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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
: Sys
tem
atic
revi
ew
WP2
: Ela
bora
tion
of k
ey c
ompo
nent
s an
d pr
oces
s an
d st
ruct
ure
indi
cato
rs
2nd e
xper
t m
eetin
g
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
xper
t m
eetin
g
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
Zingg W. Lancet Infect Dis 2015;15:212
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
Zingg W. Lancet Infect Dis 2015;15:212
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
Organisation of infection control (IC) at 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
Organisation of infection control (IC) at 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
Zingg W. Lancet Infect Dis 2015;15:212
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
Zingg W. Lancet Infect Dis 2015;15:212
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
Zingg W. Lancet Infect Dis 2015;15:212
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
Zingg W. Lancet Infect Dis 2015;15:212
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
Zingg W. Lancet Infect Dis 2015;15:212
SIGHT-Indicators (KC 6)
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
Zingg W. Lancet Infect Dis 2015;15:212
SIGHT-Indicators (KC 7)
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
Zingg W. Lancet Infect Dis 2015;15:212
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
elin
e
Educ
atio
n &
Tr
aini
ng
Audi
t
Surv
eilla
nce
Feed
back
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
Zingg W. Lancet Infect Dis 2015;15:212
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
Zingg W. Lancet Infect Dis 2015;15:212
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)