IPCwiththefeetinthedirt 21-06-17

AndreasVoss 1

AndreasVoss,MD,PhDClinical Microbiology &ID

ProfessorofInfection ControlCWZand RadboudUMC

Nijmegen,TheNetherlands¤ AMR,AMR,AMR,…¤ Achangeofculture(patientsafety)¤ Documentation,certification,accreditation&morepaper¤ Publicreporting(blame&shameà alternativetruth)¤ Patientparticipation¤ Technology(WGS,microbiome)anditsfailures(H/C,scopes)¤ Education(interactive,e-learning/gaming,stopPTYOC*)¤ Handlingthemedia(ortryingto)

*preachingtoyourownchoir

… how to get(orbetter yet keep)my resources*

and how tohandlemy

administrator

*somekindof“magic”possiblyinvolved

Iam being forced to havean IPCprogram

IPCisacost-centre

¤ StillbeingforcedtorunanIPCprogram,butluckilynolawonhowmuchIhavetoinvestintoit² exceptsuggestions withregardtotheFTEforIPCnurses

¤ IPC&HAIreductionmaysavecostsfor“thesociety”butwhat’sittomyhospital?Certainlynotarevenue-generator.

Disclaimer:PresentadministratorsromHUGobviouslythinkdifferently

Your hospitaldirector’ssupport?

Secure IPC basic needs

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1. Convinceyouradministrationthat”we”haveaproblem

2. The“businesscaseforIPC”

3. Ensureyour“mission”isknown

4. ShowthatIPCismorethan“savingcosts”

5. Choosebestthingstodowithyour“fixedbudget”

6. Neverwaistagoodoutbreakorpublichealthcrisis6

Showthat HAIs areaproblem inyour hospital

Dewehavearealproblem?

Makesure that Houston(=hospital administration)knows that “we”includes

them:They haveaproblem!

… the prevent and repair team

Greatguideline– notimetotalkaboutitnow

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a well thought of and non-detectable

sum of lies and assumptions to be able

to finance what we believe is needed

¤ Describeaproblem(e.g.CLABSI)

¤ Lookforpossiblesolution(e.g.coatedcathetersvs“bundle”)

¤ DoafulleconomicevaluationestimatingthecostsofCLABSIinyourhospital(includingextraLOS)andthecostsoftheintervention² BenefitisreductionofcostsAND gainofrevenue(e.g.shorterLOS)

¤ FirstusebasicIPC– thanstartonthe“gadgets”

Donotwaituntilatypicaldoctorinyourhospitalwantstoimplementanewgadgetbasedonalternativefacts,oronargumentssuchas…

“This isso great,so much better”

Soundsun-needed?

People(includingtheMedicalDirector)willfollowyoumuchmore

readily iftheyknowwhatyoustandfor

OurmissionistopromoteahealthyandsafeenvironmentbypreventingthespreadofMDROsandthetransmissionofinfectiousagentsamongpatientsandstaff.Westrivetoaccomplishthisinanefficientandcosteffectivemanner,basedonexternalandinternalstandards,keepinginmindthebestwayswecansupportourclinicalcolleaguesandserveourpatientsandtheirfamilies.

adaptedfromHoffmannK,InfectControlToday,Dec2000

Less HAIsLess AB Less LOSSafer Care

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¤Safercare=bettercare

¤Corner-stoneinpreservingantibiotics

¤Stimulategeneralpreventivemeasurese.g.flu-shot

¤Engageinvisibleactionse.g.handhygieneactionthatgetpicked-upbypress

¤EducatenotonlyHCWs,butpatientsandthepublic

¤TrytoevaluatepatientssatisfactionwithregardtoIPC

¤ Thisisthetimetoputallyourknowledgeandengagementintovisibleaction² thebetteryoudoyourjobnormally,thelessyourworkisrecognized

¤ Timetostresstheimportanceofnewtypingmethods,rapiddiagnostictestoranIPCmeasurethatsofarwasn’tfunded² VREoutbreak:cleaningwipes² Flu-threat:GeneXpert andothers

What are you asking for?

¤ Taskdifferentiation¤ Link-nursesystem¤ Prioritizehighprevalenceunits/problems

² actuallychoose“posteriorities”youreallydon’tdo!² turfunwantedtasks(e.g.needle-stickaccidentstooccupationalhealth)² inventnewpositionsinprofessionalguidelines(DSMH/DSRD)

¤ Investinbettersoftwareandautomation (e.g.surveillance)¤ Engageclinicians(e.g.surgeonsinchargeofSSIimprovement)

1. Structureandpositioninorganization

2. Accesstoalldatasources

3. Useofrapiddiagnostictests&typing

4. Moralsupport(byadministrationandmedicaldirector)

5. FinanceCMEincluding(non-ICP)education

6. Freedomandsupporttoimplementnewidea’s

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¤ Independentdepartment

¤ Directlinewithadministration

¤ ReferredresponsibilitiesforICP

¤ ICTsupport&software

¤ Locatedwithinhospital,preferablyinconjunctionwithMMBorID-service

¤ AbetterthanSENICformation

Infection Control-teamCoordinating

ICPAdmin.support

Datamanger

IC.techICP’s

Infection ControlPhysician

1ICPper5000admissions,1IC-MDper25000admissions

Accessto:

¤ Alldepartments(requestedandun-requested)¤ Allpatientfiles¤ ORsystems¤ Complicationregistrationsystems¤ Censusdataofthehospital¤ Facilityservicesandmedicaltechniquereports Notagiven

everywhere

¤ Administrationandmedicaldirector(orexecutiveboardofthemedicalstaff)needtobethemainandvisibledriversofthepatientsafetyculturechange

¤ Withouttheirsupportnomajorchangesinyourinstitutionwillbeachievable

MoreMDs &RNs

Med Director

NewHCW

CEO

MD

RNs DO NOT CLINB, PLAY ON, AND AROUND PIPE

Certainly true with regard to Infection Control.

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Certainly true with regard to Infection Control.

MoreMDs &RNs

Med Director

CEO

MD

RNs

Less newHCW

DO NOT CLINB, PLAY ON, AND AROUND PIPE

¤ ContinuousInfectionControlEducation(CICE)forICPsisamust¤ Investin“soft”educationsuchascommunicationskills,

behavioral&implementationscience,negotiationskills,…

¤ Makein-houseICPeducationmandatory(min.startingHCWs)¤ IC-meetingsforregionalstakeholders(andthegeneralpublic)¤ IncludeICPtrainingearly-onintrainingofnursesandinterns

(preferablyatschoollevel)

ICPs

otherH

CWs

¤ Behavior¤ Patientparticipation¤ Transmissionprevention

² Handhygiene,Environmentalcontrol

¤ Surveillance¤ Guidelines

1

What is a Surgical Site Infection (SSI)?

Surgical site infections (SSIs) are wound infections that occur after invasive surgical procedure at the body part where surgery has been performed. These infections may involve only the skin, or may be more serious and involve tissue under the skin or organs. A surgical site infection may cause symptoms such as: redness, warmth, pain or tenderness around the affected site, discharge of pus or fever. The majority of SSIs become apparent within 30 days from the sur-gical procedure. Surgical site infection can often be prevented if care is taken before, during and after surgery.

What are hospitals doing to pre-vent the occurrence of surgical site infections?

Hospitals perform surgical site surveillance for specific operations and can then compare to national levels.

Ask your health care provider information if they participate in surgical site infection sur-veillance programme?

As part of the preoperative process, for cardiotho-racic, orthopaedic or other high risk surgery you will be screened for Staphylococcus aureus carriage (a nasal swab will be collected).

If you are a carrier of Staphylococcus aureus you will need to adhere to treatment with an ointment and possibly an antiseptic wash for the recommended duration before and after your surgery.

You may be prescribed antibiotics to further reduce the risk of developing an infection. In most cases, antibiotics will be administered within 60 minutes before the surgery starts and should not last for longer than 24 hours follow-ing surgery.

What can I do to prevent Sur-gical site infections?

Before the surgery:

Smoking is a known risk factor associated with complications during and also after the surgical procedure. People who smoke are prone to de-veloping more infections after surgery. It is recommended that you stop smok-

ing 4 weeks or longer before your sur-gery

Your healthcare provider should be informed of the following:

Your medical history, particularly in ca-se of diabetes mellitus.

Your travel history within the last year or previous recent hospitalisation abroad.

A PATIENT INFORMATION LEAFLET

PREVENTING SURGICAL SITE INFECTIONS

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Hospital Cleaning

HPV UV

+/- specialwall paint

Copperand(nano)technology

¤ Thefeedbackofstructure-,process- andoutcomeparameterstoHCWswillcontinuetobeanimportantpartofinfectioncontrol

¤ Surveillanceonlyworkswhengoing“full-circle”(PDCA)¤ Bundles,includingbundlecompliance,shouldbeincludedin

surveillancesystems

Nottheneedforsurveillancebutthemethodswillchange

… only works if youactually dosomething

with the data…

Rightalgorithm&possiblychangeddefinitions

Truck=healthcare quality system

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Myhospitaldirectorisnexttomeinthedirt

notstoppingmefromdoingwhatneedstobedone,butgivingmeapush!(evenititsometimestookawhileforthemtorecognizethatshouldbetheirjob)