LEARNING LESSONS FROM IMPROVEMENT OF MANAGEMENT OF HEALTHCARE ACQUIRED INFECTION GSAS Sponsored Seminar / Workshop

LEARNING LESSONS FROM IMPROVEMENT OF MANAGEMENT OF HEALTHCARE ACQUIRED INFECTION

GSAS Sponsored Seminar / Workshop

Professor Charles Egbu PhD University of Salford, UK

Qatar National Convention Centre, Doha – Qatar 14th June 2014

EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION 2

HAI in ContextFM in ContextThe Role of FM in the Control of HAIThe Role of Knowledge Management and

Knowledge Mapping in Controlling HAIPerformance Management and FM in the

Control of HAI

Structure of Presentation


• HAI by definition means the infection was neither present nor incubating at the time of admission but has developed during the course of a stay in hospital or other facility

(Haley, 1986 as cited in Horton and Parker 2002; Comptroller and Auditor General, 2000; Public Health Laboratory Service, 2000; Scottish Executives Action Plan, 2002; World Health Organisation, 2002; Montana State Hospital, 2003).

Healthcare Associated Infection (HAI)

EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION

Tranquil GardensNursing Home

HomeCare

Acute Care Facility

Outpatient/Ambulatory

Facility

Long Term Care Facility

The Healthcare System More than Just Hospitals

Source: Alice Guh, MD, MPH – (CDC)


She was progressing in the neonatal intensive care unit until she developed a bloodstream infection

related to her umbilical catheter.

Your baby was born prematurely.



The surgery goes well but he later dies in a nursing home of a

MRSA wound infection that developed after

surgery.

Your father has open heart surgery.



• HAI is recognised as presenting a significant problem in terms of quality of care and cost for hospitals, governments and consumers in most countries (Department of Human Services, 1998).

• In prevalence surveys of hospital infection in the UK, and other developed countries, the acquired infection rate was approximately 10% (which means approximately 10% of patients in hospitals at any one time have acquired an infection from hospitals).

• The control of HAI exists as a major concern, and the high frequency of HAI is seen as evidence of poor quality of health service delivery, which has significant cost implications (WHO, 2002).



The costs associated with HAI have medical and economic ramifications. HAI has ramifications for patients and healthcare facilities; and associated costs are exacerbated during an outbreak which also affects patients’ confidence in the service.

The economic consequences include lost bed days and increased work load with some estimates showing that 380,000 bed days per annum are lost to HAIs. This is equivalent to 1000 hospital beds and associated staffing input being wasted in dealing with HAI related delays in discharge.

There is also the social and personal burden that unnecessary illness and complications place upon patients and their families.



Infection control is everybody’s business, thus, there is a need for better collaboration and coordination among clinical and non-clinical teams to come up with an effective and ‘seamless’ infection control practices.

Infection Control


HAI is everybody’s business

Clinical

Doctors

Nurses

Microbiologists, etc.

Construction

Engineers

Architects, etc.

FM

Cleaning

Catering

Waste Mgt

Maintenance

Estate engineering

Strategic management

Healthcare managers

Policy makers, etc.

Different User Roles


• There are many reasons why patients develop HAI. Some of these relate to the immunocompetence of the patient, while others reflect the environment in which the patient is nursed or the skill of the surgeon and the team conducting their care.

• Facilities Management (FM) services have a significant role in controlling HAI. The design and maintenance of the building is important to provide a risk free environment for the patients as well as for the healthcare workers.



From a Facilities Management perspective, the Design and Maintenance of the building is important in providing a risk-free environment for the patients as well as for the healthcare workers.

Design considerations include ventilation requirements, patient accommodation, facilities such as hand wash basins and toilets and the materials to be used for the surfaces.

FM and HAI


• ‘Effective cleaning of hospital wards is essential for the health and safety of both patients and staff, and makes an important contribution to the quality of care patient’s experience. However, there is a growing perception that standards of cleanliness in hospitals have been declining. Domestic services play a key part in minimising the risk of hospital acquired infections, which have serious consequences for patients and lead to significant costs to the NHS’ (Auditor General, 2000).

HAI AND CLEANING


• “A safe environment (the estate), clean surroundings and an appropriate diet (hotel services) are integral parts in the diagnosis, treatment and recovery of those who are ill “. Rees (1998)

• If HAI is to be controlled effectively, it is essential to focus on non-clinical areas such as Facilities Management (FM)” as well (Meers et al, 1992; Horton and Parker, 2002).

FM and HAI


The Principles of a Safe Environment (Source: Horton and Parker, 2002)


FM in healthcare usually includes a myriad of services. These are mainly in two categories: - hard FM and soft FM.

Hard FM relates to management and maintenance of property. The built environment, including infrastructure facilities such as

estate and property, indoor air, structure and fabric, water supply, electricity and telecommunication systems come under the first category (hard FM);

Soft FM includes the management of support services. Catering, cleaning, waste management, security, and laundry.

Hard and Soft Facilities Management


Integrated Facilities Management

Core Business

Accounts IT

Personnel

PurchasingDistributionTransport

Property & Facilities

Focus on Core Business Reduced Costs Increased Flexibility Improved Service Quality Introduce Best Practice Establish a Vehicle for Change

Drivers for Change

Source: Ian R Fielder


Effective design and maintenance of water supply systems – The Control of Legionella

Design and maintenance of inanimate surfaces – Minimal dust accumulation

The space around beds – control of cross infection

HVAC design and maintenance – control of airborne infection

The design of visible and accessible hand-washing facilities – control of contact transmission

HAI AND THE DESIGN, CONSTRUCTION AND MAINTENANCE OF FACILITIES


KNOWLEDGE MANAGEMENT AND

KNOWLEDGE MAPPING

19


• “Around 15% of HAI could be avoided through strengthened arrangements for prevention and control, and better application of existing knowledge and good practice”.

Department of Health. (2001). NHS Performance Indicators: A Consultation http://www.doh.gov.uk/piconsultation/haicar.htm

HAI and Knowledge Management

http://www.doh.gov.uk/piconsultation/haicar.htm


• A lack of co-ordination and integration of knowledge sources exist for the control of HAI. There is also paucity of literature for facilities management professionals/staff in infection control, even though they have an important role to play in the control of HAI.

HAI and Knowledge Management


Knowledge Management

The management of any process of mapping, creating, acquiring, capturing, transferring, sharing and using knowledge wherever it resides in order to meet existing and emerging needs, to identify and exploit existing and acquired assets and to develop new opportunities.


Knowledge Mapping and Maps• Knowledge mapping is defined as the process,

methods and tools for analysing knowledge areas in order to discover features or meaning and to visualise these in a comprehensive, transparent form, such that the business-relevant features are clearly highlighted.

Speel et al.(1999)

• Knowledge mapping techniques aim to track the acquisition and loss of information and knowledge.

• It explores personal and group competencies and illustrates how knowledge flows throughout an organisation or ‘network’.


Knowledge Maps

• A knowledge map describes what knowledge is used in a process, and how it flows around the process.

• It describes:– who has what knowledge (e.g. tacit/explicit), – where the knowledge resides (e.g. individuals,

infrastructure), and – how the knowledge is transferred or disseminated

(social)IBM Global Services- Technique Paper 2000

• Knowledge maps are created by transferring certain aspects of knowledge into a graphical form that is easily understandable.


Routine

RationaleTechnique

Staff/carer issues Equipment/services

Hand washing

Aseptic

Surgical

Agents

Skin care

Compliance

Sinks

Taps

Cleaning

Waste

RationaleTechnique

Staff/carer issues Equipment/services

Hand Hygiene

Surgical

Agents

Sinks

Taps

Cleaning

Waste

Example of a Knowledge Map


‘Performance Management (PM)’ was first used in the 1970s, but it did not become a recognised process until the latter half of the 1980s (Armstrong and Baron, 1998).

PM is mostly identified as a system which enhances individual performances to support or achieve organisational goals.

PM cannot be defined in the absolute and that its meaning is contextual in terms of both individuals and activities. (Adair et al; 2003)

Bartely (2000) has recommended that PM is essential to assess the level of adoption of control of HAI standards in FM services.

Performance Management


• Little has been researched or published in the areas of performance management in healthcare organisations, and even less so in the context of domestic services.

• There is evidence of a lack of common understanding of what is meant by performance, or how performance could be measured in practice, especially with regard to the control of HAI in domestic services.

Performance Management in Healthcare Organisations


Balanced Scorecard (BSC). Developed by Kaplan and Norton

European Foundation Quality Management (EFQM) model PQASSO (Practical Quality Assurance System for Small

Organisations) “The Big Picture (an organisational improvement framework

and diagnostic tool for identifying strengths and weaknesses within an organisation or programmes of work)

Investors in People (a UK national standard for improving organisational performance by training and developing people to achieve organisational goals).

Performance Management - Approaches


The UK national Performance Assessment Framework (PAF) six areas of performance 1. Health improvement; 2. Fair access; 3. Effective delivery of appropriate healthcare4. Efficiency; 5. Patient/carer experience; and 6. Health outcomes of NHS care

PAF, arguably, does not give much attention to infection control as part of their overall assessment in hospitals

Performance Management – UK NHS


PM approaches in-use in the control of HAI in domestic services

Audits by domestic serviceAudits by infection control teams (ICT)Environmental auditsAudits by the National Audit OfficePatient satisfaction surveyPA for domestic managersBenchmarking techniquesPA for domesticsPersonal Development PlansPAF by the NHSProgramme evaluation techniquesISO 9001:2000BSCEFQM (Based on 412 completed questionnaires from domestic managers and infection control team members across England and Scotland)


PM is essential to assess the level of adoption of control of HAI standards in FM services.

Measure progress towards achieving corporate objectives and targets.

Promote the accountability of service providers to the public and other stakeholders.

Compare performance to identify opportunities for improvement. Performance indicators may be used to identify opportunities for

improvement through comparison both within the organisation over time or between different units or organisations.

Promote service improvement by publicising performance level.

Performance Management (PM) and HAI

THANK YOU

Documents

LEARNING LESSONS FROM IMPROVEMENT OF MANAGEMENT OF HEALTHCARE ACQUIRED INFECTION GSAS Sponsored Seminar / Workshop