Infection Control:

VA Programs Are Comparable to Nonfederal Programs but Can Be Enhanced

HRD-90-27: Published: Jan 31, 1990. Publicly Released: Jan 31, 1990.

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Pursuant to a congressional request, GAO reviewed Department of Veterans Affairs (VA) hospitals' infection control programs, focusing on: (1) whether VA used infection control data to prevent future infections; (2) whether VA infection control programs were adequately staffed and organized; and (3) VA infection control programs' effectiveness compared to nonfederal hospital programs.

GAO found that: (1) VA had not updated its infection control guidance since 1979; (2) VA guidelines clearly required only 16 of 56 basic elements considered essential to infection control programs; (3) infection control practitioners in 5 of 7 VA medical centers that GAO studied took personal initiatives that exceeded VA guidance, thereby incorporating most of the 56 basic elements; (4) practitioners incorporated 12 elements less frequently than the remaining 44 elements, because the VA guidelines did not adequately address those elements; (5) VA hospitals generally incorporated 44 GAO program elements, while nonfederal hospitals generally incorporated 42; (6) VA and nonfederal hospitals' specific practices were similar; (7) as VA guidelines required only one infection control practitioner for every 200 to 250 beds, 55 percent of VA programs were understaffed in 1987; and (8) VA regional offices inadequately monitored infection control programs in four of seven medical centers reviewed, primarily because the regional offices lacked guidance from a central, coordinating office, did not share infection control data, and did not include knowledgeable personnel in their inspection teams.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The VA Chief Medical Director stated that VA infection control guidance has been revised and updated. VA published VHA directive 10-92-033 to accomplish this revision and update.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director, VA, to update VA infection control guidance. At a minimum, the guidance should require components similar to those in the basic GAO infection control program elements.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: According to internal VA correspondence from the Chief Medical Director dated March 14, 1990, the Director of Medical Service has been designated as the VA Central Office focus for the infection control program. The Director will be assisted in this responsibility by the Infectious Disease Field Advisory Group.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director, VA, to designate a single unit in the VA central office to oversee its infection control programs, including: (1) coordinating the central office's policies and procedures; and (2) implementing a mechanism for sharing information among practitioners.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: VA has established a mechanism for each medical center to report on infection control activities, infection rates, staffing equipment, and other needs. This will allow Central Office officials and regional directors to monitor the program and provide the resources needed.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director, VA, to incorporate procedures in regional office survey requirements to ensure that each medical center's infection control program is adequately reviewed.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: VA has established a mechanism for each medical center to report on infection control activities, infection rates, staffing equipment, and other needs. This will allow Central Office officials and regional directors to monitor the program and provide the resources needed.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director, VA, to require center directors to reexamine the level of managerial support and resources given to their infection control programs and to provide additional support where appropriate.

    Agency Affected: Department of Veterans Affairs

 

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