The Power of InformationAchieving a National Infection Management System

October 2013Trevor English

Health Sector Challenges• Challenges in implementing consistent standards for IPC practice and surveillance

have been identified by the the public health sector

• These negatively impact patient safety and outcomes, increase the burdens of cost and ability for the sector to tackle increased demand on IPC, including concerns with infections and antimicrobial resistance

• Without methods for defining and measuring current practice and infectious diseases it is hard to determine how the New Zealand health sector is performing, what interventions are needed or possible and how they perform

• Local IPC practice is challenged by manual processes, lack of accessibility and transparency to real time data to support good clinical decisions and patient management

• Surveillance is challenging due to a lack of national standards and definitions, as well as the same issues with data accessibility and communication

A Blitz of Media Coverage

Nothing New on the Horizon

The “return of our old enemies in an untreatable form”

“The majority of new infectious diseases that have emerged in the last 40 years are caused by drug-resistant bacteria.”

Ellen Silbergeld, Professor of Environmental Health Sciences and Epidemiology,Johns Hopkins University’s, Bloomberg School of Public Health

What is really at stake?“Everything about how we live and expect to live. Once upon a time in the United States — that is, before World War II — infections that we now think of as easily treatable routinely struck down children, as well as adults in the prime of life.” Editor Remapping Debate

• More complications• More hospitalizations and less successful treatment• More deaths

In the USA each year 1.7 million acquire HAI and there are 99,000 deaths, according to the Center for Disease Control and Prevention

INFECTION control costs about $76 million a year in Australian public hospitals but 177,000 patients acquire an infection each year, a Lake Macquarie academic study has found.

Healthcare-associated infections• Occur in up to 10% of patients receiving healthcare

• NZ Hospital Healthcare Associated Infections estimated cost $137m pa

• ACC DHB Treatment Injury Claims 2011/12 infection related events exceeded 900. A subset of SSIs between 2005-2013 cost ACC $11.4m

• SSI are the second most common type of healthcare-associated infection (≈20% of all HAI) and are associated with an increased LOS and cost

• Patients who develop SSI have a 2-to-11 fold higher risk of death than patients without an SSI

• Surveillance programmes (monitoring and feedback) result in reduction in SSI

The Problem and Solution

The Dream The Path

The Team The Team

“in New Zealand we don’t have the money so we have to think”

Interventions proven to reduce SSI• Warm the patient (on the way to theatre)• Complete the surgical checklist• Surgical antimicrobial prophylaxis – ‘right drug, right dose,

right time’• Alcohol-based skin preparation and sterile drapes• Continue warming the patient• Double gloves

Interventions proven to reduce SSI• High flow oxygen (≈ 80%)• Monitoring of blood glucose• Wound protectors for colorectal surgery• Antimicrobial sutures for colorectal surgery• Good surgical technique• Avoid blood transfusions

National SSII Programme

Staged delivery of the programme– Orthopaedics – total hip and knee joint arthroplasty (2013)– Cardiac Surgery (2015)– Caesarean sections ?

Started with orthopaedics – hip and knee joint arthroplasties– 8 ‘development site’ DHB → All 20 DHB by Oct 2013– Manual collection of data entered via the web into a central

data warehouse hosted at Canterbury DHB– Central reporting

» Process measures and outcome markers

National SSII Programme

CDC NHSN (NNIS) definitions for surgical site infections• Superficial, deep incisional or organ/joint space

Standardized data collection– Patient demographics, surgeon details, surgical process and 30 and 90

day follow-up – Shift from 1 year to 90 day follow-up

Web-based entry into a national database

Multi-discipline collaboration

Quality and Safety Markers

QSM = process markers and outcome measuresProcess markers

– Best practice processes or interventions known to lead to reduced harm and improved outcome for patients

• Surgical antimicrobial prophylaxis• Skin antisepsis

Outcome measures– Capture the expected reduction in harm, improvement in

health and associated cost savings from interventions put in place

Improvement in action

Improvement in action

Improvement in action

Improvement in action

ICNet• “Off the shelf” software solution• IPC reporting platform with modules

– SSI module– Antimicrobial stewardship

• Currently in use at – CDHB and West Coast DHB– TDHB– HBDHB

• Committed to use– ADHB– Waitemata DHB

• National Monitor supporting the SSII programme

ICNet overview

Operations

Infections

Patient Movements

Antibiotics

ICNet NGInfection

Surveillance

SSI MonitorSurgical Site

Infection

ABX-Alert AntimicrobialStewardship

IPC staff productivity case studySame patterns in UK and CDHB

0

1

2

3

4

Pre ICNet Post ICNet

4

2

4

33

20.5 0.5

IP&C work pattern changes at Chesterfield Trust have been replicated at CDHB. Using ICNet to clear administration tasks allows IP&C staff to spend more time and focus on patient care and infection prevention.

50%+ Reduction

3

1 1 1

A clinician’s perspective Dr Sally Roberts, National Clinical Lead, HQSC

1. ”Infection prevention and control requires accurate readily available data collected in a timely manner to fully inform decision making. The current means of capturing data – laborious manual-based methods – does not support this. A software solution is urgently required.

2. Analysis and reporting needs to be simplified. The current burden of manual data capture often distracts from data interpretation and does not allow time for quality improvement activities. The SSII national monitor has shown that centralised reporting of the data will allow for the delivery of comparable data across all DHBs.

3. Data collection needs to be consistent nationally. Manual methods allow for variation in the application of standard definitions, avoidance of capturing all essential data as it exists in multiple databases and is often person-dependent.

4. We will not be able deliver the HQSC IPC programmes, in particular the SSII programme, without such a programme as the manual collection of data is not deemed a high priority for resource-limited IPC services.”

To achieve the dream

• National leadership / priority / Plan• Engaged infection control practitioners• Coordinated approach to infection control• Common data systems• Vendor support• National reporting and use of the data• National procurement process

We are on the path!

• National leadership / priority / Plan– Recognition of need– MoH, HQSC and ESR– National business case work

• Engaged infection control practitioners– Workforce demonstrated engagement with SSII– Generally motivated group

• Coordinated approach to infection control– Actively collaborate nationally – could enhance

We are on the path!• Common data systems

– ICNet in 6 DHBs, National Monitor in place– Laboratory providers

• 8 DHB Labs – 6 on or committed to ICNet• 4 Private lab providers

• Vendor Support

• National reporting and use of the data– SSII national monitor is in place– ESR need access to good timely data

• National procurement process

The Problem and Solution

The Dream The Path

The Team The Team

“in New Zealand we don’t have the money so we have to think”