Study: Rural hospitals need to put more resources into infection control

Nebraska is both a largely rural and geographically long state.

Omaha, one of its largest cities, could be as much as a seven-hour drive from towns on its westernmost border. That made it hard for health officials on the far side of the state to make it out for periodic state chapter meetings of Association for Professionals in Infection Control and Epidemiology (APIC) hosted in that city on the east side of the state.

And that was what struck Margaret Drake, a healthcare-associated infection preventionist for the Nebraska Department of Health and Human Services.

Performing on-site inspections of 36 health facilities in rural areas of Nebraska, she and a group of researchers found that those facilities known as Critical Access Hospitals faced special challenges when it came to infection control practices. She is the lead author of an abstract presented Wednesday on the topic at the annual national APIC meeting.

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"They are rural, they are isolated and they don't have all the resources more urban hospitals have," Drake said. "And because they are small, they often think: 'We don't do as many Foley catheters or central line catheters so we don't have to focus as much on that or audit that.'" 

In fact, research shows lower volume hospitals would likely need more training than hospitals that have larger volumes and more practice performing those procedures. The study found that the largest gaps were in the areas of injection safety, central line-associated bloodstream infection prevention and catheter-associated urinary tract infection prevention. 

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Examinations of the hospitals found that many of the employees put in charge of overseeing infection control may not have received certain types of training, for example, in understanding how to identify the biggest infection risks in a hospital by conducting a risk assessment. They might be splitting their time between infection control, quality control and serving as a full-time, functioning bedside nurse due to resource challenges.

"We need people to get behind the fact that you need to devote the time to infection control, you need to have an infection control preventionist focused on this," Drake said.

The study, which was funded by the CDC, was entirely voluntary and meant to raise awareness and offer recommendations rather than castigate anyone, Drake said: "The hospitals were very open to this."