10 elements of a high-performing infection prevention program

While most recognize the urgency for implementing evidence-based, sustainable infection prevention and control (IPC) strategies, hospitals face significant challenges to maintain targeted HAI reduction goals.

Infection prevention and control (IPC) programs in hospitals continue to dramatically reduce the incidence of healthcare-associated infections (HAIs). However, a recent point-prevalence survey found that on any given day, about 1 in 31 hospital patients have at least one HAI.

Designing and maintaining a high-performing infection prevention program requires executive support, alignment with the strategic goals and objectives of the organization, and the development of collaborative partnerships with clinical and ancillary support services.

Key programmatic components include:

1. Leadership support. Establishing a supportive infrastructure and an adequate budget for a high-performing infection prevention program requires involvement at the highest levels of a healthcare organization’s leadership. An Infection Control Committee that includes medical and nursing leaders will ensure endorsement of the program’s goals and objectives with the clinical staff.
2. Multi-disciplinary team involvement. Implementation of a high-performing infection prevention program requires participation from individuals across the healthcare organization–from senior leadership to environmental services staff. Clear responsibilities for all staff must be established and each person needs to have an understanding of the importance of his or her role in reducing infections.
3. Adequate staffing of trained Infection Preventionists. Healthcare organizations have responded to the increased focus on infection prevention and control by devoting greater resources to IP. While some smaller acute care and many long-term care facilities still have part-time IPs, healthcare organizations are increasingly recognizing the need for at least one full-time IP with formal training. Depending on the size of the organization and the demographics of the patient population, substantially larger and more diverse teams of professionals may be appropriate for IP.
4. General staff and patient education. Engagement of healthcare workers requires annual education in the basics of infection prevention and the organization’s policies and procedures related to infection prevention, as well as in servicing on policy updates and new technologies implemented to minimize infection risk to patients. Patients should be educated upon admission of the infection prevention practices that their healthcare workers should be following to prevent the transmission of infection, such as handwashing. Patients infected with multi-drug resistant organisms (MDRO) such as Clostridioides difficile or other communicable diseases should receive specific education on their role in preventing transmission to others.
5. Evidence-based policies and procedures. Evidence-based policies and procedures should include hand hygiene, care of invasive devices such as urinary catheters, sterilization and disinfection, and environmental cleaning. Specific guidelines for MDRO screening and isolation policies should be written and accessible to all staff.
6. Surveillance of HAI outcomes and processes targeted at infection reduction should include established, timely feedback mechanisms and well-communicated metrics for success. Automated surveillance systems receive real-time data feeds from admission/discharge/transfer, lab, pharmacy, radiology, and surgery to identify patients at risk for HAIs and flag patients who require isolation management. This real-time monitoring allows the trending of key metrics rapid intervention by the IP.
7. Outbreak management. Rapid detection of outbreaks is essential to prevent ongoing transmission of the potential pathogen to other patients, visitors, and healthcare workers. A high-performing infection prevention program establishes the endemic rate of sentinel organisms in the facility and monitors for adverse trends.
8. Employee health partnership. It is essential that employees infected with communicable diseases adhere to the work restrictions dictated in the organization’s Employee Health policies and procedures to protect patients, visitors, and other healthcare workers. Additionally, the healthcare workers will be screened for immunity to communicable diseases upon hire and may be required to receive vaccinations e.g. measles, mumps, rubella, or varicella vaccine as recommended by the CDC, the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Further, healthcare workers are strongly encouraged to receive annual influenza vaccinations and may be required to be vaccinated to retain employment. Influenza vaccination compliance reporting is mandated by CMS for most types of healthcare facilities.
9. Antimicrobial stewardship. High-performing infection prevention programs include an antimicrobial stewardship (AMS) component that monitors antimicrobial agent selection across the institution and tracks patterns of antimicrobial overuse as well as emerging resistance and bug/drug mismatching. Members of the AMS team provide pertinent information to clinicians on best practices for antimicrobial dosing and administration. The data captured in an automated surveillance system aids the development of MDRO reports and antibiograms to display susceptibility profiles for specific organisms by source and location.
10. Public health reporting. High-performing infection prevention programs are familiar with local, state, and federal public health reporting requirements and ensure timely reporting.

Conclusion

High-performing IPC programs are critical to success in today's pay-for-performance healthcare climate, and the commitment must start with executive leadership to create a culture of patient safety and personal accountability. Consistent feedback provided to key stakeholders on HAI and MDRO outcome metrics and process metrics focused on compliance with evidence-based reduction practices will promote engagement and enhance collaboration to meet and maintain reduction targets. By focusing on these areas, your hospitals can improve the performance of its IPC program and the overall transparency around Hospital-Acquired Conditions (HACs) to improve patient and financial outcomes.

References

¹HAI and antibiotic use prevalence survey, CDC website. Accessed on 3/26/19