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Effective methods in reducing the number of occupational exposures in a health care setting
Abstracts Diagnoses were BSI-45%, HAP-35%, Urosepsis-10%, CAP-5% and Aspiration Pneumonia-5%. Kunin’s Appropriateness criteria was highest for Cat II and Cat V with 27% each, 30% got definitive therapy and de-escalation in 72%. Mean LOS was 8 (IQR 4-15), APACHE II-38, SOFA-14 and TISS-28 score20. Mean DOT/ 1000 patient days for restricted antimicrobials were Colistin34.5, Meropenam-16, Vancomycin-10, Teicoplanin-16, Pip-Tazo-98, Cefoperozone+Sulbactum-68 with a mean Direct ICU cost /patient (US$) Was-Ventilated:620 and Non-Ventilated:340. Conclusion & Future work: Data collection for the PreCDSS implementation period using AU-Crit is currently underway and the CDSS is on developmental stage with SQLite database for data storage and security.
DISINFECTANT TESTING CRITERIA FOR CLOSTRIDIUM DIFFICILE Trevor Glasbey, Dr, Greg Whiteley Whiteley Corporation, Tomago, Australia Introduction: The efficacy of disinfectants and disinfectant wipes against the spore forming Clostridium difficile (C difficile) is important to Infection Preventionists (IPs). There are variety of test methods for assessing disinfectant efficacy against C difficile and contact time claims are dependent on which test method is applied. The guidelines for Therapeutic Goods Order 54 (TGO54) do not specify a particular test for environmental disinfectants thus allowing manufacturers to select the method that provides the lowest contact time without improving underlying efficacy. This study examines presents results using various test methods for C difficile and other anaerobic spores using various standardised disinfectant active materials. Methods: Disinfectant testing using internationally recognised test methods were conducted against C difficile and other spore forming bacteria. Test methods including EN 13704, ASTM E2197 and suspension based methods outlined in the Guidelines for TGO54 were assessed. The suspension tests included both vegetative and spore enriched suspensions as well as the USA EPA method with spores dried onto carriers. Other variables included the organic and inorganic soils. Results: Differences in the test results are shown with a standardised concentration of disinfectant molecules including PAA and chlorine. The contact time required to meet the requirements of each test protocol was observed from 30 seconds to 20 minutes. Conclusion: Different test methods produce starkly different indications on efficacy again C difficile and anaerobic spores generally. IPs require more information than simply the “kill time” to accurately assess the likely in-situ performance of disinfectants or disinfectant wipes.
125 respectively and were statistically equivalent. The CHG hand wash produced a 1.53 LR and was statistically inferior to the alcohol sanitizer and TCS hand wash. Conclusions: No differences in susceptibility to ABHR 70% alcohol was shown by antibiotic resistant bacteria when compared to the sensitive strains. Hand washes should be chosen carefully due to the variable susceptibility showed by MRSA strains tested, and the formulation specific performance of these biocides.
DOES STRUCTURED EDUCATIONAL INTERVENTION PROGRAMME LEAD TO SUSTAINABLE KNOWLEDGE IMPROVEMENT ON INFECTION CONTROL PRACTICES AMONG UNDER GRADUATE MEDICAL STUDENTS? Usha Balasundaram, Dr, Shanmuga Vadivoo Natarajan, Dr Annapoorana Medical College & Hospital, Salem, India Introduction: Medical students should have adequate Infection control knowledge for better compliance. This study aimed to assess the effectiveness of structured training on improving the infection control practices. Method: This study is a quasi-experimental type with before and after design. Proforma encompassing Knowledge of student towards Infection control practices under five domains was used. Following this a structured package of educational intervention comprised of one day Continued Medical Education, Audio Visual Demonstration followed by bedside real time hands on training on infection control practices was provided. Finally knowledge and skill was assessed by Objective structured practical examination (OSPE) and post-test questionnaire. Domain wise proportions of correct responses were compared between pre and post intervention using z test. Results: A total of 382 Medical undergraduate students participated. Of the five domains, biomedical waste management (43%) and personal protective equipment (52%) got least scoring. Knowledge was more in the domain of antibiotic resistance (72%) and hand washing (60%). Invariably, all five domains showed significant knowledge improvement from the baseline to immediately after training as well as six months later. [Proportion of correct knowledge on personal protective equipments: pretest-52% Vs immediate post intervention: 93% Vs 6 months post intervention: 88.4%, p<0.0001; Biomedical waste management: 43% Vs 93% Vs 88.6%, p<0.0001; transmission based precautions: 55% Vs 88% Vs 83.4%, p<0.0001] Conclusion: The overall knowledge on Infection control practices of medical students was low initially but improved drastically following the structured educational intervention programme.
EFFECTIVE METHODS IN REDUCING THE NUMBER OF OCCUPATIONAL EXPOSURES IN A HEALTH CARE SETTING DO ALCOHOL BASED HAND RUBS AND ANTIMICROBIAL SOAPS HAVE EFFICACY AGAINST ANTIBIOTIC RESISTANT BACTERIA? Elizabeth De Nardo, Dr., Christine Claighen, Christopher Beausoleil, Terri Eastman Gojo Australasia, Macquarie Park, Australia Background: Multidrug-Resistant Organisms (MRO) are often passed from person to person by the hands of caregivers. Cleaning hands with soap and water or use alcohol-based hand rubs (ABHR) are the main recommendation by The World Health Organization (WHO) for preventing the spread of MRO. However, the efficacy of hand hygiene products against MRO is not well documented. Experimental Methods: Two commercial ABHR (gel and foam) and one antimicrobial foaming hand wash with 0.3% triclosan (TCS) available in Australia were evaluated using a 15 second in vitro Time-Kill (ASTM E 2315) against up to 15 different strain of antibiotic susceptible and resistant bacteria. Additionally, ABHR with 62% ethanol, antimicrobial hand wash with 4% chlorhexidine gluconate (CHG), and antimicrobial foaming hand wash with 0.3% triclosan were evaluated by an in vivo hand wash method (ASTM E 2755-10) against MRSA (strain ATCC #33591). Results: By in vitro testing, ABHR gel or foam 70% reduced all bacteria strains tested by 6 log10 ( 99.9999%) in 15 seconds. By in vivo testing, the 62% ethanol ABHR and TCS hand wash produced LRs of 2.05 and 1.93,
Ana Suto, Louise Hobbs, Dr The Royal Melbourne Hospital, Parville, Australia Introduction: Melbourne Health (MH) embarked on a process to reduce occupational exposures due to continually not meeting the Victorian Blood Exposure Surveillance (ViBES) (2010) aggregate rate of 0.52 per 1000 occupied bed days for total occupational exposures. Safety engineered devices and various campaigns were implemented to combat this issue. Method: A review of the data was undertaken to identify the types and locations where exposures were occurring. Key activities identified in the ward environment were blood taking, giving subcutaneous injections and point of disposal. The main area outside of the wards was the operating room (OR). A number of targeted interventions were introduced to reduce incidents that included caddies (point of disposal), safety vacutainer blood collection system, retractable subcutaneous needles, personal protective equipment awareness and review of OR incidents applying human error theory factors. Results: From January 2012 to June 2015 the following reductions were noted; occupational exposures associated with venepuncture reduced from 22 to 12 (54% reduction), point of disposal fell from 74 to 2 (81% reduction) and subcutaneous needle incidents went from 13 in January 2015 to 6 (46% reduction). Reviewing the OR incidents using human factor theory identified fatigue as being the main contributing factor predominantly associated with
126 suture needles (42%). OR numbers continue to be reported on average of 5 per month. Conclusion: Introduction of a number of strategies has reduced our overall occupational exposures from 253 in 2009 to 138 in 2015. Our next area of focus will be to reduce our operating room exposures.
EMERGENCY DEPARTMENT INFECTIOUS DISEASES QUICK REFERENCE GUIDE FOR USE IN REGIONAL HEALTH SERVICES Sue Atkins Department of Health and Human Services, Ballarat, Australia Background: In the Grampians Region Victoria acute healthcare services there is either an Emergency Department staffed with medical and nursing expertise at all times, or an Urgent Care Center often covered by one nurse who works in the adjacent acute care ward at the same time, while medical support is off site. Infectious diseases in patients presenting to Urgent Care Centers are few and far between, but when they present, it is usually out of hours where support is not readily available. Method: An Emergency Department Infectious Diseases Quick Reference Guide was developed covering six infectious diseases that require quick identification to prevent an outbreak. This guide included triage triggers for signs and symptoms, infection prevention strategies, and notification channels. To compliment this guide an Infection Prevention and Control Screening Tool was also developed for all presentations to urgent care. Both were implemented in all Grampians Region acute healthcare services in early 2016. Results: Those working in Urgent Care Centers in the Grampians Region have a tool to support infection prevention and assist with the timely identification of infectious diseases leading to appropriate management and timely notification. Conclusion: It is important that staff in Urgent Care Centers have the tools to identify infectious diseases and isolate as necessary to prevent an outbreak with potential severe consequences. While these tools are not a comprehensive list of infectious diseases it does raise awareness of early detection and management of infectious diseases while encouraging discussion with patients to determine potential risks.
ENVIRONMENTAL CLEANING RESEARCH: PARTICIPATING IN THE REACH STUDY Alison Farrington 1, Michelle Allen 1, Lisa Hall, Dr1, Brett Mitchell, Associate Professor2 On behalf of the REACH study team 1 Queensland University of Technology, Kelvin Grove, Australia 2 Avondale College of Higher Education, Wahroonga, Australia Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study is a partnership project funded by the National Health and Medical Research Council (NHMRC). It aims to evaluate the effectiveness and cost-effectiveness of a novel cleaning bundle intervention. Eleven major Australian hospitals are participating in this research, with the trial component running from May 2016 until July 2017. Methods: The REACH trial uses a stepped wedge study design. This design ensures each trial site receives an eight week control period, followed by a randomly allocated intervention period between 20 and 50 weeks. Participation in such a major research activity requires a significant commitment from each trial hospital. To ensure this commitment is sustainable, the REACH study team will maintain a high level of contact with each site. Local site teams will also be a key aspect of conducting the research. During the pre-trial phase a research team will be established at each hospital. This team will include an infection prevention and control practitioner and an environmental services lead. Additional site team members will reflect local context and team structure. Site teams will assist with administrative activities for the trial, data collection and, importantly, the effective engagement of environmental services staff. Results and Conclusion: The local site team will be essential for successful implementation of the REACH research activities. Examples of site teams’ composition and activities will be showcased to highlight diversity and the value of strong collaboration in supporting behaviour change and quality improvement initiatives.
Abstracts ESTABLISHMENT OF AN INFECTION PREVENTION AND CONTROL PROGRAM IN JEDDAH HOSPITALS OF SAUDI ARABIA: A THREE-YEAR PROJECT Muhammad Halwani, Dr1, Nidal. Tashkandy, Dr.2 Al Baha University, Faculty of Medicine, Jeddah, Saudi Arabia 2 Health Affairs, Ministry of Health, Jeddah, Saudi Arabia
1
Background: The objective of this study was to establish a scientificallybased program to prevent infections in the twelve hospitals of the Ministry of Health in Jeddah, Saudi Arabia. We documented compliance and the impact of the program on infection rates over a 3-year period. Materials: An auditor from the infection control administration visited each hospital every four months from January 2009 to December 2011. The auditor used a set of performance indicators 55 in total, which were based on the British Infection Prevention Society’s auditing tool for monitoring infection control standards and were modified to reflect the clinical environment of Jeddah’s hospitals. Compliance of the indicators was recorded during the visit. The overall compliance at each hospital was calculated yearly and after the three years. Results: Routine audits after 3 years revealed that only 36% (37/104) of the infection control departments (ICDs) in the Jeddah hospitals were supervised by specialized personnel. In addition, 44% (44/101) of ICDs supervised and managed isolation rooms properly, and 50% (52/104) of hospital sinks were equipped with the required tools for hand hygiene. Decisions that were made by the infection control committee were followed by 45% (47/104) of ICDs, and 53% (55/104) of infection control committee decisions were implemented. Conclusion: Development of a standardised infection prevention and control program in conjunction with regular audits and feedback managed to pick up major defects in infection control in Jeddah hospitals. We believe that this program can be a useful tool for improving infection control practices in hospitals.
EVALUATING A PROCESS OF CHANGE IN HOSPITAL ENVIRONMENTAL CLEANING e THE ROLE OF LOGIC MODELS Alison Farrington 1, Michelle Allen 1, Lisa Hall, Dr1, Brett Mitchell, Associate Professor2 On behalf of the REACH study team 1 Queensland University of Technology, Kelvin Grove, Australia 2 Avondale College of Higher Education, Wahroonga, Australia Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will evaluate the impact of a novel environmental cleaning bundle in 11 hospitals around Australia. In each trial site we will collect a range of data, including healthcare associated infection rates, associated costs and changes in the thoroughness of cleaning. While these data will assist in determining the overall effectiveness and cost-effectiveness of the cleaning bundle it is important to understand what aspects of the practice change process worked, under what conditions, and why. Methods: The project team will systematically document and review the implementation process at each hospital site. To frame this process evaluation we have developed a logic model to identify what assumptions are being made and what expectations there are about how the process will work at each trial hospital. Results: The model outlines a proposed link between trial processes and intended trial outcomes. It shows the flow of activities and potential impact of local context and external factors in implementing change. Conclusion: The process of developing a logic model e a pictorial representation of key trial inputs, outputs and outcomes e has clarified the underlying assumptions involved in improving hospital environmental cleaning. This will inform a systematic evaluation of the change process in each of the participating hospital sites, which will assist with translation of trial outcomes to other hospital settings and to the environmental services workforce.
EVIDENCE BASED RECOMMENDATIONS FOR A NATIONAL HEALTHCARE ASSOCIATED INFECTION SURVEILLANCE PROGRAM Philip Russo 1,2, Allen Cheng, Professor3, Mike Richards, Professor4, Nick Graves, Professor1, Lisa Hall, Dr1 1 Queensland University of Technology, Brisbane, Australia 2 Griffith University, Brisbane, Australia
DISINFECTANT TESTING CRITERIA FOR CLOSTRIDIUM DIFFICILE Trevor Glasbey, Dr, Greg Whiteley Whiteley Corporation, Tomago, Australia Introduction: The efficacy of disinfectants and disinfectant wipes against the spore forming Clostridium difficile (C difficile) is important to Infection Preventionists (IPs). There are variety of test methods for assessing disinfectant efficacy against C difficile and contact time claims are dependent on which test method is applied. The guidelines for Therapeutic Goods Order 54 (TGO54) do not specify a particular test for environmental disinfectants thus allowing manufacturers to select the method that provides the lowest contact time without improving underlying efficacy. This study examines presents results using various test methods for C difficile and other anaerobic spores using various standardised disinfectant active materials. Methods: Disinfectant testing using internationally recognised test methods were conducted against C difficile and other spore forming bacteria. Test methods including EN 13704, ASTM E2197 and suspension based methods outlined in the Guidelines for TGO54 were assessed. The suspension tests included both vegetative and spore enriched suspensions as well as the USA EPA method with spores dried onto carriers. Other variables included the organic and inorganic soils. Results: Differences in the test results are shown with a standardised concentration of disinfectant molecules including PAA and chlorine. The contact time required to meet the requirements of each test protocol was observed from 30 seconds to 20 minutes. Conclusion: Different test methods produce starkly different indications on efficacy again C difficile and anaerobic spores generally. IPs require more information than simply the “kill time” to accurately assess the likely in-situ performance of disinfectants or disinfectant wipes.
125 respectively and were statistically equivalent. The CHG hand wash produced a 1.53 LR and was statistically inferior to the alcohol sanitizer and TCS hand wash. Conclusions: No differences in susceptibility to ABHR 70% alcohol was shown by antibiotic resistant bacteria when compared to the sensitive strains. Hand washes should be chosen carefully due to the variable susceptibility showed by MRSA strains tested, and the formulation specific performance of these biocides.
DOES STRUCTURED EDUCATIONAL INTERVENTION PROGRAMME LEAD TO SUSTAINABLE KNOWLEDGE IMPROVEMENT ON INFECTION CONTROL PRACTICES AMONG UNDER GRADUATE MEDICAL STUDENTS? Usha Balasundaram, Dr, Shanmuga Vadivoo Natarajan, Dr Annapoorana Medical College & Hospital, Salem, India Introduction: Medical students should have adequate Infection control knowledge for better compliance. This study aimed to assess the effectiveness of structured training on improving the infection control practices. Method: This study is a quasi-experimental type with before and after design. Proforma encompassing Knowledge of student towards Infection control practices under five domains was used. Following this a structured package of educational intervention comprised of one day Continued Medical Education, Audio Visual Demonstration followed by bedside real time hands on training on infection control practices was provided. Finally knowledge and skill was assessed by Objective structured practical examination (OSPE) and post-test questionnaire. Domain wise proportions of correct responses were compared between pre and post intervention using z test. Results: A total of 382 Medical undergraduate students participated. Of the five domains, biomedical waste management (43%) and personal protective equipment (52%) got least scoring. Knowledge was more in the domain of antibiotic resistance (72%) and hand washing (60%). Invariably, all five domains showed significant knowledge improvement from the baseline to immediately after training as well as six months later. [Proportion of correct knowledge on personal protective equipments: pretest-52% Vs immediate post intervention: 93% Vs 6 months post intervention: 88.4%, p<0.0001; Biomedical waste management: 43% Vs 93% Vs 88.6%, p<0.0001; transmission based precautions: 55% Vs 88% Vs 83.4%, p<0.0001] Conclusion: The overall knowledge on Infection control practices of medical students was low initially but improved drastically following the structured educational intervention programme.
EFFECTIVE METHODS IN REDUCING THE NUMBER OF OCCUPATIONAL EXPOSURES IN A HEALTH CARE SETTING DO ALCOHOL BASED HAND RUBS AND ANTIMICROBIAL SOAPS HAVE EFFICACY AGAINST ANTIBIOTIC RESISTANT BACTERIA? Elizabeth De Nardo, Dr., Christine Claighen, Christopher Beausoleil, Terri Eastman Gojo Australasia, Macquarie Park, Australia Background: Multidrug-Resistant Organisms (MRO) are often passed from person to person by the hands of caregivers. Cleaning hands with soap and water or use alcohol-based hand rubs (ABHR) are the main recommendation by The World Health Organization (WHO) for preventing the spread of MRO. However, the efficacy of hand hygiene products against MRO is not well documented. Experimental Methods: Two commercial ABHR (gel and foam) and one antimicrobial foaming hand wash with 0.3% triclosan (TCS) available in Australia were evaluated using a 15 second in vitro Time-Kill (ASTM E 2315) against up to 15 different strain of antibiotic susceptible and resistant bacteria. Additionally, ABHR with 62% ethanol, antimicrobial hand wash with 4% chlorhexidine gluconate (CHG), and antimicrobial foaming hand wash with 0.3% triclosan were evaluated by an in vivo hand wash method (ASTM E 2755-10) against MRSA (strain ATCC #33591). Results: By in vitro testing, ABHR gel or foam 70% reduced all bacteria strains tested by 6 log10 ( 99.9999%) in 15 seconds. By in vivo testing, the 62% ethanol ABHR and TCS hand wash produced LRs of 2.05 and 1.93,
Ana Suto, Louise Hobbs, Dr The Royal Melbourne Hospital, Parville, Australia Introduction: Melbourne Health (MH) embarked on a process to reduce occupational exposures due to continually not meeting the Victorian Blood Exposure Surveillance (ViBES) (2010) aggregate rate of 0.52 per 1000 occupied bed days for total occupational exposures. Safety engineered devices and various campaigns were implemented to combat this issue. Method: A review of the data was undertaken to identify the types and locations where exposures were occurring. Key activities identified in the ward environment were blood taking, giving subcutaneous injections and point of disposal. The main area outside of the wards was the operating room (OR). A number of targeted interventions were introduced to reduce incidents that included caddies (point of disposal), safety vacutainer blood collection system, retractable subcutaneous needles, personal protective equipment awareness and review of OR incidents applying human error theory factors. Results: From January 2012 to June 2015 the following reductions were noted; occupational exposures associated with venepuncture reduced from 22 to 12 (54% reduction), point of disposal fell from 74 to 2 (81% reduction) and subcutaneous needle incidents went from 13 in January 2015 to 6 (46% reduction). Reviewing the OR incidents using human factor theory identified fatigue as being the main contributing factor predominantly associated with
126 suture needles (42%). OR numbers continue to be reported on average of 5 per month. Conclusion: Introduction of a number of strategies has reduced our overall occupational exposures from 253 in 2009 to 138 in 2015. Our next area of focus will be to reduce our operating room exposures.
EMERGENCY DEPARTMENT INFECTIOUS DISEASES QUICK REFERENCE GUIDE FOR USE IN REGIONAL HEALTH SERVICES Sue Atkins Department of Health and Human Services, Ballarat, Australia Background: In the Grampians Region Victoria acute healthcare services there is either an Emergency Department staffed with medical and nursing expertise at all times, or an Urgent Care Center often covered by one nurse who works in the adjacent acute care ward at the same time, while medical support is off site. Infectious diseases in patients presenting to Urgent Care Centers are few and far between, but when they present, it is usually out of hours where support is not readily available. Method: An Emergency Department Infectious Diseases Quick Reference Guide was developed covering six infectious diseases that require quick identification to prevent an outbreak. This guide included triage triggers for signs and symptoms, infection prevention strategies, and notification channels. To compliment this guide an Infection Prevention and Control Screening Tool was also developed for all presentations to urgent care. Both were implemented in all Grampians Region acute healthcare services in early 2016. Results: Those working in Urgent Care Centers in the Grampians Region have a tool to support infection prevention and assist with the timely identification of infectious diseases leading to appropriate management and timely notification. Conclusion: It is important that staff in Urgent Care Centers have the tools to identify infectious diseases and isolate as necessary to prevent an outbreak with potential severe consequences. While these tools are not a comprehensive list of infectious diseases it does raise awareness of early detection and management of infectious diseases while encouraging discussion with patients to determine potential risks.
ENVIRONMENTAL CLEANING RESEARCH: PARTICIPATING IN THE REACH STUDY Alison Farrington 1, Michelle Allen 1, Lisa Hall, Dr1, Brett Mitchell, Associate Professor2 On behalf of the REACH study team 1 Queensland University of Technology, Kelvin Grove, Australia 2 Avondale College of Higher Education, Wahroonga, Australia Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study is a partnership project funded by the National Health and Medical Research Council (NHMRC). It aims to evaluate the effectiveness and cost-effectiveness of a novel cleaning bundle intervention. Eleven major Australian hospitals are participating in this research, with the trial component running from May 2016 until July 2017. Methods: The REACH trial uses a stepped wedge study design. This design ensures each trial site receives an eight week control period, followed by a randomly allocated intervention period between 20 and 50 weeks. Participation in such a major research activity requires a significant commitment from each trial hospital. To ensure this commitment is sustainable, the REACH study team will maintain a high level of contact with each site. Local site teams will also be a key aspect of conducting the research. During the pre-trial phase a research team will be established at each hospital. This team will include an infection prevention and control practitioner and an environmental services lead. Additional site team members will reflect local context and team structure. Site teams will assist with administrative activities for the trial, data collection and, importantly, the effective engagement of environmental services staff. Results and Conclusion: The local site team will be essential for successful implementation of the REACH research activities. Examples of site teams’ composition and activities will be showcased to highlight diversity and the value of strong collaboration in supporting behaviour change and quality improvement initiatives.
Abstracts ESTABLISHMENT OF AN INFECTION PREVENTION AND CONTROL PROGRAM IN JEDDAH HOSPITALS OF SAUDI ARABIA: A THREE-YEAR PROJECT Muhammad Halwani, Dr1, Nidal. Tashkandy, Dr.2 Al Baha University, Faculty of Medicine, Jeddah, Saudi Arabia 2 Health Affairs, Ministry of Health, Jeddah, Saudi Arabia
1
Background: The objective of this study was to establish a scientificallybased program to prevent infections in the twelve hospitals of the Ministry of Health in Jeddah, Saudi Arabia. We documented compliance and the impact of the program on infection rates over a 3-year period. Materials: An auditor from the infection control administration visited each hospital every four months from January 2009 to December 2011. The auditor used a set of performance indicators 55 in total, which were based on the British Infection Prevention Society’s auditing tool for monitoring infection control standards and were modified to reflect the clinical environment of Jeddah’s hospitals. Compliance of the indicators was recorded during the visit. The overall compliance at each hospital was calculated yearly and after the three years. Results: Routine audits after 3 years revealed that only 36% (37/104) of the infection control departments (ICDs) in the Jeddah hospitals were supervised by specialized personnel. In addition, 44% (44/101) of ICDs supervised and managed isolation rooms properly, and 50% (52/104) of hospital sinks were equipped with the required tools for hand hygiene. Decisions that were made by the infection control committee were followed by 45% (47/104) of ICDs, and 53% (55/104) of infection control committee decisions were implemented. Conclusion: Development of a standardised infection prevention and control program in conjunction with regular audits and feedback managed to pick up major defects in infection control in Jeddah hospitals. We believe that this program can be a useful tool for improving infection control practices in hospitals.
EVALUATING A PROCESS OF CHANGE IN HOSPITAL ENVIRONMENTAL CLEANING e THE ROLE OF LOGIC MODELS Alison Farrington 1, Michelle Allen 1, Lisa Hall, Dr1, Brett Mitchell, Associate Professor2 On behalf of the REACH study team 1 Queensland University of Technology, Kelvin Grove, Australia 2 Avondale College of Higher Education, Wahroonga, Australia Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will evaluate the impact of a novel environmental cleaning bundle in 11 hospitals around Australia. In each trial site we will collect a range of data, including healthcare associated infection rates, associated costs and changes in the thoroughness of cleaning. While these data will assist in determining the overall effectiveness and cost-effectiveness of the cleaning bundle it is important to understand what aspects of the practice change process worked, under what conditions, and why. Methods: The project team will systematically document and review the implementation process at each hospital site. To frame this process evaluation we have developed a logic model to identify what assumptions are being made and what expectations there are about how the process will work at each trial hospital. Results: The model outlines a proposed link between trial processes and intended trial outcomes. It shows the flow of activities and potential impact of local context and external factors in implementing change. Conclusion: The process of developing a logic model e a pictorial representation of key trial inputs, outputs and outcomes e has clarified the underlying assumptions involved in improving hospital environmental cleaning. This will inform a systematic evaluation of the change process in each of the participating hospital sites, which will assist with translation of trial outcomes to other hospital settings and to the environmental services workforce.
EVIDENCE BASED RECOMMENDATIONS FOR A NATIONAL HEALTHCARE ASSOCIATED INFECTION SURVEILLANCE PROGRAM Philip Russo 1,2, Allen Cheng, Professor3, Mike Richards, Professor4, Nick Graves, Professor1, Lisa Hall, Dr1 1 Queensland University of Technology, Brisbane, Australia 2 Griffith University, Brisbane, Australia