Hospital organisation, management and structure for prevention of HAI. Walter Zingg (UK)

3rd Joint Meeting of the ARHAI-Networks
ECDC Point prevalence survey, 2016-2017
Indicators
Carl Suetens (ECDC), Walter Zingg (UK)

3rd Joint Meeting of the ARHAI Networks, Stockholm
Evidence and expert opinion for
infection control measures in
Europe (SIGHT project)
Walter Zingg, MD
Imperial College London

• Overall goal: identify the most effective and generally
applicable elements of hospital infection prevention and
control programmes to support the broadest possible
implementation across Europe
• 1st objectives: collect, review and appraise in a systematic
manner the best available evidence of effectiveness at
local/national level of selected components of programmes
• 2nd objectives: develop expert guidance on key
components, put them into perspective and define
structure and process indicators

Number of records
identified through
database searching
N = 47,948
Additional records
identified through
other sources
N = 131
Duplicates from different databases removed: 8362
Articles for title and abstract evaluation: 39,717
Removed after title and abstract evaluation: 37,487
Articles for full text evaluation: 2230
Articles excluded: 1397
- Selection criteria not met: 1040
- Full text inaccessible: 357
Articles for quality assessment: 833
Total records identified: 48,079
Articles included for data analysis and synthesis: 92
[RCT (3), CBA (5), ITS (4), CCS (4), NCBA (34), NCC
(22), Qualitative (16), Mixed-methods (4)]
Duplicates from different dimensions removed: 226
Removed due to insufficient quality: 515
Zingg W. Lancet Infect Dis 2015;15:212

WP1:SystematicreviewWP2:Elaborationofkeycomponents
andprocessandstructureindicators
2ndexpert
meeting
Dimension 1
[Organisation, structure]
Dimension 2
[Surveillance, feedback]
Dimension 3
[Education, training]
Dimension 4
[Multimodal strategies,
behavioural change]
Dimension 5
[Policies/resources on
isolation precautions]
Allocation of indicators to
the key components
Additional
systematic review
[auditing, target setting,
patient participation,
knowledge management]
Definition of the search strategy; inclusion/exclusion criteria
Elements (14) Elements (5) Elements (11) Elements (4)
Final set of key components (10)
Elements (11)
1stexpert
meeting
2nd set of key components
Creation of list of indicators3rd set of key components
1st set of key components

Process and performance Indicators

o Clear and concise
o Action focused (should lead to action)
o Important (stakeholders agree that the indicator makes a relevant
contribution to respond to a problem)
o Measurable (collecting meaningful and credible data)
o Simple
o Acceptable (to stakeholders)
o Valid (accurately measure what they claim to measure)
o Reliable (consistent over space and time)
o Sensitive for change (detects change over time and across settings)
o Free from bias (no systematic errors)
→ Provides strategic insight required for effective planning and sound
decision-making
Campbell SM. BMJ 2003;326:816
Buyle FM. Eur J Clin Microbiol Infect Dis 2013;32:1161

Organisation of infection control (IC) at
hospital level
Key component
An effective infection control
programme in an acute care
hospital must include at least:
one full-time specifically trained
IC-nurse ≤ 250 beds; a dedicated
physician trained infection
control; microbiological support;
data management support
o Detailed infection control activities: number
of ongoing surveillance and prevention
programmes, outbreaks, number of
performed audits - longitudinal
o Established infection control (Organisation):
appropriate staffing, IC committee in place,
defined goals for IC, identified IC budget, IC
on the agenda of the hospital
administration, defined outbreak
management, vaccination programmes for
health-care workers - transversal
Indicators

SIGHT-Indicators (KC 1)
o Detailed infection control activities:
number of ongoing surveillance and
prevention programmes, outbreaks,
number of performed audits –
longitudinal
o Established infection control
(Organisation): appropriate staffing, IC
committee in place, defined goals for
IC, identified IC budget, IC on the
agenda of the hospital administration,
defined outbreak management,
vaccination programmes for health-care
workers - transversal
ECDC PPS
IPC programme components
o Is there an annual IPC plan, approved/
signed off by the hospital CEO?
 Yes  No
o Is there an annual IPC report, approved/
signed off by the hospital CEO?
 Yes  No
o Number of FTE infection control nurses
o Number of FTE infection control doctors
o Number of blood culture sets/year
o Number of stool tests for CDI/year
o At weekends, can clinicians request
routine microbiological tests and receive
back results?
On Saturdays:  yes  no
On Sundays:  yes  no
hospital level

TATFAR
o TATFAR core indicator 6: “Does your
facility provide any salary support for
dedicated time for antimicrobial
stewardship activities
o TATFAR core indicator 12: “Is there a
formal procedure for a physician,
pharmacist, or other staff member to
review the appropriateness of an
antimicrobial after 48 hours from the
initial order (post-prescription
review)?”
ECDC PPS
Antimicrobial Stewardship
o Number of FTE antimicrobial
stewardship
o Start date/indication of antibiotics
o Antibiotics reviewed after 48-72 hours
hospital level

Isolation capacity
[SIGHT-Indicators (KC 1)]
ECDC PPS
o Number of beds in ward
o Number of patient rooms in ward
o N of single rooms in ward
o N of single rooms with individual
toilet and shower
hospital level

Ward occupancy and workload
To make sure that the ward
occupancy does not exceed the
capacity for which it is designed
and staffed; staffing and
workload of frontline health-care
workers must be adapted to
acuity of care; and the number of
pool/agency nurses and
physicians minimized
Key component
o Average bed occupancy (85%) at midnight
o Average staffing of frontline workers
o Average proportion of pool/agency
professionals
Indicators

o Average bed occupancy (85%) at
midnight
o Average staffing of frontline workers
o Average proportion of pool/agency
professionals
ECDC PPS
Staffing/Occupancy
o Number of FTE registered nurses
o Number of FTE nurses aides
o Number of FTE registered nurses in
ICU
o Number of FTE nurses aids in ICU
o Number of FTE antimicrobial
stewardship
o N of beds occupied at 00:01 on the
day of PPS
(Nurse-patient ratio: hospitalwide & ICU)
Ward occupancy and workload

Materials, equipment, and ergonomics
Sufficient availability of and easy
access to material and
equipment and optimized
ergonomics
Key component
o Alcohol-based handrub at the point of care
(proportion)
o Sinks stocked with soap and single-use
towels (proportion)
Indicators

o Alcohol-based handrub at the point
of care (proportion)
o Sinks stocked with soap and single-use
towels (proportion)
ECDC PPS
Alcohol-based handrub (ABHR) at the
point of care
o Alcohol hand rub consumption in
ward (L/year)
o Number of beds in ward
o N of beds in ward with ABHR
dispensers at point of care
o Percentage of HCWs on ward with
ABHR dispensers in pocket
Materials, equipment, and ergonomics

Use of guidelines, education, and training
Use of guidelines in combination
with practical education and
training
Key component
o Guidelines locally adapted (written)
o Number of new staff trained using the
local guidelines
o Teaching programmes are based on local
guidelines
Indicators

Team-oriented and task-oriented education
and training
Education and training involves
frontline staff, and is team- and
task-oriented
Key component
o Audit of education and training
programmes
o Results of knowledge tests and competency
assessments
Indicators

Standardisation of audits
Organizing audits as a
standardized (scored) and
systematic review of practice with
timely feedback
Key component
o Number of audits (overall, and stratified by
departments/units and topics) for
specified time period – Yes/No
Indicators

o Organizing audits as a standardized
(scored) and systematic review of
practice with timely feedback
ECDC PPS
IPC programme components
o N observed hand hygiene
opportunities per year
o Vascular and/or or urinary catheter
insertion, and/or intubation care
o Use of PPE (i.e. one opportunity for
correct use of gloves, masks, aprons
etc)
Standardisation of audits

Prospective surveillance, feedback, and
networks
Participating in prospective
surveillance and offering active
feedback, preferably as part of a
network
Key component
o Participation of (inter-) national
surveillance initiatives
o Number and type of wards with a
surveillance
o Hospitalwide/selected wards
o Regular review of the feedback strategy –
Timely feedback
Indicators

o Participation of (inter-) national
surveillance initiatives
o Number and type of wards with a
surveillance
o Hospitalwide/selected wards
o Regular review of the feedback
strategy – Timely feedback
ECDC PPS
Participation in surveillance networks
In the previous year, which surveillance
networks did your hospital participate in
?
SSI
ICU
CDI
Antimicrobial resistance
Antimicrobial consumption
Prospective surveillance, feedback, and
networks

Development of multimodal strategies and
tools
Implementing infection control
programmes follow a multimodal
strategy including tools such as
bundles and checklists developed
by multidisciplinary teams and
taking into account local
conditions
Key component
o Verification that established prevention
programmes follow a multimodal strategy
o Process indicators: hand hygiene
compliance, compliance with medical/care
procedures by checklists, compliance with
cleaning/disinfection procedures
o Outcome indicators: standardized rates for
HAI, infections with MDROs, transmission of
MDROs
Indicators

o Verification that established prevention programmes follow a multimodal strategy
o Process indicators: hand hygiene compliance, compliance with medical/care procedures
by checklists, compliance with cleaning/disinfection procedures
o Outcome indicators: standardized rates for HAI, infections with MDROs, transmission of
MDROs
Development of multimodal strategies and
tools
ECDC PPS
Guideline
Education&
Training
Audit
Surveillance
Feedback
Pneumonia (healthcare- or ventilator-associated)
Bloodstream infections (HA- or catheter-associated)
Surgical site infections
Urinary tract infections (HA- or catheter-associated)

Identification and engagement of strategy
champions
Identifying and engaging
champions in the promotion of a
multimodal intervention strategy
Key component
o Interviews with frontline staff and
infection control professionals
Indicators

Creating a positive organisational culture
A positive organizational culture
by fostering working relationships
and communication across units
and staff groups
Key component
o Questionnaires about work satisfaction
o Crisis management
o Human resource indicators: absenteeism,
health-care worker turnover
Indicators

o Questionnaires about work
satisfaction
o Crisis management
o Human resource indicators:
absenteeism, health-care worker
turnover
ECDC PPS
Organisational culture
Total % absenteeism [total absenteeism
days] / [total working days per year] in
previous 5 years:
Year-1 [___]%
Year-2 [___]%
Year-3 [___]%
Year-4 [___]%
Year-5 [___]%
Creating a positive organisational culture

Hospital organisation, management and structure for prevention of HAI. Walter Zingg (UK)

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