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Patient-centred risk management strategy for multi-resistant organisms

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Patient-centred risk management strategy for multi-resistant organisms Infection Prevention Quality, Safety and Patient Experience February 2012 – PowerPoint PPT presentation

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Title: Patient-centred risk management strategy for multi-resistant organisms


1
Patient-centred risk management strategy for
multi-resistant organisms
  • Infection Prevention
  • Quality, Safety and Patient Experience
  • February 2012

2
Update on VRE guidelines for hospitals
2012
1999
3
Guide
  • The patient-centred risk management strategy for
    multi-resistant organisms (MROs)
  • a guide for hospitals
  • can adapt for local use
  • The guide is not designed for residential care

4
Australian Guidelines for the Prevention and
Control of Infection In Healthcare (2010)
  • Based on
  • Australian Commission on Safety and Quality in
    Health Care (ACSQHC)
  • Australian Guidelines for the Prevention and
    Control of Infection In Healthcare (2010)
  • National approach
  • Best available evidence
  • Risk management framework
  • Patient-centred
  • 2 level strategy
  • Core
  • Additional strategies
  • Antimicrobial stewardship promotion

5
Risk management framework
  • Risk management principles applied to MROs
  • 1. Avoid risk
  • Not avoidable in healthcare
  • Must be managed

6
Risk management principles applied to MROs
  • 2. Identify risk
  • Who is at risk?
  • What is infectious agent?
  • 3. Analyse risk
  • How is it transmitted?
  • Why can this happen?
  • How likely is it to happen?
  • What are the consequences?

7
Risk management principles applied to MROs
  • 4. Evaluate risk
  • What can be done to reduce or eliminate the risk?
  • 5. Treat risk
  • Who will do it?
  • How will it be monitored?

8
Risk assessment and modified contact precautions
  • Risk assessment and modified contact precautions
    already in place in many health services to
    prioritise single rooms
  • Risk factors
  • Patient population
  • Setting/infrastructure
  • Local experience of MRO
  • Possible endemic MROs
  • Degree of antimicrobial stewardship

9
Patient-centred risk management strategy for
multi-resistant organisms
  • Health care services can adapt to their local
    needs
  • Transmission-based precautions for all MROs
  • Designed for acute care health services

10
Routine Practices and Additional Precautions in
Health Care Settings Health Canada, Revised
July 2011
  • Adapted Provincial Infectious Diseases Advisory
    Committee (PIDAC)
  • Routine Practices and Additional Precautions in
    all Health Care Settings
  • revised July 2011
  • Based on chain of infection principles
  • infectious agent
  • source patient
  • environment
  • susceptibility of the host

11
Patient-centred risk management strategy for
multi-resistant organisms
  • Risk assessment for management of MROs
  • Consider
  • Patient risks
  • Environmental risks
  • Organisational risks
  • Patient risks
  • Clinical/additional risk factors
  • Colonised/infected
  • Antibiotic exposure/use
  • Decolonisation opportunities
  • Patient population in hospital area/ ward

12
Risk assessment for management of MROs
  • Environmental risks
  • Layout hospital area/ward
  • Environmental cleaning and disinfection
  • Local prevalence of MROs
  • Organisational risks
  • Level of HCW training in infection control
    principles
  • Background surveillance monitoring strategies
  • Implementation of antimicrobial stewardship

13
Patient-centred risk assessment
  • Using patient-centred risk assessment
  • Emphasizes consistent practice of standard
    precautions
  • Tailors the use of contact precautions to local
    conditions

14
Patient-centred risk assessment
  • Advantages
  • Current status of patient considered
  • Low risk patients/settings
  • Improved access to medical care
  • Less demand on single rooms
  • Reduced financial costs (consumables etc)
  • Potentially less cancelled/postponed procedures
  • Patient not feeling isolated
  • Disadvantages
  • Risk assess at each episode of care
  • Standard precautions must be rigorously followed

15
Patient-centred risk management strategy for
multi-resistant organisms
  • MRO working group
  • Infection prevention and infectious disease
    consultants representing 5 health services
  • Feedback from regional Department of Health
    infection prevention consultants
  • 4 pilot study hospitals
  • large metro
  • large regional
  • medium sub regional
  • medium private sub regional
  • Outcome measures
  • No increase in clinical specimens of MROs during
    pilot
  • Number of times tool misinterpreted

16
Pilot
  • Pilot results
  • 6-8 weeks
  • 52 patients with MRO risk assessed
  • 17/52 standard precautions
  • 35/52 transmission-based precautions
  • Feedback
  • No increase in clinical isolates of MROs
  • Flow chart easy to use
  • Uncertainty with terminology (changed)
  • Scenarios helpful

17
Pilot
  • Limited time for pilot
  • Used the experience of 2 large health services
    who have risk assessment and modified contact
    precautions in place 1-2 years
  • No increase in clinical isolates
  • Local policies to assist risk assessment
  • specify which patient populations and which wards
    require single rooms and contact precautions

18
Patient-centred risk management strategy for
multi-resistant organisms
19
Quick guide flow chart
  • Quick guide flow chart
  • Appendix 1 of the strategy is a quick guide flow
    chart for assessment clinical risk and additional
    risk factors
  • Set up with tick boxes
  • Can completed for individual patients and filed
    in medical record
  • Used as a wall chart
  • Adapt locally, for example specify high risk
    patient populations and areas/wards

20
Where is the guide? Search Infection prevention
in Victoria
21
Patient-centred risk management strategy for
multi-resistant organisms
  • Patient-centred
  • Risk-based approach
  • Guide- adapt locally
  • Acute hospitals
  • Transmission based precautions
  • for all MROs

22
Implementation resources- ACSQHC
  • OSSIE toolkit
  • Case studies
  • Checklists
  • Templates/ worksheets
  • Action plans
  • Project plans
  • URL links
  • Additional reading

23
Implementation resources
  • 5 phase approach to change management developed
    by the Clinical Handover Initiative at ACSQHC
  • O Organisational leadership
  • S Simple solution development
  • S Stakeholder engagement
  • I Implementation
  • E Evaluation and management

http//www.health.gov.au/internet/safety/publishin
g.nsf/Content/home
24
Patient-centred risk management strategy for
multi-resistant organisms
  • Acknowledgements
  • MRO working group members
  • Rural Infection Control Practice Group (RICPRAC)
    members

25
Infection Prevention in health services
  • Department Health Infection Prevention in health
    services initial contact
  • Theresa Williamson
  • Acting Manager, Quality and Safety Programs
  • 9096 7258
  • who will liaise with the Director, Quality,
    Safety and Patient Experience regarding who best
    to advise
  • theresa.williamson_at_health.vic.gov.au For the
    moment all infection control advice will be
    managed from resources within the department.
    As usual communicable diseases matters
  • Communicable Diseases Prevention and Control Unit
    1300 651160
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