Infection Prevention and Control
Annual Report 2009-10
Annual Report 2009-10
Table of Contents Executive Summary ............................................................................................................. 3 Introduction to Infection Prevention and Control (IPAC) ................................................... 4 Hand Hygiene ...................................................................................................................... 5 Methicillin-Resistant Staphylococcus aureus (MRSA) ......................................................... 6 Vancomycin-Resistant Enterococci (VRE) ........................................................................... 7 Clostridium difficile Infection (CDI) ..................................................................................... 8 Influenza .............................................................................................................................. 9 Outbreaks .......................................................................................................................... 11 Pulmonary Tuberculosis (TB) ............................................................................................ 12 Education........................................................................................................................... 13 Infection Control Champions (ICC) .................................................................................... 14 Surgical Site Infection (SSI) Surveillance ........................................................................... 15 Central-Line Associated Bloodstream Infection (CLABSI) Surveillance............................. 16 Oxoid Award ...................................................................................................................... 16 Appendices ........................................................................................................................ 17 Appendix A: Infection Prevention and Control Team ................................................ 17 Appendix B: Providence Health Care Facilities .......................................................... 18 Appendix C: Definitions.............................................................................................. 19 References......................................................................................................................... 20
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Infection Prevention and Control
Executive Summary Infection Prevention and Control (IPAC) plays a critical role in Providence Health Care’s (PHC) commitment to patient safety. Rates of hospital-associated infections reflect a multitude of factors, including patient population, hand hygiene compliance, laboratory practices, surveillance system refinements, and infection control awareness and practices among health care workers. In 2009/10, we saw a continued decrease in MRSA incidence, with a rate of 0.7 cases/1000 patient-days compared to 1.0 cases/1000 patient-days in 2008/09. VRE rates increased slightly from 2008/09 at 2.1 cases/1000 patient-days to a rate of 2.4 cases/1000 patient-days. Compared to the previous fiscal year, Clostridium difficile infection rates increased slightly from 1.0 case/1000 patient-days to 1.2 cases/1000 patient-days. We are pleased to announce a number of new surveillance initiatives which were launched or enhanced in 2009/10. A central-line associated bloodstream infection (CLABSI) surveillance system in the intensive care unit (ICU) was launched this year, after being piloted during the last quarter of fiscal year 2008/09. In collaboration with the Department of Obstetrics and Gynecology, a surgical site infection (SSI) surveillance system to monitor Caesarean Section SSI rates was initiated. In addition, a surveillance system to monitor hip and knee arthroplasty SSI rates was enhanced. We continually strive to improve our control strategies when responding to outbreaks of infections. In response to pandemic H1N1 influenza (pH1N1), we launched a surveillance system to track nosocomial transmission of influenza. Despite significant community transmission of pH1N1, there were no hospital outbreaks of influenza at PHC in 2009/10. We look forward to the coming year with new initiatives underway to prevent and control infections at PHC. The success of infection prevention and control is dependent on the involvement of front-line health care professionals, physicians, hospital administrators, patients, residents and visitors. We thank everyone who has contributed to the IPAC initiatives and look forward to continuing our successful collaborations. Sincerely, The Infection Prevention and Control Team
2009 Team Winner – Oxoid Judges’ Special Award for excellence in Infection Prevention and Control
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Annual Report 2009-10
Introduction to Infection Prevention and Control (IPAC) Infection Prevention and Control (IPAC) is consistent with the Values and Mission of Providence Health Care (PHC). The Vision of the IPAC team is to create and sustain a culture in which infection prevention and control is integrated into all aspects of care at all PHC facilities. The Mission of the IPAC team is to be dedicated to the prevention and control of health care-associated infections in a supportive working environment. The practices of the IPAC team are grounded in evidencebased scientific principles. Infection control services are provided to PHC with structure and authority in collaboration with local, regional, and provincial partners. Our vision and mission are carried out using the initiatives described below. Surveillance: Monitoring health careassociated infections using standardized case definitions is critical to the prevention and control of hospital-based transmission of infectious agents. At PHC, the objectives of surveillance for PHC-associated infections are to:
Detect cases through enhanced screening so that appropriate precautions can be implemented
Detect outbreaks of infectious diseases in order to implement control measures
Monitor trends in PHC-associated transmission, and provide a means of determining when interventions are required
Determine the burden of specific infectious diseases to PHC
Evaluate and improve interventions.
Case management: Control measures for patients identified with a communicable disease are based on how infectious agents are transmitted, and include education and implementation of standard, contact, droplet, and airborne precautions. When other patients, residents, or staff may have been exposed before a case is identified, contact tracing is conducted to ensure that the disease was not transmitted to others. Outbreak management: In collaboration with Vancouver Coastal Health Public Health, IPAC is responsible for investigating clusters of cases and determining whether there is an outbreak at a PHC facility. Control measures are promptly implemented when each outbreak is declared. Environmental hygiene: IPAC works with multidisciplinary teams to implement environmental infection control strategies. These include planning for construction projects and advising on environmental decontamination and cleaning procedures. Education: IPAC provides education to staff, patients and visitors in order to increase awareness around appropriate IPAC measures. Education is provided via classes, presentations, consultations, and the IPAC website. Research: IPAC conducts research in order to support the integration of evidence-based practices into daily practice and evaluate the effectiveness of current strategies at PHC. Policies and Procedures: IPAC continuously reviews, develops, and implements policies and procedures to guide evidence-based best practices.
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Infection Prevention and Control
Hand Hygiene Hand hygiene (washing with soap and water or using an alcohol-based rub) is considered the most important measure for preventing the spread of bacteria and viruses in health care settings. However, overall compliance with hand hygiene among health care professionals is known to be suboptimal.1 In October 2005, the Clean Hands for LifeTM campaign was launched in collaboration with Vancouver Coastal Health and Bayer HealthCare (Canada). The goal of the campaign was to improve hand hygiene compliance by promoting awareness through posters, promotional materials, and educational sessions. The Clean Hands for LifeTM campaign was extended at PHC in 2009/10. Major activities included:
the launch of unit feedback boards that display quarterly hand hygiene compliance results;
the development of a “Clean Hand Zone” at the entrance of targeted units;
the dissemination of “Ask Me if I have just cleaned my hands” buttons and “My 5 Moments for Hand Hygiene” posters; and
the introduction of point of care alcoholbased hand rub with reminders in some acute care units.
In addition, a hand hygiene education module for nurses and allied health professionals was launched towards the end of fiscal year 2009/10. These compliment the existing hand hygiene module physicians complete as part of credentialing. Monitoring hand hygiene is an essential component of programs aimed at improving compliance. PHC has monitored compliance using observational audits since 2005. Regular quarterly hand hygiene audits were started in the third fiscal quarter of 2008/09. We expanded to include the Emergency Department in the first fiscal quarter of 2009/10. Infection control practitioners measure compliance by direct observation of staff, and compliance was calculated using the following formula: % Compliance = # hand hygiene events x100 # opportunities Compliance varied by unit, health care worker type, and facility. An incremental increase was seen in hand hygiene compliance during fiscal year 2009/10. Compliance ranged from 40% in Quarter 1 to 49% in Quarter 2 and 4 (Figure 1), which is consistent with published North American rates.1 Further efforts are currently underway to facilitate and improve local unit accountability of hand hygiene compliance.
Percent compliance
100% 80% 60% 40% 20% 0%
Medical
Nursing
Other
Overall
Qtr 1
31%
45%
24%
40%
Qtr 2
38%
52%
39%
49%
Qtr 3
43%
47%
46%
46%
Qtr 4
29%
53%
39%
49%
Figure 1. Hand hygiene compliance by health care worker type, 2009/10
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Annual Report 2009-10
Methicillin-Resistant Staphylococcus aureus (MRSA) MRSA is an antibiotic resistant bacterium that can be transmitted in health care settings. Most patients are colonized with MRSA, rather than infected. MRSA has the potential to cause serious infections for which treatment options are limited.
pared to 2003/04 (Figure 2, p
