Background.The incidence of healthcare-associated infections (HAIs) in the public health sector in South Africa is not known due\nto the lack of a surveillance system. We report on the challenges experienced in the implementation of a surveillance system for\nHAIs in intensive care units (ICUs). Methods. A passive, paper-based surveillance system was piloted in eight ICUs to measure the\nincidence of ventilator-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bloodstream\ninfection. Extensive consultation with the ICU clinical and nursing managers informed the development of the surveillance system.\nThe Plan-Do-Study-Act method was utilized to guide the implementation of the surveillance. Results.The intended outputs of the\nsurveillance system were not fully realized due to incomplete data. The organizational culture did not promote the collection of\nsurveillance data.Nurses felt that the surveillance formadded to their workload, and the infection control practitioners were unable\nto adequately supervise the process due to competing work demands. Conclusions. A manual system that adds to the administrative\nworkload of nurses is not an effective method of measuring the burden of HAIs. Change management is required to promote an\norganizational culture that supports accurate data collection for HAIs.
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