This article was downloaded by: [University of Calgary] On: 03 February 2015, At: 00:31 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
An Infection Control Program, the First Step toward Quality Assurance Martha J. Grimes
a
a
Washington Metropolitan Chapter , USA Published online: 13 Jul 2010.
To cite this article: Martha J. Grimes (1977) An Infection Control Program, the First Step toward Quality Assurance, Hospital Topics, 55:4, 6-8, DOI: 10.1080/00185868.1977.9950406 To link to this article: http://dx.doi.org/10.1080/00185868.1977.9950406
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
An Infection Control Program, The First Step Toward Quality Assurance By: Martha J. Grimes
Downloaded by [University of Calgary] at 00:31 03 February 2015
MARTHA J. GRIMES is Infection Control Coordinator of Prince George General Hospital and Medical Center, a 655 bed modern teaching hospital in the suburbs of Washington, D.C. In November 1975 she assumed this position, expanding a part time Infection Control Nurse position to full time and establishing an Infection Control Program in the hospital She is currently a member of the ANA and an officer of APIC, Washington Metropolitan Chapter.
A
n active infection control program in hospitals has now become not only a reality, but a necessity in the accredited institution. The need for controls and documentation of activities associated with preventive measures taken evolved as medical technology developed. The necessity surfaced, was recommended, and now expected. Higher risk patients and those with compromised immune systems are treated more frequently,aggressively, and with more sophisticated diagnostic, invasive, and surgical procedures. The use and over-use of antibiotics has precipitated the growth of resistant strains of disease associated organisms that not only are difficult to treat, but often cause infections that are life-threatening Hospital personnel have become specialized and are of various educational backgrounds, professional and paraprofessional. Many levels of care givers are not aware of the risks of cross contamination or do not view it as an important aspect of services rendered. Some who are aware, have acclimated themselves to view all hospital acquired infections as inevitable. No other program in the hospital has as broad an overview of the contribution of every aspect of services rendered in a hospital, or as great a responsibility to the patient, staff, visitors and the general environment, as infection control. The valuable contributions of each level, from housekeeping, maintenance, dietary, up through the diagnostic and professional services are recognized and appreciated. Infection control has a prime role in quality assurance, identifying weaknesses in the routine and stimulating disease prevention changes as it supports standards developed by special interest groups. Infection control as we once knew it, was a rigid, systematic method of caring for the patients with communicable diseases; with major emphasis on proper isolation and confinement of the patient. 6
The group or committee responsible for establishing isolation procedures actively monitored the known infected patient, or those with communicable diseases, to be sure appropriate measures were taken. Staph outbreaks in the fifties proved that infections can be acquired in the hospital, and that, by preventing cross contamination, (establishing controls) risk of hospital acquired infections can be minimized. For many years thereafter, the committee seemed to focus on wound infections, especially looking for staph carriers. This promoted a tendency to hide or cover up any occurance of an infection in the hospital. It made data collection next to impossible, and committee work was disregarded unless problems were obvious in the institution. During the late sixties and early seventies, former attitudes toward cross contamination and transmission of organisms were challenged by many professional groups. The emergence of Gram Negative organisms and their role in infections began to take a significant role in hospital epidemiology. Many studies were done utilizing computer analysis of problems with infection control. The role of host susceptability and immunological defense mechanisms became apparent. Lab technology became more sophisticated and supportive of clinical work. New hospital needs and controls surfaced. As new knowledge, research, and hospital services advanced with medical science, the function and activities of the Infection Control Committee gained strength and responsibility. Small, semi-organized groups that criticized practices became viable hospital committees that are required by accrediting agencies and expected to function as a resource point of controls to prevent the spread of disease and minimize risks to the patients and staff. The Infection Control committee is rapidly becoming a junction of concerns between the hospital administration, professional services, the patients, and the community. It is concerned with the quality of care in all aspects of patient services dealing with possible hospital infections through prevention, education, monitoring, data collection and evaluation of data. This can be attained only by an active committee with a strong leader and an alert coordinator of activities that can implement and monitor a program that meets the needs of the entire hospital; patient care aspects as well as support services. HOSPITAL TOPICS
Downloaded by [University of Calgary] at 00:31 03 February 2015
In order to meet this obligation, standards or procedures must be established for each area of the hospital, which become the control points. These must identify all that is done to and for the patient or staff member that is associated with known risk of cross contamination or transmission of infection. The development of standards are the responsibility of the specific hospital services. An objective review, evaluation and approval of these standards or procedures are the responsibility of the committee; thereby, not controlling services rendered to the patient, but the way they are provided. Monitoring these controls is a multidisciplinary team that has a legal and professional responsibility to the hospital and each individual patient and staff member. The infection control program is a comprehensive approach to multiple problems. Conclusions are based on association, distribution, and risk. The program has a direct link to quality control in
the institution, with special concerns being those services or procedures that have been linked by epidemiological data to the likelihood of infection. By studying epidemiological disease statistics, prediction of future needs within the institution is possible for both consumers and health providers. Through investigation, documentation, and statistics, Infection Control provides safety and quality controls to the hospital community by identifying the areas of risk, potential problem areas, and good performance. Once identified, recommendations for minimizing these risks should be made and appropriate action taken. In meeting the goals of an active infection control program, assurance of quality care and a reasonable measure of safety is assured every patient and employee in the institution. This provides a foundation on which to further develop more complex aspects of a quality assurance program in the hospital.
Establishment Of A Basic Infection Control Program The establishment of a hospital wide infection control program is a complex, many faceted endeavor that should be well planned, fully 'supported, and actively worked on; continuously and consistently. It requires a full time person responsible for planning, implementing and coordinating efforts of the committee and all hospital services, as they relate to disease prevention. This person is ideally an epidemiologist or a qualified Infection Control Practitioner. Once a hospital becomes committed to infection control, much care should be given to choosing the person assigned this responsibility. The infection control practitioner should be clincially sound, familiar with the interfacing of various hospital services, assertive, aware of the hospital financial stability, committed to quality patient care, willing to work flexible hours, and willing to learn hospital epidemiology if not educationally prepared for this responsibility. Once assigned, a plan of action needs to be formulated. This plan can only be designed after indepth discussions with the chairman and key persons on the committee, hospital administration, and nursing administration so that the current status of activities, and the goals and commitment of these key supporters can be evaluated. Another consideration that must be evaluated is the functional attitude and performance of all care givers in the institution as it applies to infection control. The Practitioner can then evaluate what hislher special preparation to meet the specific JU LY/AUG UST 1977
hospital needs must be, and which hospital areas must be given priority. The role of the Infection Control Practitioner must be clearly understood by all hospital services, and written guidelines for responsibility and authority developed. Communication lines must always be open. The first official act of the Practitioner must be a meeting, formal or informal, with all departments and supervisors to identify the functional role of the Infection Control Practitioner, and introduce the concept of an Infection Control Program as opposed to a slotted position. From that point forward, this person must be visable in all areas. An honest evaluation of baselines and priorities then needs to be developed, along with a time frame for implementation. The following is a suggested list that can be divided into strong and weak items, giving direction to priorities and helping estimate a time frame. 1. Degree of administrative commitment to a program. 2. Acceptance by the professional staff medical, ?I ursing, diagnostic, and supportive. 3. Extent of lab support in clinical practice, communication, and education. 4. Strength and leadership of committee chairman. 5. Identification of knowledgeable physician in infectious diseases and hidher degree of interest andcooperation. 6. Available current resource material; in the hospital, community, state, and elsewhere. 7
Downloaded by [University of Calgary] at 00:31 03 February 2015
7. Existing staf development programs for all levels that relate to Infection Controlpractices. 8. Existing policia, procedures or standards relating to areas that in wlve infection control. 9. A reporting system that is acceptable and practical. 10. Product evaluation to assure that products and equipment in use promote compliance with good practices. 11. Patient placement. 12. Available local support for the Practitioner; APIC, Heart and Lung Association, TB Association. 13. Emplope health practices. Documentation of all activities cannot be over emphasized, especially in a newly created position. It is an assurance for future success and support, demonstrates growth and development of the program, and provides background data for future program expansion. Early in the self-orientation period of planning, establishment of priorities, and time frame, several things must be done: 1. Acquisition of wsource material. 2. Contact with the IocalAPICgroup. 3. RN prep, time in the laboratoy . If Medical Technologyprep, time at the bedside with an RN. 4. Contact with resource persons that include the local health department, state health department, EIS officer, and the Centerfor Disease Control. 5. Establish a simpk, workable recording system of documenting activities and necessary permanent documents. 6. Get appointed to minimum, but necessary committees that are relevant to infection control. They may include safety, product review, quality assurance, andpolicy andprocedure.
u
Initial patient care aspects of infection control should begin with the isolated patient. You cannot control hospital acquired infections until you can effectively manage the community acquired infections. The method for caring for the isolated patient, current policies and procedures for isolation, supplies and equipment available, and staff development regarding isolation are a practical beginning. Particular attention should be given to definitions of terms used and a development of guidelines for classifying hospital acquired infections. Until this is done, it is impossible to attempt data collection and statistics. A reporting system is needed to objectively evaluate the number of hospital acquired infections, trends of infections, clusters of infections, and compiling of meaningful statistics. 8
Differentiation must be clear regarding diagnosed and suspected infections, with a separate mechanism for reportable diseases and in-house problems. Post discharge notices must also be planned. A surveillance system then needs to be established. Rounds throughout the hospital should be made in a practical way. Some areas could be visited every other week, weekly, or two to three times a week. Problems as they relate to infection control should be handled rapidly and effectively. As an example, occurence of infections in a specific area in greater than average number, contaminated IV solutions, product recall, employee exposure to communicable diseases, etc. Products that do not easily promote good technique should be evaluated and appropriate recommendations made for upgrading. Research into standards of practice in regard to a preventive approach to infection control can then begin. A manual* for the individual hospital will need to be developed that includes an Infection Control Policy for each individual unit in the hospital. This policy should be developed by the specific service, reviewed by the Practitioner for completeness, and presented to the Infection Control Committee for approval. Staff development should be continuous, especially with the new employee. Professional growth and development must be taken into account. Programs available should be attended whenever possible. Time should be allotted for research into current standards. A basic program so established is a foundation on which to grow. Success of the program can be measured in improved patient care, comprehension of source and transmission by all levels, prompt correction of potential problems, and immediate attention with an organized plan of action for acute problem solving. Once the program is established, periodic review for organization and efficiency can be most beneficial. The establishment of an effective infection control program is complex. It is invaluable to the institution. It is cost effective. Quality care to all patients and a reasonable measure of safety to all who work there is a valid measurement. Decreased nosocomial rates can be demonstrated through statistics. Patient care can be evaluated through audit. *Editor’s Note: Thew are several manuals available, some prepared by Nurse Epidemidogists which can be purchased and adapted to individual hospital requirements. They can saw much time in assembling an outline, department by department.
HOSPITAL TOPICS
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
An Infection Control Program, the First Step toward Quality Assurance Martha J. Grimes
a
a
Washington Metropolitan Chapter , USA Published online: 13 Jul 2010.
To cite this article: Martha J. Grimes (1977) An Infection Control Program, the First Step toward Quality Assurance, Hospital Topics, 55:4, 6-8, DOI: 10.1080/00185868.1977.9950406 To link to this article: http://dx.doi.org/10.1080/00185868.1977.9950406
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
An Infection Control Program, The First Step Toward Quality Assurance By: Martha J. Grimes
Downloaded by [University of Calgary] at 00:31 03 February 2015
MARTHA J. GRIMES is Infection Control Coordinator of Prince George General Hospital and Medical Center, a 655 bed modern teaching hospital in the suburbs of Washington, D.C. In November 1975 she assumed this position, expanding a part time Infection Control Nurse position to full time and establishing an Infection Control Program in the hospital She is currently a member of the ANA and an officer of APIC, Washington Metropolitan Chapter.
A
n active infection control program in hospitals has now become not only a reality, but a necessity in the accredited institution. The need for controls and documentation of activities associated with preventive measures taken evolved as medical technology developed. The necessity surfaced, was recommended, and now expected. Higher risk patients and those with compromised immune systems are treated more frequently,aggressively, and with more sophisticated diagnostic, invasive, and surgical procedures. The use and over-use of antibiotics has precipitated the growth of resistant strains of disease associated organisms that not only are difficult to treat, but often cause infections that are life-threatening Hospital personnel have become specialized and are of various educational backgrounds, professional and paraprofessional. Many levels of care givers are not aware of the risks of cross contamination or do not view it as an important aspect of services rendered. Some who are aware, have acclimated themselves to view all hospital acquired infections as inevitable. No other program in the hospital has as broad an overview of the contribution of every aspect of services rendered in a hospital, or as great a responsibility to the patient, staff, visitors and the general environment, as infection control. The valuable contributions of each level, from housekeeping, maintenance, dietary, up through the diagnostic and professional services are recognized and appreciated. Infection control has a prime role in quality assurance, identifying weaknesses in the routine and stimulating disease prevention changes as it supports standards developed by special interest groups. Infection control as we once knew it, was a rigid, systematic method of caring for the patients with communicable diseases; with major emphasis on proper isolation and confinement of the patient. 6
The group or committee responsible for establishing isolation procedures actively monitored the known infected patient, or those with communicable diseases, to be sure appropriate measures were taken. Staph outbreaks in the fifties proved that infections can be acquired in the hospital, and that, by preventing cross contamination, (establishing controls) risk of hospital acquired infections can be minimized. For many years thereafter, the committee seemed to focus on wound infections, especially looking for staph carriers. This promoted a tendency to hide or cover up any occurance of an infection in the hospital. It made data collection next to impossible, and committee work was disregarded unless problems were obvious in the institution. During the late sixties and early seventies, former attitudes toward cross contamination and transmission of organisms were challenged by many professional groups. The emergence of Gram Negative organisms and their role in infections began to take a significant role in hospital epidemiology. Many studies were done utilizing computer analysis of problems with infection control. The role of host susceptability and immunological defense mechanisms became apparent. Lab technology became more sophisticated and supportive of clinical work. New hospital needs and controls surfaced. As new knowledge, research, and hospital services advanced with medical science, the function and activities of the Infection Control Committee gained strength and responsibility. Small, semi-organized groups that criticized practices became viable hospital committees that are required by accrediting agencies and expected to function as a resource point of controls to prevent the spread of disease and minimize risks to the patients and staff. The Infection Control committee is rapidly becoming a junction of concerns between the hospital administration, professional services, the patients, and the community. It is concerned with the quality of care in all aspects of patient services dealing with possible hospital infections through prevention, education, monitoring, data collection and evaluation of data. This can be attained only by an active committee with a strong leader and an alert coordinator of activities that can implement and monitor a program that meets the needs of the entire hospital; patient care aspects as well as support services. HOSPITAL TOPICS
Downloaded by [University of Calgary] at 00:31 03 February 2015
In order to meet this obligation, standards or procedures must be established for each area of the hospital, which become the control points. These must identify all that is done to and for the patient or staff member that is associated with known risk of cross contamination or transmission of infection. The development of standards are the responsibility of the specific hospital services. An objective review, evaluation and approval of these standards or procedures are the responsibility of the committee; thereby, not controlling services rendered to the patient, but the way they are provided. Monitoring these controls is a multidisciplinary team that has a legal and professional responsibility to the hospital and each individual patient and staff member. The infection control program is a comprehensive approach to multiple problems. Conclusions are based on association, distribution, and risk. The program has a direct link to quality control in
the institution, with special concerns being those services or procedures that have been linked by epidemiological data to the likelihood of infection. By studying epidemiological disease statistics, prediction of future needs within the institution is possible for both consumers and health providers. Through investigation, documentation, and statistics, Infection Control provides safety and quality controls to the hospital community by identifying the areas of risk, potential problem areas, and good performance. Once identified, recommendations for minimizing these risks should be made and appropriate action taken. In meeting the goals of an active infection control program, assurance of quality care and a reasonable measure of safety is assured every patient and employee in the institution. This provides a foundation on which to further develop more complex aspects of a quality assurance program in the hospital.
Establishment Of A Basic Infection Control Program The establishment of a hospital wide infection control program is a complex, many faceted endeavor that should be well planned, fully 'supported, and actively worked on; continuously and consistently. It requires a full time person responsible for planning, implementing and coordinating efforts of the committee and all hospital services, as they relate to disease prevention. This person is ideally an epidemiologist or a qualified Infection Control Practitioner. Once a hospital becomes committed to infection control, much care should be given to choosing the person assigned this responsibility. The infection control practitioner should be clincially sound, familiar with the interfacing of various hospital services, assertive, aware of the hospital financial stability, committed to quality patient care, willing to work flexible hours, and willing to learn hospital epidemiology if not educationally prepared for this responsibility. Once assigned, a plan of action needs to be formulated. This plan can only be designed after indepth discussions with the chairman and key persons on the committee, hospital administration, and nursing administration so that the current status of activities, and the goals and commitment of these key supporters can be evaluated. Another consideration that must be evaluated is the functional attitude and performance of all care givers in the institution as it applies to infection control. The Practitioner can then evaluate what hislher special preparation to meet the specific JU LY/AUG UST 1977
hospital needs must be, and which hospital areas must be given priority. The role of the Infection Control Practitioner must be clearly understood by all hospital services, and written guidelines for responsibility and authority developed. Communication lines must always be open. The first official act of the Practitioner must be a meeting, formal or informal, with all departments and supervisors to identify the functional role of the Infection Control Practitioner, and introduce the concept of an Infection Control Program as opposed to a slotted position. From that point forward, this person must be visable in all areas. An honest evaluation of baselines and priorities then needs to be developed, along with a time frame for implementation. The following is a suggested list that can be divided into strong and weak items, giving direction to priorities and helping estimate a time frame. 1. Degree of administrative commitment to a program. 2. Acceptance by the professional staff medical, ?I ursing, diagnostic, and supportive. 3. Extent of lab support in clinical practice, communication, and education. 4. Strength and leadership of committee chairman. 5. Identification of knowledgeable physician in infectious diseases and hidher degree of interest andcooperation. 6. Available current resource material; in the hospital, community, state, and elsewhere. 7
Downloaded by [University of Calgary] at 00:31 03 February 2015
7. Existing staf development programs for all levels that relate to Infection Controlpractices. 8. Existing policia, procedures or standards relating to areas that in wlve infection control. 9. A reporting system that is acceptable and practical. 10. Product evaluation to assure that products and equipment in use promote compliance with good practices. 11. Patient placement. 12. Available local support for the Practitioner; APIC, Heart and Lung Association, TB Association. 13. Emplope health practices. Documentation of all activities cannot be over emphasized, especially in a newly created position. It is an assurance for future success and support, demonstrates growth and development of the program, and provides background data for future program expansion. Early in the self-orientation period of planning, establishment of priorities, and time frame, several things must be done: 1. Acquisition of wsource material. 2. Contact with the IocalAPICgroup. 3. RN prep, time in the laboratoy . If Medical Technologyprep, time at the bedside with an RN. 4. Contact with resource persons that include the local health department, state health department, EIS officer, and the Centerfor Disease Control. 5. Establish a simpk, workable recording system of documenting activities and necessary permanent documents. 6. Get appointed to minimum, but necessary committees that are relevant to infection control. They may include safety, product review, quality assurance, andpolicy andprocedure.
u
Initial patient care aspects of infection control should begin with the isolated patient. You cannot control hospital acquired infections until you can effectively manage the community acquired infections. The method for caring for the isolated patient, current policies and procedures for isolation, supplies and equipment available, and staff development regarding isolation are a practical beginning. Particular attention should be given to definitions of terms used and a development of guidelines for classifying hospital acquired infections. Until this is done, it is impossible to attempt data collection and statistics. A reporting system is needed to objectively evaluate the number of hospital acquired infections, trends of infections, clusters of infections, and compiling of meaningful statistics. 8
Differentiation must be clear regarding diagnosed and suspected infections, with a separate mechanism for reportable diseases and in-house problems. Post discharge notices must also be planned. A surveillance system then needs to be established. Rounds throughout the hospital should be made in a practical way. Some areas could be visited every other week, weekly, or two to three times a week. Problems as they relate to infection control should be handled rapidly and effectively. As an example, occurence of infections in a specific area in greater than average number, contaminated IV solutions, product recall, employee exposure to communicable diseases, etc. Products that do not easily promote good technique should be evaluated and appropriate recommendations made for upgrading. Research into standards of practice in regard to a preventive approach to infection control can then begin. A manual* for the individual hospital will need to be developed that includes an Infection Control Policy for each individual unit in the hospital. This policy should be developed by the specific service, reviewed by the Practitioner for completeness, and presented to the Infection Control Committee for approval. Staff development should be continuous, especially with the new employee. Professional growth and development must be taken into account. Programs available should be attended whenever possible. Time should be allotted for research into current standards. A basic program so established is a foundation on which to grow. Success of the program can be measured in improved patient care, comprehension of source and transmission by all levels, prompt correction of potential problems, and immediate attention with an organized plan of action for acute problem solving. Once the program is established, periodic review for organization and efficiency can be most beneficial. The establishment of an effective infection control program is complex. It is invaluable to the institution. It is cost effective. Quality care to all patients and a reasonable measure of safety to all who work there is a valid measurement. Decreased nosocomial rates can be demonstrated through statistics. Patient care can be evaluated through audit. *Editor’s Note: Thew are several manuals available, some prepared by Nurse Epidemidogists which can be purchased and adapted to individual hospital requirements. They can saw much time in assembling an outline, department by department.
HOSPITAL TOPICS
