- Email: [email protected]
Central Zone Infection Control Matrix Project: A developing model for infection control service delivery in Queensland
Central Zone Infection Control Matrix Project: A developing model for infection control service delivery in Queensland Alanna Geary • RN RM BN MHSc-Infection Control Senior Project Officer Communicable Diseases Unit, Queensland Health, Brisbane, Qld
Tony Allworth • MBBS FRACP FRCPA FACTM MASM
Project Manager, Director of Infectious Diseases & Infection Control Royal Brisbane and Royal Women's Hospital, Herston, Qld
Louise Davis • BappSc, GDipPH, MASM Senior Project Officer Communicable Diseases Unit, Queensland Health, Brisbane, Qld
Dolly Olesen • RN MHSc-Infection Control
Infection Control Program Area Manager, Quality and Safety Program Communicable Diseases Unit, Queensland Health, Brisbane Qld
Abstract While challenges for infection control programs can arise on an almost daily basis, perhaps the most important challenge is that of the management of an overall infection control program. With increasing attention directed to infection control, it is imperative that infection control practitioners (lCPs) embrace the challenge and utilise the opportunities to promote infection control as a specialised discipline within a framework of quality and best-practice. It is also imperative that developing infection control quality initiatives are in line with the direction of the Australian Infection Control Association (AICA) and meet the needs of the ICPs charged with the responsibility of managing facility-specific infection control programs. A project has been funded under the infection control program area of the Quality Improvement and Enhancement Program (QIEP) ' to develop and facilitate a model of service delivery in Queensland Health. The ultimate outcome of this project is to support a culture of best practice and maintenance of clinical governance through the utilisation of standardised methodologies and defined clinical frameworks. The aim of the model is to provide standardisation of infection control practice in the Central Zone in accordance with relevant statutory requirements and the Queensland Health Infection Control Guidelines through a communication and support matrix. The model also assists to integrate public health services and Queensland Health pathologtj services and the districts, thereby reducing dllplication of services and educational reSOllrces in terms of manllals, policies and gllidelines. Additionally, the program establishes formalised preceptorship of staff IIndertaking infection cOl1trol, which has the potential to lead to cultural change towards standardised contemporary practice.
Australian Infection Control
Volume 8
Issue 4
December 2003
Introduction
management. Central Zone Queensland therefore provided
In January 2001, Commonwealth money was made available via the Australian healthcare agreements for quality improvement initiatives.
Under the infection control
program area of the Quality Improvement and Enhancement
an ideal environment in which to develop an integrated model of infection control service delivery. This model also supported
the va lues of the strategic direction for
Queensland Health through the achievement of health
Program (QIEP), a component of this funding was utilised to
outcomes in line with State and national recommendations.
develop a model of service delivery aimed specifically to the
Pilot survey
standardisation of infection control programs within the
State.
In order to appropriately assess the applicability and hmctionality of the model, a pilot survey was conducted. An
Queensland Health has divided the State into three
investigative mapping and profiling study was undertaken of
geographical zones (Figure 1).
These zones, known as
healthcare facilities in the Central Zone. This initial survey
Northern, Central and Southern Zones, are each managed by
comprised 17 health service districts, each incorporating a
zonal managers. Individual facilities are managed by district
suite of hospitals and community health services, the
managers, with delegation to hospital executives. Zones are
administrative operations of which are overseen by their
largely managed as individual entities with overall control
respective districts.
being afforded to Queensland Health. The geographical and functional
diversity of Queensland
Health
provides
challenges in terms of governance, limited human resources, infection
control! infectious
diseases
expertise
and
information technology. Another challenge in infection control service delivery is the
differences in geographical boundaries between public health and pathology services and the zonal model of Queensland Health. Also evident was that role delineation was unclear in
areas of non-notifiable communicable diseases and outbreak
The aim of this initial survey was to ascertain where and to what extent infection control programs where being undertaken by staff previously identified by Queensland Health
as
the
infection
control
contacts
for
their
facility/district and to provide an overview of infection control activity within health districts. Profiling and scoping of identified Central Zone Queensland health infection control programs were undertaken through the administration of a questionnaire to these staff.
The
results of this survey provided an overview of infection control program elements being offered or utilised by Central
Figure 1.
Queensland Health zonal map (©1999, State of Queensland, Queensland Health).
Zone healthcare facilities, and provided an indication of the gaps eviden t in service delivery and a basis to begin formulating the matrix. In all. 17 districts were surveyed. These districts comprised
12 regional/rural facilities and five metropolitan facilities. Two districts ran a co-joint infection control program and therefore were included as one program in two districts. In 10 facilities, a full-time infection control practitioner (ICP) was employed; however, in some facilities it was ascertained that responsibilities such as wound care/management, waste management and workplace health and safety were also included in the role description. The remainder of facilities employed staff to undertake infection control in a part-time capacity, the mean being 10.5 hours per week.
While Queensland Health identified
infection control contacts for each district, findings from the survey indicated that only 67% offered a district-wide program. The employment position of the person responsible for the infection control program is summarised in Table 1.
Australian Infection Control
VolumeS
Issue 4
December 2003
To ascertain the role of infection control in facilities,
•
Where new vaccines are released or schedules are
information was sought from participants on which elements
changed, collaborating with infection control programs to
of infection control were provided and the amount of time
share standardised advice, information and fact sheets,
spent undertaking these tasks. Table 2 outlines
the
diversity
and offer presentations to relevant staff. of infection control
responsibilities within districts and the number and percentage of the total who were undertaking these
The results of the pilot study were used as the basis for discussion and the subsequent focus groups and were
responsibilities as a part of their program. While some staff
provided to focus group participants.
provided services outside the scope of infection control
Focus groups
practice due to the nature of their role and/or facility size, only those elements which pertain specifically to infection
In conjunction with the survey, a number of focus groups
control are listed.
were undertaken.
It was also useful to obtain information on formal and
informal communication links already in existence between facilities and/ or services such as public health and pathology.
Participants included staff undertaking
infection control, district managers, directors of nursing and pathology staff from Gympie, Bundaberg, Rockhampton, Emerald and Longreach.
A further focus group was
A number of points were raised as a result of this survey
undertaken at a central forum with corporate office staff,
which indicated that current links with aligned services were
infection control staff from Central Zone and another with
not optimal and improvements could be beneficial to
infection control staff from Northern and Southern Zones.
infection control and provision of care within the districts. These included: •
Improving lines of communication for the notification of outbreaks,
their
subsequent
management
and
involvement in outbreak management teams. •
Seeking advice and collaboration where useful or necessary.
These focus groups were aimed at ascertaining more precisely the important elements of infection control programing and determined if consistency in practice would be an achievable outcome of the project. It also provided infection control staff with the opportunity to determine priorities for infection control programs and provided a bench marking and networking opportunity.
•
Promulgating decisions and processes.
•
Formating mechanisms for the provision of feedback on
Focus group results
cases and their progress.
There were a number of processes or resources that
• •
Ensuring uniform use and sharing of fact sheets and
participants believed were missed opportunities or would
guidelines.
further enhance their programs. These included:
Formalising links with Emergency Departments and
•
laboratories. •
Seeking advice on clinical aspects of some disease processes, risk factors, and approaches to deal with the issues within the context of the health continuum.
Table 1.
n=16
•
Clinica l nu rse PC level 3 nurse
Director of nursing
Australian Infection Control
%
4
25
10
62.5
1
6
More appropriate use of pathology systems such as AUSLAB to facilitate communication between infection control and pathology.
•
Facility appropriate surveillance systems including mechanisms for signal infection surveillance rather than
6
Enrolled nurse
Cl C /
infection control issues.
Employment position of person responsible for the infection control programme.
Employment position
More appropriate discharge planning and improved community links in the management of patients with
continuous surgical site surveillance for some facilities. •
Assistance with infection control management plans and the expectations of these for smaller facilities.
•
•
Teleconferencing to promote information sharing and professional development.
Volume 8
Issue 4
December 2003
Table 2.
.
---.--~-----------------.-----------
Infection control programme elements offered in Central Zone.
Inll'dion (onlrol programme ell'nll'nh
n=16
""
Development/maintenance of infection control policies/procedures for your facility/district
15
94
Participation in nursing staff orientation regarding infection control practices
14
87
Participation in evaluating new equipment/products re infection control/cleaning issues
13
81
Envirorunenta I surveillance / audi ts
13
81
Management of occupational exposures for needlestick/blood and body fluids
13
81
Formation of participation in multi-disciplinary infection Control Committee
13
81
Participation in bed placement of patients with significant organisms
13
81
Surveillance and data collection of surgical wound infections
13
81
Surveillance and data collection of blood stream infections
12
75
Participation in allied health staff orientation regarding infection control practices
12
75
Participation in other facility staff orientation regarding infection control practices
12
75
Development of facility / district infection control strategic plans
11
69
Participation in facility outbreak investigations
11
69
Participation with public health units during outbreak investigations
11
69
Participation on Waste Management Committees
10
62
Staff vaccination clinics
10
62
Participation on Building and Refurbishment / Planning Committees
9
56
Participation on facility accreditation committees
8
50
Participation in medical staff orientation regarding infection control practices
8
50
Responsibility for managing an allocated budget for your infection control programme
8
50
Other surveillance activities
8
50
Participation on Sterilisation and Disinfection Committees
6
50
Other activitie
6
50
Surveillance and data collection of respiratory infections
5
31
SurveilJance and data collection of urinary tract infections
5
31
------------------------------------------------------
--------------------------------------------
--------------1 Australian Infection Control
VolumeS
Issue 4
December 2003
•
Process manual to assist standardisation of practice. The
the steering committee. The matrix template (Figure 2) was
procedures which could be adapted to suit individual
developed to demonstrate the interrelationships between
needs.
Other tools that would be useful would be
facilities and ICPs, with a zonal coordinator role to facilitate
PowerPoint presentations, advice on business case or
zonal infection control initiatives and ongoing management
project management, reference lists for accessing human
of the Central Zone infection control matrix (CZICM).
and material resources and where information pertinent to the infection control role could be obtained. •
Assistance with professional development for infection control staff.
•
regardless of facility size and demographics, was endorsed by
process manual should contain generic policies/
Information technology was an issue for many rural and remote areas, with access to the intranet being limited or 'very slow'. Furthermore, accessibility to necessary drives
Process manual & intranet website 2 In
conjunction
with
a
facilitation
pathway
for
communication, development commenced on a process manual and intranet website which would provide ICPs with a 'one-stop shop' for infection control information and advice.
such as A drive and CD Rom drive was not available in
The process manual, a hard-copy version of the intranet
some districts.
website, provides a reference guide for ICPs. The CZICM process manual and associated website are designed to
Development of the model
provide ICPs with a ready reference on the elements of a
The matrix The development of a communication matrix that supported small facilities, encouraged and promoted resource sharing between facilities, facilitated discussion and provided a
sound infection control program. •
reference for staff undertaking the role of infection control,
Figure 2.
Included in these
references are: Contact names and numbers of CZICM Ieps and infection control portfolio holders.
Central Zone infection control matrix.
GYM PIE
~.t-----'+
/
REDCUFFE - CABOOL TURE RedcUtfe
caboolture Kllcoy
SUNSHINE COAST Nombour CENTRAL WEST
C::~ra
~
.... m
_
Lon.J~C"
\
Barcaldine Blackillll ,~
I.s lsford
}undah Muttaburn Tombo Winton
L +
CENTRAL HIGHLANDS Emerald Blackwater Springsure
ROCK HAMPTON
:~bP~na 't'eppoon
t t
7j (:'J .l. The Prince Cho rles Hospi tal
J
i
Inf~ction
J
.I
'j
Zonal Control Co-ordinator
Wome n ·s Hospfta l
OY~~~li':!7" s
J
FRASER COAST Maryborough Hervey Bay
SOUTH BURNETT
g~C~ Murgon Nanango Wondai
•
t
GLADSTONE
BANANA Blloela Baralaba Moora
BUN DABERG
Olllders
Gin Gin
Mt Perry
. .1-----.....
NORTH BURNETT G"ynd" h
~
Monto Munduberra
Theooore
Australian Infection Control
Volume 8
Issue 4
December 2003
•
•
Contact names and numbers for infectious diseases
Word/Powerpoint and can be altered for individual facility
support, pathology/microbiology support and public health assistance.
use.
Standardised procedures for infection control, including a Central Zone template. These procedures are designed to standardise infection control practice through utilisation of the Queensland Health Infection Control Guidelines )' 4, however, allow individual facilities the opportunity to add
additional
facility
specific
operationalise processes locally.
information
to
Procedures can be
reproduced utilising the set template or a 'cut and paste' option is available to allow individual facilities to utilise pre-existing templates. •
Educational PowerPoints which can be used by ICPs for the education of staff within their facility. There is also information attached to these Power Points which enable the person delivering the education to obtain background resources for self-directed learning.
•
Appropriate links to resources that will assist in outbreak management situations, policy development, surveillance definitions and decision-making processes related to infection control.
•
Business case and project plan templates to assist in the development and management of an infection control program. Also included are links to Queensland Health intranet sites to assist in business case development.
•
Templates and information on the auditing process requirements for infection control and appropriate infection control standards.
•
Links and information related to the collection of surveillance information, including signal surveillance and a root cause analysis framework to assist infection control.
The process manual and website provide an instant reference to most of the requirements for an infection control program. For those facilities where access to information technology is limited, the hard copy version provides most of the resources necessary and contact details of people who may be able to assist.
In facilities where information technology is more
Telehealth conferences During the course of the project, three telehealth conferences were conducted. These were aimed at providing education to districts within the Zone, with selection of topics being made to meet with current demand and issues as they relate to infection control.
They were also designed to enhance
communication and 'buy-in' between sites.
Due to the
number of 'ports' available, it was necessary to limit the number of sites to approximately 20. However, sites were rotated depending on demand and each district received at least one port. These conferences produced very positive feedback from sites.
Collaboration with pathology services Microbiology plays an integral role within the context of an infection control program. The alignment of microbiology through Queensland Health pathology services and infection control has been evident through the course of the project, in most facilities. There were, however, a number of issues raised which where
able to be dealt with by the project team. These issues did not in any way impede the infection control nurses' ability to
perform tasks appropriately; however, better use of available resources can lead to more efficient use of time. During the course of the project, a number of initiatives have been between the project team and pathology services to ensure effective use of systems. standardisation
These have included
of pathology alert systems
for
the
management of patients with multi-resistant organisms, discussions related to the appropriate use of environmental sampling and assistance in the management of occupational exposures.
Strategy implementation The concept of the CZICM was presented to Central Zone staff on 27 November 2002. On 11 February 2003, an official introduction of the CZICM and demonstration of the website was conducted in conjunction with an educational session.
accessible and connections to the intranet readily available,
The implementation and introduction of the available
the web-based version may be the more practical option. The
resources and subsequent site visits provided staff involved
website allows for templates, prepared procedures and
in infection control service delivery an opportunity to explore
educational powerpoints to be downloaded from the web for
current available resources. Site visits around the zone were
use in facilities. They are available in pdf or
conducted by the two project officers in order to ensure that:
Australian Infection Control
Volume 8
Issue 4
December 2003
•
Staff understood the CZlCM and how it would work.
educational resources was released in October 2003 and the
•
Staff were involved in decision-making processes involved with the CZICM. Individual facilities would contribute to the CZICM.
•
The CZICM provided appropriate and relevant resource
intranet service.
material for all facilities.
The CZICM could 'value-add' to infection control programs already in existence through consultation with aligned services such as pathology and public health.
• •
an adjunctive, the website was produced on CD Rom for those facilities with lirn.ited access to the Queensland Health
•
•
intranet-based website was operationa l at the same time. As
Consultative processes Through the duration of the project a number of key communication processes were adhered to.
A steering
committee was put in place with representation from infectious diseases, infection control, QHPS, Queensland
Resource materials would assist in providing infection
Health, infection Control Practitioners Association of
control programs.
Queensland (ICPAQ) and public health.
Staff understood the benefits for standardisation of
A representative from the infection Control Practitioners
practice through the Zone.
Association of Queensland was also on the stee rin g committee to assist in communication links.
The CZICM has been operational now since November 2002
Consultation
with the wider audience of staff in Central Zone facilities was
when the first teleconference was held. Since that time the
imperative. Therefore regular contact via teleconferencing,
additional resources of the website, process manual,
site visits and phone consultation assisted this process.
additional teleconferences and communication through the
Conclusion
project officers has seen the CZICM continue to develop.
The lessons Learnt from the development of the CZICM are:
A second edition of the process manual containing more
•
information including procedure templates, audit tools and
Communication and coHaboration with aU members of the proposed team are imperative to its s uccess.
MetroMax Q ®Storage System
::l
Best Combination for Quick Adjustment. Quick Assembly. Quick Cleaning
res•
.
~
E
o u
.
•
-
-
~
~I'
.~
.- ,. ..
>
~
with smooth
Cl)
shelves
"
U .> Cl)
"'C
For more informatio n call us today on '800 804 006 or visit our website www.device.com.au
•
~ ~ ~
_ _DEVICE
~f" TECHNDI.DGIE5 Device Technologies... more than you think
~ --~---~----~-~--~ Australian Infection Control
•
L
--110--
Volume 8
Issue 4
December 2003
• •
User buy-in is imperative to ongoing success and
•
facilitates change management.
Health Infection Control Expert Working Group through
Developed tools must appropriately meet the needs of the
the Central Zone infection control coordinator and the Queensland Health ICP.
target audience. •
Regular
site
visits
or
facilitating
networking/
benchmarking opportunities will assist in ensuring that
•
Infectious diseases consultative support.
•
Effective communication strategies involving a cooperative network involving Queensland Health
infection control programs are appropriate for the facility
Central Zone facilities, laboratories and public health to ensure a comprehensive approach to infections and the
they are intended for. •
Continued development of procedures and regular updating of these will ensure that standardisation of infection control practice continues.
•
Direct links and collaboration with the Queensland
provision of epidemiological expertise. •
matrix assists in consistent treatment and advice in
Regular teleconferencing is an appropriate strategy for communication and in the provision of education and is well received by those districts where availability to
The use of a comprehensive communication support relation to the management of occupational exposures.
•
In the management of emerging and re-emerging multiresistant pathogens, the provision of appropriate, timely information and policy development for the treatment,
tertiary services due to geographical location is limited or less than optimal.
management and appropriate antibiotic use will be
Benefits of the CZICM model to districts
improved through the use of an infection control and
There are a number of advantages of the model for all
infectious disease communication support matrix.
facilities within Central Zone.
These include, but are not
limited to: •
•
vaccination programs, waste management and sharps
Ongoing assistance in interpretation of State and national
disposal, cleaning services, disinfection and sterilisation
guidelines. •
Development of the processes and refinement of procedures related to signal surveillance.
This is
and product evaluation. •
numbers of surgical procedures does not lend itself to the
Benefits of the CZICM model to Queensland Health
performance of surgical site surveillance.
The CZICM provides a number of benefits to Queensland
Signal
surveillance provides facilities with the opportunity to address the key aspects of infection surveillance and undertake appropriate investigative procedures.
Health. These benefits include: •
the Central Zone.
with the corporate vision. •
•
Healthcare (CHRISP).
•
Surveillance
and
Prevention
Provision of education for staff to assist in professional
aimed at the provision of analysis and advice on the occurrence, causation and prevention of healthcare
Development and provision of benchmarking and
related infections. •
Assistance in the development of business plans that may result from outcomes of the CZICM.
Setting the research agenda for infection control within the Zone.
•
Related
CHRISP is a Queensland Health initiative
development. networking opportunities. •
Support for the aims and objectives of other corporately focused infection control services such as The Centre for
Maintenance of the process manual and website to ensure ongoing accessibility and current information.
•
The provision of a Central Zone vision for infection control service delivery, which would be in alignment
Expert advice in the ongoing development, management and enhancement of infection control programs within
•
Accessibility to an appropriate resource at the clinical coalface.
particularly relevant in small facilities where decreased
•
Consistent advice, communication and support for issues relating to building and refurbishment, staff and patient
•
Contribution to the Queensland Health Strategic Planning in relation to infection control.
Standardisation of infection control processes and procedures throughout the Zone.
•
Support of a statewide focus for infection control.
Ensuring effective, efficient utilisation of services offered
•
Development and implementation of performance
by pathology and public health.
Australian Infection Control
indicators for infection control.
--0--
Volume 8
Issue 4
December 2003
Summary
deli very and standa rd isa tio n of prac tice. Overall, the feeling
The a im of the project was to stand a rd ise infection con trol practice and provide a supportive mode l fo r a collabo rative app roach to infec ti on con trol serv ice deli very.
Ln order to
ascertain the success of the model. an evaluation process was cond ucted. This eva lua tion process was undertaken via an ex te rna l agency_ The rationale for usin g an ex tern al source
was to ensure th a t eva luation was condu cted by an inde pe nd en t a udi to r, mail outs a nd res ults were kep t anonymous and appropriate da ta analysis was und erta ken. A qu a lita ti ve and qu antitati ve tool was utili sed on ad vice
from the CZICM projec t tea m. Seventy-one surveys were mailed to d istricts, pubtic hea lth units a nd path ology services
in Central Zone. A 46% response rate was achieved . s u ppo rt a nd
ac know led g ment tha t
There was overa ll
of staff was that CZICM had hi gh strateg ic importa nce in the fie ld of infection control.
Acknowledgments The project team wou ld Uke to ac know ledge Centra l Zone ICPs a nd district executi ves in Ce ntral Zone for their time, effort and commitment to th e p roject. We woul d also like to acknow led ge the wo rk and co mmitm ent of the steering co mmittee a nd
ap propria te to the needs of Central Zone.
Staff indica ted
resou rces and th e reso urce networ k it prov id ed, and understood the appro pria teness of s tand a rdi sed p ractice fo r
o verv iew of infec ti on contro l in Q ueensla nd. Th anks are also
stages of the project).
References 1.
Q ueensland Health . Quality Improvcment & Enhancement Program (QIEP). Ava ilab le at http: // www. health .qld.gov.au / q uality/ Accessed 30 October 2003.
2.
Qucensland Hea lth Public Hea lt h Services. Cent ral Zone In fection Contro l Matrix. Ava ilable at http://qheps / p hs/ czicm / home.h tm . Accessed 30 October 2003,
3.
Q ueens land Health Infection Con trol. Ava ilab le at h ttp://www. hea lth .q ld.gov.ilu/i nfec tionco nt ro l/about .h tm l. Accessed 30 October 2003.
4.
Q ueenslan d Health infec tion Control Guide li nes (2nd ed ). 2001.
infec tio n contro l. It was also felt by staff that th e mod el was a wo rth whil e initia ti ve as a mod el fo r infectio n co ntrol service
throu g ho ut Q uee nsland who have
ex tend ed to Chris tine Lostroh (Project manager in the initia l
th is model was
sa ti sfacti on in the concepts of the CZICM, were utiliSing the
reps
prov ided inform a ti o n a nd contributed to prov iding an
STE RI S·
Flexibility Today for Tomorrow's Applications Sterile Processing ......Just in Time Proven Safe and Effective ...... Guaranteed
For more information call us today on 1800 804 006 or visit our website www.device.(om.au
think Aus tralian Infection Control
Volume 8
Issue 4
December Z003
Tony Allworth • MBBS FRACP FRCPA FACTM MASM
Project Manager, Director of Infectious Diseases & Infection Control Royal Brisbane and Royal Women's Hospital, Herston, Qld
Louise Davis • BappSc, GDipPH, MASM Senior Project Officer Communicable Diseases Unit, Queensland Health, Brisbane, Qld
Dolly Olesen • RN MHSc-Infection Control
Infection Control Program Area Manager, Quality and Safety Program Communicable Diseases Unit, Queensland Health, Brisbane Qld
Abstract While challenges for infection control programs can arise on an almost daily basis, perhaps the most important challenge is that of the management of an overall infection control program. With increasing attention directed to infection control, it is imperative that infection control practitioners (lCPs) embrace the challenge and utilise the opportunities to promote infection control as a specialised discipline within a framework of quality and best-practice. It is also imperative that developing infection control quality initiatives are in line with the direction of the Australian Infection Control Association (AICA) and meet the needs of the ICPs charged with the responsibility of managing facility-specific infection control programs. A project has been funded under the infection control program area of the Quality Improvement and Enhancement Program (QIEP) ' to develop and facilitate a model of service delivery in Queensland Health. The ultimate outcome of this project is to support a culture of best practice and maintenance of clinical governance through the utilisation of standardised methodologies and defined clinical frameworks. The aim of the model is to provide standardisation of infection control practice in the Central Zone in accordance with relevant statutory requirements and the Queensland Health Infection Control Guidelines through a communication and support matrix. The model also assists to integrate public health services and Queensland Health pathologtj services and the districts, thereby reducing dllplication of services and educational reSOllrces in terms of manllals, policies and gllidelines. Additionally, the program establishes formalised preceptorship of staff IIndertaking infection cOl1trol, which has the potential to lead to cultural change towards standardised contemporary practice.
Australian Infection Control
Volume 8
Issue 4
December 2003
Introduction
management. Central Zone Queensland therefore provided
In January 2001, Commonwealth money was made available via the Australian healthcare agreements for quality improvement initiatives.
Under the infection control
program area of the Quality Improvement and Enhancement
an ideal environment in which to develop an integrated model of infection control service delivery. This model also supported
the va lues of the strategic direction for
Queensland Health through the achievement of health
Program (QIEP), a component of this funding was utilised to
outcomes in line with State and national recommendations.
develop a model of service delivery aimed specifically to the
Pilot survey
standardisation of infection control programs within the
State.
In order to appropriately assess the applicability and hmctionality of the model, a pilot survey was conducted. An
Queensland Health has divided the State into three
investigative mapping and profiling study was undertaken of
geographical zones (Figure 1).
These zones, known as
healthcare facilities in the Central Zone. This initial survey
Northern, Central and Southern Zones, are each managed by
comprised 17 health service districts, each incorporating a
zonal managers. Individual facilities are managed by district
suite of hospitals and community health services, the
managers, with delegation to hospital executives. Zones are
administrative operations of which are overseen by their
largely managed as individual entities with overall control
respective districts.
being afforded to Queensland Health. The geographical and functional
diversity of Queensland
Health
provides
challenges in terms of governance, limited human resources, infection
control! infectious
diseases
expertise
and
information technology. Another challenge in infection control service delivery is the
differences in geographical boundaries between public health and pathology services and the zonal model of Queensland Health. Also evident was that role delineation was unclear in
areas of non-notifiable communicable diseases and outbreak
The aim of this initial survey was to ascertain where and to what extent infection control programs where being undertaken by staff previously identified by Queensland Health
as
the
infection
control
contacts
for
their
facility/district and to provide an overview of infection control activity within health districts. Profiling and scoping of identified Central Zone Queensland health infection control programs were undertaken through the administration of a questionnaire to these staff.
The
results of this survey provided an overview of infection control program elements being offered or utilised by Central
Figure 1.
Queensland Health zonal map (©1999, State of Queensland, Queensland Health).
Zone healthcare facilities, and provided an indication of the gaps eviden t in service delivery and a basis to begin formulating the matrix. In all. 17 districts were surveyed. These districts comprised
12 regional/rural facilities and five metropolitan facilities. Two districts ran a co-joint infection control program and therefore were included as one program in two districts. In 10 facilities, a full-time infection control practitioner (ICP) was employed; however, in some facilities it was ascertained that responsibilities such as wound care/management, waste management and workplace health and safety were also included in the role description. The remainder of facilities employed staff to undertake infection control in a part-time capacity, the mean being 10.5 hours per week.
While Queensland Health identified
infection control contacts for each district, findings from the survey indicated that only 67% offered a district-wide program. The employment position of the person responsible for the infection control program is summarised in Table 1.
Australian Infection Control
VolumeS
Issue 4
December 2003
To ascertain the role of infection control in facilities,
•
Where new vaccines are released or schedules are
information was sought from participants on which elements
changed, collaborating with infection control programs to
of infection control were provided and the amount of time
share standardised advice, information and fact sheets,
spent undertaking these tasks. Table 2 outlines
the
diversity
and offer presentations to relevant staff. of infection control
responsibilities within districts and the number and percentage of the total who were undertaking these
The results of the pilot study were used as the basis for discussion and the subsequent focus groups and were
responsibilities as a part of their program. While some staff
provided to focus group participants.
provided services outside the scope of infection control
Focus groups
practice due to the nature of their role and/or facility size, only those elements which pertain specifically to infection
In conjunction with the survey, a number of focus groups
control are listed.
were undertaken.
It was also useful to obtain information on formal and
informal communication links already in existence between facilities and/ or services such as public health and pathology.
Participants included staff undertaking
infection control, district managers, directors of nursing and pathology staff from Gympie, Bundaberg, Rockhampton, Emerald and Longreach.
A further focus group was
A number of points were raised as a result of this survey
undertaken at a central forum with corporate office staff,
which indicated that current links with aligned services were
infection control staff from Central Zone and another with
not optimal and improvements could be beneficial to
infection control staff from Northern and Southern Zones.
infection control and provision of care within the districts. These included: •
Improving lines of communication for the notification of outbreaks,
their
subsequent
management
and
involvement in outbreak management teams. •
Seeking advice and collaboration where useful or necessary.
These focus groups were aimed at ascertaining more precisely the important elements of infection control programing and determined if consistency in practice would be an achievable outcome of the project. It also provided infection control staff with the opportunity to determine priorities for infection control programs and provided a bench marking and networking opportunity.
•
Promulgating decisions and processes.
•
Formating mechanisms for the provision of feedback on
Focus group results
cases and their progress.
There were a number of processes or resources that
• •
Ensuring uniform use and sharing of fact sheets and
participants believed were missed opportunities or would
guidelines.
further enhance their programs. These included:
Formalising links with Emergency Departments and
•
laboratories. •
Seeking advice on clinical aspects of some disease processes, risk factors, and approaches to deal with the issues within the context of the health continuum.
Table 1.
n=16
•
Clinica l nu rse PC level 3 nurse
Director of nursing
Australian Infection Control
%
4
25
10
62.5
1
6
More appropriate use of pathology systems such as AUSLAB to facilitate communication between infection control and pathology.
•
Facility appropriate surveillance systems including mechanisms for signal infection surveillance rather than
6
Enrolled nurse
Cl C /
infection control issues.
Employment position of person responsible for the infection control programme.
Employment position
More appropriate discharge planning and improved community links in the management of patients with
continuous surgical site surveillance for some facilities. •
Assistance with infection control management plans and the expectations of these for smaller facilities.
•
•
Teleconferencing to promote information sharing and professional development.
Volume 8
Issue 4
December 2003
Table 2.
.
---.--~-----------------.-----------
Infection control programme elements offered in Central Zone.
Inll'dion (onlrol programme ell'nll'nh
n=16
""
Development/maintenance of infection control policies/procedures for your facility/district
15
94
Participation in nursing staff orientation regarding infection control practices
14
87
Participation in evaluating new equipment/products re infection control/cleaning issues
13
81
Envirorunenta I surveillance / audi ts
13
81
Management of occupational exposures for needlestick/blood and body fluids
13
81
Formation of participation in multi-disciplinary infection Control Committee
13
81
Participation in bed placement of patients with significant organisms
13
81
Surveillance and data collection of surgical wound infections
13
81
Surveillance and data collection of blood stream infections
12
75
Participation in allied health staff orientation regarding infection control practices
12
75
Participation in other facility staff orientation regarding infection control practices
12
75
Development of facility / district infection control strategic plans
11
69
Participation in facility outbreak investigations
11
69
Participation with public health units during outbreak investigations
11
69
Participation on Waste Management Committees
10
62
Staff vaccination clinics
10
62
Participation on Building and Refurbishment / Planning Committees
9
56
Participation on facility accreditation committees
8
50
Participation in medical staff orientation regarding infection control practices
8
50
Responsibility for managing an allocated budget for your infection control programme
8
50
Other surveillance activities
8
50
Participation on Sterilisation and Disinfection Committees
6
50
Other activitie
6
50
Surveillance and data collection of respiratory infections
5
31
SurveilJance and data collection of urinary tract infections
5
31
------------------------------------------------------
--------------------------------------------
--------------1 Australian Infection Control
VolumeS
Issue 4
December 2003
•
Process manual to assist standardisation of practice. The
the steering committee. The matrix template (Figure 2) was
procedures which could be adapted to suit individual
developed to demonstrate the interrelationships between
needs.
Other tools that would be useful would be
facilities and ICPs, with a zonal coordinator role to facilitate
PowerPoint presentations, advice on business case or
zonal infection control initiatives and ongoing management
project management, reference lists for accessing human
of the Central Zone infection control matrix (CZICM).
and material resources and where information pertinent to the infection control role could be obtained. •
Assistance with professional development for infection control staff.
•
regardless of facility size and demographics, was endorsed by
process manual should contain generic policies/
Information technology was an issue for many rural and remote areas, with access to the intranet being limited or 'very slow'. Furthermore, accessibility to necessary drives
Process manual & intranet website 2 In
conjunction
with
a
facilitation
pathway
for
communication, development commenced on a process manual and intranet website which would provide ICPs with a 'one-stop shop' for infection control information and advice.
such as A drive and CD Rom drive was not available in
The process manual, a hard-copy version of the intranet
some districts.
website, provides a reference guide for ICPs. The CZICM process manual and associated website are designed to
Development of the model
provide ICPs with a ready reference on the elements of a
The matrix The development of a communication matrix that supported small facilities, encouraged and promoted resource sharing between facilities, facilitated discussion and provided a
sound infection control program. •
reference for staff undertaking the role of infection control,
Figure 2.
Included in these
references are: Contact names and numbers of CZICM Ieps and infection control portfolio holders.
Central Zone infection control matrix.
GYM PIE
~.t-----'+
/
REDCUFFE - CABOOL TURE RedcUtfe
caboolture Kllcoy
SUNSHINE COAST Nombour CENTRAL WEST
C::~ra
~
.... m
_
Lon.J~C"
\
Barcaldine Blackillll ,~
I.s lsford
}undah Muttaburn Tombo Winton
L +
CENTRAL HIGHLANDS Emerald Blackwater Springsure
ROCK HAMPTON
:~bP~na 't'eppoon
t t
7j (:'J .l. The Prince Cho rles Hospi tal
J
i
Inf~ction
J
.I
'j
Zonal Control Co-ordinator
Wome n ·s Hospfta l
OY~~~li':!7" s
J
FRASER COAST Maryborough Hervey Bay
SOUTH BURNETT
g~C~ Murgon Nanango Wondai
•
t
GLADSTONE
BANANA Blloela Baralaba Moora
BUN DABERG
Olllders
Gin Gin
Mt Perry
. .1-----.....
NORTH BURNETT G"ynd" h
~
Monto Munduberra
Theooore
Australian Infection Control
Volume 8
Issue 4
December 2003
•
•
Contact names and numbers for infectious diseases
Word/Powerpoint and can be altered for individual facility
support, pathology/microbiology support and public health assistance.
use.
Standardised procedures for infection control, including a Central Zone template. These procedures are designed to standardise infection control practice through utilisation of the Queensland Health Infection Control Guidelines )' 4, however, allow individual facilities the opportunity to add
additional
facility
specific
operationalise processes locally.
information
to
Procedures can be
reproduced utilising the set template or a 'cut and paste' option is available to allow individual facilities to utilise pre-existing templates. •
Educational PowerPoints which can be used by ICPs for the education of staff within their facility. There is also information attached to these Power Points which enable the person delivering the education to obtain background resources for self-directed learning.
•
Appropriate links to resources that will assist in outbreak management situations, policy development, surveillance definitions and decision-making processes related to infection control.
•
Business case and project plan templates to assist in the development and management of an infection control program. Also included are links to Queensland Health intranet sites to assist in business case development.
•
Templates and information on the auditing process requirements for infection control and appropriate infection control standards.
•
Links and information related to the collection of surveillance information, including signal surveillance and a root cause analysis framework to assist infection control.
The process manual and website provide an instant reference to most of the requirements for an infection control program. For those facilities where access to information technology is limited, the hard copy version provides most of the resources necessary and contact details of people who may be able to assist.
In facilities where information technology is more
Telehealth conferences During the course of the project, three telehealth conferences were conducted. These were aimed at providing education to districts within the Zone, with selection of topics being made to meet with current demand and issues as they relate to infection control.
They were also designed to enhance
communication and 'buy-in' between sites.
Due to the
number of 'ports' available, it was necessary to limit the number of sites to approximately 20. However, sites were rotated depending on demand and each district received at least one port. These conferences produced very positive feedback from sites.
Collaboration with pathology services Microbiology plays an integral role within the context of an infection control program. The alignment of microbiology through Queensland Health pathology services and infection control has been evident through the course of the project, in most facilities. There were, however, a number of issues raised which where
able to be dealt with by the project team. These issues did not in any way impede the infection control nurses' ability to
perform tasks appropriately; however, better use of available resources can lead to more efficient use of time. During the course of the project, a number of initiatives have been between the project team and pathology services to ensure effective use of systems. standardisation
These have included
of pathology alert systems
for
the
management of patients with multi-resistant organisms, discussions related to the appropriate use of environmental sampling and assistance in the management of occupational exposures.
Strategy implementation The concept of the CZICM was presented to Central Zone staff on 27 November 2002. On 11 February 2003, an official introduction of the CZICM and demonstration of the website was conducted in conjunction with an educational session.
accessible and connections to the intranet readily available,
The implementation and introduction of the available
the web-based version may be the more practical option. The
resources and subsequent site visits provided staff involved
website allows for templates, prepared procedures and
in infection control service delivery an opportunity to explore
educational powerpoints to be downloaded from the web for
current available resources. Site visits around the zone were
use in facilities. They are available in pdf or
conducted by the two project officers in order to ensure that:
Australian Infection Control
Volume 8
Issue 4
December 2003
•
Staff understood the CZlCM and how it would work.
educational resources was released in October 2003 and the
•
Staff were involved in decision-making processes involved with the CZICM. Individual facilities would contribute to the CZICM.
•
The CZICM provided appropriate and relevant resource
intranet service.
material for all facilities.
The CZICM could 'value-add' to infection control programs already in existence through consultation with aligned services such as pathology and public health.
• •
an adjunctive, the website was produced on CD Rom for those facilities with lirn.ited access to the Queensland Health
•
•
intranet-based website was operationa l at the same time. As
Consultative processes Through the duration of the project a number of key communication processes were adhered to.
A steering
committee was put in place with representation from infectious diseases, infection control, QHPS, Queensland
Resource materials would assist in providing infection
Health, infection Control Practitioners Association of
control programs.
Queensland (ICPAQ) and public health.
Staff understood the benefits for standardisation of
A representative from the infection Control Practitioners
practice through the Zone.
Association of Queensland was also on the stee rin g committee to assist in communication links.
The CZICM has been operational now since November 2002
Consultation
with the wider audience of staff in Central Zone facilities was
when the first teleconference was held. Since that time the
imperative. Therefore regular contact via teleconferencing,
additional resources of the website, process manual,
site visits and phone consultation assisted this process.
additional teleconferences and communication through the
Conclusion
project officers has seen the CZICM continue to develop.
The lessons Learnt from the development of the CZICM are:
A second edition of the process manual containing more
•
information including procedure templates, audit tools and
Communication and coHaboration with aU members of the proposed team are imperative to its s uccess.
MetroMax Q ®Storage System
::l
Best Combination for Quick Adjustment. Quick Assembly. Quick Cleaning
res•
.
~
E
o u
.
•
-
-
~
~I'
.~
.- ,. ..
>
~
with smooth
Cl)
shelves
"
U .> Cl)
"'C
For more informatio n call us today on '800 804 006 or visit our website www.device.com.au
•
~ ~ ~
_ _DEVICE
~f" TECHNDI.DGIE5 Device Technologies... more than you think
~ --~---~----~-~--~ Australian Infection Control
•
L
--110--
Volume 8
Issue 4
December 2003
• •
User buy-in is imperative to ongoing success and
•
facilitates change management.
Health Infection Control Expert Working Group through
Developed tools must appropriately meet the needs of the
the Central Zone infection control coordinator and the Queensland Health ICP.
target audience. •
Regular
site
visits
or
facilitating
networking/
benchmarking opportunities will assist in ensuring that
•
Infectious diseases consultative support.
•
Effective communication strategies involving a cooperative network involving Queensland Health
infection control programs are appropriate for the facility
Central Zone facilities, laboratories and public health to ensure a comprehensive approach to infections and the
they are intended for. •
Continued development of procedures and regular updating of these will ensure that standardisation of infection control practice continues.
•
Direct links and collaboration with the Queensland
provision of epidemiological expertise. •
matrix assists in consistent treatment and advice in
Regular teleconferencing is an appropriate strategy for communication and in the provision of education and is well received by those districts where availability to
The use of a comprehensive communication support relation to the management of occupational exposures.
•
In the management of emerging and re-emerging multiresistant pathogens, the provision of appropriate, timely information and policy development for the treatment,
tertiary services due to geographical location is limited or less than optimal.
management and appropriate antibiotic use will be
Benefits of the CZICM model to districts
improved through the use of an infection control and
There are a number of advantages of the model for all
infectious disease communication support matrix.
facilities within Central Zone.
These include, but are not
limited to: •
•
vaccination programs, waste management and sharps
Ongoing assistance in interpretation of State and national
disposal, cleaning services, disinfection and sterilisation
guidelines. •
Development of the processes and refinement of procedures related to signal surveillance.
This is
and product evaluation. •
numbers of surgical procedures does not lend itself to the
Benefits of the CZICM model to Queensland Health
performance of surgical site surveillance.
The CZICM provides a number of benefits to Queensland
Signal
surveillance provides facilities with the opportunity to address the key aspects of infection surveillance and undertake appropriate investigative procedures.
Health. These benefits include: •
the Central Zone.
with the corporate vision. •
•
Healthcare (CHRISP).
•
Surveillance
and
Prevention
Provision of education for staff to assist in professional
aimed at the provision of analysis and advice on the occurrence, causation and prevention of healthcare
Development and provision of benchmarking and
related infections. •
Assistance in the development of business plans that may result from outcomes of the CZICM.
Setting the research agenda for infection control within the Zone.
•
Related
CHRISP is a Queensland Health initiative
development. networking opportunities. •
Support for the aims and objectives of other corporately focused infection control services such as The Centre for
Maintenance of the process manual and website to ensure ongoing accessibility and current information.
•
The provision of a Central Zone vision for infection control service delivery, which would be in alignment
Expert advice in the ongoing development, management and enhancement of infection control programs within
•
Accessibility to an appropriate resource at the clinical coalface.
particularly relevant in small facilities where decreased
•
Consistent advice, communication and support for issues relating to building and refurbishment, staff and patient
•
Contribution to the Queensland Health Strategic Planning in relation to infection control.
Standardisation of infection control processes and procedures throughout the Zone.
•
Support of a statewide focus for infection control.
Ensuring effective, efficient utilisation of services offered
•
Development and implementation of performance
by pathology and public health.
Australian Infection Control
indicators for infection control.
--0--
Volume 8
Issue 4
December 2003
Summary
deli very and standa rd isa tio n of prac tice. Overall, the feeling
The a im of the project was to stand a rd ise infection con trol practice and provide a supportive mode l fo r a collabo rative app roach to infec ti on con trol serv ice deli very.
Ln order to
ascertain the success of the model. an evaluation process was cond ucted. This eva lua tion process was undertaken via an ex te rna l agency_ The rationale for usin g an ex tern al source
was to ensure th a t eva luation was condu cted by an inde pe nd en t a udi to r, mail outs a nd res ults were kep t anonymous and appropriate da ta analysis was und erta ken. A qu a lita ti ve and qu antitati ve tool was utili sed on ad vice
from the CZICM projec t tea m. Seventy-one surveys were mailed to d istricts, pubtic hea lth units a nd path ology services
in Central Zone. A 46% response rate was achieved . s u ppo rt a nd
ac know led g ment tha t
There was overa ll
of staff was that CZICM had hi gh strateg ic importa nce in the fie ld of infection control.
Acknowledgments The project team wou ld Uke to ac know ledge Centra l Zone ICPs a nd district executi ves in Ce ntral Zone for their time, effort and commitment to th e p roject. We woul d also like to acknow led ge the wo rk and co mmitm ent of the steering co mmittee a nd
ap propria te to the needs of Central Zone.
Staff indica ted
resou rces and th e reso urce networ k it prov id ed, and understood the appro pria teness of s tand a rdi sed p ractice fo r
o verv iew of infec ti on contro l in Q ueensla nd. Th anks are also
stages of the project).
References 1.
Q ueensland Health . Quality Improvcment & Enhancement Program (QIEP). Ava ilab le at http: // www. health .qld.gov.au / q uality/ Accessed 30 October 2003.
2.
Qucensland Hea lth Public Hea lt h Services. Cent ral Zone In fection Contro l Matrix. Ava ilable at http://qheps / p hs/ czicm / home.h tm . Accessed 30 October 2003,
3.
Q ueens land Health Infection Con trol. Ava ilab le at h ttp://www. hea lth .q ld.gov.ilu/i nfec tionco nt ro l/about .h tm l. Accessed 30 October 2003.
4.
Q ueenslan d Health infec tion Control Guide li nes (2nd ed ). 2001.
infec tio n contro l. It was also felt by staff that th e mod el was a wo rth whil e initia ti ve as a mod el fo r infectio n co ntrol service
throu g ho ut Q uee nsland who have
ex tend ed to Chris tine Lostroh (Project manager in the initia l
th is model was
sa ti sfacti on in the concepts of the CZICM, were utiliSing the
reps
prov ided inform a ti o n a nd contributed to prov iding an
STE RI S·
Flexibility Today for Tomorrow's Applications Sterile Processing ......Just in Time Proven Safe and Effective ...... Guaranteed
For more information call us today on 1800 804 006 or visit our website www.device.(om.au
think Aus tralian Infection Control
Volume 8
Issue 4
December Z003