Audits in Infection Prevention and Control 1 Explain

Audits in Infection Prevention and Control

1. Explain the relevance of audit in IP&C practice 2. Identify audit tools and methods 3. Describe the main principles of audits December 1, 2013 Learning objectives 2

• 40 minutes December 1, 2013 Time involved 3

• Audit means checking practice against a standard • Improves by providing information about practices • Use for risk assessment, strategic planning, and root cause analysis • Essential to have an audit team • Results need to be known by decision makers December 1, 2013 Key points 4

• Healthcare-associated infections (HAI) are due to multiple factors • Prevention depends on surveillance and infection prevention and control (IP&C) practices • Practices are outlined in guidelines, policies, and procedures December 1, 2013 Introduction 5

• Reporting of noncompliance or issues of concern • Identifying where improvement is needed • Monitoring and evaluating the effectiveness of the organisation’s risk management process December 1, 2013 Audit objectives 6

• Set objectives • Identify, analyse and respond to risks that could impact the organisation • Internal auditors can offer advice and help risks December 1, 2013 Risk Management 7

December 1, 2013 The PDSA cycle 8

December 1, 2013 The PDSA cycle 9

• Templates to evaluate implementation of the standard • Can focus on • Procedures December 1, 2013 Audit tools • hand hygiene, isolation, cleaning, disinfection or sterilisation • Practices • personal protective equipment, insertion and care of intravascular, respiratory and urinary devices, hair removal, prophylactic antibiotic 10

• Audit tools must match the recommended practices and resources of the institution • The audit can be performed by the IP&C team or other designated staff December 1, 2013 Audit Tools 11

• Select areas • Focus on a few important ones • Report should include • • • December 1, 2013 Audit Method Description of the physical layout Observation of practices Action taken/Practice changed Collection of local audit data Analysed audit data 12

December 1, 2013 Audit plan 13

December 1, 2013 Annual audit plan 14

• All staff must be included • Need to understand its purpose is to improve practice December 1, 2013 Preparation of Audit Team • Not punitive or to identify weaknesses • Pre-audit meetings essential • Consistence and anonymity • Identify leaders in the area • Knowledge assessment 15

Available from Community and Hospital Infection Control Association-Canada and World Health Organization • Hand hygiene • Standard precautions/routine practices • Use of isolation/precautions • Use of personal protective equipment • Monitoring of sterilisation equipment • And many others………. . December 1, 2013 Toolkits to Complete Audits 16

• Weekly reports • Rapid feedback on incidental issues • Monthly reports December 1, 2013 Routine Reports • Audit results, education, training, and consultations • Quarterly reports • Formal reports including recommendations and management • Annual reports • A summary of audits carried and the resulting improvement 17

• Behavioural theories and interventions insufficient • Interventions must account for different levels • Interdependence of factors, environmental constraints, and institutional climate taken into account • Factors necessary for change 1. Dissatisfaction with the current situation 2. Perception of alternatives 3. Recognition, of the ability and potential to change December 1, 2013 Behavioural Change 18

• Multi-model structured way of improving processes and outcomes • Collection of processes needed to effectively and safely care for patients • Interventions “bundled” together and when combined, improve outcomes • Consists of small (3 -5) set of procedures, determined by robust evidence • Successfully completing each step is a straightforward process and can be audited December 1, 2013 Basic principles: Bundles 19

• A statement of commitment • A cause-effect chart • Standard operating procedures • Data collection sheet • Explanation for staff December 1, 2013 Bundle pack 20

December 1, 2013 Cause and effect diagram 21

• Written guidelines for each procedure • Updated, acceptable, practical • An audit checks if guidelines are being followed December 1, 2013 Guidelines 22

• Data derived from audits used to inform the IP&C program • The intent of audits is to promote good practice, improve patient care, and ensure safety • A key person must be identified in each area to help facilitate implementation of any recommendations • Auditing is relatively simple, but time-consuming • Important to plan and develop an audit calendar December 1, 2013 Summary 23

• Millward S, Barnett J, Tomlinson D. A clinical infection control audit programme. J Hosp Infect 1993; 24: 219232. • Bryce EA, Scharf SL and Walker MM: Infection control practitioner audit form for patient/resident service units. Canadian J Infect Control 2002; 17: 23 -26. • Yokoe DS, et al. A compendium of strategies to prevent healthcare associated infections in acute care hospitals, Infect Control Hospital Epidemiol 2008; 29 (Suppl 1): 1221. December 1, 2013 References 24

1. 2. Audits have demonstrated improvement in processes and outcomes. T/F An audit tool helps evaluate a) b) c) d) 3. Practice against a standard Health care behaviour Surveillance Epidemiological investigation December 1, 2013 Quiz Regarding audits, it is incorrect that: a) b) c) d) The intent of audits is to promote good practice, improve patient care, and ensure safety. Audit means checking practice against a standard It is punitive There needs to be a plan 25

• IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe. • The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. • For more information go to http: //theific. org/ December 1, 2013 International Federation of Infection Control 26