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

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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)

1st e

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2nd set of key components

Creation of list of indicators 3rd set of key components

1st set of key components

Process and performance Indicators

What makes a good indicator?

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

Organisation of infection control (IC) at hospital level

TATFAR

SIGHT-Indicators (KC 1) 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


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


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


SIGHT-Indicators (KC 2) 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


SIGHT-Indicators (KC 3) 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


SIGHT-Indicators (KC 8) 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

Guid

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Educ

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Tr

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Audi

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Surv

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Feed

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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


SIGHT-Indicators (KC 10) 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

3rd Joint Meeting of the ARHAI-Networks ECDC Point prevalence survey, 2016-2017

Indicators Carl Suetens (ECDC), Walter Zingg (UK)

Health & Medicine

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