Skip to main content Accessibility help

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

  • Anucha Apisarnthanarak (a1), M. Todd Greene (a2) (a3), Edward H. Kennedy (a3), Thana Khawcharoenporn (a1), Sarah Krein (a2) (a3) (a4) and Sanjay Saint (a2) (a3) (a4)...



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.




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


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.


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.


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.


Corresponding author

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


Hide All
1. Christenson, M, Hitt, JA, Abbott, G, Septimus, EJ, Iversen, N. Improving patient safety: resource availability and application for reducing the incidence of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27:245251.
2. Rosenthal, VD, Maki, DG, Salomao, R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145:582591.
3. Macias, AE, Bruckner, DA, Hindier, JA, et al. Parenteral infusions as culture media from a viewpoint of nosocomial bacteremia. Rev Invest Clin 2000;52:3943.
4. Mayon-White, RT, Ducei, G, Kereselidze, T, Tikomirov, E. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect 1988;11(suppl A):4348.
5. Ponce-de-Leon, S. The needs of developing countries and the resources required. J Hosp Infect 1991;18(suppl A):376381.
6. Rezende, EM, Couto, BR, Starling, CE, Modena, CM. Prevalence of nosocomial infections in general hospitals in Belo Horizonte. Infect Control Hosp Epidemiol 1998;19:872876.
7. Western, KA, St John, RK, Shearer, LA. Hospital infection control—an international perspective. Infect Control 1982;3:453455.
8. Pittet, D, Allegranzi, B, Storr, J, Donaldson, L. “Clean Care Is Safer Care”: the Global Patient Safety Challenge 2005-2006. Int J Infect Dis 2006;10:419424.
9. Yokoe, DS, Mermel, LA, Anderson, DJ, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemm 2008;29(suppl 1):S12S21.
10. Krein, SL, Hofer, TP, Kowalski, CP, et al. Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc 2007;82:672678.
11. Krein, SL, Kowalski, CP, Damschroder, L, Forman, J, Kaufman, SR, Saint, S. Preventing ventilator-associated pneumonia in the United States: a multicenter mixed-methods study. Infect Control Hosp Epidemiol 2008;29:933940.
12. Saint, S, Kowalski, CP, Kaufman, SR, et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis 2008;46:243250.
13. McCullagh, P. Regression models for ordinal data. J R Stat Soc Series B 1980;2:109142.
14. Radane, J, Lazar, N. Methods and criteria for model selection. J Am Stat Assoc 2004;99:279290.
15. Apisarnthanarak, A, Thongphubeth, K, Yuekyen, C, Warren, DK, Fraser, VJ. Effectiveness of a catheter-associated bloodstream infection bundle in a Thai tertiary care center: a 3-year study. Am J Infect Control 2010;38:449455.
16. Korbkitjaroen, M, Vaithayapichet, S, Kachintorn, K, Jintanothai-tavorn, D, Wiruchkul, N, Thamlikitkul, V. Effectiveness of comprehensive implementation of individualized bundling infection control measures for prevention of health care-associated infections in general medical wards. Am J Infect Control 2011;39: 471476.
17. Apisarnthanarak, A, Suwannakin, A, Maungboon, P, Warren, DK, Fraser, VJ. Long-term outcome of an intervention to remove unnecessary urinary catheters, with and without a quality improvement team, in a Thai tertiary care center. Infect Control Hosp Epidemiol 2008;29:10941095.
18. Apisarnthanarak, A, Thongphubeth, K, Sirinvaravong, S, et al. Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp Epidemiol 2007;28:791798.
19. Meddings, J, Rogers, MA, Macy, M, Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51:550560.
20. Rosenthal, VD. Central line-associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 2009;49:18991907.
21. Royer, T. Implementing a better bundle to achieve and sustain a zero central line-associated bloodstream infection rate. J Infus Nurs 2010;33:398406.
22. Unahalekhaka, A, Jamulitrat, S, Chongsuvivatwong, V, Ovretveit, J. Using a collaborative to reduce ventilator-associated pneumonia in Thailand. Jt Comm J Qual Patient Sa 2007;33:387394.
23. Danchaivijitr, S, Supchutikul, A, Waitayapiches, S, Kachintorn, K. Quality of nosocomial infection control in Thailand. J Med Assoc Thai 2005;88(suppl 10):S145S149.
24. Krein, SL, Damschroder, LJ, Kowalski, CP, Forman, J, Hofer, TP, Saint, S. The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study. Soc Sei Med 2010;71:16921701.

Related content

Powered by UNSILO

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

  • Anucha Apisarnthanarak (a1), M. Todd Greene (a2) (a3), Edward H. Kennedy (a3), Thana Khawcharoenporn (a1), Sarah Krein (a2) (a3) (a4) and Sanjay Saint (a2) (a3) (a4)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.