Survey Examines Knowledge Sharing in Infection Prevention in Routine and Outbreak Situations

In this cross-sectional Society for Healthcare Epidemiology of America Research Network survey on knowledge sharing in infection prevention Sommerstein, et al. (2017) identified a rudimentary understanding of how to communicate and share knowledge within healthcare institutions. The researchers say their data support the need of further research in this important field.

The recent outbreak of Ebola virus disease demonstrated that emerging infections may require rapid establishment, adaptation and upscaling of precaution measures. Defining state-of-the-art measures is only the first step; healthcare institutions need to manage knowledge in order to implement measures. This includes recognizing important information, retaining and sharing the information within the organization and assuring that the knowledge is used for appropriate actions. This crucial process is often incomplete and communication strategies related to infection prevention (IP) in hospitals are often ineffective. Evaluating strategies to share knowledge has been overlooked in much of the healthcare epidemiology literature. There are some successful examples of improved inter-facility knowledge translation methods. In one case, an intervention program led to a measurable decrease in infections. This experience across one U.S. state demonstrates that the exchange of guidelines and implementation strategies among healthcare institutions and, particularly, infection preventionists can be fruitful. Correspondingly, the study intended to gather data on current forms of knowledge sharing in IP in hospitals and between different institutions. We evaluated routine and outbreak situations and tried to identify suitable strategies for improvement.

On Feb. 11, 2016, a cross-sectional electronic survey was sent out by the Society for Healthcare Epidemiology of America Research Network to the IP contacts of all 228 participating institutions; this was followed by an email reminder on March 10, 2016. The survey covered different aspects of knowledge sharing: existence and availability of guidelines; means of, experience with, and obstacles towards training of HCW; feedbacks; web-based training; and education of newly employed HCW. For most questions, a routine scenario (example: hand hygiene) was compared to an outbreak scenario (example: recent Ebola outbreak).

The researchers received 69 valid responses from 228 institutions (30%). Of these, 47 (68%) were located in the United States, 6 (9%) in Canada, and 16 (23%) were outside North America. The full results of the survey are available online (Additional file 1). Most institutions generated hospital-specific internal guidelines (96% for routine and 93% for outbreak scenarios). Over 50% of institutions depended on one of four outside sources for preparing their instructions. The main sources were the CDC, SHEA, WHO, and the Association for Professionals in Infection Control and Epidemiology. While 70% of respondents would be willing to share their guidelines with other hospitals for free, only 30% of institutions used internal guidelines from other hospitals. The main forms of educating HCW included on-site training, mass email, website announcements, and web-based training. The approach to educate HCW did not differ between routine and outbreak scenarios. Nearly half of the responders estimated that both on-site training and mass email are the most effective ways to distribute updates. This was followed by web-based training (~35%) and website announcements (~30%). Responders thought that less frequent distribution of website announcements would satisfy the needs of IP (p < 0.001) and HCW (p < 0.001). On the contrary, responders estimated that current use of mass email and on-site training is congruent with the needs of IP and HCW (Fig. 1a). Responders considered “ineffective communication” as the main obstacle in educating HCW. They rated this obstacle as being more relevant from the IP perspective than for the receiving HCW (p < 0.001). In contrast, they thought that “lack of time” was more important as an obstacle for the HCW than for IP (p < 0.001). Lack of interest was another barrier, seen from the HCW’s standpoint, and was estimated to occur more frequently in the routine (33%) compared to outbreak (16%) scenario (p = 0.03). Nearly half of the responders did not test the HCWs knowledge acquisition for assessing the effectiveness of their communication strategy.

Reference: Sommerstein R, Geser S, Atkinson A, Tschan F, Morgan DJ and Marschall J. Knowledge sharing in infection prevention in routine and outbreak situations: a survey of the Society for Healthcare Epidemiology of America Research Network. Antimicrobial Resistance & Infection Control. 20176:79.