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QUALITY INDICATORS FOR
INFECTION PREVENTION AND
CONTROL IN BELGIAN ACUTE CARE
HOSPITALS
NSIH symposium 2019
Sara Dequeker
• Context
• Background: IPC programmes
• Background: Quality indicators
• Goal QI project
• Methods
• Set of indicators
• Quality scores
• Quality class
• Preliminary Results
• Organization indicators
• Mean indicators
• Activity indicators
• Process indicator
• Conclusion
Table of content
CONTEXT
• 7 out of 100 hospitalized patients
will acquire at least one health care
associated infection (HAI) (in Belgian
acute care hospital)
extra public healthcare cost
• 20-30% preventable
• WHO recommendation to prevent HAI is
having infection prevention and control
(IPC) programmes in place at national
and hospital level
Background: IPC programmes
• Quality is not easy to define or to measure
• No universal accepted definition
• Multiple levels: patients to health policies
• Multiple dimensions: e.g. safety and efficiency
• Quality indicators: ‘a measurable aspect of care provided for which
there is evidence and/or consensus that it represents quality on the
grounds of scientific research or consensus among experts’.
Background: Quality indicators
MAIN GOAL: To define, prioritize and implement strategies and
interventions to prevent HAI in order to improve the quality of care in
hospitals
=> Promote quality of IPC programmes by offering strategies and
interventions in the form of indicators.
Goal QI project
Grow and improve
METHODS
Set of indicators
• Indicators selected and developed by ‘Federaal Platform voor
Ziekenhuishygiëne’ (BAPCOC)
• Set of indicators defined for the 3 years (2017 – 2019)
• Contains all historical indicators (used in 2013, 2015 and 2016)
supplemented with a new group of indicators
• Collected in a ‘lastenboek’/ ‘cahier des charges’
(http://www.nsih.be/surv_iq/participation_nl.asp)
Set of indicators
Four groups of indicators
• Organisation indicators (N=5)
• Evaluate the presence of a strategic plan, yearly action plan, …
• Mean indicators (N=6)
• Evaluate the presence of means e.g. number of dedicated infection control
staff
• Activity indicators (N=41)
• Evaluate the presence of surveillances, process audits, procedures, …
• Process indicators (N=1)
• Evaluate the consumption of alcohol-based hand-gel
Quality scores
• Weighted scores developed by ‘Federaal Platform voor
Ziekenhuishygiëne’ (BAPCOC)
http://www.nsih.be/surv_iq/participation_nl.asp
• Stable set of indicators for three years BUT scoring evolves (‘17-
’19)
• Some historical indicators (‘13, ‘15-’16) get new scores
• Progressively more focus on audits and less on procedures
• Total score of 100
• Not comparable over the years
Quality scores
Quality class
• Three quality classes:
• ‘good’ (≥80%)
• ‘moderate’
• ‘weak’ (<66,67%)
• For each indicator group and for total of indicators
• Based on the quality scores
PRELIMINARY RESULTS
Data up to and including 2018
Organization indicators
Belgium Brussels Flanders Wallonia
2018
(n=102)
2018
(n=12)
2018
(n=53)
2018
(n=37)
Median quality score (range)
(min.=0 – max.=10)
10
(4 – 10)
10
(4 – 10)
10
(6 - 10)
10
(6 – 10)
Percentage hospitals per quality class
Weak (score <7) 6 8 6 5
Moderate(score = 7) 2 0 4 0
Good (score ≥8) 92 92 91 95
n, number hospitals
0 10 20 30 40 50 60 70 80 90 100
General long-term strategic plan (3-5 years) for IPC
This strategic plan is integrated in the hospital's strategic plan
Number of meetings of the IPC committee ≥ 4 per year
Detailed action plan for IPC
Annual report for IPC
Infection control nurse is part of the nursing middle management
2013 2015 2016 2017 2018
Organization indicators
Mean indicators
Belgium Brussels Flandres Wallonia
2018
(n=102)
2018
(n=12)
2018
(n=53)
2018
(n=37)
Median quality score (range)
(min.=0 – max.=9)
9
(5 – 9)
9
(7 – 9)
9
(5 – 9)
9
(5 – 9)
Percentage hospitals per quality class
Weak (score <6) 3 0 2 5
Moderate (score = 6) 0 0 0 0
Good (score ≥9) 97 100 98 95
n, number hospitals
0 10 20 30 40 50 60 70 80 90 100
Effective number of IPC physicians ≥ 90% of the theoretical number
Effective number of IPC nurses ≥ 90% of the theoretical number
Referents for IPC
Number of referents for IPC on ICU / the number of ICU's ≥ 1
Number of referents for IPC on units / the number of units ≥ 1
2013 2015 2016 2017 2018
Mean indicators
Activity indicators
Belgium Brussels Flanders Wallonia
2018
(n=102)
2018
(n=12)
2018
(n=53)
2018
(n=37)
Median quality score (range)
(min.=0 – max.=79)
71 (31 - 79)
70 (52 – 78)
72 (57 – 79)
71 (31-78)
Percentage hospitals per quality class
Weak (score <51) 2 0 0 5
Moderate (score 51 -62) 15 25 9 19
Go0d (score ≥63) 83 75 91 76
n, number hospitals
Local surveillances
0 10 20 30 40 50 60 70 80 90 100
MRSA (local)
Bloodstream infections (local)
Multi-resistant Gram-negative bacteria (local)
Toxigenic C. difficile infections (local)
Infections in Intensive Care Units (local)
Surgical site infections (local)
VRE local
2013 2015 2016 2017 2018
Processaudits (used since 2013)
0 10 20 30 40 50 60 70 80 90 100
Audit procedure central line-associated bloodstream infections
Audit procedure catheter-associated urinary tract infections
Audit procedure invasive mechanical ventilation associated infections
Audit procedure surgical site infections
Audit related to hand hygiene compliance (outsite national campaign)
At least 150 observed opportunities
2013 2015 2016 2017 2018
Activity indicators since 2017,
decrease/increase of minimum 10%
0 10 20 30 40 50 60 70 80 90 100
An approach for optimizing the choice of venous vascular access
Participation in a point prevalence survey related to healthcare-associatedinfections and antimicrobial use
Audit of the procedure for antibiotic prophylaxis in surgery
Audit of the procedure for the prevention of contact/droplet/airbornetransmission
Audit of the procedure to prevent transmission by screening
Audit of the procedure related to admission of known MDRO carriers
Audit of the procedure for the disinfection of endocavity ultrasound probes
Audit of the procedure to prevent the risk of infection in delivery rooms
2017 2018
Process indicator
20,3
21,3
22,3
23,424,1
20
21
22
23
24
25
2013 2015 2016 2017 2018
Consumption Hand alcohol
l/1000 hospitalization days
Indicator
Description
Belgium 2017
(n=103)
2018 (n=102)
Hand alcohol consumption (liter / 1000 hospitalization days) ≥ average in 2016
(24.7 l / 1000 hospitalization days)
43 42
n, number hospitals
Total
Belgium Brussels Flanders Wallonia
2018 (n=103) 2018 (n=12) 2018 (n=53) 2018 (n=37)
Median quality score (range)
(min.=0 – max.=100)
90 (49 - 100)
88 (69 – 99)
91 (74-100)
90 (49-97)
Percentage hospitals per quality class Weak (score <67) 2 0 0 5
Moderate (score 67 - 79) 14 25 8 19
Good (score ≥ 80) 84 75 92 76
n, number hospitals
CONCLUSION
• Almost all indicators have improved since 2013
• Infection prevention and control teams are moving forward
• Keep implementing core components of the infections prevention and
control programmes
• BUT
• Still room for improvement
• Impact on outcome HAIs remains to be demonstrated
– Similar initiative by the WHO! (https://www.who.int/infection-
prevention/tools/core-components/IPCAF-facility.PDF?ua=1)
• Indicators after 2019?
Key results
Reports in Healthstat
Contact
Sciensano • Rue Juliette Wytsmanstraat 14 • 1050 Brussels • Belgium
T +32 2 642 51 11 • T Press +32 2 642 54 20 • info@sciensano.be • www.sciensano.be
Sara Dequeker• sara.dequeker@sciensano.be • +32 2 642 52 34
Quality scores
Quality scores
Quality scores
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