Talk at APSIC 2015, Taipei, Taiwan

1. 28-­‐03-­‐15
1
Who
do
you
want
to
accredit?
A. The
hospital
as
a
whole
–
with
regard
to
infec=on
control
B. The
Infec=on
Control
unit
Both
works
–
depending
on
how
broad
you
evaluate
the
seFng
in
which
the
IC
unit
operates
Na=onal
IC
guidelines
Norm
with
regard
to
size
and
structure
of
IC
units
¤ Na=onal
IC
guidelines
¤ Norm
with
regard
to
size
and
structure
of
IC
units
¤ Recognized
training
for
ICP
&
MD’s
¤
Laws
with
regard
to
CME
¤
Laws
with
regard
to
transmissible
diseases
¤
Inspectorate
² An
authority
that
can
penalize
non-­‐conforming
healthcare
ins=tu=ons
¤ Risk
of
acquiring
preventable
infec=ons
due
to
breaks
in
preven=ve
measures
² Guidelines
implementa=on
&
behavioral
change
¤ An=microbial
resistance
impeding
pa=ent’s
safety
² Interrupt
transmission
of
MDROs
² An=microbial
stewardship
Indicators
need
to
asses
the
above!

2. 28-­‐03-­‐15
2
¤ Structure
¤ Process
¤ Outcome
¤ to
ensure
that
the
infec=on
control
team
is
geFng
the
necessary
funding
to
adequately
do
their
work
in
a
seFng
that
commits
to
pa=ents
safety
aspects
Important
indicator,
but
² Par=cular
considera=on
needed
² Major
piXalls
-­‐
weighing
of
individual
steps
of
the
process.
• “A
chain
is
only
as
strong
as
it’s
weakest
link”
is
not
correct
for
many
processes!
Process
if
okay,
but
outcome
is
what
it’s
all
about
¤
Incidence
of
defined
MDRO
in
blood-­‐cultures
per
100,000
days
at
risk
² Overall
admisson
days
of
the
hospital
-­‐
(2
x
admissions)
¤
Environmental
cleaning
²
final
cleaning
a`er
discharge
of
isola=on
pa=ent
check
with
microbiology
or
ATP
¤ Hand
hygiene
² WHO
method
or
compliance
rate
Please
–
No
more!
Medicine
2015
Paper
work
instead
of
work
with
pa=ents

3. 28-­‐03-­‐15
3
¤
Easy
to
collect
²
Extractable
from
LIS
and
HIS
²
App
support
¤
Clearly
and
well
defined
²
Everyone
really
measuring
the
same,
comparable
between
different
hospitals
¤
Immediately
accessible
for
the
user
²
Guide
interven=ons
Do not allow non-
professionals to
formulate them
MD*
*lead
ICP ICP
ICT
Inspec-
torate
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26
Crosssec8onal
surveillance
of:
¤ Two
outcome
variables:
² Prevalence
of
HAI
(SSI,
LRTI,
UTI,
GI,
bacterial
conjunc=vi=s)
² prevalence
of
rectal
carriage
of
ESBL
producing
Enterobacteriacea
¤ Two
resident-­‐related
risk
factors:
² prevalence
of
medical
device
² prevalence
of
an=microbial
therapy
¤ Three
ward-­‐related
risk
factors:
² environmental
contamina=on
² shortcomings
in
infec=on
preven=on
precondi=ons
² availability
of
local
infec=on
preven=on
guidelines
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26
¤
For
each
outcome
variable
or
risk
factor,
breakpoints
were
set
to
make
the
division
in
3
categories
²
low,
intermediate
and
high
²
Classifica=on
based
on
na=onal
prevalence
surveys,
scien=fic
publica=ons
and
if
no
data
was
available
on
expert
opinion
¤
Popula=on
characteris=cs
get
considered
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26

4. 28-­‐03-­‐15
4
¤ Infec=ons
in
NH
¤ Intravenous
administra=on
¤ Medicine
administra=on
¤ Cleaning/disinfec=on
and
steriliza=on
¤ Storage
of
sterile
materials
¤ Waste
collec=on
and
transport
¤ Urine
drainage
and
defeca=on
¤ Care
of
airways
¤ Wound
care
¤ Tube
feeding
¤
MDRO/MRSA
¤
Norovirus
¤
Scabies
¤
Legionella
control
¤
Food
safety
¤
Pets
in
the
NH
¤
Registra=on
of
ID
¤ Hand
hygiëne
¤ PPE
¤ Personal
hygiene
¤ Personnel
ID
blood
exp
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26
¤
Bathroom
sink
¤
Bedside
cabinet
¤
Table
living
room
¤
Microwave
kitchen
¤
Bedside
commode
¤
U=lity
room
¤
Sterile
storage
shelve
¤
Toilet
seat
¤
Washing
bowl
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26
¤
Availability
of
hand
alcohol
¤
Availability
of
gloves,
gowns,
masks
¤
Availability
of
needle
container
¤
Availability
of
bedpan
washer
¤
Availability
of
plas=c
aprons
¤
Presence
of
at
least
one
HH
sink
per
15
residents
¤
Presence
of
at
least
wo
toilet
groups
per
15
residents
¤
Presence
of
at
least
one
single
room
with
bathroom
per
15
residents
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26
Willemsen
et
al
Antmicrob
Resistance
Infect
Control
2014;3:26

5. 28-­‐03-­‐15
5
Dutch
Society
of
ICP
Dutch
Society
of
Medical
Microbiology
Quality
Visita8on
commiEee
(2006)
¤
Aiming
at
the
work
of
the
infec=on
control
team/unit
–
not
the
hospital
as
a
whole
¤
Audits
are
done
by
ICPs
and
IC-­‐MDs
¤
The
audit
is
based
on
interna=onal
and
na=onal
laws
and
guidelines,
including
ISO
14001
and
OHSAS
18001
¤
Uses
Plan-­‐Do-­‐Check-­‐Act
(PDCA)
principles
The
quality
criteria
are
defined
as:
¤
Norms
=
must
haves
¤
Points
of
anen=on(
POA)
=
the
minimum
norms
(checkable
via
quick-­‐scan)
¤
Addi=onal
points
=
want
to
haves
1. Mission
and
vison
2. Strategy
Aims
3. Work
of
the
IC
unit
4. Human
resource
aspects
5. Finances
6. Housing
7. Internal
Quality
Control
Norm
¤ Unit
has
a
vision
and
mission
POA
¤ Present
on
paper
¤ Only
one
vision
and
mission
¤ Concurrent
with
hospital
VM
¤ The
ambi=on
formed
by
VM
should
be
known
to
others
¤
Quality
system
¤
Strategy
planning
report

6. 28-­‐03-­‐15
6
Norm
¤ Quality
system
designed,
documented
and
implemented
PAO
¤ Complete
Quality
Manual
¤ Inten=on
to
cooperate
documented
¤ Scope
defined
¤ Responsibili=es
of
controlling
groups
documented
Norm
¤ Strategy
and
according
aims
are
formulated
and
supported
(FTE,
$)
¤ Responsibili=es
formulated
POA
¤ Mul=-­‐year
strategy
plan
present
¤ Year
plan
present
² SMART-­‐formulated
² corresponding
with
mul=-­‐year
plan
² Controlled
planning
and
achievements
² Safety,
integrity,
privacy,
communica=on
Norm
¤ Clear
descrip=on
of
responsibili=es
and
what
the
unit
is
doing
POA
¤ What
are
the
primary
tasks
–
documented
¤ “Customers”
know
what
the
tasks
are
¤ Tasks
are
priori=zed
¤ Possible
overlap
with
technical
services,
cleaning,
CSD,
…
described
I
skip
the
next
7
slides
but
they
are
online
¤ Surveillance
and
implementa=on
of
improvement
IC
guidelines
based
on
na=onal
laws/guidelines
¤ Outbreak
management
¤ Training
¤ Audits
¤ Consultancy
¤ Cleaning,
disinfec=on,
steriliza=on
¤ Construc=on
¤ Control
of
water
and
air
¤ Buying
of
disposables
othet
biomedical
products
¤ Research
Norm
¤
Posi=on
and
hirachical
and
func=on
management
of
units
is
described
POA
¤ Organogram
present
¤ SLA
with
external
organisa=ons
¤ Par=cipa=on
in
comminees
(internal
extermal)
¤ Communica=on
and
exchange
of
informa=on
with
microbiology
lab

7. 28-­‐03-­‐15
7
1. Mission
and
vison
2. Strategy
Aims
3. Work
of
the
IC
unit
4. Human
resource
aspects
5. Finances
6. Housing
7. Goods
8. Internal
Quality
Control
¤ Internal
structure
and
responsibility
¤ Descrip=on
of
the
professional
func=ons
¤ Overview
of
individuals
tasks
and
addi=onal/
external
work
¤ Planning
(free,
on-­‐duty,
…)
including
con=nuity
in
the
work
and
communica=on/reachability
¤ SOPs
² New
co-­‐worker,
(cont.)
eductaion/training,
size
of
the
unit,
guidline
with
regard
to
part-­‐=me
work,
…
¤ Yearly
professional
evalua=on
of
each
co-­‐worker
¤
Independence
of
the
unit
¤
Document
who
is
responsible
for
finances
–
budget
control
¤
Contracts
and
SLAs
¤
Insurances
¤
Close
to
wards
¤
Adequate
rooms
² including
telephones,
computers,
printers,
…
¤
Access
to
all
systems
(LIS,
HIS,
OR
ystem,
…)
¤
Safety
aspects
¤
Documents
and
archives
¤
Internal
and
external
quality
control
of
the
unit
¤
Management
review
¤
Lots
of
good
stuff,
and
probably
needed
for
an
accredita=on,
best
we
have,
but
…
¤
Very
theore=cal
Long
and
a
lot
of
work
¤
Addi=onal
to
professional
audit
by
peers
–
instead
of
integrated

8. 28-­‐03-­‐15
8
We
can’t
make
it
fun,
but
we
do
our
best
to
make
it
prac=cal
and
easy