Infection Control & Hospital Epidemiology

Original Articles

National Survey of Practices to Prevent Healthcare-Associated Infections in Thailand: The Role of Safely Culture and Collaboratives

Anucha Apisarnthanaraka1 c1, M. Todd Greenea2a3, Edward H. Kennedya3, Thana Khawcharoenporna1, Sarah Kreina2a3a4 and Sanjay Sainta2a3a4

a1 Division of Infectious Diseases, Thammasat University Hospital, Pathumthani, Thailand

a2 University of Michigan Health System, Ann Arbor, Michigan

a3 Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan

a4 Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan


Objective. To evaluate hospital characteristics and practices used by Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP), the 3 most common types of healthcare-associated infection (HAI) in Thailand.

Design. Survey.

Setting. Thai hospitals with an intensive care unit and 250 or more hospital beds

Methods. Between January 1, 2010, and October 31, 2010, research nurses collected data from all eligible hospitals. The survey assessed hospital characteristics and practices to prevent CAUTI, CLABSI, and VAP. Ordinal logistic regression was used to assess relationships between hospital characteristics and use of prevention practices.

Results. A total of 204 (80%) of 256 hospitals responded. Most hospitals (93%) reported regularly using alcohol-based hand rub. The most frequently reported prevention practice by infection was as follows: for CAUTI, condom catheters in men (47%); for CLABSI, avoiding routine central venous catheter changes (85%); and for VAP, semirecumbent positioning (84%). Hospitals with peripherally inserted central catheter insertion teams were more likely to regularly use elements of the CLABSI prevention bundle. Greater safety scores were associated with regular use of several VAP prevention practices. The only hospital characteristic associated with increased use of at least 1 prevention practice for each infection was membership in an HAI collaborative.

Conclusions. While reported adherence to hand hygiene was high, many of the prevention practices for CAUTI, CLABSI, and VAP were used infrequently in Thailand. Policies and interventions emphasizing specific infection prevention practices, establishing a strong institutional safety culture, and participating in collaboratives to prevent HAI may be beneficial.

(Received November 14 2011)

(Accepted February 08 2012)


c1 Division of Infectious Diseases, Thammasat University Hospital, Pathumthani, Thailand 12120 (