FIMDP 2013 DEPT OF COMMUNITY MEDICINE SRM MEDICAL COLLEGE,SRM UNIVERSITY & UNSW AUSTRALIA 9 TH & 10 TH JAN 2013

Transcription

1 FIMDP 2013 DEPT OF COMMUNITY MEDICINE SRM MEDICAL COLLEGE,SRM UNIVERSITY & UNSW AUSTRALIA 9 TH & 10 TH JAN 2013

2 Hospital infection control School of Public Health and Community Medicine Dr Holly Seale Senior Research Fellow School of Public Health and Community Medicine University of New South Wales

3 Hospital acquired infections Risk is universal and pervades every health-care facility and system worldwide. Epidemiology Approximately 1 in 10 hospitalized patients will acquire an infection after admission. ¼ of nosocomial infections occur in ICUs 90,000 deaths/year in USA Attributable annual cost $4.5 $5.7 billion Cost is largely borne by the healthcare facility Does not reflect the loss of productivity and other less quantifiable human and economic costs associated with a serious HAI. Plowman RP, Graves N, Roberts JA. Hospital acquired infection. London: Office of Health Economics; Weinstein RA. Emerg Infect Dis 1998;4: Jarvis WR. Emerg Infect Dis 2001;7:

4

5

6 Factors that promote infection Increasing variety of medical procedures and invasive techniques Continual emergence of drug-resistant bacteria Decreased immunity among patients Poor infection control practices Increasing age of patients Impact Host factors Functional disability and emotional stress Disabling conditions that reduce the quality of life. Leading causes of death Patient costs/hospital costs Increased length of stay and drug use Increased drug resistance Agent factors Environmental factors

7 Infection control: Hospital management

8 patient pathways business planning Building design Human resources Occupational Health, Health clearance, priority Vaccination setting governance Human resources Working patterns, team formation Staffing levels, training, recruitment, communications Facilities management retention, appraisals, Hospital job descriptions, induction, leave infrastructure management, agency, shifts risk management resource allocation Particular impact in context of ICUs information technology bed management antibiotic stewardship Staffing Infection control procedures/training Capital planning Patient ratios

9 Impact of human resources management on infection control Direct link: Occupational health health clearance/checks i.e. TB screening vaccination of staff against preventable infections Indirect link Shift patterns team formation skill-mix staffing levels staff training HR activities (recruitment and retention, induction, leave management, agency staff)

10

11 Hospital management must consider infection control primarily as a core aspect of patient safety, and as an indicator of quality of care. Infection prevention and control relies upon: The successful interplay and management of multiple systems The Integration of infection prevention and control into management at all levels Forcing specific consideration of infection risk for patients throughout multiple management systems. Entirely dependent on implementation of best practice in individual clinical care.

12 Future directions Cannot rely on individual specialist teams or isolated group of committed experts Comprehensive whole scale organisational approach required Infection risk needs to be considered in almost all areas of hospital management, patient pathways and care. Fully integrating infection control into structure, systems, metrics and culture Must also include a research and education strategy

13 Infection control: Healthcare workers

14 PROBLEM = ADHERENCE Individual infection control strategies

15 Compliance with guidelines Currently there is a lack of compliance to evidence-based infection control guidelines to prevent device and procedure associated HAIs including: catheter-associated urinary tract infections central line-associated bloodstream infections ventilator-associated pneumonia surgical site infections The extent infection control guideline compliance is especially variable, with the literature demonstrating a range of 20% to 100% However, generally the literature indicates that compliance to infection control guidelines is unacceptably low McCoy KD, Beekmann SE, Ferguson KJ, et al. Monitoring adherence to Standard Precautions. American journal of infection control 2001;29: Gammon J, Morgan-Samuel H, Gould D. A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. Journal of clinical nursing 2008;17:

16 The reason for low compliance include: Poor or inappropriately chosen clinical leaders A lack of awareness Ineffective communication/dissemination of guidelines Time constraints Workload Disagreement over the composition of infection control guidelines Dealing with high vs. low risk patients Overcrowding Understaffing Outbreaks

17 Example 1: Hand hygiene Often too busy/insufficient time Hand hygiene interferes with HCW-patient relation Low risk of acquiring infection from patients Lack of role model from colleagues or superiors Not thinking about it/forgetfulness Scepticism about the value of hand hygiene Disagreement with the recommendations Lack of scientific information of definitive impact of improved hand hygiene on HAI WHO Guidelines on Hand Hygiene in Health Care 2009

18 Example 2: Mask/Respirator use Available data suggest a general poor compliance with recommendations Physical discomfort Communication interference Perception of risk/anxieties Embarrassment Commitment to prevention measures Poorly fitted Not easily accessible Spreads undesired alarming impressions Interfere with breathing Facial hair

19 Example 3: Non-receipt of influenza vaccination

20 Future directions: campaigns to improve compliance General approaches: education, communication, audits, mandates, encouragement, inducements, feedback Directed at individual, ward or hospital level Variable time period Single vs. multimodal Evaluation? Must take into account factors that affect human behaviour 1. Rational (eg, motivation to comply with a best practice), 2. Contextual (eg, environmental factors that improve or impede a behaviour, such as access to sinks) 3. Emotional features (eg, excessive stress).

21 Conclusions There is a current need to explore factors that create and sustain a culture of safety in the healthcare workplace, and in particular whether the barriers or motivators differ across professional groups within an organisation. Safety climate is being increasingly recognized as one of the most important determinants of safe work practice An organisational approach to Infection prevention is needed, involving management structures and systems to change behaviour and culture, to drive and support sustainable improvement Consider including infection control compliance as a healthcare indicator

22 References 1. Caban-Martinez AJ, Lee DJ, Davila EP, et al. Sustained low influenza vaccination rates in US healthcare workers. Preventive Medicine 2010;50: Wicker S, Rabenau HF, Doerr HW, Allwinn R. Influenza vaccination compliance among health care workers in a German university hospital. Infection 2009;37: Al-Tawfiq JA, Antony A, Abed MS. Attitudes towards influenza vaccination of multi-nationality health-care workers in Saudi Arabia. Vaccine 2009;27: Seale H, Wang Q, Yang P, et al. Influenza vaccination amongst hospital health care workers in Beijing. Occupational Medicine 2010;60: Esposito S, Bosis S, Pelucchi C, et al. Influenza vaccination among healthcare workers in a multidisciplinary University hospital in Italy. BMC Pub Health 2008;8: Loulergue P, Moulin F, Vidal-Trecan G, et al. Knowledge, attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations. Vaccine 2009;27: Dinelli MIS, Moreira TdNF, Paulino ERC, da Rocha MCP, Graciani FB, de Moraes-Pinto MI. Immune status and risk perception of acquisition of vaccine preventable diseases among health care workers. American Journal of Infection Control 2009;37: Abu-Gharbieh E, Fahmy S, Rasool BA, Khan S. Influenza vaccination: healthcare workers attitude in three Middle East countries. International Journal of Medical Sciences 2010;7: Muhammad HSS, Hayes B. Factors determining uptake of influenza vaccine among healthcare workers in a hospital setting. Journal of Hospital Infection 2010;76: Llupià A, Alberto LG-B, Victoria O, et al. New interventions to increase influenza vaccination rates in health care workers. American Journal of Infection Control 2010;38: