What indicators should healthcare managers use to control nosocomial infections?

Background and Objectives: Nosocomial infections (infections acquired from healthcare services) constitute a major challenge for modern healthcare systems. Healthcare managers need complete and valid information to make the appropriate decisions to fight these infections. Unfortunately, this information is often scattered or simply lacking. The purpose of this study was to develop a dashboard of indicators to help local healthcare managers monitor and control a wide range of dimensions related to nosocomial infections. Methods: A general approach of “pilot testing” was used, comprised of the following steps: literature review to draw a list of possible indicators, consultation of experts in microbiology-infectiology to select scientifically valid indicators in this list, consultation of healthcare managers to select useful indicators, operationalization of the indicators, data collection in six Quebec (Canada) hospital complexes to test the feasibility of the selected indicators, analysis of results and final selection of indicators. Results: The literature review identified 299 possible indicators. After consulting the experts in microbiology-infectiology and the healthcare managers, and having collected data in the hospitals, the proposed dashboard includes 97 indicators divided in three categories: structure, process and results. These indicators cover all the important dimensions that should be monitored by healthcare managers to control nosocomial infections. Conclusions: The proposed list of indicators is both scientifically valid and administratively feasible. However, many healthcare settings lack the financial resources and expertise required to collect the data needed to measure the proposed indicators. If the control of nosocomial infections is a priority for health authorities, proper investments are needed.