- Email: [email protected]
Fluorescent audits – A shining example of objective assessment of compliance with cleaning standards
Abstracts 3
Infectious Diseases Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia 4 Faculty of Medicine, Dentistry and Health, University of Melbourne, Melbourne, Australia Background: Australia does not have a national healthcare associated infection surveillance program (HAISP). Several State-wide HAISPs based on the National Health and Safety Network developed independently. This body of research aimed to map out a pathway for a national HAISP in Australia. Methods: To identify variation in current surveillance practices across Australia, infection prevention staff in hospitals with >50 acute beds were invited to complete an online survey. The survey explored surveillance methods and, through a series of clinical vignettes, agreement in HAI identification. We then used a discrete choice experiment (DCE) to identify key stakeholder (KSH) preferences when considering a national HAISP. A total of 184 participants were purposively selected to participate in the DCE. Results: A total of 104 participants responded to the online survey. Variation in methodology, staff skill and support was identified across Australia. Moderate agreement in HAI identification (range 53%-75) was found. Response rate at the DCE was 66%. The strongest preferences for national HAISP were: 1) mandatory program with continuous targeted surveillance 2) a protocol with risk adjustment 3) annual competency assessments 4) very accurate data, 5) hospital level data publicly reported. Conclusion: Whilst the true epidemiology of HAIs in Australia remains unknown, the national HAI surveillance landscape is now understood. This body of research has identified gaps, opportunities, and preferences of KSHs to enable progress towards a meaningful national HAISP. Data from this research will now be considered along with best practice, feasibility, resources and implementation requirements in developing a national program.
EXPLORING THE ATTITUDES OF MEDICAL STUDENTS TOWARDS A NEW HAND HYGIENE TEACHING APPROACH Rajneesh Kaur, Dr, Husna Razee, Dr, Holly Seale, Dr UNSW Australia, Sydney, Australia Introduction: Poor hand hygiene (HH) practices amongst medical students have previously been attributed to students not being exposed to sufficient teaching materials during their training. This study aimed to develop and pilot test a teaching module directed at improving the knowledge and attitudes of undergraduate medical students towards HH. Methods: The HH teaching module was designed based on educational materials used by the World Health Organisation and other patient safety organisations. The development was also informed by the findings from our previous studies including in-depth interviews with staff and students and a survey of Australian medical schools. As part of the review process, in-depth group interviews were undertaken with 24 undergraduate medical students (years 1 to 5) to explore their attitudes towards the new approach and their level of acceptability and perceived usefulness of the developed teaching materials. Results: Students believed that they lacked awareness about HH and healthcare associated infections (HAIs) and that course materials needed to reinforce the link between the two concepts. Favourable feedback was received from the interviewed medical students towards the developed Scenario Based Learning activity; however the group interview activity was not received well by students. They suggested that the HH teaching activities should be compulsory and not optional for medical students. In order to reinforce good HH practices and to improve knowledge around HH and HAIs, they felt that the activities should be repeated during each phase of their degree. Conclusion: Overall we received a positive response to the educational module.
FACING THE CHALLENGES OF IMPLEMENTING NATIONAL STANDARD 3: A DISTRICT APPROACH Patricia Karbowiak Hunter New England Local Health District, Maitland, Australia Background: Publication of the National Standards 2012, presented acute inpatient healthcare facilities in Australia with unprecedented challenges in
127 implementation of standard practice for prevention of healthcare associated infections. Hunter New England Local Health District in the north east of NSW is one of the largest in Australia, with over 40 acute care facilities, including 7 district and tertiary hospitals. It services a population of over 1 million. Complying with the standard in the timeframe provided, with available resources seemed insurmountable. The challenge: How could we work smarter? Methods: Participation in the draft phase of the standard allowed the District to anticipate the requirements of Standard 3, developing necessary policies and planning the implementation and management strategies in order to comply. Results: All acute sites surveyed for Accreditation since 2012 have gained a full three years Accreditation with the exception of one site. Hand hygiene compliance climbed from 65% (2010) to sustained levels above 85% since 2013. Healthcare-associated, MRSA bloodstream events fell from 20-27 per annum (2008-2010) data, to below 10 (2015). Conclusion: The Infection Prevention Service proactively addressed the new challenges and embeded necessary changes in anticipation of the Standard. The programmes and resources developed and instigated by the district have been used state-wide to assist in the creation of standardised auditing and policies. There remain challenges relating to portions of the Standard particularly around governance, sterilisation, action planning to remediate non-compliance and consumer engagement. As a Service we are ready to meet and overcome these outstanding challenges.
FLUORESCENT AUDITS e A SHINING EXAMPLE OF OBJECTIVE ASSESSMENT OF COMPLIANCE WITH CLEANING STANDARDS Carla De Marco, Louise Hobbs, Caroline Marshall, A/Professor Melbourne Health, Parkville, Australia Introduction: Literature describes how the environment plays an important role in the transmission of micro-organisms. In 2012, the Infection Prevention Service began trialling a fluorescent audit process to measure cleaning efficacy. The discrepancy between the trial results and our visual audit results generated serious concern. The intent of the trial was to establish an evidence base to generate changes to the cleaning service provided. Method: Between October 2015 and March 2016, 88 discharge cleans were audited using the new fluorescent audit tool. The fluorescent marking was standardised for all rooms. Using the tool, compliance was reported as a percentage of total elements marked. During the same time period these results were compared with those from the Victorian observational audits, where compliance was reported as a percentage of aesthetic acceptability. Results: The visual audits scored above 90% for ward areas throughout the trial period. Of the 88 discharge cleans; 17(19%) scored 100% cleaned elements, 23(26%) scored 80-99%, 42(48%) scored 5-79%, 6(7%) scored 04%. Subsequently Melbourne Health has embedded the use of the fluorescent audit tool to measure and drive cleaning improvement strategies. Conclusion: Reliance on a visual measure of cleanliness does not ensure a clean environment for patients. Given the ever increasing risk posed by the environment, consideration should be given to adopt measureable cleaning methodologies to ensure that compliance with environmental cleaning standards is optimised.
FROM CLINICAL GOVERNANCE TO NEW PRODUCT DESIGN: COLLABORATIVE TOOLS FOR IDENTIFYING PROBLEMS AND DISRUPTIVE SOLUTIONS IN INFECTION PREVENTION AND CONTROL Madeleine Clegg Nanosonics, Sydney, Australia Introduction: Infection prevention and control (IP&C) in the healthcare setting is a shared responsibility and requires a system of clinical governance to continuously monitor and improve outcomes. There are parallels between the strategic plans and systems implemented in facilities for cost-effective IP&C, and the methodologies used by manufacturers in new product development to design commercially viable and clinically relevant solutions. Methods: Presented are some practical tools that can be used by infection control professionals (ICPs) to manage challenges in the clinical setting in an innovative way. These tools can be separated into two phases; problem finding and problem solving. Problem finding involves understanding the size
Infectious Diseases Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia 4 Faculty of Medicine, Dentistry and Health, University of Melbourne, Melbourne, Australia Background: Australia does not have a national healthcare associated infection surveillance program (HAISP). Several State-wide HAISPs based on the National Health and Safety Network developed independently. This body of research aimed to map out a pathway for a national HAISP in Australia. Methods: To identify variation in current surveillance practices across Australia, infection prevention staff in hospitals with >50 acute beds were invited to complete an online survey. The survey explored surveillance methods and, through a series of clinical vignettes, agreement in HAI identification. We then used a discrete choice experiment (DCE) to identify key stakeholder (KSH) preferences when considering a national HAISP. A total of 184 participants were purposively selected to participate in the DCE. Results: A total of 104 participants responded to the online survey. Variation in methodology, staff skill and support was identified across Australia. Moderate agreement in HAI identification (range 53%-75) was found. Response rate at the DCE was 66%. The strongest preferences for national HAISP were: 1) mandatory program with continuous targeted surveillance 2) a protocol with risk adjustment 3) annual competency assessments 4) very accurate data, 5) hospital level data publicly reported. Conclusion: Whilst the true epidemiology of HAIs in Australia remains unknown, the national HAI surveillance landscape is now understood. This body of research has identified gaps, opportunities, and preferences of KSHs to enable progress towards a meaningful national HAISP. Data from this research will now be considered along with best practice, feasibility, resources and implementation requirements in developing a national program.
EXPLORING THE ATTITUDES OF MEDICAL STUDENTS TOWARDS A NEW HAND HYGIENE TEACHING APPROACH Rajneesh Kaur, Dr, Husna Razee, Dr, Holly Seale, Dr UNSW Australia, Sydney, Australia Introduction: Poor hand hygiene (HH) practices amongst medical students have previously been attributed to students not being exposed to sufficient teaching materials during their training. This study aimed to develop and pilot test a teaching module directed at improving the knowledge and attitudes of undergraduate medical students towards HH. Methods: The HH teaching module was designed based on educational materials used by the World Health Organisation and other patient safety organisations. The development was also informed by the findings from our previous studies including in-depth interviews with staff and students and a survey of Australian medical schools. As part of the review process, in-depth group interviews were undertaken with 24 undergraduate medical students (years 1 to 5) to explore their attitudes towards the new approach and their level of acceptability and perceived usefulness of the developed teaching materials. Results: Students believed that they lacked awareness about HH and healthcare associated infections (HAIs) and that course materials needed to reinforce the link between the two concepts. Favourable feedback was received from the interviewed medical students towards the developed Scenario Based Learning activity; however the group interview activity was not received well by students. They suggested that the HH teaching activities should be compulsory and not optional for medical students. In order to reinforce good HH practices and to improve knowledge around HH and HAIs, they felt that the activities should be repeated during each phase of their degree. Conclusion: Overall we received a positive response to the educational module.
FACING THE CHALLENGES OF IMPLEMENTING NATIONAL STANDARD 3: A DISTRICT APPROACH Patricia Karbowiak Hunter New England Local Health District, Maitland, Australia Background: Publication of the National Standards 2012, presented acute inpatient healthcare facilities in Australia with unprecedented challenges in
127 implementation of standard practice for prevention of healthcare associated infections. Hunter New England Local Health District in the north east of NSW is one of the largest in Australia, with over 40 acute care facilities, including 7 district and tertiary hospitals. It services a population of over 1 million. Complying with the standard in the timeframe provided, with available resources seemed insurmountable. The challenge: How could we work smarter? Methods: Participation in the draft phase of the standard allowed the District to anticipate the requirements of Standard 3, developing necessary policies and planning the implementation and management strategies in order to comply. Results: All acute sites surveyed for Accreditation since 2012 have gained a full three years Accreditation with the exception of one site. Hand hygiene compliance climbed from 65% (2010) to sustained levels above 85% since 2013. Healthcare-associated, MRSA bloodstream events fell from 20-27 per annum (2008-2010) data, to below 10 (2015). Conclusion: The Infection Prevention Service proactively addressed the new challenges and embeded necessary changes in anticipation of the Standard. The programmes and resources developed and instigated by the district have been used state-wide to assist in the creation of standardised auditing and policies. There remain challenges relating to portions of the Standard particularly around governance, sterilisation, action planning to remediate non-compliance and consumer engagement. As a Service we are ready to meet and overcome these outstanding challenges.
FLUORESCENT AUDITS e A SHINING EXAMPLE OF OBJECTIVE ASSESSMENT OF COMPLIANCE WITH CLEANING STANDARDS Carla De Marco, Louise Hobbs, Caroline Marshall, A/Professor Melbourne Health, Parkville, Australia Introduction: Literature describes how the environment plays an important role in the transmission of micro-organisms. In 2012, the Infection Prevention Service began trialling a fluorescent audit process to measure cleaning efficacy. The discrepancy between the trial results and our visual audit results generated serious concern. The intent of the trial was to establish an evidence base to generate changes to the cleaning service provided. Method: Between October 2015 and March 2016, 88 discharge cleans were audited using the new fluorescent audit tool. The fluorescent marking was standardised for all rooms. Using the tool, compliance was reported as a percentage of total elements marked. During the same time period these results were compared with those from the Victorian observational audits, where compliance was reported as a percentage of aesthetic acceptability. Results: The visual audits scored above 90% for ward areas throughout the trial period. Of the 88 discharge cleans; 17(19%) scored 100% cleaned elements, 23(26%) scored 80-99%, 42(48%) scored 5-79%, 6(7%) scored 04%. Subsequently Melbourne Health has embedded the use of the fluorescent audit tool to measure and drive cleaning improvement strategies. Conclusion: Reliance on a visual measure of cleanliness does not ensure a clean environment for patients. Given the ever increasing risk posed by the environment, consideration should be given to adopt measureable cleaning methodologies to ensure that compliance with environmental cleaning standards is optimised.
FROM CLINICAL GOVERNANCE TO NEW PRODUCT DESIGN: COLLABORATIVE TOOLS FOR IDENTIFYING PROBLEMS AND DISRUPTIVE SOLUTIONS IN INFECTION PREVENTION AND CONTROL Madeleine Clegg Nanosonics, Sydney, Australia Introduction: Infection prevention and control (IP&C) in the healthcare setting is a shared responsibility and requires a system of clinical governance to continuously monitor and improve outcomes. There are parallels between the strategic plans and systems implemented in facilities for cost-effective IP&C, and the methodologies used by manufacturers in new product development to design commercially viable and clinically relevant solutions. Methods: Presented are some practical tools that can be used by infection control professionals (ICPs) to manage challenges in the clinical setting in an innovative way. These tools can be separated into two phases; problem finding and problem solving. Problem finding involves understanding the size