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Continuous �Quality Improvement in IPC��

Rihette Lodewyk�AD: IPC�Standards Compliance

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Outline

IPC indicators for continuous monitoring (hospitals and PHC)
Example of a continuous IPC monitoring process
IPC data sources
How to calculate a median from data (to decide on target/objective)
Root cause analysis – fishbone diagram
Quality improvement project

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Policy

Guideline on quality management
Provincial IPC SOP – QIPs in IPC
IDEAL facility QIPs

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Hospital IPC Outcome Indicators�

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Healthcare associated infection rate per 1000 inpatient days per month

Ventilator Associated Pneumonia rate per 1000 ventilator days (only ICUs) per month

Central Line Associated Blood Stream Infections per 1000 central line days per month

Catheter Associated Urinary Tract Infections per 1000 urinary catheters per month

% Surgical Site Infections per 100 (hundred) Operating Procedures per month

% Peripheral Line Associated Blood Stream Infections per 100 peripheral lines inserted per month

Number of Healthcare Associated Blood Stream Infections per month (not line related) from alert organisms

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Hospital IPC - Process measures

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% Attendance of IPC committee monthly meeting per month

% Of all personnel trained on standard and transmission-based IPC precautions per month

% Hand Hygiene Compliance according to the 5 moments per month – per category and per HH moment

% Compliance to Environmental Cleanliness per month

% VAP bundle compliance per month - 10% of ventilated patients – verifications performed

% CLABSI bundle compliance per month - 5 verifications per day in specialized units, 5 verifications per week in district hospitals

% CAUTI bundle compliance - 5 verifications per day in specialized units, 5 verifications per week in district hospitals

% SSI bundle compliance – (10 surgery patient file audits) per month – major surgery (all hospitals with theatre facilities where caesarean/sections and other major surgery are carried out

Total number of wards/units with alert organism (resistant organism) outbreaks

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IPC performance indicators - PHC

Number of IPC committee meetings per sub-district or district (for PHC)
% Attendance of IPC committee meetings
% Compliance to environmental cleanliness
% Compliance to conducting annual IPC risk assessments
Percentage of PHCs monitoring IPC indicators and submit reports

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Define Goals, Objectives, Targets examples

GOALS

Long term – The Goal it to ensure a safe patient environment

OBJECTIVES

How short term progress are measured, decided by median, adjust objective accordingly
e.g. HAI rate less than 5 per 1000 inpatient days per month

TARGETS

10% of healthcare workers trained per month on standard precautions
80% of healthcare workers trained on standard precautions 2026/2027
Laminated Hand washing posters at 100% of all hand wash stations by August 2026
By September 2026, every ward/unit must have a trained hand hygiene compliance observer on every shift

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How to calculate a median 1

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Median example

Plot the data from lowest to highest
45.3, 47.8, 53, 57, 62.6, 64.2, 67.6
Seven data points
Select the middle (3 lowest before and 3 highest after)
Median is 57%
If there were 6 data points, select the 2 middle points and divide by 2
E.g. Objective for next 6 months - median above 57 %

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Examples of continuous monitoring process

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Develop QIP 1 – Problem statement

Why are you doing this project?
What is the problem you are addressing?
Who is affected?
When is it a problem?
Why does it matter?
How is it affecting the patient?
Align the QIP with at least one of the following:

Safety
Effectiveness
Patient-centred
Timely
Efficient
Equitable

Current situation?
Leading to? (Undesirable event)

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ROOT CAUSE ANALYSIS

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Develop QIP 2

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QIP 3

ESTABLISHING MEASURES: How will you know that a change is an improvement?

Measurement over time is essential to Quality Improvement. Measures can be outcome, process or balancing measures. Baseline, benchmark or median data are needed to show improvement.
Try to define your measure as a numerator/denominator
E.g. Numerator – Number of compliant hand hygiene observations (10)

Denominator – Number of hand hygiene opportunities observed (20)

% Hand hygiene compliance for August – 50% (monitor continuously on monthly basis) – see example on slide 10

Median of previous 6 months – 47.5%

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QIP 4

SELECTING CHANGES: What changes can be made that will result in improvement?

Ideas for changes often come from those working in the system, from other similar improvement efforts (colleagues and quality learning centres) or from change concepts and theory. What are some opportunities for change and improvement? What are you considering?
What specific change concepts will achieve the Aim?

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QIP 5

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QIP 6

PROJECT SUMMARY:

What were the outcomes of the project?
Did you achieve the project goals?
What were the main lessons learned?
Are the improvements or changes sustainable?
How will you implement/spread any identified improvements?
What would be the best next steps?

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Template for QIP (example)

Problem identified	Activities	Objective	Responsible person	Time frame	Progress
Outbreak – CRAB Neonatal BSIs and colonisations	Re-training – standard precautions Cleaners Dieticians Radiographers Household aids Nursing staff Doctors	All neonatal personnel	Cleaning supervisors IPC Coordinator HRD OPM Clinical manager	30 May 2024	ANs PNs done
	Cohort all patients with CRAB Identify most suitable isolation area		OPM Nursing staff	Immediately	ICU done
	Dedicated staff for isolation Re-allocate staff from other units to assist		OPM Nursing staff Head of nursing	Daily delegation	done
	Monitor adherence to standard and transmission based precautions, using checklists and provide on the spot training	100%	IPC coordinators OPM IPC link	Daily (24h)	60%
	Weekly screening of all inpatients for CRAB (groin swabs)	100% of all neonates in the unit every Monday		Every Monday until closure of outbreak 6 weeks after last positive specimen	Outbreak closed

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Quality improvement requires five essential elements for success:

fostering and sustaining a culture of change and safety,
developing and clarifying an understanding of the problem,
involving key stakeholders,
testing change strategies, and
continuous monitoring of performance and reporting of findings to sustain the change

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References:

National IPC Strategic Framework and practical manual for implementation
Centres for Disease Control and Prevention (CDC) www.cdc.gov
National Healthcare Safety Network – Patient Safety Component 2025

https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf

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� E-MAIL ADDRESS: LODEWYKH@FSHEALTH.GOV.ZA

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