Got Milk? Check! Got Infection Prevention and Control Plan?
If there was ever a time to prepare or re-evaluate your health organization’s Infection Prevention and Control Plan (IPCP), Q4-2014 would certainly be in the top 5 most urgent times to do so! The CDC recently released Ebola preparedness and personal protective equipment guidelines, explicitly stating that now is the time to prepare. The guidelines provide suggestions to assist with detecting possible Ebola cases, protecting employees, and responding appropriately. As scary as the current Ebola outbreak is, the fact of the matter is that thousands of people die every year via healthcare-related infections, simply by going to the hospital! The CDC reports that 1.7 million infections each year are healthcare-related, causing a staggering 99,000 deaths. If that’s not enough to make your hospital’s IPCP a priority, the CDC reports that these healthcare-related infections result in an estimated $20 billion in healthcare costs. So where do we start…well, washing hands more frequently isn’t a bad place to start. But there’s certainly more to an IPCP than just a good hand scrub.
If there was ever a time to re-evaluate your health organization’s Infection Prevention and Control Plan, it’s now! Every hospital needs an effective IPCP to help prevent infectious diseases from being spread among staff, patients, and visitors. The steps within a hospital’s IPCP should be both practical to implement and track, and appropriate for the hospital’s scope of services. An audacious IPCP may look appealing on paper, but it must be reasonably implementable in order to expect staff and others to adhere to its guidelines. Once in place, steps need to be taken to ensure the IPCP is followed and evaluated for improvement, at least annually. An effective Infection Prevention and Control Plan is managed across three phases: Planning, Implementation, and Evaluation & Improvement.
From building a house to preparing for retirement to preventing the spread of infectious diseases, it all starts with solid planning. For a healthcare organization’s IPCP, the most pressing concern is to first assess where the highest risks exist, to help guide the goals and prioritization of the plan. But even then, some neglect to ask the question: who’s in charge here? Accordingly, in order to properly execute the planning stage of an IPCP:
- Assign one or more personnel to be responsible for developing the IPCP program as well as those responsible for managing the program once it is established.
- Perform a hospital-wide assessment of risks for acquiring and transmitting infections. For example, if some sterilization and disinfection procedures do not adequately adhere to CDC’s recommendations, this should be considered a risk to be noted.
- Assess each risk by probability of occurrence in addition to potential for harm. Each of these assessments may be on a scale from one to five or as simple as High/Medium/Low. With the risks assessed, the data is easily visualized using a heat matrix showing the likelihood-of-occurrence on the x-axis (e.g., Improbable, Occasional, and Frequent) and the severity-of-impact on the y-axis (Negligible, Moderate, and Catastrophic). Multiplying the likelihood-rating by the severity-rating gives you the risk rating which may be used to prioritize risks against each other. Furthermore, an initial heat matrix also serves as a visual baseline to compare future assessments against.
- Establish goals using both the risk assessment’s heat matrix and managerial input with the goal of minimizing the possibility of transmitting infections. Goals should include:
- Mitigating identified risks,
- Limiting uncontrolled exposure to pathogens,
- Limiting transmission of infections via procedures and via the use of medical equipment & supplies, and
- Improving compliance with the oft-noted yet under-appreciated hand washing guidelines.
- In addition to goals, the IPCP should include policies and procedures for:
- Identifying, reporting, investigating, and controlling infectious diseases,
- Communicating the prevention of infectious diseases to healthcare professional, patients, and yes, even visitors (e.g., hand sterilization posters), and
- Addressing how the hospital will respond to being inundated with infectious patients and the care of those patients over an extended time period.
Like ISO 9000 compliance, the implementation of an effective IPCP program is mostly about doing what you said you’d do! If you’re unsure if you have covered all the appropriate areas of concern, closely review The Joint Commission Hospital Standard IC.02.01.01 for a more compelte listing of activities to ensure your hospital’s IPCP implementation fully covers requirements. As with CDC guidelines, these standards don’t simply exist to support accreditation and regulatory requirements, but to improve the overall quality of care of patients.
During the implementation phase of your hospital’s IPCP program, specific, ongoing attention must be given to the cleaning, disinfecting, sterilizing, and storing of medical equipment, devices, and supplies. The CDC reports that 46.5 million surgical procedures are performed in hospital settings; each and every one of these procedures involves contact between a medical device with a patient’s sterile tissue and mucous membranes. And each and every one presents the possibility of introducing pathogens, possibly leading to healthcare-related infections. Studies have shown that compliance with disinfection and sterilization is a vulnerable area for procedural lapse. Accordingly, the implementation phase of the IPCP should advocate continued compliance with disinfection and sterilization procedures by taking the following steps:
- Provide orientation, training and regular competency verification;
- Standardize disinfection and sterilization procedures by unit, department, and/or hospital-wide; and
- Remind and reinforce training by posting easy to spot notices and instructional placards.
The underlying goal of the implementation of an IPCP is to prevent the transmission of infectious diseases among patients and healthcare professionals. Accordingly, healthcare organizations should:
- Provide screening for exposure to infectious diseases for healthcare professionals, and
- Provide means for assessment, testing and treatment for healthcare professionals and patients who have, or are suspected of having, an infectious disease or have been exposed to an infectious disease.
Evaluation & Improvement
Just as important as planning and implementation, is the evaluation and improvement of the IPCP program, to ensure its continued effectiveness. The effectiveness of the IPCP program should be evaluated at least annually and when new risks warrant such an evaluation. The Ebola outbreaks in Guinea, Liberia and Sierra certainly warrants an immediate evaluation of every hospital’s IPCP to ensure its effectiveness and adherence to new guidelines being issued by the CDC. During evaluation, carefully review:
- Progress on prioritized risks (e.g., is the heat chart looking better?);
- Assessment of new risks (e.g., how does the new heat chart compare to the baseline?);
- Progress on IPCP goals; and
- Implementation of IPCP-related activities.
In an effort to improve communications and visibility of the quality of the IPCP program, evaluation results should be shared with the patient safety program management team. And most importantly, findings should be used to adjust and improve the overall IPCP program.
From physical therapists cleaning medical equipment, to kitchen staff sanitizing utensils, to administrative staff using precautions to prevent spreading infections via clipboards, everyone needs to be knowledgeable of IPCP goals, adhere to standardized procedures, and be cognizant that the actions they take quite literally saves lives.