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Infection Prevention and Control

Annual Report

April 2018 - March 2019

Image courtesy of: NIAID (2009)

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Contents

Executive Summary ......................................................................................................................................................................... 3

PHSA Infection Prevention and Control Program ............................................................................................................... 4

Our Vision ................................................................................................................................................................ ....................... 4

Our Mission .................................................................................................................................................................................... 4

Our Services ................................................................................................................................................................ ................... 4

Our Team 2018-2019 ..................................................................................................................................................................... 5

Team Photographs ...................................................................................................................................................................... 6

Knowledge Translation ................................................................................................................................................................ .. 8

Research Activities ........................................................................................................................................................................... 9

Surveillance................................................................................................................................................................ ...................... 12

Outbreak Management ................................................................................................................................................................ 16

Quality Improvement ................................................................................................................................................................... 17

Strategic Plan ................................................................................................................................................................ .................. 20

Appendix A - PHSA IPAC Organizational Chart as of January 2019.......................................................................... 24

Appendix B – Definitions ............................................................................................................................................................ 25

Appendix C - PHSA IPAC Quality Improvement Plan 2017-2019 ............................................................................. 27

Appendix D – References............................................................................................................................................................ 29

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Executive Summary

At the Provincial Health Services Authority (PHSA), the safety of patients, staff and visitors is of ultimate importance. To help meet this commitment, the PHSA Infection Prevention and Control (IPAC) service was formed in 2006, reporting to the PHSA VP of Quality, Safety and Outcome Improvement. The IPAC team works collaboratively with stakeholders within PHSA, other health authorities, the Provincial Infection Control Network of BC (PICNet), and regional and national organizations in supporting best practices to prevent and control infections at PHSA facilities. The IPAC team is involved in a variety of activities that include:

• Knowledge translation (education and research) • Hand hygiene program • Surveillance • Outbreak management • Construction consultation • Cleaning, disinfection, and sterilization consultation • Quality improvement initiatives • Policy and procedure development

During 2018-19, the IPAC team participated in many projects and initiatives including:

• Starting work on a combined IPAC manual for PHSA • Quality improvement projects around antibiotic-resistant organism (ARO) screening and

patient/family/visitor hand hygiene • Implementation of a champions program at BC Emergency Health Services

The following table highlights trends in health care-associated infection (HAI) rates for 2018-19: Indicator 2017-18 Rate 2018-19 Rate Trend*

PHSA Overall Hand Hygiene Compliance 93.9% 92.1%

PHSA HA-CDI Rate 5.5 per 10,000 inpatient days

6.2 per 10,000 inpatient days

PHSA HA-MRSA Rate 3.6 per 10,000 inpatient days

2.4 per 10,000 inpatient days

PHSA HA-VRE Rate 2.1 per 10,000 inpatient days

0.7 per 10,000 inpatient days

CLABSI Rate in PICU 0.5 per 1,000 catheter days 0.5 per 1,000 catheter days

CLABSI Rate in NICU 2.0 per 1,000 catheter days 2.3 per 1,000 catheter days

HA = health care-associated; CDI = Clostridium difficile infection; MRSA = methicillin-resistant Staphylococcus aureus; VRE = vancomycin-resistant enterococci; CLABSI = central line-associated bloodstream infection; PICU = pediatric intensive care unit; NICU = neonatal intensive care unit *NOTE: The rate changes are not statistically significant.

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PHSA Infection Prevention and Control Program

Our Vision Empowering everyone to prevent infections! These words paint a picture of the world PHSA Infection Prevention and Control seeks to create. Our vision captures the notion that each person in the health care team has a role to play in the prevention of infections. Our goal is to ensure that everyone has the knowledge and confidence to participate in infection prevention.

Our Mission Our mission is to ensure the protection of patients, staff and visitors from preventable infections. We aim to achieve this through: • A proactive approach to current and evolving challenges • Facilitating implementations and solutions • Expert consultation based on applicable regulations, evidence, and best practice • Collaborating with local, provincial, and national partners

Our Services • Knowledge translation – creating and sharing IPAC knowledge with internal and external stakeholders • Hand hygiene program – monitoring and improving hand hygiene compliance among team members,

patients, and family/visitors • Surveillance – monitoring for health care-associated infections and identifying opportunities for

improvement • Outbreak management – investigating clusters of infections and controlling and preventing outbreaks • Construction consultation – providing advice to minimize the infectious risks associated with construction

and renovation projects and promoting compliance with Canadian/provincial standards • Cleaning, disinfection and sterilization consultation – advising stakeholders on reprocessing issues and

promoting compliance with best practices • Quality improvement – implementing projects and initiatives to improve IPAC practices and prevent

infections • Policies and procedures – developing and revising IPAC manuals

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Our Team 2018-2019

Georgene Miller, RN, MSN VP, Quality, Safety & Outcome Improvement

Amrita Dhaliwal Hand Hygiene Coordinator

Jocelyn Srigley, MD, FRCPC Corporate Director, PHSA IPAC, Medical

Microbiologist

Baljinder Sidhu, RN, CIC Infection Prevention Specialist – Reprocessing &

Auditing

Robyn Hunter, RN, CIC PHSA IPAC Director

Colin Sham Hand Hygiene Auditor

Ghada Al-Rawahi, MD, FRCPC IPAC Medical Lead, BCCA, Medical Microbiologist

Ashifa Dhanji, RN Infection Control Practitioner, CW Hospital

David Harris, MD, FRCPC IPAC Medical Lead, BCMHSUS

Carole Rodger, RN Infection Control Practitioner, CW Hospital

David Goldfarb, MD, FRCPC Infection Control Officer, Medical Microbiologist

Lisa Krueckl, RN Infection Control Practitioner, CW Hospital

Laura Sauve, MD, FRCPC Infection Control Officer, Peds Infectious Disease

Marney Hunt, RN Infection Control Practitioner, CW Hospital

Peter Tilley, MD, FRCPC Infection Control Officer, Medical Microbiologist

Michelle Chang, RN Infection Control Practitioner, CW Hospital

Amy Calinao, RPN Infection Control Practitioner, Burnaby Centre/

Heartwood

Vladlena Abed, RN, CIC Construction Specialist, Infection Control

Practitioner, BC Cancer

Jacqueline Hlagi, RPN Infection Prevention Specialist, BCMHSUS

Adriana Ezelyk, RN, CIC Infection Control Practitioner, BC Cancer

Tracia Batson-Dottin, RN Infection Control Practitioner, Forensics

Alison Chant, RN, CIC Infection Control Practitioner, BC Cancer

Mark Reavy, RN Infection Control Practitioner, Corrections

Kristie Harding, RN Infection Control Practitioner, BC Cancer

Janie Nichols, RN, CIC Infection Prevention Specialist, BC Emergency

Health Services Kerstin Humbert-Droz, RN

Infection Control Practitioner, BC Cancer

Lisa Young, RN Leader, IPAC, BC Emergency Health Services

Judy Tearoe, RN Infection Control Practitioner, BC Cancer

Jun Chen Collet, MSc IPAC Epidemiologist

Sheetal Kainth, RN Infection Control Practitioner, BC Cancer

Linda Choy IP Specialist Construction

Beth Skuggedal, RN Infection Control Practitioner, BC Cancer

Prerna Pant Administrative Support

Fran Lewis Administrative Support

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Team Photographs

PHSA Infection Prevention and Control staff

(Missing: Linda Choy, Robyn Hunter, Janie Nichols,Tracia Batson-Dottin, Kerstin Humber-Droz)

BC Cancer

(Missing: Robyn Hunter, Kerstin Humber-Droz)

BC Mental Health & Substance Use Services

(Missing: Tracia Batson-Dottin)

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Our Facilities

SITES Inpatient

Beds Admissions Outpatient

Visits

• BC Cancer o Vancouver o Vancouver Island o Abbotsford o Kelowna o Prince George o Surrey

25 736 160,953 N/A N/A 95,143 N/A N/A 53,070 N/A N/A 66,160 N/A N/A 22,821 N/A N/A 82,406

• BC Centre for Disease Control o New Westminster Clinic o Vancouver Clinic

N/A N/A TB 14,645 STD 19,059

• BC Children’s Hospital • BC Child and Youth Mental Health • Sunny Hill Health Centre for Children

121 6,507 135,007 54 416 18,448 14 130 12,291

• BC Women’s Hospital + Health Centre 137 16,511 58,763

• BC Emergency Health Services N/A N/A N/A

• Forensic Psychiatric Services Commission o Forensic Psychiatric Hospital o Kamloops Regional Clinic o Nanaimo Regional Clinic o Prince George Regional Clinic o Surrey / Fraser Valley Regional

Clinic o Vancouver Regional Clinic o Victoria Regional Clinic

• Burnaby Centre for Mental Health & Addiction

• Heartwood Centre for Women

181 390 2,598 94 23 N/A 28 154 N/A

• Correctional Health Services at: o Alouette Correctional Centre for

Women o Ford Mountain Correctional Centre o Fraser Regional Correctional

Centre o Kamloops Regional Correctional

Centre o Nanaimo Correctional Centre o North Fraser Pre-trial Centre o Okanagan Correctional Centre o Prince George Regional

Correctional Centre o Surrey Pretrial Services Centre o Vancouver Island Regional

Correctional Centre

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Knowledge Translation

Education for Team Members, Volunteers, Patients, Families and Visitors During 2018-19, Infection Prevention and Control provided 136 hours of educational sessions for 2,367 team members who included staff, physicians, students and volunteers.

Information on IPAC topics is available for team members, volunteers, patients, families, and

visitors through the CW ePOPs website, as well as on the PHSA intranet. http://policyandorders.cw.bc.ca/ipac

Infection Control Week (October 15-19, 2018) This is a yearly opportunity to provide education to team members, volunteers, patients, families and visitors at all PHSA sites. This year’s activities included site-wide emails, booths, and roaming education carts. This was followed shortly after by Halloween, and the IPAC really got into the spirit to raise awareness!

(IPAC Canada, 2018) (BC Cancer Surrey Staff, Oct. 2018)

(BC Cancer Prince George Staff, Oct. 2018)

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World Hand Hygiene Day (May 6, 2018) At this year’s World Hand Hygiene Day, display tables featuring hand hygiene education were created. Visitors and staff were encouraged to ask questions and were given prizes! Additionally, during both World Hand Hygiene Day and Infection Control Week our IPAC teams handed out activity sheets for patients, families, and visitors.

(C&W Visitor, 2018) (HH Display BC Cancer Victoria, 2018)

PHSA IPAC won a Twitter #STOPCleanYourHandsDay prize in a contest organized by the Canadian Patient Safety Institute (CPSI) in May 2018.

Research Activities

Peer-reviewed publications 1. Al-Rawahi GN, Al-Najjar A, McDonald R, Deyell RJ, Golding GR, Brant R, Tilley P, Thomas E, Rassekh SR,

O'Gorman A, Wong P, Turnham L, Dobson S. Pediatric oncology and stem cell transplant patients with healthcare-associated Clostridium difficile infection were already colonized on admission. Pediatr Blood Cancer 2019;66(5):e27604. doi: 10.1002/pbc.27604.

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2. Donovan TL, Forrester L, Collet JC, Wong L, Mori J, Lloyd-Smith E, Ranns B and Han G. Challenging the assertion of comparability of surveillance and administrative data. Infect Control Hosp Epidemiol 2018;39(11):1391-2.

3. Katz KC, Golding GR, Choi KB, Pelude L, Amaratunga KR, Taljaard M, Alexandre S, Collet JC, Davis I, Du T,

Evans GA, Frenette C, Gravel D, Hota S, Kibsey P, Langley JM, Lee BE, Lemieux C, Longtin Y, Mertz D, Mieusement LMD, Minion J, Moore DL, Mulvey MR, Richardson S, Science M, Simor AE, Stagg P, Suh KN, Taylor G, Wong A, Thampi N; Canadian Nosocomial Infection Surveillance Program. The evolving epidemiology of Clostridium difficile infection in Canadian hospitals during a postepidemic period (2009–2015). Can Med Assoc J 2018;190(25):E758-E765.

Conference abstracts 1. Srigley JA. Hospital patient and visitor hand hygiene knowledge, attitudes, and practices (oral

presentation). Quality Forum 2019. Vancouver, British Columbia. February 2019.

2. Mijović H, Al-Nasser Y, Al-Rawahi GN, Roberts AD “Experience with Using Rapid Molecular Testing in Diagnosing Pulmonary and Extra-pulmonary Pediatric Tuberculosis in a Non-Endemic Setting – A Retrospective Case Series”, End TB 2019: 23rd annual conference of the Union-North America Region, Poster Presentation- Vancouver, BC, February 21-23, 2019

3. Tearoe JF, Al-Rawahi G, Chant A, Ezelyk A. Plants in the outpatient setting plants in the outpatient

oncology setting: enhancing patient safety in a healing environment (poster presentation). IPAC Canada 2018 National Conference, Banff, Alberta. May 2018.

4. Young L. Paramedics’ confidences and concerns about infectious disease pandemic preparedness

(poster presentation). IPAC Canada 2018 National Conference, Banff, Alberta. May 2018.

5. Al-Rawahi GN, Al-Najjar A, McDonald R, Deyell RJ, Golding GR, Brant R, Tilley P, Thomas E, Rassekh SR, Dobson S. “Healthcare-associated Clostridium difficile Infection in Pediatric Oncology and Bone Marrow Transplant Patients”, AMMI Canada-CACMID Annual Conference, Oral Presentation , May 4, 2018

6. Ranasinghe R, Han G, Azana R, Short K, Forrester L, Collet J, Mori J, Ranns B, Lloyd-Smith E, Croxen EA,

Gamage B, Bryce E, Hoang L. Epidemiological, molecular and genomic characterization of carbapenemase-producing organisms (CPOs) in British Columbia (BC) (oral presentation). Association of Medical Microbiology and Infectious Disease Canada Annual Conference. Vancouver, British Columbia. May 2018.

7. Wong M, Yu YZ, Bone J, Srigley JA. Impact of patient and visitor hand hygiene

interventions on healthcare worker hand hygiene compliance (poster presentation). Association of Medical Microbiology and Infectious Disease Canada Annual Conference. Vancouver, British Columbia. May 2018.

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Collaborations Kristie Harding continued in her role as chair of the Oncology Interest Group, which expanded this year to welcome the Transplant population into the group so is now known as the Oncology Transplant Interest Group (OTIG). Jacquie Hlagi was the President of the IPAC BC chapter and Chair of the IPAC Canada Membership core Committee. Janie Nichols was the co-chair of the pre-hospital interest group for IPAC Canada. Dr. Laura Sauve was a member of the Canadian Pediatric Society’s Infectious Diseases and Immunization Committee, which provides guidance for general pediatricians across the country on infection related questions, including IPAC. Bal Sidhu served on the IPAC Canada Board of Directors. IPAC team members continue to collaborate with provincial and national groups including the Provincial Infection Control Network (PICNet), IPAC Canada, and the Canadian Nosocomial Infection Surveillance Program (CNISP).

Awards and Accomplishments Vladlena Abed achieved her CIC certification, and Janie Nichols and Bal Sidhu were recertified. Ashifa Dhanji graduated from University of British Columbia with a Master of Science in Nursing in November 2018. Jacquie Hlagi and Bal Sidhu received their Masters of Public Health in January 2019 from the University of Roehampton and Merit University, respectively. Robyn Hunter, Director for PHSA IPAC, graduated the Quality Academy, March 2019.

Continuing Education IPAC team members attended various learning opportunities including the 2018 IPAC Canada Annual Conference (Banff, Alberta), IPAC-BC educational day, Canadian Standards Association courses, web tele-classes, Children’s Hospital Infection & Microbiology Programs (CHIMPs) Rounds, and Oncology rounds at BCCA.

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Surveillance IPAC conducts surveillance of health care-associated infections (HAIs) at BC Children’s Hospital (BCCH), BC Women’s Hospital + Health Centre (BCW), and BC Cancer – Vancouver, and implements timely interventions based on these data to reduce HAIs. This section provides information on the incidence and trends of HAIs at PHSA facilities.

Clostridium difficile Infection (CDI) • In 2018/19, 72 patients were admitted at PHSA acute care facilities with laboratory-confirmed

Clostridium difficile infection (CDI). Of those, 34 (47%) were classified as health care-associated CDI cases (HA-CDI), corresponding to a rate of 6.2 cases/10,000 patient days.

• At the facility level, both BC Cancer - Vancouver and BCCH rates have increased compared to last year’s rates. There were no cases identified at BCW in 2018/19.

Figures 1 - 4: HA-CDI rates by facility site from 2009/10 to 2018/19. F

Figure 1 Figure 2

Figure 1 Figure 2

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Methicillin-Resistant Staphylococcus aureus (MRSA) • In 2018/19, 87 new MRSA cases (including colonization and infection) were identified among patients

admitted to PHSA facilities. Of these, 23 (26%) were classified as health care-associated MRSA (HA-MRSA).

• The PHSA HA-MRSA rate decreased to 2.4 cases/10,000 patient days. Rate decreases were seen at both BCCH and BCW. No HA-MRSA case were identified at BC Cancer in 2018/19.

Figure 5-8: HA-MRSA rates by facility site from 2009/10 to 2018/19.

Figure 5 Figure 6

Figure 3 Figure 4

Vancomycin-Resistant Enterococci (VRE) • In 2018/19, 14 new VRE cases (colonization only) were identified at PHSA facilities. Seven (50%) of

them were classified as health care-associated VRE (HA-VRE).

• The overall PHSA HA-VRE rate decreased to current 0.7 per 10,000 inpatient days from 2.1 cases/10,000 patient days last year. This rate reduction was mainly driven by BCW in which there were zero cases identified, compared to 15 cases identified last year. Rate increases were seen at BCCH (6 cases) and BC Cancer (1 case).

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Figure 9-12: HA-VRE rates by facility site from 2009/10 to 2018/19.

Figure 5 Figure 6

Figure 7 Figure 8

Carbapenemase-Producing Organisms (CPO) Screening of CPO among inpatients began in 2012 at BC Cancer and in 2014 at BCCH/BCW.

In 2018/19, only one CPO case was identified at BCCH through admission screening, and this case was not associated with PHSA facilities.

Central Line-Associated Blood Stream Infection (CLABSI) Pediatric Intensive Care Unit (PICU)

• One CLABSI case was identified in PICU in 2018/19.

• Since 2009/10, the CLABSI rate in PICU has remained low, with a clear downward trend.

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Figure 13: CLABSI rate in PICU

Neonatal Intensive Care Unit (NICU)

• In 2018/19, 11 CLABSI cases were identified in NICU, which was slightly higher than last year’s rate but remains low.

• The CLABSI rate in NICU has also shown a non-significant downward trend from 2009/10 to 2018/19.

Figure 14: CLABSI rate in NICU

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Outbreak Management There were two respiratory outbreaks at PHSA sites in 2018-19. The management and containment of the following outbreaks relied heavily on collaborating with clinical and support staff for each site. Patients exhibiting symptoms of infection were quickly placed on additional precautions and antiviral prophylaxis was implemented when indicated. Below are the outbreaks that occurred within PHSA in 2017-2018.

Facility Patients/Staff Affected Organism Length of Outbreak Ford Mountain

Correctional Centre 7 Influenza A 8 days

Burnaby Centre for Mental Health &

Addiction 6 Influenza A 9 days

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Quality Improvement For the full PHSA IPAC Quality Improvement Plan, refer to Appendix C.

BC Children’s Hospital and BC Women’s Hospital + Health Centre Patient and Family Hand Hygiene Projects

Several quality improvements projects have taken place within the area of hand hygiene. IPAC worked with UBC medical students to assess the hand hygiene knowledge, attitudes, and practices of patients, family, and visitors; this included a survey and observational audits in May 2018. In response to low hand hygiene rates, IPAC collaborated with Quality and Safety leads and unit staff to pilot projects on several units. In the Oncology department, the team developed and implemented teaching tools for nurses to use with patients and families for hand hygiene education. IPAC supported the program by providing ‘Edu-Quicks’. In the NICU, the medical students worked with unit staff and family representatives to develop a hand hygiene video. Quality & Safety worked with a group of nursing students to conduct a site-wide needs assessment. The intention is to use the learnings from these projects to roll out a site-wide campaign to improve patient, family, and visitor hand hygiene in addition to staff hand hygiene.

Clean Utility Room and Soiled Utility Rooms in Ambulatory Care Clinics IPAC previously conducted clean supply and soiled utility room audits across the C&W campus in response to a communique from the Ministry of Health. Gaps were identified in the Ambulatory Care Building (ACB). IPAC collaborated with ACB staff to implement best practice initiatives. As a result, ACB achieved 100% on their subsequent audits.

Perinatal/Neonatal Programs for Pre-admission ARO Screening IPAC collaborated with unit leadership. Together, screening guidelines were defined for the given populations. IPAC provided support to facilitate knowledge translation so that staff was better able to conduct ARO screening.

In-patient Laundry Guidelines With the transition to the new Teck Acute Care Center (ACC), some new processes such as domestic laundry for inpatients were left undefined. To support nursing staff in the Teck ACC, IPAC created defined guidelines for inpatient domestic laundry use. These guidelines were then put into a poster format and placed in each unit’s laundry room for families to reference.

Viral Hemorrhagic Fever (Ebola) Preparedness IPAC participated in ‘table top’ exercises with site stakeholders at C & W for viral hemorrhagic fever preparedness. Preliminary updates to the Viral Hemorrhagic Fever algorithm were made to reflect current, evidence-based practices.

BC Cancer Point of Care Risk Assessment Study at BC Cancer – Abbotsford

This study took place between September 2018 and January 2019. It established the baseline level of knowledge of routine practices (RP) and Point of Care Risk Assessments (PCRA) among health care providers (HCP) in the outpatient oncology health care center in Canada. The study’s primary focus was specifically on PCRA.

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The study utilized a Knowledge, Attitude, and Practice (KAP) survey to obtain a baseline assessment of the oncology outpatient centre HCP’s knowledge, attitudes and barriers to the implementation of infection control routine practices (RP). 122 HCPs who provide direct patient care were surveyed. Of these 50 questionnaires were completed and received. Data were analysed to measure the impact of various knowledge and attitude variables on the self-reported adherence to PCRA in the respondent’s daily interactions with patients. Among other findings, it was determined that 58.7% of HCPs in BC Cancer-Abbotsford reported receiving ongoing IPAC education at work, suggesting that the educational opportunities for IPAC training in BC Cancer-Abbotsford are sufficient.

Construction Projects Many cancer centres across the province have undergone structural changes to their physical space. ICPs have been involved with the design and upgrade process from the beginning contributing to safe physical clinical spaces. Projects of note: expansion of the chemo room and clinic space in Surrey; addition of the dentistry program in Abbotsford; PET Imaging installation in Victoria; Kelowna planning for a constructed (Clinic A, BC Cancer-Surrey) addition to house a PET Imaging scanner with an expected opening date of May 2020.

(Clinic A, BC Cancer-Surrey)

CPO Screening Initiative at BC Cancer - Surrey All patients with foreign health care exposure are identified prior to entry of the centre and infection control precautions are implemented early. Originally initiated as a pilot project in the Surrey Centre, this has become standard practice at that site. This year, the CPO Algorithm has been amended, in consultation with the Centre and Fraser Health Authority, to align practices across health authorities. This new streamlined process allows for more complete screening and reduced the need for multiple screening swabs.

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BC Mental Health and Substance Use Services Laundry at Heartwood Centre

An IPAC safety concern was identified at the Heartwood Centre related to clients laundering the bed linens and towels, in addition to doing personal laundry on the unit. BC Best Practices for Environmental Cleaning and CSA guidelines were consulted for guidance on the use of PPE, water temperature, water volume, and detergent concentration. IPAC made recommendations to transition to the linen and laundry services already in place at BC Women’s Hospital, in addition to recommendations for bed linens to be changed once per week, towels changed after use, and linen carts replenished once per week. Heartwood Centre is currently in the process of securing resources to support the recommendations.

Mattresses at Heartwood Centre IPAC was made aware that the client mattresses at Heartwood Centre for Women were cloth. Further discussions with staff revealed that the mattresses were covered with an impervious cover. IPAC made the recommendation to replace all cloth mattresses with waterproof and wipeable mattresses. They worked with the centre to develop a process for mattress cleaning and inspection. Best practice guidelines for mattresses in health care were developed and implemented for the centre. The centre is currently in the process of implementing new mattresses.

British Columbia Emergency Health Services Champions Program

The BCEHS paramedic IPAC Champion Program is based upon an acute care model that started in the UK. Modified for the pre-hospital setting, this program intends to support IPAC best practice discussions and ongoing improvement of practices at the station level. A BCEHS paramedic IPAC Champion has received additional IPAC training on PPE (donning and doffing), hand hygiene, point of care risk assessments, and routine/additional precautions. This project was successfully trialed in the Fraser district and will be expanding to other districts.

The Champions have also promoted hand hygiene improvement initiatives by participating the Hand Hygiene Day (May). (Champion Training, 100 Mile House, April 2019)

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Strategic Plan The PHSA IPAC team will continue to focus on quality improvement activities in 2019-20 and beyond to achieve our vision of empowering everyone to prevent infections, including: A proactive approach to current and evolving challenges • Continuing the study of copper surfaces in the new Teck Acute Care Centre at BC Children’s and BC

Women’s Oak Street campus

Facilitating implementations and solutions • Implementing programs to improve patient/visitor hand hygiene at all PHSA sites • Implementing a timely data feedback platform on health care-associated infections to front line staff Expert consultation based on applicable regulations, evidence and best practice • Working with BC Cancer, BCEHS, and BCMHSUS to ensure Accreditation Canada standards continue to be

met in preparation for the upcoming surveys.

Collaboration with local, provincial, and national partners • Working with the Clinical Systems Transformation (CST) team and IPAC colleagues at Vancouver Coastal

Health and Providence Health Care to prepare for implementation of the Cerner electronic medical record at PHSA sites

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Appendix A - PHSA IPAC Organizational Chart as of January 2019

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Appendix B – Definitions

Colonization: The presence, growth, and multiplication of an organism without observable clinical symptoms or immune reaction. The patient is asymptomatic. Infection: Invasion by and multiplication of a microorganism in body tissue resulting in clinical manifestations of disease. VRE case: Laboratory confirmation of vancomycin-resistant enterococci from specimens indicative of colonization or infection. This includes: o Cases identified for the first time during their hospital admission. o Cases identified previously at outpatient clinics but currently the patients being admitted with positive

VRE isolates. o Cases identified in the emergency department that are admitted subsequently (during the same

day).

This does NOT include: o Cases identified in the emergency department but are not admitted. o Cases identified in outpatient clinics or other outpatient cases. o Case re-admitted with VRE

Health care-associated VRE: A VRE case (as defined above) identified greater than 3 calendar days after admission, OR a VRE case identified 3 calendar days or less after admission, but is related to a previous admission within the last 12 months MRSA case: Laboratory confirmation of methicillin-resistant Staphylococcus aureus from specimens indicative of colonization or infection. This includes:

o Cases identified for the first time during their hospital admission. o Cases identified previously at outpatient clinics but currently the patients being admitted with

positive MRSA isolates. o Cases identified in the emergency department that are admitted subsequently (during the same day). This does NOT include: o Cases identified in the emergency department but are not admitted o Cases identified in outpatient clinics or other outpatient cases o Case re-admitted with MRSA.

Health care-associated MRSA: A MRSA case (as defined above) identified greater than 3 calendar days after admission, OR a MRSA case identified 3 calendar days or less after admission, but is related to a previous admission within the last 12 months.

CDI case: Laboratory confirmation (positive toxin or culture with evidence of toxin production) of Clostridium difficile in an unformed stool specimen (does not include patients <1 year old).

Primary CDI infection: The first episode of CDI ever experienced OR a new episode of CDI which occurs more than 8 weeks after the previous toxin-positive assay.

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Health care-associated CDI: A CDI case (including primary and relapse CDI cases) with symptom onset greater than 3 calendar days or more after admission, OR a CDI case with symptom onset in the community or 3 calendar days or less after admission, provided that symptom onset was less than 8 weeks after the last discharge.

CPO case: Laboratory confirmation of carbapenem resistance/reduced susceptibility caused by a carbapenemase in specified Gram negative organisms, including Enterobacteriacae and Acinetobacter spp.

Central line-associated bloodstream infection (CLABSI): A laboratory-confirmed bloodstream infection (BSI) where a catheter was in place for >2 calendar days on the date of the positive blood culture, with day of device placement being Day 1. Patient with BSI has met one of the following criteria:

o A recognized pathogen cultured from one or more blood cultures and unrelated to an infection at another site.

OR o At least one of: fever (>38°C), chills, hypotension (if aged < 1 yr: one of fever (> 38 °C), hypothermia

(< 36 °C), apnea, or bradycardia) AND infection signs and symptoms/ positive laboratory results are not related to an infection at another site AND common skin contaminant cultured from 2 or more blood cultures drawn on separate occasions.

Catheter includes: • Non-tunneled central venous catheter, coated or non-coated (e.g. pulmonary artery catheter) • Tunneled infusion device (e.g. Hickman, Broviac, tunneled hemodialysis line) • Peripherally inserted central catheter (PICC line) • Implanted vascular access device (IVAD)

Gastrointestinal outbreak: Three or more cases of gastroenteritis among patients, residents, or staff, that cannot be explained by admitting diagnoses or by non-infectious causes of symptoms (i.e. recent use of laxatives or stool softeners, chronic diarrhea, etc.), within a four- day period in the same unit or patient care area.

Respiratory outbreak: Two or more cases of influenza-like illness (fever, chills, headache, myalgia, sore throat, cough, nasal congestion, etc.) among patients, residents, or staff within a one-week period in the same unit or patient care area.

Patient days: Patient days are used as denominators in the calculation of rates to adjust for length of stay. It is calculated by the number of patients admitted (counts are usually conducted at midnight) and multiplied by the number of days of hospitalization in a given time period.

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Appendix C - PHSA IPAC Quality Improvement Plan 2017-2019 Goals Objectives Activities Sites Responsibility Timeline A Proactive Approach to Current and Evolving Challenges

Process Monitoring

IPAC Auditing (e.g. MoH) reprocessing, pet therapy, PPE)

All ICPs Ongoing

Transition IPAC Services to Teck Acute Care Centre

Reassessment of ICP portfolios and workflow; updates to infection control manual; new communication strategies among team

BC Children’s

and BC Women’s

BC Children’s and BC Women’s team

Fall 2017

Trial Antimicrobial Surfaces

Teck ACC copper study

BC Children’s

and BC Women’s

Jocelyn, June, BC Children’s and BC Women’s Team

2017-18

C&W lab copper study (partnership with VGH and others)

BC Children’s

and BC Women’s

Jocelyn, ICOs

2017-18

CPO Surveillance

CPO Screening Initiative

BC Cancer – Surrey and BC Cancer - Abbotsford

BC Cancer team 2017-18

High Risk Infectious Disease Planning

High Risk Infectious Disease Response Directives

BC Cancer BC Cancer teams in collaboration with

site leaders

2017-18

Facilitating Implementations and Solutions

Revise Infection Control Manuals

Compile one PHSA-wide IPAC manual; add policy statements

All PHSA team 2019

Cerner Implementation

New electronic health record

All All sites starting with BC Cancer

2018-19

Improve Patient Hand Hygiene

Expand program at C&W; start initiatives at BCW, BC Cancer, and BCMHSUS

All PHSA team 2017-19

HH Compliance Annual HH education refresh for all staff & volunteers

All PHSA team Ongoing

Reassess Hand Hygiene

Trial patient as observer program at BCCDC

BCCDC Jocelyn, Bal, auditors, BCCDC

ICP

2017-18

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Compliance Monitoring

Trial electronic monitoring system at C&W

BC Children’s

and BC Women’s

Jocelyn, Bal, BC Children’s and BC Women’s Team

2018

UV Disinfection Improve utilization of RD machine at C&W

BC Children’s

and BC Women’s

Charina, BC Children’s and BC Women’s Team

2017-18

Consider trial of UV disinfection lights in inpatient washrooms

BC Cancer Ghada, BC Cancer team

2017-18

Expert Consultation Based on Applicable Regulations, Evidence, and Best Practice

Assist with Implementation of BC Best Practices for Environmental Cleaning

Implementation of phase one recommendations (clean storage/soiled utility room audits, equipment cleaning)

All PHSA team January 2018

MRSA de-flagging Review

Review of current PHSA guidelines in light of new SHEA recommendations

All PHSA team 2018-19

Future planning for Dentistry Program

IC consultations re: design, work flow, reprocessing

BC Cancer - Abbotsford

BC Cancer team 2018

Accreditation Preparation

Help to ensure that IPAC and reprocessing standards are being met

BC Cancer BC Cancer team 2019

Construction Standardization

Align with latest CSA guidelines

BC Cancer BC Cancer team 2018

Collaboration with Local, Provincial, and National Partners

Implementation of BCMHSUS IPAC Program

Hire new team members; develop manual; implement/ enhance programs for hand hygiene, surveillance, reprocessing, etc.

FPH, Burnaby,

Heartwood BC

Corrections

Jocelyn, Robyn, BCMHSUS team

2017-19

Evaluate PHSA IPAC Program

Repeat stakeholder survey (previous fall 2015)

All PHSA team Spring 2018

Improve Communication

Revise IPAC POD and internet sites

All

Fran, PHSA team 2017-18

29 | P a g e

with Stakeholders

Review BC Cancer relationships with regional Health Authorities

BC Cancer

BC Cancer Team

2019

Networking with Community Partners

Collaborating with Canadian Cancer Society Lodge & Public Health re-new policy for lodgers with infections/AROs

BC Cancer BC Cancer Team 2018-19

Networking with Provincial & National Partners

Participating in PICNet working groups (surveillance, education steering committee), CNISP activities

All PHSA team Ongoing

Reinstating of the IPAC Canada Oncology Interest Group

BC Cancer BC Cancer team 2017-18

Appendix D – References

NIAID (2009) HIV-infected H9 T cell [Online Image] Retrieved October 25, 2009 from: https://www.flickr.com/photos/niaid/6813396647/in/photostream/

C&W Visitor. (2018, 05 06). BC C&W Hand Hygeine Day Visitor. Vancouver, BC, Canada: PHSA IPAC