Patient-centred risk management strategy for
multi-resistant organisms
Infection Prevention
Quality, Safety and Patient Experience
February 2012
Update on VRE guidelines for hospitals
2012
1999
Guide
• The patient-centred risk management strategy for
multi-resistant organisms (MROs)
• a guide for hospitals
• can adapt for local use
• The guide is not designed for residential care
Australian Guidelines for the Prevention and
Control of Infection In Healthcare (2010)
Based on:
Australian Commission on Safety and Quality in Health Care
(ACSQHC)
Australian Guidelines for the Prevention and Control of Infection In
Healthcare (2010)
• National approach
• Best available evidence
• Risk management framework
• Patient-centred
• 2 level strategy
– Core
– Additional strategies
• Antimicrobial stewardship promotion
Risk management framework
Risk management principles applied to MROs
1. Avoid risk
• Not avoidable in healthcare
• Must be managed
Risk management principles applied to MROs
2. Identify risk
•
Who is at risk?
•
What is infectious agent?
3. Analyse risk
•
How is it transmitted?
•
Why can this happen?
•
How likely is it to happen?
•
What are the consequences?
Risk management principles applied to MROs
4. Evaluate risk
• What can be done to reduce or eliminate the risk?
5. Treat risk
• Who will do it?
• How will it be monitored?
Risk assessment and modified contact
precautions
Risk assessment and modified contact precautions
already in place in many health services to prioritise
single rooms
Risk factors:
• Patient population
• Setting/infrastructure
• Local experience of MRO
• Possible endemic MROs
• Degree of antimicrobial stewardship
Patient-centred risk management strategy for
multi-resistant organisms
•Health care services can
adapt to their local needs
•Transmission-based
precautions for all MROs
•Designed for acute care
health services
‘Routine Practices and Additional Precautions in Health
Care Settings’; Health Canada, Revised July 2011
Adapted Provincial Infectious
Diseases Advisory Committee
(PIDAC)
Routine Practices and
Additional Precautions in all
Health Care Settings
revised July 2011
Based on “chain of infection”
principles
•infectious agent
•source patient
•environment
•susceptibility of the host
Patient-centred risk management strategy for multi-resistant
organisms
Risk assessment for management of MROs
Consider:
Patient risks
Environmental risks
Organisational risks
Patient risks
• Clinical/additional risk factors
• Colonised/infected
• Antibiotic exposure/use
• Decolonisation opportunities
• Patient population in hospital area/ ward
Risk assessment for management of MROs
Environmental risks
• Layout hospital area/ward
• Environmental cleaning and disinfection
• Local prevalence of MROs
Organisational risks
• Level of HCW training in infection control principles
• Background surveillance monitoring strategies
• Implementation of antimicrobial stewardship
Patient-centred risk assessment
Using patient-centred risk assessment
• Emphasizes consistent practice of standard
precautions
• Tailors the use of contact precautions to local
conditions
Patient-centred risk assessment
Advantages
Current status of patient considered
Low risk patients/settings
Improved access to medical care
Less demand on single rooms
Reduced financial costs (consumables etc)
Potentially less cancelled/postponed procedures
Patient not feeling “isolated”
Disadvantages
Risk assess at each episode of care
Standard precautions must be rigorously followed
Patient-centred risk management strategy for
multi-resistant organisms
MRO working group
Infection prevention and infectious disease consultants representing 5
health services
Feedback from regional Department of Health infection prevention
consultants
4 pilot study hospitals
large metro
large regional
medium sub regional
medium private sub regional
Outcome measures
No increase in clinical specimens of MROs during pilot
Number of times tool misinterpreted
Pilot
Pilot results
6-8 weeks
52 patients with MRO risk assessed
17/52 standard precautions
35/52 transmission-based precautions
Feedback
No increase in clinical isolates of MROs
Flow chart easy to use
Uncertainty with terminology (changed)
Scenarios helpful
Pilot
• Limited time for pilot
• Used the experience of 2 large health services who
have risk assessment and modified contact
precautions in place 1-2 years
No increase in clinical isolates
Local policies to assist risk assessment
– specify which patient populations and which
wards require single rooms and contact
precautions
Patient-centred risk management strategy for
multi-resistant organisms
Quick guide flow chart
Quick guide flow chart
• Appendix 1 of the strategy is a quick guide flow chart
for assessment clinical risk and additional risk factors
• Set up with tick boxes
• Can completed for individual patients and
filed in medical record
• Used as a wall chart
• Adapt locally, for example specify high risk patient
populations and areas/wards
Where is the guide?
Search: Infection prevention in Victoria
Patient-centred risk management strategy for
multi-resistant organisms
Patient-centred
Risk-based approach
Guide- adapt locally
Acute hospitals
Transmission based precautions
for all MROs
Implementation resources- ACSQHC
OSSIE toolkit
Case studies
• Checklists
• Templates/ worksheets
Action plans
Project plans
• URL links
• Additional reading
Implementation resources
5 phase approach to change
management developed by the Clinical
Handover Initiative at ACSQHC
O Organisational leadership
S Simple solution development
S Stakeholder engagement
I Implementation
E Evaluation and management
http://www.health.gov.au/internet/safety/publishing.nsf/Content/home
Patient-centred risk management strategy for
multi-resistant organisms
Acknowledgements:
MRO working group members
Rural Infection Control Practice Group (RICPRAC) members
Infection Prevention in health services
Department Health Infection Prevention in health services initial contact:
Theresa Williamson
Acting Manager, Quality and Safety Programs
9096 7258
who will liaise with the Director, Quality, Safety and Patient Experience
regarding who best to advise
theresa.williamson@health.vic.gov.au
For the moment all infection control advice will be managed from resources
within the department.
As usual communicable diseases matters:
Communicable Diseases Prevention and Control Unit 1300 651160