Rania Mohamed El-Sharkawyrania.elsharkawy@alex-mri.edu.eg

Lecturer of clinical chemistry, MRI-Alexandria University ,CPHQ,LSSGB

Health governance –MRI-Alex university unit coordinator

IHI Egypt & NAHQ member

Infection control indicators between monitoring and improvement

•Health care-associated infections lead to death, disability and excess medical costs.•Infection prevention and control program will reduce the cost if applied and monitored effectively

WHO recommendations ………GENERAL

CONCEPTS

GENERAL CONCEPTS

Health-care facilities must implement infection prevention and control policies supported by institutional management.

WHO recommendations ………

GENERAL CONCEPTS

WHO recommendations ………

• Infection prevention and control maximize patient outcomes and is part of the institute's responsibility to provide effective, efficient and quality health services

An overall approach to aninfection prevention and control policy at the health-care facilitylevel is based upon

Approach

WHO recommendations ………

Management

Indicators &

Audits

Communication and education

KPI = Key Performance Indicator

ObjectivesHow to select and implement indicators

• awareness of maintenance performance.+ =

How to use indicators for improvement

Determine………

What are indicators? KPIs are quantifiable measurements that

reflects the critical success factors of a business.

KPIs are quantitative measures of a specific part of a process or of an outcome.

KPIs have a major impact on the performance of the business

What is a KPI?

KPIs track performance against established goals.

•Key Performance Indicators (KPI) are related to goals or objectives andprovide a means for tracking performance against that goal or objective. •KPI are used to assess current performance (LAG) and guide action toward improvementand enhancement (LEAD)

PredictPredict

LEAD LAG

Current

Why indicators?

Tool for performance monitoring

Identify areas that need further study and investigation

• Track changes over time

Choice of indicators

Step 1: Define Organization`s Strategy

Step 2: Audit Existing Measures

Step 3: Develop Measures

Step 4: Educate and train

Step 5:Analyza and report

Process flow chart Observation of process Process outcome

Determine…

How to determine the indicator ?

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KPIs should be? Surgical VS Prosthetic

1-Related to quality dimension/s(efficiency, efficacy, appropriateness, availability,timelines, effectiveness, continuity )

KPIs should be?

2- Specific3-Measurable4-Aligned5-Timely6-Realistic7-Ethical8-Recorded

KPIs are not…………

1-GROUP OF METRICS• NOT EVERYTHING WE MEASURE IS A KPI !2- STATISTICS•THESE CAN HELP DEFINE KPI’s

3- A TOOL FOR BLAME

4- WALL PAPER

WHAT ARE KPI’s NOT?

Types of indicators

• Outcome ( effectiveness)

• Efficiency of PROCESS

•Monitoring &measurement of Processes

KPIs are tools for collection of data

Sentinel-event

Aggregate data

Types of indicator

Continuous-variable

Rate –based

Aggregate data

KPIs are tools for collection of data

KPIs are tools for collection of data

Types of indicator

Sentinel-evente.g Intrahospital mortality of patients due to infections within two post procedure days (MMR)

KPIs are tools for collection of data

Aggregate data

Continuous-variablee.g No of complains or incidents monthly raised / department

KPIs are tools for collection of data

Aggregate data

Rate –basede.g Proportion of staff observed performing hand hygiene beforeattending patients

HOW TO DETERMINE THE desired performance ?

Improvement…

How to use it for improvement ?

HOW TO DETERMINE THE desired performance ?

Compare against benchmark Refer to guidelines Compare self performance versus same circumstances in the same period

Core infection prevention and control interventions for health-care facilities

Indicator process Proportion of staff

observed performing hand hygiene before attending patients

Hand hygiene

Proportion of staff observed wearing

gloves when exposure to blood or body fluids

is anticipated

Personal protective equipment

Average time between admission and isolation for

tuberculosis patients

Isolation precautions

Proportion of intravenous lines

inserted using aseptic technique

Aseptic technique

Proportion of rooms appropriately

disinfected after patients' discharge

Cleaning and disinfection

Proportion of sterilized devices whose sterility is

documented with test strips

Sterilization

Three-dose hepatitis B vaccine coverage among nurses, physicians and

laboratory technicians

Immunization and exposure

management

Hand washing process indicator

Effectiveness

% of hand washing frequency = Number of times employees did wash their hands / Number of times employees should havewashed their hands)

HAND WASHING KPI

HAND WASHING KPI Outcome efficiency

% In-compliance= Number of times employees did wash hands with method in guidelines /Number of times employees should have washed their hands

Compare self performance versus same circumstances in the same period

Performance over time

Chart showing trend

Chart showing trend

Self-Reported Factors for Poor Adherence with Hand Hygiene

Hand washing agents cause irritation and drynessSinks are inconveniently located/lack of sinksLack of soap and paper towelsToo busy/insufficient timeUnderstaffing/overcrowdingPatient needs take priority

Corrective actions for improper compliance

1. Have a clear written policy and

procedure

2. Educate personnel continuously

3. Easy access to hand washing facilities

Provide an environment thatsupports hand washing - NOT Like

THIS……………………………………..LIKE THIS

Encouraging hand washing facilityBad hand washing facility

Corrective actions for improper compliance

4. Careful selection of products

5.Monitor the technique and provide

indicators

6. Record and analyze the results to

improve the compliance

Cleaning and disinfection KPI………

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Cleaning and disinfection KPI

Effectiveness (rate based indicator)

Proportion of rooms appropriatelydisinfected after patients' discharge(WHO indicator)

Cleaning and disinfection KPI

Efficiency

No of facilities reaching the desired acceptable limit / total number of

facilities

For improvement

In any organization…

It is better to have………………….

HAND WASHING KPI

Dashboard for indicators……….

DASHBORD MODEL

DASHBOARD MODEL

Other Tips for Good KPIs

REMEMBER…….

1. Have them!

2. Align them to mission, vision, strategy

3. Test them for validity and reliability, practicability

4. Discuss them and review them. Are they really key?Don’t overestimate their importance!

5. Differentiate between lag and lead indicators (determine the type)

8. Use them for Improvement

6. Benchmark them

7. KPI should lead to change