Patient-centred risk management strategy for multi-resistant organisms

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

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. 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 Implementation resources http://www.health.gov.au/internet/safety/publishing.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@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