Organisation of hospital infection control and prevention programmes.

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1 The infection control practitioner Organisation of hospital infection control and prevention programmes. Our primary goal is to prevent nosocomial infections and ensure that patients, visitors and staff are protected from unnecessary exposure to infectious agents. B. Gordts. ESCMID SHEA Training Course in Hospital Epidemiology. Prague, Estimated cases on nosocomial infections in Belgium 30 years of history of hospital infection control (HIC) regulations in Belgium UTI Pneumonia SSI Catheter Other % of hospitalized patients acquire nosocomial infection 10% possible attributable mortality May be responsible for: 250,000 additional hospital days 8,250,000 additional cost Fil rouge '63: accreditation of hospitals based on minimal requirements. '74-75: introduction of the principle of HIC in Belgian hospitals. '85: Organisation of the HIC commitee. '88: Responsibilities of IC physician, IC nurse and IC committee. Financial resources for (part of) salaries provided. '97: Additional incentive for national surveillance programs. '98: (Flanders): Mandatory reporting of (certain) nosocomial infection rates as quality indicators. Improving patient outcome trough adequate hospital infection control Essential functions Essential resources Essential structure Mandatory functions imposed upon Belgian IC practitioners (Royal Decree 88) Implement / survey: aseptic techniques decontamination / sterilization cleaning / laundry surgery ward and pathology isolation of contaminated patients (re)construction Registration of nosocomial infections Surveillance / detection of: sources of contamination contaminated carriers hospital environment Education and training of HCW s

ESCMID SHEA Training Course in Hospital Epidemiology. Prague, 2007. Estimated cases on nosocomial infections in Belgium 30 years of history of hospital infection control (HIC) regulations in Belgium.

2 Requirements for infrastructure and essential activities of infection control in hospitals* Functions Managing critical data and information. Surveillance of N.I. in order to improve outcomes Setting and recommending policies and procedures. must beestablished, implemented, maintained, updated compliancemust be monitored and maintained should communicate with state health departments. Intervening directly to prevent transmission of infectious diseases Identification of outbreaks in all hospitals Education and training of healthcare workers Resources *Scheckler WE, et al. Infect Control Hosp Epidemiol 1998;19: ID MD / RN Medical director ICP Administrator microbiologist Changing environment in hospital infection control Actual status of organisation of infection control in Belgium FROM IC-MD; IC-RN IC tasks To best of knowledge Available resources Internal advisor Acute care hospital TO IC-team IC programs Standardized approach Cost-benefit evaluation Externalcontacts(authorities) Other healthcare providers working situation of ICP s in Belgium anno 2002 Profile Tasks Time allocation Resources Who is involved in infection control in Belgium? Who is involved in infection control in Belgium? 19% 14% MD Pharmacist 86% Clin. Biol. Int. Med. 2% 2% 8% I.C.U. Surg. Other Infection control nurse Management degree 85% Full-time 15% 32% 13% 1% 8% Master Higher ed. RN other N Other 54% 69%

must beestablished, implemented, maintained, updated compliancemust be monitored and maintained should communicate with state health departments.

3 Who is involved in infection control in Belgium? Time allocation of ICP s (FTE p 1,000 beds). physicians RN Infection control nurse Management degree 85% Full-time 15% 19% Other MD Other RN Secretary Datanurse Epidemiologist I.T. Statistician France UK Italy Wallony Brussels Flanders France UK Italy Wallony Brussels Flanders Other staff 7% Actual Actual 48% of hospitals Regulation Regulation 11% 1% 1% 6% 0% 0 0,5 1 1, Importance of IC projects for IC-RN 30 years of history of hospital infection control (HIC) regulations in Belgium. 62% have other responsibilities Other administrative task 37% Purchase disposables 15% QI 9% Head Nurse 6% Nurse 2% Would invest more time in: Redaction of procedures More registration of data Waste management Cleaning procedures Registration noso infections Procedures Communication Education Follow-up isolation Committee Aseptic techniques Disposables Carrier detection Evaluation education Evaluation projects Outbreak management Construction Importance A Administrative data Importance B Q. management Importance C Bact. Surv. Environment Fil rouge '85: Organisation of the HIC commitee. '88: Responsibilities of IC physician, IC nurse and IC committee. Financial resources for (part of) salaries provided. '97: Additional incentive for national surveillance programs. '98: (Flanders): Mandatory reporting of (certain) nosocomial infection rates as quality indicators. 02: additional structure: mandatory participation in regional platforms for HIC establishment of the Federal Platform for coordination of HIC Number of nurses Regional committee for hospital infection control Federal Platform for Hospital Infection Control. Comprises IC-MD s and IC-RN s from different hospitals in the province Aims at: Synergy in know-how Rapid information exchange Peer review of structure and organisation Standardized approach of HIC problems Common approach of respective tasks Commonattributionof priorities Communication channel between ICP and authorities Interface and discussion forum Comprises delegated IC-MD s and IC-RN s from regional platforms Aims at: Quality improvement by focusing HIC to outcome improvement Coordination of IC strategies in Belgian hospitals Federal Platform for Hospital Infection Control

Statistician France UK Italy Wallony Brussels Flanders France UK Italy Wallony Brussels Flanders Other staff 7% Actual Actual 48% of hospitals Regulation Regulation 11% 1% 1% 6% 0% 0 0,5 1 1,5 0 1 2

4 Scientific societies Authorities Patient groups Federal platform for HIC Regional platforms Consensus proposal on a new structure for infection control in Belgian hospitals Federal Platform for Infection Control 2004 Hospital IC practitioners PDCA Problem analysis Find possible solutions Essential IC-functions for all institutions: Containing hospital acquired infections Development, implementation and monitoring the strategy for standard- and isolation precautions troughout the organisation. Act Plan Decide Evaluate Surveillance of nosocomial infections. Development and implementation of outbreak management. Follow-up of IC aspects in logistic activities. Implementation of national guidelines. Check Do Exchange information and experience within the regional platforms for IC. Training of the Infection control Practitioner New (minimal) structure for Infection Control activities in all Belgian hospitals IC nurse RN Bachelor + master in nursing Incl. notions of microbiology, epidemiology, infection control. At least 250 hrs IC physician MD or clinical microbiologist Incl. notions of microbiology, epidemiology, infection control. At least 300 hrs IC-Team Comprises: IC-MD, IC-RN Epidemiologist, data manager, secretary.. Mission: Directly responsible for essential functions in IC Operationally independent Project-driven approach Elaboration of annual strategic plan and activity report IC-Committee Comprises: ICP s, (3) clinicians, microbiologist, (ID physician), pharmacist, medical and nursing director, adminstrator, 1 chiefnurse Mission: Forum of debate between ICteam and hospital Imperative advice to management and staff Approval of annual strategic plan and activity report Evaluation of the IC-team

implementation and monitoring the strategy for standard- and isolation precautions troughout the organisation. Act Plan Decide Evaluate Surveillance of nosocomial infections.

5 Essential national priorities to be implemented Medical director Board of administrators Hospital board of directors IC-committee IC-team Legal description of the: Infection control team (structure) Relation/integration of IC team (members) in hospital structure Prioritary missions/projects of the IC team Mandatory participation in regional IC structure Integration of Regional IC platform into Federal IC platform Development of scientific regulatory body (IC-guidelines) Inventory: anonymous quality audit of surgery blocks Proposal of IC-quality / performance indicators Development of IC in chronic care sector and homes for the elderly

participation in regional IC structure Integration of Regional IC platform into Federal IC platform Development of scientific regulatory body (IC-guidelines)

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