Can quality circles improve hospital-acquired infection control?

It is a fundamental principle of continuous quality improvement (CQI) that processes should be the objects of quality improvement. The objective of th is study; was to improve process quality concerning the prevention of hospi tal-acquired infections in surgical departments and intensive care units by a continuous quality improvement (CQI) approach based mainly on quality ci rcles. This approach was evaluated in a prospective controlled intervention study in medium-size acute care hospitals (four intervention and four cont rol hospitals). During two intervention periods (each 10 months) four exter nal physicians with training in hospital epidemiology and infection control introduced and supervised quality circles in the intervention hospitals. P rocess quality was assessed by interviewing senior staff members before the first and after the second intervention period using standardized question naires. The gold standard process quality was defined on the basis of the C DC/HICPAC-guidelines for the prevention of hospital-acquired infections. Mo st of the evaluated aspects of process quality belonged to the HICPAC-categ ories IA and IB respectively; the CDC category I. Fifty quality circle sessions were performed in the four intervention hospi tals of which 28 were dealing directly with key subjects in infection contr ol. In the intervention hospitals, 19.8% of evaluated aspects of process qu ality which concerned the prevention of hospital-acquired infections were i mproved compared to only 6.9% in the control hospitals (P<0.05). Sixty-six point seven percent of positive changes in process quality were initiated b y the results of the quality circles. Our study demonstrates that a CQI approach based on infection control quali ty circles can lead to a substantial improvement of process quality regardi ng the prevention of hospital-acquired infections. (C) 2000 The Hospital in fection Society.