infectiepreventie en antibioticaresistentie kwaliteit door transparantie

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Maria van Dongen
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1 infectiepreventie en antibioticaresistentie kwaliteit door transparantie Jan Kluytmans Amphia Ziekenhuis Breda UMCUtrecht

2 O Neill J. The Review on Antimicrobial Resistance. December 2014.

4 AMR is everywhere

6 and it s invisible

8 Patient safety Infection control Prevention of infections (no infection > no treatment needed) Prevention of the spread of micro-organisms ( with increasing introductions > increasing importance) Antimicrobial stewardship Limits the selective pressure Netherlands has low use and it is uncertain if substantial reductions are possible

9 How to perform optimal infection control? Complex multifactorial problem No single proces measure can guarantee a good outcome Outcome measures are often difficult to define How to measure? How to adjust? Temporal trends?

10 Quality systems Standardization Transparancy Continuous improvement

11 Quality systems: How are we doing? Standardization Transparancy Continuous improvement Practically zero Scarce Rare and fragmentary

12 Example: cleaning Standardization How do you measure? Do you have objective and reproducible data? and your colleagues from the next hospital? Transparancy Do you present your data to the management? Do you publish them? Continuous improvement If the answers on the above questions are negative, this is not possible at all

13 How to solve this? Developing a multifactorial, objective and reproducible measurement Publishing the results and defining best practices Integrating it into a PDCA cycle

14 Infection Risk Scan (IRIS)

15 I41-health consortium

16 Infection RIsk Scan Objective measurement of the infection control situation in a ward, medical specialty or a healthcare center

17 Infection RIsk Scan a ONE-health approach ziekenhuis verpleeghuis crèche school kippenhouderij varkenshouderij

18 What is measured?

19 IRIS Bundle approach including outcome and proces-measures. On the level of the patient and the ward. As standardized and objective as possible. Result is judged against reference values and scored as: high, average, low risk (traffic light) Visualisation of results in risk profile and improvement plot. Easy to understand for all involved in the proces of care or management

20 IRIS - Hospital RISK PROFILE IMPROVEMENT PLOT * Willemsen & Kluytmans. NTvG. 2016

21 Verspreiding van ESBL; CPE; VRE Cumulatieve incidentie (%) Aan/afwezigheid randvoorwaarden Observaties (score) onjuist gebruik med. hulpmiddelen Prevalentiemeting (%) onjuist gebruik antibiotica Prevalentiemeting (%) Persoonlijke hygiëne medewerkers Observaties (score) Handhygiëne compliance Observaties en verbruik Omgevingscontaminatie ATP meting (score)

22 IRIS AMPHIA hospital 4x IRIS performed: o End 2013 o Summer 2014 o Spring 2015 o End 2016

23 IRIS AMPHIA hospital * Willemsen & Kluytmans. NTvG Figuur: Verbeterplots voor 5 ziekenhuisafdelingen van verschillende specialismen, gemaakt in 3 Infectierisicoscan(IRIS)-cycli met een tussenpoos van 6-8 maanden tussen elke cyclus.

24 Cleaning High level of environmental contamination: - Keyboard Computer on wheels (COW) - Toilet chairs - orphan objects (for cleaning) - Redefine responsibilities - fixed personal for cleaning - Define cleaning procedures for nursing staff à Significant reduction of ATP levels (p<0.0001)

25 HANDHYGIENE - Teaching (by and for nurses) - Handalcoholdispensers at the point of care - Teaching on the job with feedback - Increasing compliance (mean 43% > 66%) (>1000 observations per IRIS, p<0.000)

26 Conclusions Broad and sustained improvement of relevant infection control parameters using IRIS as part of a PDCA cycle Intensive process Highly appreciated by the departments, the management and infection control staff Very useful during JCI accreditation and for other external audits

27 Infection RIsk Scan ziekenhuis verpleeghuis crèche school kippenhouderij varkenshouderij

B=onjuist gebruik hulpmiddelen (%) D= omgevingscontaminatie (scorer) F= persoonlijke hygiene (score) H=

28 IRIS NURSING HOMES RISK PROFILE ESBL-dragerschap Medische hulpmiddelen IMPROVEMENT PLOT A= verspreiding ESBL (%); C= onjuist gebruik antibiotica (%) E= handhygiëne non-compliance (%) G= tekortkomingen protocollen (score) B=onjuist gebruik hulpmiddelen (%) D= omgevingscontaminatie (scorer) F= persoonlijke hygiene (score) H= randvoorwaarden (score) 11 % 7,7 % Antibiotica gebruik KATZ score 3,8 % * Willemsen et al. Antimicrob Resist and Inf Control. 2014

29 IRIS NURSING HOMES * Willemsen et al. Antimicrob Resist and Inf Control. 2014

30 IRIS NURSING HOMES * Willemsen et al. Antimicrob Resist and Inf Control. 2014

31 IRIS NURSING HOMES à Clonal spread! Eye for the invisible

32 IRIS i-4-1 health What are we doing? Building Apps for easy and standardized input of data - Automatic analysis - Real-time reports - Central database - Compare and define best practices

33 IRIS i41-health All hospitals and nursing homes have a coach Validated measurements Certified system

34 Quality system Standardization (of the basic factors) Transparancy (public reporting?) Continuous improvement (PDCA) Towards the next level in infection control

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i-4-1 Health: Welke kleur is jouw IRIS?

26 ste Dag van de Infectiepreventie 10 december 2018 i-4-1 Health: Welke kleur is jouw IRIS? Ina Willemsen Amphia ziekenhuis Breda Pascal De Waegemaeker UZ Gent Financier Co-financiers Antibiotica resistentie