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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
IPCwiththefeetinthedirt 21-06-17
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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
IPCwiththefeetinthedirt 21-06-17
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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)