Case 1: Infection Control Structure

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You are the infection control practitioner in a new, 400 bed community hospital with a six-bed adult and a six-bed paediatric intensive care unit. You have been asked to assist in establishing an Infection Control program and deciding its priorities.
Case One Questions:
1. What will be the structure of your infection control program? To whom do you think the program should report and why?

The structure should be in the form of a committee (Lautenbach, p. 403) with committee memebers holding hospital leadership positions which will enable them to provide insight, opinions and affect necessary change.

The infection control comittee should report to the facility’s medical board or medical advisory committee and/or senior management (Lautenbach, p 403).

Infection control committees composed of 8-12 members serve a single health care facility such as a hospital or long term care facility. Infection control committees composed of 15-25 members serve a health care region. (Lautenbach, p. 403)

An infection control committee is multidisciplinary with representatives from senior faclity management, the physcian group and nursing. Members from crital care, the surgical department, general medicine, the microbiology lab, pharmacy, occupational health, central processing, housekeeping and the local public health department should also be included (Lautenbach, p. 403).

The infection control program should report to their chair. The committee chair should be a physican leader for greatest effect. in best case scenario the chair is the hospital epidemiologist. With the committee reporting to a physician lead and hopefully a physician epidemiologist team lead, the infection control program is best supported to gain access to resources needed and to perform as efficiently as possible without being blogged down by leaders who do not fully understand the immplications of unmanaged infection control issues.
2. List key activities of your infection control program. Would these activities change if you were based in a long-term care institution? Why or why not?

  • hand hygiene audits
  • outbreak management: Acute event response, including outbreak investigation
  • staff and patient education
  • staff disease prevention/vacciation clinics
  • review of ongoing infection control measures
  • Surveillance
  • Performance improvement to reduce HAI
  • Reporting of HAI to the Centers for Disease Control and Prevention’s National Healthcare Safety Network as well as entities required by law (Bryant et al, 2016)

In long term care less acute issues arise, patient turnover decreased. The majority of staff are less educated therefore increased staff education and hand hygiene audits so that principals do not get overlooked due to “home -like” or more casual setting.
3. Using a table, outline your idea of a typical week for an infection control practitioner (you do not have to account for every hour of the day, but rather blocks of time or percentage of time dedicated to activities). Briefly discuss the rationale behind your time allotments.

Monday: 30% walk through of work area assigned/30% site surveillance/30% review isolation cases

Tuesday: 30% Staff education/ 30% walk through of work area assigned/30% review isolation cases

Wednesday: 30% walk through of work area assigned/30% site surveillance/30% review isolation cases

Thursday: 30% hand hygiene audits/ 30% review staff vaccination programs/ 30% site surveillance

Friday: 30% walk through of work area assigned/30% site surveillance/30% review isolation cases. (Archer, 2012).

Reviewing patients on isolation is essiential to infection prevention and control therefore should be given priority each day to stay on top of new cases. Educating staff and ensuring appropate precautions are being followed is also central to the role yet can be addressed through regular site surveillances and key components of education can be re-itterated once weekly with addition sessions as needed.
4. Would the percentage of time spent during your work week change if you were in a long-term care institution. Why or why not?

Yes it would change. LTC is less acute, less patient turnover, therefore more time could be spent on staff education, hand hygiene audits and surveillance than reviewing infection control and isolation cases as there would be fewer.
5. Where do you think Infection Prevention and Control should ‘fit’ operationally in relation to the Quality and Safety Program in a hospital?

Infection control should fit under epidemiology and within the hospital administration framework along with hospital quality management department, “care-managed entities, regulatory and accrediting agencies, lawmakers and public accountability “(Lautenbach, p. 43). Infection control must fit into this framework because “multidisciplinary collaborations are essential to instigate innovative preventative research, identify new applications for old prevention strategies, maximize synergy among the broad array of professionals engated in quality promotion effortsm minimize overlap and conserve scarse resources” (Lautenbach, p. 43)
6. What is the institutional role of Infection Prevention and Control in terms of Quality and Patient Safety initiatives?

“Healthcare-associated infections are an important measure or quality” (Lautenbach, p. 42). Hospital epidemiology and infection prevention and control must demonstrate compliance with evidence based standards and reduce incidence of nosocomial infections. With that comes insitutional pressure for infection, prevention and control teams to be clearly accountable to Quality and Patient safety. (Lautenbach, p. 42)

References:

1. Lautenbach, E., Woeltje, K., and Malani, P. 2010. Practical HealthcareEpidemiology, 3rd ed.

2. Kristina A. Bryant, Anthony D. Harris, Carolyn V. Gould, Eve Humphreys, Tammy Lundstrom, Denise M. Murphy, Russell Olmsted, Shannon Oriola and Danielle Zerr (2016). Necessary Infrastructure of Infection Prevention and Healthcare Epidemiology Programs: A Review. Infection Control & Hospital Epidemiology. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0899823X15003335

3. Archer, Joanne. (2012). Orientation Program for Infection control professionals. https://www.picnet.ca/wp-content/uploads/01-Introduction.pdf

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