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Guidelines for infection control strategic management ...

  1. 1. Acute Health, Quality and Care Continuity Branch Guidelines for Infection Control Strategic Management Planning June 2000 Department of Human Services
  2. 2. 1. Introduction Infection control is the responsibility of management and all health care workers and is an integral part of the day-to-day quality and safety operations of any hospital. It is the responsibility of all Metropolitan Health Services and hospitals to ensure the development of infection control programs and infrastructure appropriate for the effective prevention, monitoring and control of infection within their facility. • The purpose of the Guidelines • The Governments 5 point Infection Control Strategy Plan • Key priority areas for the 3 year Infection Control Strategic Management Plans • An outline of the planning process These Guidelines make reference to “hospitals” as a general term. The term ‘hospital’ refers to regional, rural and denominational hospitals and as of 1 July 2000, all Metropolitan Health Services. 1.1 The purpose of the Guidelines These Guidelines are designed to provide assistance and support for the development of infection control strategic management plans to implement the Government’s infection control strategic framework. They outline five key areas to be addressed by hospitals (acute and sub-acute care) in the planning and enhancement of infection control. The Guidelines provide a step by step approach, including developing strategic directions, setting priorities, and writing up a Strategic Management Plan. The Guidelines have been structured to take you through the planning process, and also provide some planning tools and suggested resources that you may find helpful. 1.2 Government strategy for infection control in Victoria Infection control is a priority issue for the government and recent publicity given to infection control has highlighted its importance. The government has committed $33 million funding over the next 4 years to provide a more co-ordinated approach to infection control and employ an additional 30 infection control practitioners. The Department is working on a number of initiatives to implement the Government’s policy. The importance of using the 30 practitioners to best effect, the implementation of a system for surveillance of hospital acquired infections, and improved staff infection control are key components of this strategy. In April, 2000 a comprehensive plan to improve infection control in hospitals was tabled in Parliament by the Minister for Health. The range of infection control measures include the requirement of all hospital Metropolitan Health Services and hospitals to develop strategic plans for infection control (see appendix 1). To assist with allocation of the additional 30 infection control practitioners, the Department requires all hospitals to complete the Infection Control Profile proforma and provide the requested information to the Department by 29 June. In light of these initiatives, to assist with allocation of funding over the next three years, the Department requires all hospitals to report on implementation and expenditure of existing Infection Control Plans, review the effectiveness of existing plans, and identify and outline future objectives and priorities for effective infection control and prevention, and to improve its strategic management to the Department by 16 August, 2000. Page 2
  3. 3. 1.2.1 Collaborative Planning and Service Delivery Hospitals are encouraged to develop their infection control services through collaborative planning and the establishment of strategic links between service providers. Funding is being provided to: • Develop a strategic infection control management plan that covers the whole Metropolitan Health Service, region or consortium of hospitals ( further information on a consortia approach is described in appendix 7). Plans should include details of budget allocations. • Identify a senior member of management who will act as the executive sponsor for infection control, to lead the development of infection control services and to foster management commitment and support to infection control. • Work toward the achievement of specific key outcomes within negotiated time frames. Section 1.4 of this document provides details on the five key priority outcome areas. 1.2.3 Funding and timelines All hospitals will receive $4,500 as seeding funding for the development of their Infection Control Plans. This will occur as one-off funding in June 2000. It is anticipated that around $33 in total will be allocated to Infection Control and Cleaning over the next 4 financial years. Approximately $3 million annually of the total funding will go towards improving hospital cleaning standards. Timelines for submission of Infection Control Strategic Management Plans The Effectiveness Unit of the Quality and Care Continuity Branch would like to receive the Infection Control Profile proforma by 29 June, and the report on implementation and expenditure of existing Infection Control Plans and new Infection Control Strategic Management Plans by 15 August. Please contact Mary Draper (96168209) or Melissa Aberline (96168558), if you have any queries on this. We would be grateful if you could provide this information by the above dates addressed to: Melissa Aberline Senior Project Officer Effectiveness Unit Quality & Continuity Care Branch, Acute Health Division 16th Floor, 555 Collins Street MELBOURNE VIC 3000 E-mail 1.2.4 Accountability All hospitals will need to submit annual reports over the next 3 years to the Quality and Care Continuity Branch. The Branch is keen to develop a reporting framework which promotes ongoing communication between agencies and the Unit whilst meeting monitoring and accountability requirements. Page 3
  4. 4. The reporting framework for the Infection Control Strategic Management Plans are as follows: Report Date • Infection Control Profile proforma 29 June • Infection Control Presentations to the Department 13-14 July • Report on implementation and expenditure of existing plans 15 Aug 15 Aug • Infection Control Strategic Management Plans (ICSMP) Oct-Dec • State-wide infection control resurvey 30 Jan, 2001 • ICSMP Progress Report 30 May 2001 • 12 Month annual report June 2001 • State-wide infection control meetings with all hospitals 1.3 Goals for Infection Control There are 3 principal goals for hospital infection control and prevention programs regardless of the health care setting or service mix: • Protect the patient; • Protect the health care worker, visitors, and others in the health care environment, and • Accomplish the previous goals in a timely, efficient, and cost-effective manner, whenever possible. 1.4 Outcomes for the Victorian Infection Control Strategy The overall desired outcome of the Victorian Infection Control Strategy is the implementation of evidence based practice. Critical to this is the implementation of the NH&MRC Guidelines, Australian Standards, the Department Human Services Guidelines and relevant best practice guidelines. The 1998 Infection Control Taskforce Report outlined a number of specified outcomes to be achieved by all Metropolitan Health Services and non-network hospitals. These included: • a review of structure, management and leadership of infection control programs; • existence of effective infection control policies and practices; • adoption of guidelines and standards, including adherence to Australian Standard AS4187 for the cleaning, disinfection and sterilisation of medical/surgical instruments and equipment; • establishment of risk management and OH&S programs; • establishment of nosocomial infection surveillance systems; • establishment of education and training programs for all health care workers; • maintenance of environmental cleanliness and surveillance of the physical environment, and • prevention of the emergence and spread of antibiotic resistant organisms. In light of the Taskforce Report, we have reviewed the required outcomes for the Victorian Infection Control Strategy into five priority outcome areas, in order to assist institutions in developing their plans. Page 4
  5. 5. 1.4.1 Priority outcome areas The priority outcome areas identified are: • Management commitment, leadership and accountability; • Monitoring infection control and reducing infection rates; • Prevention of adverse events; • Protecting health care workers and visitors, and • Surveillance. These priority outcome areas are explored in more detail in sections 1.4.2-1.4.6. Some possible questions you might consider for each of the priority areas are included in Appendix 7. All five priority outcomes should be addressed in the Strategic Plans. 1.4.2 Management commitment, leadership and accountability The Board is responsible for ensuring management supports and allocates appropriate resources for effective prevention, monitoring and control of infection. Key performance areas Development of a model for achieving/enhancing multidisciplinary teams The existence of a multi-disciplinary team in the delivery of infection control services is seen to be a crucial element of the Infection Control Service delivery structure. Link with infectious diseases (rural) The establishment of formal links with a infectious diseases physician or metropolitan infectious diseases service should be explored by all rural regions or consortia. Communication The provision of comprehensive and timely communication is an important aspect of infection control, both for the infection control team to receive relevant information and for infection control to convey information to all relevant staff and departments to ensure that best practices are followed. Policies and processes are in place regarding communication and the provision of information and support. Communication mechanisms have been established between all members of the infection control team, committee, management and service providers. Provide clinical sponsorship A member of senior management should be clearly identified as the executive sponsor for the infection control program. Integrate infection control into quality and planning frameworks Formal links and integration of infection control into all quality components are clearly identified. Documented plans Infection control plans should be developed by the infection control committee, documented, endorsed by the Board and reviewed annually. Resources The resources for infection control (personnel and non-personnel) should be proportional to the size, casemix and estimated infectious risks of the populations served to fulfil the functions of the infection Page 5
  6. 6. control program. The Plan should clearly identify current infection control practitioner resources and projected resource requirements. Infection control should be the responsibility of at least one designated person and the hours dedicated to infection control clearly defined. The person with this designated responsibility should have specific knowledge and training relevant to infection control and access to other educational opportunities that will increase their capacities in the field. 1.4.4 Prevent adverse events The Board has a risk management approach and ensures that senior management support an effective risk management program which incorporates strategies for addressing infection control issues. Key Performance areas Information/consultation Written policies and procedures are to be established, implemented, maintained, and updated periodically. Polices should be periodically monitored for effectiveness to ensure compliance, that they fulfil organisational requirements and they have the desired effect in prevention and control of infection. Consumer information The provision of good consumer information can be provided at a number of points within the institution and on a number of issues. Information that provides consumers with information on specific relevant health issues or risks and information generally for people who use the hospital regarding the strategies that are in place to protect consumers and their family from infection related risks. 1.4.3 Monitor IC and reduce infection rates Interruption of the transmission of or potential transmission of infectious disease, outbreak investigations and control, and performance improvement activities. Key performance areas Evidence based IC Infection Control policies and protocols should reflect current relevant research and evidence based practice. Capacity to monitor and reduce the emergence of antibiotic resistant organisms Laboratory based reporting systems are in place to provide relevant information on antibiotic resistant organisms to the infection control team and committee in a timely manner. Antibiotic policies reflect relevant Australian and State guidelines and their effectiveness is routinely monitored. Infection control risk assessment Infection control input at initial stages of planning and design to ascertain the risks for susceptible patients and prevention of infection through architectural design. (eg number of isolation facilities, handwashing facilities). Environmental surveillance Systems are in place for environmental surveillance. Audit results are routinely reported to the infection control committee and those who need to know. A system is in place for reporting variances or unusual findings promptly to be acted upon. Disinfection and sterilisation of medical equipment The Australian Standard AS4187 is adhered to in all departments/units undertaking storage and handling of sterile equipment/stock and equipment cleaning, disinfection and sterilisation. Page 6
  7. 7. Education and training It is essential that health care workers receive at least a rudimentary knowledge of the infection control specific to the setting in which they are employed. This knowledge will allow them to be better able to understand and comply with the practices and procedures necessary for the prevention and control of infections. Educational programs should be evaluated periodically for effectiveness. Implement standards and guidelines Compliance with basic accreditation standards, NH&MRC and state guidelines, and Australian Standards relevant to infection control. 1.4.5 Protect staff and visitors The Board is responsible for the provision of a safe environment for patients, staff and visitors. Key performance areas Employee health All employees are offered screening and immunisation based on the Immunisation Guidelines for Health Care Workers. The infection control program should institute policies and procedures for the evaluation of exposed or infected staff. Isolation capacity The capacity (number and mix of isolation rooms) and personal protective equipment provided to isolate patients with airborne, antibiotic resistant or communicable diseases reflects the casemix, disease risk and services provided. Planning for new or refurbished isolation facilities reflect the Guidelines for Isolation Rooms. 1.4.6 Surveillance There is a defined program for nosocomial infection surveillance which includes the collection, analysis and reporting back of data to those who need to know and take action. Key performance areas • Conduct surveillance and investigations using epidemiologic principles • Use basic statistical techniques to describe the data, calculate rates and critically evaluate significance of findings. • Develop a surveillance plan based on the casemix and services provided. • Select indicators based on the projected use of the data (eg external benchmarking and internal trending) • Use standard definitions for the identification and classification of events, indicators, or outcomes. • Evaluate and compare surveillance data to either internal or external data sources. • Report significant findings to appropriate parties Page 7
  8. 8. 2. Report on implementation and expenditure of existing infection control plans Following the 1997 Infection Control Taskforce survey, Networks and hospitals submitted costed infection control plans to the Department. Funding totalling $13.6 million was distributed to assist hospitals implement infection control plans. Additional funds were distributed in 1999-2000 for the provision of rural nurse vaccinator education; and the provision of staff vaccination and screening software. In addition to the Infection Control Strategic Management Plan, we request feedback on the implementation, achievements and challenges experienced with your 1998 Infection Control Plan together with a breakdown of expenditure. This report should be supplied together with your Strategic Plan and submitted to the Department by 16 August 2000. In addition, hospitals may be requested to present their interim plans at the information exchange forum scheduled for 13-14 July. 3. Developing New Strategies and Priorities • Developing some strategic directions • Questions to think about • Developing your strategies • Making your decisions -setting priorities and strategies 3.1 Developing some strategic directions The development of your strategic plans is both an evolving and interactive process building on the analysis of patient demographics, casemix, provision and nature of current services, characteristics of your community, demand for infection control services and strengths, limitations, gaps and critical issues in current services. Your Plan should be developed through discussion and consultation with your Infection Control Practitioner/Team, Infection Control Committee and other relevant stake holders. Through the Strategic Infection Control Management Plans we hope to: • Demonstrate incremental change towards the achievement of evidence based best practice; • Demonstrate achievable goals; • Identify current examples of best practice; • Model innovative mechanisms and processes by which infection control services can move towards best practice through continuous quality improvement. 3.2 Questions and information to think about To assist in the development of your plan, a number of questions based on the five outcome priorities have been provided in Appendix 2. Background information describing infection control program development, costs and consortium model descriptions are provided for reference material in Appendices 3-7. 3.3 Developing your strategies The Department is keen to encourage those developing the 3 year plans and strategies to set themselves achievable goals, and to make a significant difference in the short term to a few areas rather than developing a plan which covers everything, but makes limited progress across a large number of areas. Page 8
  9. 9. As you develop activities for each strategy, you will need to consider a range of implementation processes and identify short-term ( 3-12 months ) and longer term (12-24 months) performance indicators. 3.4 Making your decisions - setting priorities and strategies Making your decisions about your priorities and timeframes may be a challenge. While you have to consider a whole range of issues as indicated in this document, the important factor will be looking at service gaps and achievability within the time frame and the resources identified in your Plan. Underpinning this, of course, is also the critical issue the difference it make to consumers, visitors and staff. Agreement with your final decisions will be crucial to ensure that you have the commitment of all key stakeholders to the Infection Control Plan and its subsequent implementation. If you are having difficulties or would like any information, please contact Melissa Aberline (9616 8558) or Mary Draper (9616 8209). Page 9
  10. 10. 4. Implementation frame work pro forma (example only) Priority outcome area: Management commitment, leadership and accountability Strategy 1: multidisciplinary team Rational: The adoption of a multidisciplinary approach to infection control services involving all key stake holders is a key element of providing a co- ordinated approach to infection control services. Provision of a multidisciplinary team is informal across the Metropolitan Health Services, region or consortium, no regular meetings occur. Actions Performance Indicators Timeline Responsibility Cost Should breakdown the strategy into Should detail how each strategy will be Should indicate when the The individual, group An estimate of practical and achievable approaches to assessed strategy will commence or organisation the cost implementation and approximate duration assigned the required to from start to completion responsibility for a implement the particular strategy/action strategy/action • Identify all key members of the team 1. multidisciplinary team established and 6 months form July 2000 • Identify current gaps in the team meet on a regular basis • Establish mechanisms to bring members 2. One day workshop held to examine the together role of the team, examine current • Define responsibilities and roles for all practice, identify issues and objectives. team members 3. Documentation of processes and short term outcomes • Monitor current practice • Develop objectives Strategy: Each strategy should be presented separately, but may be grouped into specific categories. New initiative should be clearly identified from existing but expanded ones. Rationale: A brief rationale should be outlined for each strategy, including any issues.
  11. 11. Appendix 1 Victoria’s 5 Point Infection Control Strategy Infection Control Strategy Goals: to reduce hospital acquired infections to develop a co-ordinated approach to infection control to enhance hospital structures and processes for managing infection control 1. Develop a strategic approach to infection control in Victorian hospitals • Require Metropolitan Health Services/hospitals to develop strategic plans for infection control and prevention - June 2000 • Resurvey hospital infection control and sterilisation - late 2000. • Standing Committee on Infection Control structural and operational review - June/July 2000. • Introduce multidisciplinary infection control team service delivery models and employ/educate 30 additional infection control practitioners July 2000 - January 2001 • Require hospitals and health service management to regularly report to Boards on infection control issues, indicators and staff immunisation and training. 2. Improve adherence to staff infection control guidelines • Introduce systems to improve staff screening/immunisation and the surveillance and follow-up of exposures - commence April 2000. 3. Establish a Victorian Nosocomial Infection Surveillance System (VICNISS) • Introduce a targeted hospital acquired infection surveillance system and coordinating centre. 4. Monitor and reduce the emergence of antibiotic resistant organisms & vaccine preventable diseases • measure to monitor and prevent the spread of antibiotic resistant organisms and overuse of antibiotics - May 2001 • Support VRE management - Winter Emergency demand Strategy - May 2000 • Patient blood borne virus exposure notification system - June/July 2000 • Influenza vaccination campaign - under way. • Influenza Pandemic contingency planning - December 2000 5. Improve environmental surveillance • Implementation of Cleaning Standards for Victorian Public Hospitals. - under way
  12. 12. Infection Control Strategy February 2000 Strategies Action Timeframe To improve infection control in To provide a coordinated approach hospitals INFECTION CONTROL PROGRAM DEVELOPMENT & INFRASTRUCTURE SUPPORT Require Metropolitan Health Services/hospitals to provide information on allocation of Interim plan - June 1. Require Metropolitan Health infection control funding to date, and to provide a revised strategic plan on infection control Services/hospitals to develop which incorporates a range of infection control components (organisational arrangements Final plan - August strategic plans for infection control and responsibilities, related staff infection control issues, surveillance, education and and prevention training) as the basis for allocation of infection control funding in 2000/2001. 2. Resurvey hospital infection The infection control and sterilisation resurvey will be used to audit improvements control and sterilisation undertaken since 1998 audit, and to highlight, in addition to equipment purchasing and replacement issues, organisational processes, lines of responsibility, policies and protocols for staff and patient infection control and staff orientation programs (a) Commission the redevelopment of the infection control and sterilisation survey tool to (a) Survey tool revision improve on limitations of 1997 tool, and highlight additional areas. -July (b)Commission external organisation to undertake audit. (b) Tender selection July. Audit process Oct-Dec 3. Structural and operational review Review the terms of reference, reporting mechanisms and membership of the SCIC to June/July of the Standing Committee on enhance communication and reflect the collaboration between Acute and Public Health in Infection Control (SCIC) infection control service delivery. Expand membership to provide multidisciplinary expertise and enhance consumer participation. Establish sub-committees on standards/guidelines, surveillance, antibiotic use and resistant organisms, and infection control training and education. 4. Introduce multidisciplinary (b) Call for expression of interest for delivery of infection control practitioner training. (b) May infection control team service delivery models and employ/educate (c) Hospital and Metropolitan Health Services employment of 30 additional infection (c) July 30 additional infection control control practitioners practitioners (d) Deliver fast track certificate level infection control practitioner theory and practical (d) training conducted training between July-
  13. 13. Strategies Action Timeframe To improve infection control in To provide a coordinated approach hospitals December (e) New qualified infection control practitioners available to the Victorian hospitals workplace. (e) Jan/Feb 2001 STAFF INFECTION CONTROL - SCREENING/IMMUNISATION & EXPOSURES 1. Improve infrastructure support (f) Funding to be provided for software support for staff screening and immunisation, and (f) May for rural nurse vaccinator training. (g) Hospitals policy circular to be sent to emphasising management responsibility under the (g) Awaiting review of 2. Ensure compliance with staff Occupational Health and Safety Act, and Health Services Agreement Schedule, for guidelines infection control guidelines staff screening/immunisation. (h) Require Metropolitan Health Services and hospitals to develop policies and procedures (h) Part of the Infection which ensure consistent approaches to staff screening and immunisation, which Control Strategic ensure that staff with infectious diseases are not discriminated against due to their Plans status, and that systems are place to minimise potential risks to patients. (i) Auditing of hospital staff vaccination/screening policies and practices in conjunction with Infection Control Resurvey. (i) Oct-Dec (j) Hospitals to be encouraged to participate in, and contribute data to, the National Epinet blood and body fluid exposure surveillance program. (j) Part of the Infection Control Strategic Plans
  14. 14. Strategies Action Timeframe To improve infection control in To provide a coordinated approach hospitals ESTABLISH A VICTORIAN NOSOCOMIAL INFECTION SURVEILLANCE SYSTEM (VICNISS) 2. Introduce a targeted hospital Establish a coordinating centre for nosocomial infection surveillance in public acute acquired infection surveillance hospitals and an expert reference group. The Centre will deliver aggregated data to allow system and coordinating hospitals to compare performance to Victorian data and to international benchmarks. A centre. change in health care worker behaviour and subsequent reduction in infection will occur as a result of data feedback. (k) Co-ordinating Centre (k) Concurrent call for expressions of interest for the Co-ordinating Centre, and pilot -advertise tender surveillance projects. June. Pilot projects (l) Recruit hospitals to participate in VICNISS advertise July. (l) Nov (m)Launch of the VICNISS home page (m)Dec (n) July 2001 (n) Delivery of both statewide aggregated and hospital level data to participating hospitals and to the Department and Minister. (o) Aug 2001 (o) Development of surveillance system for acute care Rural base hospitals in conjunction with relevant experts and rural agencies. (p) Aug 2001 (p) Review the VICNISS to be undertaken by the Co-ordinating Centre in conjunction with key stakeholders (ie consumers, clinicians, ICPs, DHS). (q) Aug 2003 (q) Provision of risk adjusted aggregated quality data for publication/public domain and VICNISS performance indicator data. 3. Require hospitals and health (a)2000-2001 Policy and Funding Guidelines to specify performance reporting to Boards (a) July service management to regularly report to Boards on infection control issues, indicators and staff immunisation and training.
  15. 15. Strategies Action Timeframe To improve infection control in To provide a coordinated approach hospitals MONITORING & REDUCING EMERGENCE OF ANTIBIOTIC RESISTANT ORGANISMS & VACCINE PREVENTABLE DISEASES 1. Monitor and prevent the spread of (r) Develop specific surveillance approaches to antibiotic resistant infections (MRSA, (r) May 2001 antibiotic resistant organisms and VRE). overuse of antibiotics (s) Delivery of metropolitan and rural seminars to all interested health care workers on the (s) May/June management of VRE. These seminars will be designed to provide up to date information, address concerns and review guidelines on patient management. (t) Research into the direct costs associated with the management of VRE patients. (t) August (u) Introduce measures to reduce inappropriate antibiotic prescribing, in particular, (u) Computer assisted computer assisted antibiotic decision support systems. decision research commenced Nov (v) Development and evaluate effective handwashing research and strategies. 1999. Calls for multicentre research (w)Projects already completed include the use and prescribing of Vancomycin and Aug. Cephalosporins. (v) Calls for multicentre expressions of interest August. Selection completed by Sept. (w)completed 2. Patient blood borne virus (a)Develop a protocol for information to be reported to the Department of Human Services June/July exposure notification system in the event of patient exposure to blood borne viruses which have the potential for outbreaks 4. Influenza campaign (x) Decreased transmission of influenza within the hospital setting by ensuring that patients March- May attending the hospital received these vaccines as indicated. (y) Introduce measures to increase health care worker influenza vaccine coverage to
  16. 16. Strategies Action Timeframe To improve infection control in To provide a coordinated approach hospitals decrease impact on staff shortages and transmission. 5. Influenza Pandemic contingency (z) The development of a state influenza pandemic plan based on the national framework. December planning ENVIRONMENTAL SURVEILLANCE (aa)Distribution of final draft Cleaning Standards for Victorian public hospitals. (x) June Implementation of Cleaning Standards for Victorian Public (bb)Allocation of one-off funds to assist hospitals with implementation of standards (y) March Hospitals. May (cc)Validation of cleaning standards performance measures, weighting systems and establishment of benchmarks (z) March 2001 (dd)Random auditing of hospitals against cleaning standards (aa)Nov/Dec (ee)Develop an annual cleaning auditing process for public hospitals (bb)March 2001 (f) Publication of aggregated hospital cleaning auditing results (cc)March 2001
  17. 17. Appendix 2 Priority outcome possible questions (Note: These are indicative only and provided to assist) Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool Management commitment, leadership and accountability 1. Service List the service and patient mix that are currently Demographics serviced by your infection control staff. Do they include consultancy services to any of the following health care settings? • Health Care Settings • eg, acute care, aged care centres, child care centres, long -term care facilities, nursing homes, special accommodation or community health centres, ambulatory care, dialysis centre, infusion centre, hospital in the home, rehabilitation centre, medical clinics, day hospitals, nursing homes, respite care etc • What is the break-down by patient beds to these different services eg number of acute beds, number of aged care beds? What health care settings/services are referred to in your strategic management plan? 2. Development of a List the members of your multidisciplinary team. Does Wiliams S., Brimhall D, etal. model for it minimally include a infection control practitioner, a Requirements for achieving/enhan infectious diseases physician or specialist doctor or infrastructure and essential cing microbiologist? Are there gaps in the current team? activities of infection control multidisciplinar Are there mechanisms in place to bring all members and epidemiology in hospitals: y teams together (ie face-to-face, tele-conference)? Are the A Consensus Panel Report. differing roles and responsibilities of all members American Journal of Infection defined and complimentary? Is there a shared Control Vol. 26, No. 1 pp. understanding of the role of different members of the 47-60, Feb 1988. multidisciplinary team? Have the team identified critical issues in the Metropolitan Health Services, region or consortium to address and developed achievable actions? Are there multidisciplinary team meetings? If so, how do these happen and how often? 3. Link with Are there formal links with an infectious disease infectious physician or service? If not, are there opportunities to diseases (rural) establish links with a metropolitan infectious diseases service? Are they available to consult on urgent infectious diseases issues and protocol development? Are they members of your infection control team or committee? 4. Communication Does the infection control program provide expert Infection Control Taskforce
  18. 18. Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool knowledge and guidance in epidemiology and infection Report. prevention and control-related issues? Are there mechanisms/structures in place which ensure that findings, recommendations, and policies are disseminated to appropriate groups or individuals? Is there a mechanism to ensure that those who need to act upon findings/recommendations receive data and are required to feedback their actions in a timely manner to the infection control committee? Is the infection control program an integral component of the plan for continuous quality improvement of practice and patient outcomes? Is change demonstrated and infection control achievements communicated? 5. Provide clinical Is there a member of senior management who acts as the sponsorship senior sponsor and advocate for the infection control program? Do they recognise and support the importance of infection control and support the program through influencing policy making bodies? 6. Integrate infection Does your infection control practitioner participate in a control into variety of hospital activities including: various quality and committee meetings, on-site inspections, evaluation of planning construction, capital works or planning, outbreak- frameworks investigations, hospital orientation programs? Do all hospital staff position/job descriptions describe their individual responsibility for infection control? 7. Documented plans Do you have a documented infection control plan? Is the plan signed of by the board, CEO and infection control committee to provide authority? Is the program plan and measurable objectives reviewed annually? Are resource variances communicated to administration and supported? Are customer needs and satisfaction (eg staff, visitors and patients) assessed and findings integrated into the program? Is the effectiveness of the program periodically evaluated for effectiveness? 8. Resources Do you have a designated infection control practitioner APIC/CHICA Canada or access to continuing services of a person who is infection control and trained in infection prevention and control, who epidemiology: Professional provides oversight for the infection control program? Do and practice standards. they have knowledge and experience in areas of patient care practices, microbiology, asepsis, disinfection and resc/practnd.html sterilisation, adult education, infectious diseases, communication, program administration, and epidemiology? What ratio of infection control EFT do you have per acute hospital beds? Do you have adequate infection control personnel and supporting resources to fulfil your infection control strategic management plan? Do you have designated clerical support for the infection control program? Do you have access to the continuing services of a physician trained in infectious diseases or a medical microbiologist?
  19. 19. Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool Is there the provision your infection control practitioner for maintaining a knowledge base of current infection control prevention and control information through peer networking, Internet access, published literature, and professional meetings? Do you have a specific infection control budget? Does it include predictable and non predictable costs? Do you consider both clinical outcomes and financial implications when making recommendations for change in practice? Do your nosocomial infection reports include cost accounting data? Do you document cost reduction through infection control program activities? Do you have a designated infection control computer for surveillance, Internet access and other infection control related activities? Does your infection control practitioner have computer skills? Prevent adverse events 9. Information/consul Does your infection control practitioner/team provide tation consultation to administration, committees, staff, and managers on issues regarding infection control and prevention? 10.Consumer Are customer needs and satisfaction (eg staff, visitors The Blue Book, Department of information and patients) assessed and findings integrated into the Human Services program? Are findings and actions feedback to consumers and staff? Is information regarding the risk of hospital acquired infections available for consumers? Is consumer information available on blood borne viruses and other common communicable diseases and antibiotic resistant organisms (eg VRE)? Is consumer information regarding the strategies in place to reduce infection related risks available? Do you have a mechanism to ensure that patients and care-givers receive appropriate information regarding infection prevention and control eg VRE, Hepatitis, Dialysis patients, sharps and waste disposal for dialysis patients and diabetics? Monitor IC and reduce infection rates 11.Evidence based Does your infection control program apply relevant infection research findings to infection control practice, policy control and procedure development?
  20. 20. Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool 12.Capacity to Do you have an ongoing system to obtain pertinent Infection Control In The monitor and microbiologic data? Does your pathology Health Care Setting, reduce the department/service supply regular reports on significant Guidelines For The Prevention emergence of antibiotic resistant organisms to your infection control Of Transmission Of Infectious antibiotic practitioner or infection control committee? (eg MRSA, Diseases, NHMRC, April resistant VRE, multi-resistant gram negative organisms) When an 1996. E-mail: organisms outbreak occurs, do infection control staff have adequate resources and authority to ensure comprehensive and timely investigation and implementation of appropriate measures? Do you have institutional polices and The Blue Book, Department of procedures which outline roles and responsibilities? Do Human Services antibiotic prescribing policies reflect best practice? Is the effectiveness of and adherence to, antibiotic policies and protocols routinely measured? Therapeutic Guidelines Antibiotic 10th Edition, Therapeutic Guidelines LTD Tel 9329 1566. 13.Infection control Is infection control input gained at the initial stages of Mueller, J APIC State of the risk assessment planning and design? Are the risks to patients and the art report: The role of infection control mechanisms identified and documented to control during construction in minimise risks? Are infection control requirements health care facilities. American identified in all architectural design? (eg number of Journal of Infection Control isolation facilities, handwashing facilities, floor Vol 28, No 2 p156-159. coverings, furnishing). 14.Environmental Do you have documented systems in place for Australian Standards, Human surveillance environmental surveillance eg cleaning, legionaries Service Guidelines for disease, pools, spas, air-conditioning etc. Is there a Legionaries Disease mechanism to report environmental surveillance Management and Prevention, activities back to the infection control committee? Is Isolation Room Guidelines, there a system to alert those who need to know and take Victorian Cleaning Standards, action when variances or adverse events occur (eg high Food Safety Victoria. bacterial counts in water supplies, or air-conditioning cooling towers)? 15.Sterilisation Are there written policies and procedures for cleaning, Australian Standard AS4187 disinfecting and sterilising reusable medical instruments Standards Australia and equipment which are consistent with AS418? Do you conduct audits to measure adherence to these polices and procedures? Do all areas undertaking storage, handling or cleaning, disinfection and sterilisation of medical equipment comply with AS4187? (eg supply departments, sterile stock storage areas, endoscopy, podiatry, dentistry, formula rooms) Do you have a suitably qualified person responsible for the management of your sterilisation services (ie certificate in sterilisation and infection control or equivalent qualification)? Do you have documented procedures for the recall of products after sterilisation process failure? Do you have the ability to track sterilised re-useable medical items to individual patients or is a batch number tracking system in place? Do you have an instrument purchasing plan which ensures regular replacement and upgrading of equipment, and which maintains an inventory adequate to the services
  21. 21. Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool and casemix? Do you re-use items labelled single-use or single patient use? If re-use of single-use items is practiced, is there a documented plan developed, policies and a specially constituted re-use committee? Do items approved for re-use have quality control/monitoring programs and documentation systems in place? Do you have the ability to track the re-use of items back to individual patients? Is informed consent obtained from patients when re-use of single use items are to be used? Are you using open systems of glutaraldehyde for high level disinfection? Do you have a system in place which allows for the internal tracking of where glutaraldehyde is used within your agency and an approval mechanism through the infection control committee? Do you have a competency based education program for all health care workers directly involved in the handling or use of glutaraldehyde? Do you have a tracking system for instruments used on individual patients? Do you comply with the Worksafe Guidelines for gluteraldehyde use? 16.Education and Do you provide ongoing educational programs in training infection control and prevention to all health care workers? Are the programs tailored to meet the requirements of a wide range of educational backgrounds and work responsibilities? Are infection control staff active participants in the planning and implementation of staff education programs and induction? Are your infection control education programs periodically evaluated for effectiveness? Are all medical staff required to attend orientation? Is there a system to ensure that all medical and other direct patient care staff receive ongoing education and updates? 17.Implement Do your written policies and procedures address all standards and elements of care? For example, food handling, laundry guidelines handling and cleaning, visitation policies, and direct patient care practices, including handwashing and immunisation? Are the policies relevant to the health care setting, continually updated to remain current, and accessible to all staff? How do you ensure that policies and procedures are evidence-based and consistent with scientific knowledge, expert consensus, Australian Standards, Legislative requirements and NH&MRC and Department of Human Service Guidelines? Do infection control staff have appropriate access to relevant materials? Do you have a means of implementing polices and procedures that are clearly outlined? Once implemented, is the effectiveness of policy and procedure implementation monitored/measured for effectiveness, both to ensure that the policies are having the desired result in preventing and controlling infections and results feedback to the infection control committee?
  22. 22. Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool
  23. 23. Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool 4 Protect staff Do you have a staff infection control program (ie Immunisation Guidelines for and visitors vaccination, screening and exposure management)? Are Health Care Workers, 1998. all new staff offered screening and vaccination in accordance with the Immunisation Guidelines? Are the staff responsible for your staff vaccination and post- exposure program suitably qualified (ie certificated vaccinator, certificated to give BCG, accredited HIV counsellor)? Does your post-exposure program include evaluation of symptoms, evaluation for post-exposure prophylaxis, evaluation of treatment, and work restrictions? Is there a physician with expertise accessible to provide advice on post-HIV exposure and order appropriate prophylaxis? Do you have a system to capture information regarding the vaccination and screening of health care workers? Does your staff health program or any other service provide for the assessment of infected symptomatic and asymptomatic health care workers for communicability, work restrictions and treatment as appropriate? Do you have the facilities to isolate patients with communicable diseases, air-borne transmitted diseases Isolation Room Guidelines or VRE? Do the number and mix of isolation rooms Guidelines for the reflect the casemix, disease risk and services provided? Management of Patients with Have your infection control practitioner/team provided Vancomycin-Resistant expert advice on the disease risk of your patient Enterococci (VRE) population? Are isolation facilities available in Colonisation/Infection. The emergency departments and intensive care units for Blue Book. patients with airborne transmitted diseases? Do you have policies and protocols for the timely management and treatment of patients with infectious diseases? Infection control in the health care setting, guidelines for the prevention of transmission of infectious diseases, NHMRC, April 1996. E-mail:
  24. 24. Priority Outcome Possible Questions Possible Literature, Data Area Source or Tool 5. Surveillance Have you developed and documented a surveillance plan ? Does the plan reflect the population served and services provided? Do you have a hospital wide or targeted procedure specific surveillance program? Are there selected surveillance areas used for external benchmarking or internal trending? Are the findings of surveillance findings integrated into the organisation’s quality improvement activities? Does your surveillance plan use standardised definitions for the classification of infections? Are surveillance reports, findings and recommendations generated and feedback to those who need to know and need to take action? Do you evaluate and compare surveillance data to either internal or external data sources? Are there systems in place to report significant findings to appropriate parties? Does the infection control committee periodically evaluate and review the effectiveness of the surveillance plan? Do you have a computerised surveillance system or a manual (paper-based) system? Is the surveillance data secure? Do you benchmark your surveillance data against any other agencies performances or other published findings? Do you regularly report hospital acquired infection surveillance data to the Board and notify the Board of increased infection trends, outbreaks or adverse events (eg patient exposure)?
  25. 25. Appendix 3 Infection control resources, structure and functional requirements The ongoing challenge is to minimise the risks of transmission by adoption of a cost effective infection control strategy. To accomplish a reduction in infection rates an effective infection control programme has to be given sufficient designated infection control personnel with clearly defined responsibilities, adequate lines of communication, authority, and other resources to facilitate the effective prevention, detection and control of infection within a strategic framework. Is there an infection control structure with sufficient resources and clear lines of responsibility? Criteria: • There is formal links with a Infectious Diseases Service. • There is a Metropolitan Health Services, Regional or consortia Infection Control Committee (ICC). • There is an Infection Control Team responsible for the day to day infection control activities. • There are designated staff (liaison nurses or other staff) in all clinical units who liaise on all matters of infection control with the Infection Control Team. • The Board and Chief Executive Officer is ultimately responsible for effective infection control activities and for ensuring that appropriate resources are made available. Is there close professional and operational links between Infection Control and an Infectious Diseases Service? Criteria: • The active participation, role and support of an Infectious Diseases Service/physician is considered an integral and enhancing component of a diverse, effective and responsive infection control program. Is there an effective Metropolitan Health Services, Regional or Consortia Infection Control Committee? Criteria: • The Infection Control Committee should consist of a chairperson (an infectious diseases physician or infection control practitioner or a physician with an interest in infection control), infection control practitioner, management, clinical representatives, surgeons and support services. In addition other members may be co-opted as appropriate, for example, engineering, sterilisation services manager. • The committee should meet at least every two months to provide specialist advice, to formulate and monitor the implementation of policies and to determine and monitor the progress of the infection control plan against performance indicators. • To perform the infection control functions effectively, the committee; ~ commissions and approves policies and their implementation in relation to infection control, including policies for the response to major outbreaks of communicable disease or management of adverse events in the community serviced. ~ initiates the evaluation and revision of written standards and policies. Reference is made to appropriate legislation, Australian standards, NH&MRC and Victorian
  26. 26. Department of Human Services guidelines, national and international trends ~ prepares and reviews the progress of the annual program of activities (education, surveillance, policy and procedure formation and review, staff infection control) and reports to the board ~ advises on funding for the program and any contingencies ~ circulates the minutes of its meetings widely and liaises with other committees as appropriate. Is there an effective Infection Control Team or Teams (ICT)? Criteria: • The Infection Control Team comprises of the infection control practitioner/s, an infectious disease physician or interested physician, registrars and microbiologist. The Infection Control Team is responsible to the infection control committee and to the Chief Executive and Board. • The ICT meets on a regular basis and reports to the Metropolitan Health Services, Regional or consortium Infection Control Committee • The ICT functions are to: ~ liaise with all Departments and Units, Occupational Health & Safety and support services ~ advise and monitor infection control standards, practices and policies ~ conduct surveillance activities, review the effectiveness of control measures and adapt to changing local circumstances ~ organise that relevant education of all health care staff and encourage reflexive practice of infection control measures ~ make suitable arrangements for 24 hour emergency cover (eg for HIV exposure) ~ initiate appropriate responses to incidents or outbreaks of infection, or emergence of antibiotic resistant organisms, assess risks of infection and recommend allocation of resources for investigation and control. Is there sufficient qualified Infection Control Practitioners to support the program? Criteria: • The ACHS and US literature suggests that a minimum of one infection control practitioner per 250 acute care beds is required to ensure adequate infection control services in relation to the number of beds, patient demographics, diversity in size, clinical services and clinical settings. This is a conservative estimate of need, and since it was established, infection control functions have become more complex. This figure is under review in the US. The casemix of the hospital is a key consideration. All practitioners must be registered general nurses and have undergone appropriate post-graduate infection control education. • The Infection Control Practitioner/s are responsible for the overall coordination and implementation of the program on a daily basis, and should be supported by formal links with an Infectious Diseases Service/physician and adequate clerical staff, and have access to appropriate facilities to enable the implementation of the program. • The Infection Control Practitioner/s role may be augmented by adequately trained infection control liaison nurses or other staff in all clinical areas or at least in high risk areas such as surgical and intensive care units. Is there sufficient technological and infrastructure support to facilitate the program?
  27. 27. Criteria: Equipment Requirements • computer hardware and software • external Internet access • access to transportation where appropriate Infrastructure • Management information services to provide individualised reports and computer program development • Microbiology laboratory based reports • Engineering Department reports (eg air-conditioning, Legionnaires disease prevention monitoring - cooling towers, showers, monitoring of hydrotherapy and spa) • Staff Health Services to support staff infection control policies (staff screening & vaccination and post-exposure follow-up programs)
  28. 28. Appendix 4 Common Infection Control Service Needs • A decrease in the incidence of hospital acquired infections • Policy, procedure and practice standards development, implementation and review of all procedures or systems used within the Metropolitan Health Services, Region or consortium • Maintenance of an ongoing education and orientation program for all hospital personnel in the use of such practice standards, policies and procedures • Resource/Consultative Services • Surveillance and investigation of hospital acquired infections, outbreaks and adverse events • Monitoring of staff infection control in collaboration with the occupational health department and staff health services • Monitoring the use of antibiotics • Monitoring the use of disinfectants, cleaning standards, equipment disinfection and sterilisation practices • Cost containment whenever possible • Improved communication • Fulfilling infection control requirements for ACHS Accreditation • Quality assurance procedures to monitor effectiveness of infection control programs.
  29. 29. Appendix 5 Staff Health Program Infection control and staff health programs should work together to develop joint activities for infection control for employees. The hospital-based employee health program should be responsible for the diagnosis (in consultation with the Infectious Diseases Unit), treatment and prevention of infectious diseases and post-exposure management of health care workers. Because of this, a hospital-based staff health service plays an important role in the infection control program and is a key element in protecting patients and other staff from nosocomial infections. A reduction in staff injuries and occupational exposures save costs in the longer term (refer to costings detailed below), but it is essential to have a comprehensive prospective injury surveillance program which includes: • screening, and vaccination; • data collection and analysis; • through investigation of accidents, interventional strategies with continued observational evaluation, and • prompt follow-up and management of injuries and ongoing education if injuries and occupational are to be minimised. Staff Health Services Models Two models for staff health services operate in most Victorian agencies - (1) the infection control consultant operates as both infection control clinical nurse consultant and staff health services in addition to other administrative and/or educational roles or (2) a designated staff health nurse/officer delivers staff health services. Essential components of a effective Metropolitan Health Services, regional or consortium staff health service program (from an infection control perspective) • policy development, implementation and evaluation of adherence • biohazard risk prevention and management programs - staff screening and vaccination programs - blood and body fluid exposure follow-up and counselling - surveillance of occupational exposures and injuries - sharps awareness education • protocols for evaluation of acute infectious illnesses in employees • investigations into outbreaks of infection in employees Possible questions to consider Does the current model emphasises the role of the staff health program as a Metropolitan Health Services, regional or consortium infection control program? Are there clear lines of communication and reporting between the staff health service and the infection control program and infection control committee? Does the staff health program focus on infection control for employees and the infection control program focus on infection control activities for patients? Are there protocols for triage, evaluation, prophylaxis, and follow-up after staff exposures and the roles and responsibilities of the staff health service clearly defined.? Have you explored the feasibility of a central staff health service for the Metropolitan Health Services, Region or consortium? Is there a system in place which captures and offers all new employees appropriate screening and vaccination? Is there a database in place which captures information on staff screening and vaccination?
  30. 30. Are staff exposures centrally managed and surveillance data analysed and reported by staff health services to the infection control committee and those who should know and take action? Cost Of Staff Blood/Body Fluid Exposures/Needle sticks It is difficult to estimate the costs associated with needle stick injuries. These costs may include medical, legal, and loss of income expenses. In 1991, the Sydney Occupational Health and Safety Service reported a “conservative” estimate of $550 for one uncomplicated injury treated in-house (ie does not result in transmission of infection). In 1995, the Melbourne Alfred Health Care Group demonstrated costs ranging between $116.91 - 1518.05 depending on several cost factors and scenarios. These costings did not account for indirect costs, the cost of litigation in the event of a health care worker acquiring a blood borne infection could be substantial. In December 1995 a leading Infectious Diseases Physician from a Brisbane based institution died from an AIDS related complications 3 years after an accidental needle stick with a HIV positive patient. The national surveillance system for occupational exposure to blood borne infections, Epinet, is available to collate and analyse data and has the endorsement of the Australian Infection Control Association. Epinet is able to meet the important needs of infection control/occupational health and safety in understanding the mechanisms of how, why and when occupational hazards occur and should provide the basis for a pro-active approach to risk management. References: Waters M. Prevention and Management of Sharps Related Injuries in the Health Care Setting. Infect. Control J, 1991 August: 3-8. Harrington, G.A., Russo P.L., Spellman, D. Costs Associated with Needlestick Injuries. Australian Infection Control, 1995 June: 13-18. Bolyard E., Tablan O., Williams W. etal HICPAC Guideline for Infection Control in Health Care Personnel American Journal of Infection Control Vol. 26, No. 3, 289-354, June 1998. Human Services Victoria, Immunisation Guidelines for Health Care Workers (HCW) Public Health Branch 1998.
  31. 31. Appendix 6 The cost of infection control services Infection control costs can be divided into predictable (implementation and maintenance of IC programs) and unpredictable (outbreaks). Savings, both direct and indirect, that are a direct result of effective infection control policies, and measures taken to reduce or prevent hospital acquired infections and to control outbreaks, have been demonstrated in numerous studies all over the world. Further cost containment and improved efficiency and effectiveness may be explored across a Metropolitan Health Services, Region or Consortia through: • alignment of policy and standards • centralisation and standardisation of data collection and reporting • computer enhancement, alignment and reduction in duplication of surveillance and staff vaccination activities • product evaluation • staff vaccination and screening
  32. 32. Appendix 7 Consortium structure and function The concept of a consortium service model is simple - several hospitals do for all what none can do alone. The Metropolitan Health Service, Region or consortium acquires the services of infection control practitioners, teachers for infection control and standardisation of infection control policies. To make the service function in a meaningful way, all hospitals and programs must be willing to share infection occurrence data, as well as educational and surveillance costs, and have a genuine interest in improving standards of infection control and to the reduction of duplication of activities through centralisation of services (eg data analysis, standards and policy formulation, surveillance reporting, staff vaccination and screening). A Metropolitan Health Services, Regional or consortium service is well adapted to serve community and smaller health care agencies that do not have full-time “seasoned” infection control personnel or the extensive resources of a tertiary hospital. The long term goals of an integrated approach to infection control may include: • To establish links between current infection control clinical nurse consultants thus improving the overall co-ordination and collaboration • To improve patient care and employee safety through ongoing analysis of risk factors and application of interventional strategies (eg staff screening and vaccination programs) • To maximise productivity and utilisation of personnel trained in infection control and problem-solving techniques • To increase the efficiency and effectiveness of risk control programs within a framework of acceptable cost to the Metropolitan Health Services, Region or consortium • To develop and implement an integrated data management information system The main organisational functions may include: • Regular hospital inspections and audits by consulting personnel • Ongoing education for; ~ infection control liaison personnel ~ employees, volunteers and medical staff • Formation and review of infection control policy and procedure • Research related to policies and standards • Resources/consultative services (infection control and wound management) • Surveillance of nosocomial infection occurrences • Outbreak investigations • Cost-containment efforts • Provision of appropriate reports with specific focus on potential risks and adverse events • Product evaluation References: Enrenkranz, N. Observations on the Consortium Method of Infection Control. Infection Control, 1986 Vol 7. No.8 396-396. Hambraeus A. Quality and Education in Infection Control. Establishing an infection control structure. Journal of Hospital Infection 1995 Vol 30 (Supplement) 232-240.
  33. 33. Appendix 8 - Acute Health, Quality and Care Continuity Care Unit - Infection Control Profile Proforma Please indicate which of the following best describes the infection control and prevention service model which your institution/s will operate 1. Proposed infection under over the next 3 years. control and prevention 1. ¨ Entire metropolitan health service infection control collaboration model 2. ¨ Rural region wide infection control service 3. ¨ Rural sub-region infection control service 4. ¨ A collaborative infection control service with resources shared between a number of hospitals (ie a consortium) 5. ¨ Individual hospital/site infection control service 6. ¨ Combination of the above (please specify No’s)__________ Please indicate which of the following best describes the staff infection control service model which your institution/s will operate under over the 2. Proposed staff next 3 years. infection control/health 1. ¨ Entire metropolitan health service staff infection control collaboration service 2. ¨ Rural region wide staff infection control service 3. ¨ Rural sub-region staff infection control service 4. ¨ A collaborative staff infection control service with resources shared between a number of hospitals (ie a consortium) 5. ¨ Individual hospital/site staff infection control service 6. ¨ Combination of the above (please specify No’s)__________ Acute care facility name/s (eg The Sub-acute service names (specify eg Bundoora Other service names (specify eg Bundoora 3. Name of Alfred): Extended Care Centre) Extended Care Centre) hospitals/services who 1. 1. 1. will be included in the infection control 2. 2. 2. service 3. 3. 3. 4. 4. 4. 5. 5. 5. 6. 6. 6. 4. Casemix of service Type of beds (ü please indicate) No. of beds (please specify) If you provide acute care services, Total bed numbers to (if services are provided ¨ acute care _______ acute care do you currently provide any of be serviced by infection please ensure that ¨ rehabilitation the following? control service (please
  34. 34. information on actual ¨ aged care _______ rehabilitation specify) allocated bed numbers are ¨ psychiatric care ¨ complex surgery completed in the space ¨ long term care _______ aged care ¨ adult intensive care ______________ provided) ¨ community health centre ¨ paediatric intensive care ¨ nursing home _______ psychiatric care ¨ neonatal intensive care ¨ special accommodation ¨ emergency services ¨ other (specify) _______ long term care ¨ transplantation _________________________ ¨ dialysis _______ nursing home ¨ oncology/haematology _________________________ ¨ other high risk patients _______ special accommodation (specify) _________________________ _________________________ _______ other (specify) _________________________ _________________________ _________________________ __________________________________ 5. Infection Control Total current infection control Total increased actual infection control staff EFT requirement to provide an Staff practitioner/nurse EFT effective infection control and prevention program. 6. Staff Health Total current number of staff Services health EFT 7. Staff Demographics Total number of hospital Average number of staff turn-over per annum (total for all hospitals the employees infection control service will encompass) We would be grateful if you could provide this information by 29 June addressed to: Melissa Aberline Senior Project Officer Effectiveness Unit Quality & Continuity Care Branch, Acute Health Division 16th Floor, 555 Collins Street MELBOURNE VIC 3000 E-mail
  35. 35. Comments: