulation of data and excessive use of antibiotics to hide HCAIs) in infection control data was analysed separately and reported previously [15]. …”

Section: Methodsmentioning

confidence: 99%

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Perceptions of healthcare professionals regarding the main challenges and barriers to effective hospital infection control in Mongolia: a qualitative study

et al. 2012

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BackgroundIt is not fully understood why healthcare decision-makers of developing countries often give low priority to infection control and why they are unable to implement international guidelines. This study aimed to identify the main perceived challenges and barriers that hinder the effective implementation of infection control programmes in Mongolia.MethodsIn 2008, qualitative research involving 4 group and 55 individual interviews was conducted in the capital city of Mongolia and two provincial centres.ResultsA total of 87 health professionals participated in the study, including policy and hospital-level managers, doctors, nurses and infection control practitioners. Thematic analysis revealed a large number of perceived challenges and barriers to the formulation and implementation of infection control policy. These challenges and barriers were complex in nature and related to poor funding, suboptimal knowledge and attitudes, and inadequate management. The study results suggest that the availability of infection control policy and guidelines, and the provision of specific recommendations for low-resource settings, do not assure effective implementation of infection control programmes.ConclusionsThe current infection control system in Mongolia is likely to remain ineffective unless the underlying barriers and challenges are adequately addressed. Multifaceted interventions with logistical, educational and management components that are specific to local circumstances need to be designed and implemented in Mongolia. The importance of international peer support is highlighted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Perceptions of healthcare professionals regarding the main challenges and barriers to effective hospital infection control in Mongolia: a qualitative study

et al. 2012

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“…9 While competition can provide a strong stimulus for improvement, there is an inherent risk of gaming in quality indicators that are displayed externally or publicly reported. 10,11 However, benchmarking or public reporting are not the primary purpose of this tool. Moreover, the feedback received from usability testing indicated that hospitals falling into the inadequate category were just as likely to agree with the assessment as those with a higher level.…”

Section: Discussionmentioning

confidence: 99%

Testing the WHO Hand Hygiene Self-Assessment Framework for usability and reliability

Stewardson¹,

Allegranzi²,

Perneger³

et al. 2013

Journal of Hospital Infection

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“…In an environment with comparative metrics, such as pay for performance, questionable practices emerge to improve infection prevention outcomes. Broadly, healthcare providers can conceal HAIs via a number of strategies and infection prevention personnel can also fail to report HAI cases [24]. A summary of practical interventions to game the system and get to zero was published by Horowitz [25••].…”

Section: The Diagnostic System Can Be Gamed: Infection Prevention Outcomes Are Misleadingmentioning

confidence: 99%

Hospital Infection Prevention: How Much Can We Prevent and How Hard Should We Try?

Bearman¹,

Doll²,

Cooper³

et al. 2019

Curr Infect Dis Rep

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Purpose of Review To summarize the extent to which hospital-acquired infections (HAIs) are preventable and to assess expectations, challenges, and barriers to improve patient outcomes. Recent Findings HAIs cause significant morbidity and mortality. Getting to zero HAIs is a commonly stated goal yet leads to unrealistic expectations. The extent to which all HAIs can be prevented remains debatable and is subject to multiple considerations and barriers. Current infection prevention science is inexact and evolving. Evidence-based infection prevention practices are often incompletely implemented and at times controversial. Highly sensitive surveillance results in overdiagnosis, calling into question the real incidence of HAIs. Perceived reductions in HAIs by gaming the system lead to false conclusions about preventability and may cause harm. Successful HAI reduction programs require executive oversight yet keeping hospital leaders engaged in infection prevention is a challenge given competing priorities. Medicine is not a physical science with precisely defined laws; thus, infection prevention interventions are subject to variable outcomes. Summary Perhaps up to 55-70% of HAIs are potentially preventable. This is subject to a law of diminishing returns as the preventable proportion of HAIs may reduce over time with improvements in patient safety. As the principle tenet of medicine is first do no harm, infection prevention programs should relentlessly pursue reliable, sustainable, and practical strategies for heightened patient safety.

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Gaming in infection control: A qualitative study exploring the perceptions and experiences of health professionals in Mongolia

Cited by 8 publications

References 24 publications

Perceptions of healthcare professionals regarding the main challenges and barriers to effective hospital infection control in Mongolia: a qualitative study

Perceptions of healthcare professionals regarding the main challenges and barriers to effective hospital infection control in Mongolia: a qualitative study

Testing the WHO Hand Hygiene Self-Assessment Framework for usability and reliability

Hospital Infection Prevention: How Much Can We Prevent and How Hard Should We Try?

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