national standards in infection control for healthcare facilities

NATIONAL STANDARDS IN INFECTION CONTROL FOR HEALTHCARE FACILITIES

Department of HealthPhilippine Hospital Infection

Control SocietyPhilippine Hospital Infection Control Nurses Association

Why is Infection Control Important

1. Increasing incidence of healthcare associated infection caused by antibiotic resistant organisms.

2. More susceptible patients admitted in HCF.

– Very old and very young

– Immunosuppressed

– Invasive diagnostic and therapeutic procedures

– Chronic diseases

Why is Infection Control Important

3. Emergence of life threatening infection like SARS and other emerging infections.

4. Threat of Pathogenic Avian Flu pandemic and terrorism.

Cost of Health Care Associated Infection

PERSONNEL

• Need for hospitalization

• Income loss

• Pain and suffering

• Disfigurement/Disability

• Death

INSTITUTIONS

• Loss of revenue

• Extra duty

• Liability insurance

• Malpractice

• Reputation

Cost of Health Care Associated Infection

BSI Pneumonia UTI

Extra days

confinement

15 11 13

Added cost US$ 2,619 US$ 2,051 US$ 1,970

Rosenthal and Migone. Nosocomial Infections Costs And Extra Days In Intensive

Care Units In Argentina. Prospective Cohort Matched Cases.

IV Infections Control And Hospital Epidemiology

Pan American Congress. 2002, Cancun, Mexico.

ARE HEALTHCARE FACILITIES in the PHILIPPINES PREPARED

TO RESPOND TO EMERGING and RE-EMERGING INFECTIONS?

Country preparedness

means

Capability to prevent and control highly transmissible infection

through

An Effective National Infection Control Program

with universally accepted standards

implemented by

All Healthcare Facilities

and

Coordinated by the

CHIEF OF HOSPITAL

Development of Standard in Infection Control for Health Care Facilities

Historical background:

1986 DOH Department order to create 3 important hospital committees.

1992 Philippine Hospital Infection Control Society affiliate of Philippine Hospital Association.

1996 DOH reiterated 1986 order but with no implementing guidelines.

Development of Standards in Infection Control for Health Care Facilities

2000 *Need to have Standards of Infection Control Programs.

2004 * Post SARS – Development of Standard after collaboration with DOH and NGO professional societies (PHICS, PHICNA, PSMID)

- Technical Working Group created to develop/formulate standards

National Policy on Infection Prevention and Control in Healthcare Facilities• Draft/Proposals/ Presentations during

PHICS Conventions

• Sept 27, 2012- Creation of the National Center for Health Facility Development Technical Working Group for the Development of the National Policy on Infection Prevention and Control

• Finally signed January 8, 2016

• July 30 2008

• Administrative Order No 0023

• Subject: National Policy on Patient Safety

• Key Priority area…includes strengthening of infection control standards, maintenance of environment of care

• And waste management standards

Development of Standards in Infection Control for Health Care Facilities

2005 *Draft of Standards sent to professional societies for their comments/suggestions

- Final document – now in print.

- Updated- 2009

Standards in Infection Control for Health Care Facilities

Standards on:

I Management, Structure, Functions and Responsibilities

II Policies, Guidelines and Procedures

III Microbiology Service

IV Surveillance

V Education and Training

I. Standard on Management Structure and Functions and Responsibilities

Management, Structure, Function and Responsibilities

Each health care facilities (HCF) shall have a coordinated institutional program provided with:

• Significant and adequate personnel with clearly defined responsibilities, commensurate authority, clear lines of communication.

Management, Structure, Function and ResponsibilitiesEach health care facilities (HCF) shall have

a coordinated institutional program provided with:

• Resources to facilitate effective implementation of infection control program.

The Infection Control Committee created under the Chief of Hospital serves as the management structure of the Health Care

Facilities.

The Infection Control Committee (ICC) has a multidisciplinary membership composed of:

• Chief of Hospital or his designated representative.

• Core Members

• Auxiliary members

The ICC Core Members composed of:

• Administrative Officer or equivalent

• Representative from:

– Clinical Departments including Infectious Disease Section

– Nursing Service

– Microbiology Laboratory

– Special & High Risk units• Emergency Room

• Operating Room

• Dialysis Unit

• Intensive Care Unit

• Endoscopy Unit

• Transplant Unit

Auxiliary Members

Representative from:

• Employees Health Service

• maintenance or Engineering Service

• Pharmacy

• Central Sterilization Unit

• Dietary Service

• Linen and Laundry Service

Auxiliary Members

Representative from:

• Purchasing and Supply Department

• Housekeeping Department

• Linked healthcare facilities

• Clinical Laboratory

• Others as needed

ICC Function and Responsibilities

1. Formulate/update infection control policies, guidelines and procedures.

2. Ensure implementation of infection control, guidelines and procedures.

3. Ensure availability of resources and contingencies for infection control program.

ICC Function and Responsibilities

6. Disseminate the necessary information and coordinate with medical, nursing, administration, other hospital committees and other appropriate government agencies.

7. Oversees the performance of the ICT

8. Approves the infection control training modules.

9. Conduct IC meetings regularly at least quarterly and as needed.

There shall be a functional Infection Control Team

The Infection Control Team

The Infection Control Team shall be responsible for the day-to-day infection control activities.

There shall be at least 1 full time Infection Control Nurse (ICN) a registered nurse who has been trained or is receiving training in infection control provided by an accredited training organizations like PHICS, PHICNA, PSMID. The ICN coordinates with the ICP as well as with other senior hospital staff.

There shall be sufficient number of trained ICNs to facilitate and ensure the effective implementation of infection control program in the healthcare facility. The ICN may be augmented by trained nurses (link nurses) in patient care areas or at least in high-risk clinical areas.

ICT Functions

1. Conducts and document surveillance activities.

2. Coordinates with the Infectious Disease Section, Microbiology Laboratory and administration as well as other departments about known or suspected cases of notifiable/ reportable infectious disease, food poisoning and other significant infections such as Multi Drug Resistance Organism (MDRO)

ICT Functions

3. Investigates and initiates appropriate responses to incidents or outbreaks of infections, assess risks of infection and recommends allocation of resources for investigation, management and control.

4. Responds to urgent problems of infection control through a 24 hours emergency referral system.

ICT Functions

5. Ensures adequate, accurate and timely reporting and feedback of information to concerned areas/unit.

6. Propose resource requirement for the program and any contingencies.

7. Develops IC training modules, organizes the relevant education and training programs for all healthcare staff and encourages reflexive practice of infection control measures.

ICT Functions

8. Monitors compliance to infection control policies, guidelines and procedures.

9. Gives advice on the procurement of medical equipment, drugs/medicines and supplies.

10. Participates in the planning and design of plant facilities critical to infection control, i.e. renovations, repairs, relocation of critical areas.

11. Recommends/propose to ICC actions, which may have implications for infection control in the hospital.

II. Standards on Policies, Guidelines and Procedures

Standards on Guidelines, Policies and Procedures

There are written guidelines, policies and procedures that address infection prevention and control detection in the healthcare facility.

Standard 1

Each department or service has an updated copy of the approved hospital guidelines, policies and procedures pertinent to their activities

Requirements:

Guidelines, Policies and Procedures

1. Patient admissions/referrals, isolation and timely case reporting of highly transmissible and notifiable/ reportable infectious diseases.

2. General Infection Control Guidelines, policies and procedures

3. Infection Control Guidelines, Policies and Procedures on Prevention of Healthcare Associated Infection.

4. Infection Control Guidelines and Policies on Housekeeping Procedures.

5. Infection Control Guidelines, policies and Procedures for Specific Patient Care Areas.

6. Infection Control Guidelines, Policies and Procedures for Hospital Service Department/ Units.

Con’t

7. Guidelines, Policies and Procedures on Outbreak Investigation.

8. Infection Control Guidelines and Policies related to Purchasing of medical equipment, drugs/medicines and supplies.

Con’t

9. Guidelines and Policies on Rational Antibiotic Use of coordination with Microbiology Laboratory and pharmacy Therapeutic Committee.

10. Guidelines and Policies on Upholding Patient Confidentiality (Patient’s Rights)

Con’t

General Infection Control Guidelines, Policies and Procedures on:

• Hand Hygiene

• Isolation Precaution

• Decontamination, Disinfection, Sterilization; Disinfectants for specific medical equipment/items and area.

• Environmental Care and Healthcare Waste Management

• Protection of Healthcare workers

IC Guidelines, Policies and Procedures on Prevention of Healthcare-Associated Infection:

• Respiratory Care

• In-dwelling Intravascular device Care

• Urinary Catheter Care

• Wound Care

IC Guidelines, Policies on Housekeeping Procedures for:

• Isolation Rooms

• Regular Rooms/Wards

• Special Areas and High Risk Units

• Out Patient Department

IC Guidelines, Policies and Procedures for Specific Care Areas:

• ICU/CCU

• OR, DR, Nursery

• Dialysis Unit

• Burn Unit, trauma Ward

• Emergency Room

• Transplant Unit

• Dental Clinic

• Endoscopy Unit

• Oncology unit

IC Guidelines, Policies and Procedures for Hospital Service Departments / Units

• Laboratory

• Dietary

• Laundry

• Linen

• Pharmacy

• Sterile Service

• Engineering and Building Service

• Patient transport facilities

• maorgue

These guidelines, policies and procedures are made known to all personnel through an administrative order/ memorandum disseminate during orientation and regular in-service training. A simple audit tool will be utilized to monitor compliance.

Standard 2

III. Standards on

Microbiology

Services

Microbiology Services

There shall be access to a licensed microbiology section in a DOH licensed clinical laboratory that shall provide quality diagnostic and clinical services required for epidemiologic evaluation, effective surveillance and infection control.

Standard 1 For Healthcare Facilities with Microbiology Laboratory

There is a document available to all users of the laboratory, which describes the organization, and scope of the laboratory services and standard operating procedures.

The document describes:

• Availability of services during regular working hours, after office hours, public holidays and emergencies.

• Proper collection, handling, transport, processing and disposal of specimens.– Instructions on the appropriate specimens

to be collected, the availability of request forms, appropriate containers, swabs, transport media etc.

Requirements:

The document describes:

– Method of labeling and details required to complete the request form (e.g. Patient information data, relevant clinical information, the type of specimen and the examination required)

• Type and range of specimens routinely examined and those examined by special arrangement

• Proper collection of appropriate specimen and isolation and identification procedures of potentially pathogenic microorganism to specie level.

The document describes:

• Interpretation of results and timely dissemination of information to concerned areas.

• Availability of reports, technical and clinical advice and procedures to access services.

• Quality control procedures (internal and external).

• Information on national reference laboratory for services not available within the microbiology laboratory of the healthcare facility.

The document describes:

• Guidelines, Policies and Procedures to be observed on safe handling, transport and disposal of specimens.

– Biosafety and biohazard precautions.

– Disinfection and sterilization of laboratory facilities.

– Good microbiologic laboratory facilities.

– Personal protective equipment (PPE), vaccination and the prophylaxis required for laboratory personnel.

– Safe waste management based on national guidelines

– Acceptable/recommended recycling methods for laboratory supplies.

The document describes:

• Identification and antibiotic susceptibility

patterns of bacterial isolates to antimicrobial agents based on international standards.

• Results of screening tests for hospital staff and employees (e.g. Stool culture for dietary staff).

• Monitoring of sterilization and disinfection procedures.

• Technical assistance for environmental sampling and cultures when indicated.

The document describes:

• Appropriate data storage, retrieval and communication facilities for tracking of specimen, tracing of report and preparation of surveillance information directly relating to infection control.

IV. Standard on Surveillance

There is a defined program of surveillance and reporting of healthcare associated and community acquired infection including the collection, analysis, dissemination, feedback and storage of data.

Standard I. There shall be a defined surveillance

program

Requirements:• The Infection Control Committee (ICC) defines

goals, objectives and priorities for all surveillance activities on healthcare-associated infections, including time frame, areas, patient population to be studied and method to be used.

• The ICC shall adopt the universally accepted definitions of healthcare-associated infections to be used in all surveillance activities.

Requirements:• The surveillance forms shall be adapted and

standardized.

• The ICT collects, analyzes and reports the data to clinicians administrators and others who could use them constructively as basis for intervention.

• The ICT uses the surveillance data of evaluation of the program, identifying problems, as well as revision of guidelines.

Requirements:

• The ICT coordinates with the microbiology laboratory in the development of a program for the surveillance of microorganisms, antibiotic resistance patterns as well as clustering of patient groups within their hospital network.

• The ICT may compare data with benchmark set by national/international bodies as well as with other institution for collaborative activities.

There is an efficient mechanism of reporting healthcare-associated and community acquired notifiable/reportable infections including significant outbreaks/potential outbreaks to ICT, ICC and to the National Epidemiology Center, Department of Health (NEC-DOH).

Standard 2

Requirements

• There is an organized/systematic method/procedure of reporting Healthcare-Associated Infections (HAI) and Community-Acquired infections (CAI) with potential for outbreaks.

• The ICC regularly reports their semi-annual infection rates, antibiotic resistance pattern to the clinicians, and administration.

Requirements

• The ICC immediately reports to NEC-DOH through the Chief of Hospital any suspicion of potential outbreaks for their information and appropriate action following the NEC-DOH reporting system.

V. Standards on Education

and Training

All healthcare staff including support services shall receive appropriate education and training on epidemiology, surveillance, prevention and control of healthcare-associated infections.

Standard 1

There are adequate resources available in the hospital for the required education and training activities.

Requirements:

• There are adequate resources for education, skills building and training of healthcare staff and support/auxiliary services.

• There are available and accessible venues for teaching and training.

Requirements:

• There is access to up-to-date tools like audio-visual materials and/or relevant books and journals in infection control and hospital epidemiology at the infection control office.

• There is available budget to allow attendance of ICC members to infection control training, conference, production of educational materials and related activities.

Requirements:

• There are continuing education opportunities within and outside healthcare facility.

Standard 2

There are infection control educational programs for the healthcare staff and support services focused on relevant topics for specific clinical setting.

Requirements

• There are institutional materials available for education and training which includes:– Epidemiology of Healthcare-Associated

Infection

– Basic Principles in Prevention and Control: hand Hygiene, Isolation Precaution, decontamination, Disinfection & Sterilization, Care of the Environment and Hospital Waste Management

Requirements

– Infection Control During Routine Patient Care

– Infection Control in Special and High Risk Area

– Infection Control in Hospital Ancillary Services

Healthcare worker: Infection Risks and Prevention

Requirements

• There is involvement of the ICC/ICT in the orientation and continuing education of patients, students, trainees and other healthcare staff and other healthcare personnel.– There is involvement of the ICC/ICT in the

course design and implementation of basic level training and continuing education of healthcare staff.

Requirements

– There is a basic course in infection control conducted regularly, at least twice a year as needed and records of the attendance of all staff on these educational activities.

– There is a defined policy for teaching patients and the appropriate members of their families (e.g. Watchers class) about the precautions relevant to the diagnosis of the affected/infected patients.

Requirements

• There are mechanisms for information dissemination and assessment of knowledge and practices of healthcare staff on new guidelines and written policies on infection control practices, surveillance and observational studies.

• There are tools for knowledge assessment of infection control practices, and procedures (e.g. Equipment disinfection methods, when and how to isolate patients, etc.)

Requirements

• The Infection Control Committee monitors and conducts periodic assessment of infection control practices.

Successful implementation of these Standards

needs

FULL COOPERATION and PARTICIPATION

of

Government and Non-Government Health Care Facilities

and monitoring and evaluation by

the DOH and accrediting organizations

Mission/ Vision of HICU

• Mission

To be the instruments of change towards improvement in processes and relationships within the hospital in order that hospital associated infection rates are decreased and infectious diseases are managed in a timely and effective manner; minimizing risks to other patients and to staff.

Vision

A hospital of well-informed health-care practitioners, while individually and collectively providing excellent patient care, are also working towards patient and personnel safety; minimizing the risk for adverse patient events such as nosocomial infections.

Responsibilities of HICU

HICU is both policy-generating and policy-implementing

1. Education on infection control of all PGH employees abd house staff.

2. Targeted Surveillance of priority infections in high risk areas

3. Control of antibiotic use and monitoring of antimicrobial resistance

Cont…

• 4. Supervision and monitoring of sterilization and disinfection of equipment/instruments and hospital areas.

• 5. Waste management

• 6.. Prevention, management and counseling of exposures of PGH employees to infectious diseases.