LEARNING LESSONS FROM IMPROVEMENT OF
MANAGEMENT OF HEALTHCARE ACQUIRED
INFECTION
GSAS Sponsored Seminar / Workshop
Professor Charles Egbu PhD
University of Salford, UK
Qatar National Convention Centre, Doha – Qatar
14th June 2014
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Structure of Presentation
HAI in Context
FM in Context
The Role of FM in the Control of HAI
The Role of Knowledge Management and
Knowledge Mapping in Controlling HAI
Performance Management and FM in the
Control of HAI
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Healthcare Associated Infection (HAI)
• HAI by definition means the infection was
neither present nor incubating at the time of
admission but has developed during the
course of a stay in hospital or other facility
(Haley, 1986 as cited in Horton and Parker 2002; Comptroller and
Auditor General, 2000; Public Health Laboratory Service, 2000;
Scottish Executives Action Plan, 2002; World Health Organisation,
2002; Montana State Hospital, 2003).
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The Healthcare System 
More than Just Hospitals
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Acute Care Facility
Home
Care
Outpatient/
Ambulatory
Facility
Tranquil Gardens
Nursing Home
Long Term Care Facility
Source: Alice Guh, MD, MPH – (CDC)
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Your baby was born prematurely.
She was progressing in the neonatal intensive care
unit until she developed a bloodstream infection
related to her umbilical catheter.
Source: Alice Guh, MD, MPH – (CDC)
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Your father has open heart surgery.
The surgery goes well
but he later dies in a
nursing home of a
MRSA wound infection
that developed after
surgery.
Source: Alice Guh, MD, MPH – (CDC)
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Healthcare Associated Infection (HAI)
• HAI is recognised as presenting a significant problem in
terms of quality of care and cost for hospitals, governments
and consumers in most countries (Department of Human
Services, 1998).
• In prevalence surveys of hospital infection in the UK, and
other developed countries, the acquired infection rate was
approximately 10% (which means approximately 10% of
patients in hospitals at any one time have acquired an
infection from hospitals).
• The control of HAI exists as a major concern, and the high
frequency of HAI is seen as evidence of poor quality of health
service delivery, which has significant cost implications
(WHO, 2002).
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
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Healthcare Associated Infection (HAI)
 The costs associated with HAI have medical and economic
ramifications. HAI has ramifications for patients and healthcare
facilities; and associated costs are exacerbated during an outbreak
which also affects patients’ confidence in the service.
 The economic consequences include lost bed days and increased
work load with some estimates showing that 380,000 bed days per
annum are lost to HAIs. This is equivalent to 1000 hospital beds
and associated staffing input being wasted in dealing with HAI
related delays in discharge.
 There is also the social and personal burden that unnecessary
illness and complications place upon patients and their families.
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Infection Control
 Infection control is everybody’s business, thus,
there is a need for better collaboration and
coordination among clinical and non-clinical teams
to come up with an effective and ‘seamless’
infection control practices.
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
HAI is everybody’s business
Clinical
FM
Cleaning
Doctors
Nurses
Microbiologists, etc.
Catering
Waste Mgt
Maintenance
Estate engineering
Strategic management
Construction
Healthcare managers
Engineers
Policy makers, etc.
Architects, etc.
Different User Roles
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Healthcare Associated Infection (HAI)
• There are many reasons why patients develop HAI.
Some of these relate to the immunocompetence of
the patient, while others reflect the environment in
which the patient is nursed or the skill of the surgeon
and the team conducting their care.
• Facilities Management (FM) services have a
significant role in controlling HAI. The design and
maintenance of the building is important to provide a
risk free environment for the patients as well as for
the healthcare workers.
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
FM and HAI
 From a Facilities Management perspective, the
Design and Maintenance of the building is
important in providing a risk-free environment for
the patients as well as for the healthcare workers.
 Design considerations include ventilation
requirements, patient accommodation, facilities
such as hand wash basins and toilets and the
materials to be used for the surfaces.
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
HAI AND CLEANING
• ‘Effective cleaning of hospital wards is essential
for the health and safety of both patients and staff,
and makes an important contribution to the quality
of care patient’s experience. However, there is a
growing perception that standards of cleanliness
in hospitals have been declining. Domestic
services play a key part in minimising the risk of
hospital acquired infections, which have serious
consequences for patients and lead to significant
costs to the NHS’ (Auditor General, 2000).
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
FM and HAI
• “A safe environment (the estate), clean
surroundings and an appropriate diet (hotel
services) are integral parts in the diagnosis,
treatment and recovery of those who are ill “.
Rees (1998)
• If HAI is to be controlled effectively, it is essential
to focus on non-clinical areas such as Facilities
Management (FM)” as well (Meers et al, 1992;
Horton and Parker, 2002).
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
The Principles of a Safe Environment (Source: Horton and Parker,
2002)
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Hard and Soft Facilities Management
 FM in healthcare usually includes a myriad of services. These are
mainly in two categories: - hard FM and soft FM.
 Hard FM relates to management and maintenance of property.
 The built environment, including infrastructure facilities such as
estate and property, indoor air, structure and fabric, water supply,
electricity and telecommunication systems come under the first
category (hard FM);
 Soft FM includes the management of support services.
 Catering, cleaning, waste management, security, and laundry.
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Integrated Facilities Management
Accounts
IT
Personnel
Core
Business
Property &
Facilities
Purchasing
Transport
Distribution


Drivers for
Change




Focus on Core Business
Reduced Costs
Increased Flexibility
Improved Service Quality
Introduce Best Practice
Establish a Vehicle for Change
Source: Ian R Fielder
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
HAI AND THE DESIGN, CONSTRUCTION AND
MAINTENANCE OF FACILITIES
 Effective design and maintenance of water supply systems –
The Control of Legionella
 Design and maintenance of inanimate surfaces – Minimal
dust accumulation
 The space around beds – control of cross infection
 HVAC design and maintenance – control of airborne infection
 The design of visible and accessible hand-washing facilities –
control of contact transmission
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
KNOWLEDGE MANAGEMENT
AND
KNOWLEDGE MAPPING
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
HAI and Knowledge Management
• “Around 15% of HAI could be avoided
through strengthened arrangements for
prevention and control, and better
application of existing knowledge and good
practice”.
Department of Health. (2001). NHS Performance Indicators: A Consultation
http://www.doh.gov.uk/piconsultation/haicar.htm
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
HAI and Knowledge Management
• A lack of co-ordination and integration of
knowledge sources exist for the control of HAI.
There is also paucity of literature for facilities
management professionals/staff in infection
control, even though they have an important role
to play in the control of HAI.
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Knowledge Management
The management of any process of mapping,
creating, acquiring, capturing, transferring,
sharing and using knowledge wherever it resides
in order to meet existing and emerging needs, to
identify and exploit existing and acquired assets
and to develop new opportunities.
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Knowledge Mapping and Maps
• Knowledge mapping is defined as the process,
methods and tools for analysing knowledge areas in
order to discover features or meaning and to visualise
these in a comprehensive, transparent form, such that
the business-relevant features are clearly highlighted.
Speel et al.(1999)
• Knowledge mapping techniques aim to track the
acquisition and loss of information and knowledge.
• It explores personal and group competencies and
illustrates how knowledge flows throughout an
organisation or ‘network’.
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Knowledge Maps
• A knowledge map describes what knowledge is used in a
process, and how it flows around the process.
• It describes:
– who has what knowledge (e.g. tacit/explicit),
– where the knowledge resides (e.g. individuals,
infrastructure), and
– how the knowledge is transferred or disseminated
(social)
IBM Global Services- Technique Paper 2000
• Knowledge maps are created by transferring certain aspects
of knowledge into a graphical form that is easily
understandable.
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Routine
Aseptic
Technique
Rationale
Surgical
Agents
Hand Hygiene
washing
Sinks
Skin care
Staff/carer issues
Compliance
Equipment/services
Taps
Cleaning
Waste
Example of a Knowledge Map
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Performance Management
 ‘Performance Management (PM)’ was first used in the
1970s, but it did not become a recognised process until
the latter half of the 1980s (Armstrong and Baron, 1998).
 PM is mostly identified as a system which enhances
individual performances to support or achieve
organisational goals.
 PM cannot be defined in the absolute and that its
meaning is contextual in terms of both individuals and
activities. (Adair et al; 2003)
 Bartely (2000) has recommended that PM is essential to
assess the level of adoption of control of HAI standards
in FM services.
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
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Performance Management in Healthcare
Organisations
• Little has been researched or published in the areas of
performance management in healthcare organisations,
and even less so in the context of domestic services.
• There is evidence of a lack of common understanding of
what is meant by performance, or how performance
could be measured in practice, especially with regard to
the control of HAI in domestic services.
EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Performance Management - Approaches
 Balanced Scorecard (BSC). Developed by Kaplan and
Norton
 European Foundation Quality Management (EFQM) model
 PQASSO (Practical Quality Assurance System for Small
Organisations)
 “The Big Picture (an organisational improvement
framework and diagnostic tool for identifying strengths and
weaknesses within an organisation or programmes of work)
 Investors in People (a UK national standard for improving
organisational performance by training and developing
people to achieve organisational goals).
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
Performance Management – UK NHS
 The UK national Performance Assessment Framework (PAF)
 six areas of performance
1. Health improvement;
2. Fair access;
3. Effective delivery of appropriate healthcare
4. Efficiency;
5. Patient/carer experience; and
6. Health outcomes of NHS care
PAF, arguably, does not give much attention to infection
control as part of their overall assessment in hospitals
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
PM approaches in-use in the control of HAI in
domestic services
Audits by domestic service
Audits by infection control teams (ICT)
Environmental audits
Audits by the National Audit Office
Patient satisfaction survey
PA for domestic managers
Benchmarking techniques
PA for domestics
Personal Development Plans
PAF by the NHS
Programme evaluation techniques
ISO 9001:2000
BSC
EFQM
(Based on 412 completed questionnaires from domestic managers and
infection control team members across England and Scotland)
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EFFECTIVE MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
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Performance Management (PM) and HAI
 PM is essential to assess the level of adoption of
control of HAI standards in FM services.
 Measure progress towards achieving corporate objectives
and targets.
 Promote the accountability of service providers to the public
and other stakeholders.
 Compare performance to identify opportunities for
improvement.
 Performance indicators may be used to identify
opportunities for improvement through comparison both
within the organisation over time or between different units
or organisations.
 Promote service improvement by publicising performance
level.
THANK YOU