INFECTION PREVENTION AND CONTROL

Annual Report

April 2017 – March 2018

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TABLE OF CONTENTS

Executive Summary .................................................................................................................................................................. 3

PHSA Infection Prevention and Control Program ......................................................................................................... 4

Our Vision ................................................................................................................................................................................. 4

Our Mission.............................................................................................................................................................................. 4

Our Services ............................................................................................................................................................................ 4

Our Team 2017-2018 .......................................................................................................................................................... 5

Team Photographs ............................................................................................................................................................... 6

Our Facilities ................................................................................................................................................................ ........... 8

Knowledge Translation ........................................................................................................................................................... 9

Education for Team Members, Volunteers, Patients, Families and Visitors ................................................. 9

Research Activities ............................................................................................................................................................ 11

Collaborations ..................................................................................................................................................................... 13

Awards ................................................................................................................................................................ .................... 13

Continuing Education ....................................................................................................................................................... 14

Surveillance ................................................................................................................................................................ ............... 15

Outbreak Management ......................................................................................................................................................... 19

Quality Improvement ............................................................................................................................................................ 20

Strategic Plan ............................................................................................................................................................................ 23

Appendix A - PHSA IPAC Organizational Chart As of March 31, 2018 .............................................................. 24

Appendix B – Definitions ..................................................................................................................................................... 25

Appendix C - PHSA IPAC Quality Improvement Plan 2017-2019 ....................................................................... 27

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Executive Summary

At the Provincial Health Services Authority (PHSA), the safety of patients, staff and visitors is of ultimate importance. To help meet this commitment, the PHSA Infection Prevention and Control (IPAC) service was formed in 2006, reporting to the PHSA VP of Quality, Safety and Outcome Improvement. The IPAC team works collaboratively with other groups within PHSA, other health authorities, the Provincial Infection Control Network of BC (PICNet), and regional and national health services in supporting best practices to prevent and control infections at PHSA facilities. The IPAC team is involved in a variety of activities that include:

• Knowledge translation (education and research) • Hand hygiene program • Surveillance • Outbreak management • Construction consultation • Cleaning, disinfection, and sterilization consultation • Quality improvement initiatives • Policy and procedure development

During 2017-18, the IPAC team participated in many projects and initiatives including:

• Supporting the move to the Teck Acute Care Centre at BC Children’s and BC Women’s Oak Street campus

• Launch of a new IPAC manual website at BC Cancer • Development of a new IPAC program for Correctional Health Services • Implementation of an environmental cleaning toolkit at BC Emergency Health Services

The following table highlights trends in health care-associated infection (HAI) rates for 2016-17:

Indicator 2016-17 Rate 2017-18 Rate Overall trend (2009/10 – 2017/18)

PHSA Overall Hand Hygiene Compliance 94% 93.9%

PHSA HA-CDI Rate 7.7 per 10,000 inpatient days

5.5 per 10,000 inpatient days

PHSA HA-MRSA Rate 3.1 per 10,000 inpatient days

3.6 per 10,000 inpatient days

PHSA HA-VRE Rate 0.2 per 10,000 inpatient days

2.1 per 10,000 inpatient days

CLABSI Rate in PICU 0.5 per 1,000 catheter days Zero

CLABSI Rate in NICU 5.2 per 1,000 catheter days

2.0 per 1,000 catheter days

HA = health care-associated; CDI = Clostridium difficile infection; MRSA = methicillin-resistant Staphylococcus aureus; VRE = vancomycin-resistant enterococci; CLABSI = central line-associated bloodstream infection; PICU = pediatric intensive care unit; NICU = neonatal intensive care unit *NOTE: The decrease in HA-VRE is statistically significant, while the other rate changes are not statistically significant.

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PHSA Infection Prevention and Control Program

Our Vision Empowering everyone to prevent infections! These words paint a picture of the world the Infection Prevention and Control (IPAC) Service seeks to create. Our vision captures the notion that each person in the health care team has a role to play in the prevention of infections. Our goal is to ensure that everyone has the knowledge and confidence to participate in infection prevention.

Our Mission Our mission is to ensure the protection of patients, staff and visitors from preventable infections. We aim to achieve this through: • A proactive approach to current and evolving challenges • Facilitating implementations and solutions • Expert consultation based on applicable regulations, evidence, and best practice • Collaborating with local, provincial, and national partners

Our Services • Knowledge translation – creating and sharing IPAC knowledge with internal and external stakeholders • Hand Hygiene Program – monitoring and improving hand hygiene compliance among team members,

patients, and family/visitors • Surveillance – monitoring for health care-associated infections and identifying opportunities for

improvement • Outbreak management – investigating clusters of infections and controlling and preventing outbreaks • Construction consultation – providing advice to minimize the infectious risks associated with

construction and renovation projects and promoting compliance with Canadian/provincial standards • Cleaning, disinfection and sterilization consultation – advising stakeholders on reprocessing issues and

promoting compliance with best practices • Quality improvement – implementing projects and initiatives to improve IPAC practices and prevent

infections • Policies and procedures – developing and revising IPAC manuals

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Our Team 2017-2018

Georgene Miller, RN, MSN VP, Quality, Safety & Outcome Improvement

Marney Hunt, RN Infection Control Practitioner, CW Hospital

Jocelyn Srigley, MD, FRCPC Corporate Director, PHSA IPAC, Medical Microbiologist

Lisa Krueckl, RN Infection Control Practitioner, CW Hospital

Ghada Al-Rawahi, MD, FRCPC IPAC Medical Lead, BCCA, Medical Microbiologist

Charina Rivas, RN Infection Control Practitioner, CW Hospital

David Goldfarb, MD, FRCPC Infection Control Officer, Medical Microbiologist

Carole Rodger, RN Infection Control Practitioner, CW Hospital

David Harris, MD, FRCPC IPAC Medical Lead, BCMHSUS

Julita Sienkiewicz, RN Infection Control Practitioner, CW Hospital

Laura Sauve, MD, FRCPC Infection Control Officer

Vladlena Abed, RN, Construction Specialist, Infection Control Practitioner, BC Cancer

Peter Tilley, MD, FRCPC Infection Control Officer, Medical Microbiologist

Alison Chant, RN, CIC Infection Control Practitioner, BC Cancer

Robyn Hunter, RN, CIC PHSA IPAC Director

Adriana Ezelyk, RN, CIC Infection Control Practitioner, BC Cancer

Jun Chen Collet, MSc IPAC Epidemiologist

Kristie Harding, RN Infection Control Practitioner, BC Cancer

Baljinder Sidhu, RN, CIC, IPAC Specialist – Reprocessing & Auditing

Kerstin Humbert-Droz, RN Infection Control Practitioner, BC Cancer

Viola Tang, RN Redevelopment

Sheetal Kainth, RN Infection Control Practitioner, BC Cancer

Louise Holmes, RN Redevelopment

Kimberly Mallory, RN, CIC Infection Control Practitioner, BC Cancer

Amrita Dhaliwal Hand Hygiene Auditor

Judy Tearoe, RN Infection Control Practitioner, BC Cancer

Katelyn Muir Hand Hygiene Auditor

Tracia Batson-Dottin, RN Infection Control Practitioner, Forensics

Colin Sham Hand Hygiene Auditor

Kseniya Gavris, RN Infection Control Practitioner, BC Cancer

Fran Lewis Administrative Support

Jacqueline Hlagi, RPN Infection Prevention and Control Specialist, BCMHSUS

Michelle Chang, RN Infection Control Practitioner CW Hospital

Ron Morley, RPN Infection Control Nurse, Forensics

Ashifa Dhanji, RN Infection Control Practitioner, CW Hospital

Lisa Young, RN Leader, IPAC, BC Emergency Health Services

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Team Photographs

PHSA Infection Prevention and Control staff

BC Cancer

Missing: Adriana Ezelyk

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BC Children’s Hospital and BC Women’s Hospital + Health Centre

BC Mental Health & Substance Use Services – Forensic Psychiatric Hospital

David Harris – IPAC Medical

Lead

Jacqueline Hlagi – IPAC

Specialist

Kristie Harding – IC Practitioner

Judy Tearoe – IC Practitioner

Tracia Batson-Dottin – IC

Practitioner

Missing: Lisa Krueckl, Ashifa Dhanji, Carole Rodger, Colin Sham, Amrita Dhaliwal,

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Our Facilities

SITES

Acute Care Beds

Annual Admis-sions

Out-patient Visits

• BC Cancer o Vancouver o Vancouver Island o Abbotsford o Kelowna o Prince George o Surrey

19

637

125,011

N/A N/A 75,486 N/A N/A 37,687 N/A N/A 52,745 N/A N/A 18,617 N/A N/A 58,334

• BC Centre for Disease Control o New Westminster Clinic o Vancouver Clinic

N/A

N/A TB 14,508

STD 18,159

• BC Children’s Hospital • BC Child and Youth Mental Health • Sunny Hill Health Centre for Children

130 6,436 128,991 39 389 15,980 14 123 10,740

• BC Women’s Hospital +Health Centre 130 11,697 63,543

• BC Emergency Health Services N/A N/A N/A

• Forensic Psychiatric Services Commission o Forensic Psychiatric Hospital o Kamloops Regional Clinic o Nanaimo Regional Clinic o Prince George Regional Clinic o Surrey / Fraser Valley Regional Clinic o Vancouver Regional Clinic o Victoria Regional Clinic

• Burnaby Centre for Mental Health & Addiction

• Correctional Health Services at: o Alouette Correctional Centre for

Women o Ford Mountain Correctional Centre o Fraser Regional Correctional Centre o Kamloops Regional Correctional

Centre o Nanaimo Correctional Centre o North Fraser Pre-trial Centre o Okanagan Correctional Centre o Prince George Regional Correctional

Centre o Surrey Pretrial Services Centre o Vancouver Island Regional

181 355 2,530

94 247 N/A

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Correctional Centre • Heartwood Centre for Women

27

139

Knowledge Translation

Education for Team Members, Volunteers, Patients, Families and Visitors During 2017-18, Infection Prevention and Control provided 35 hours of educational sessions for 861 team members who included staff, physicians, students and volunteers.

Information on IPAC topics is available for team members, volunteers, patients, families, and visitors through the CW ePOPs website, as well as on the PHSA

intranet. http://policyandorders.cw.bc.ca/ipac

Hand hygiene education for patients, families and visitors UBC medical students worked with IPAC on a pilot project to improve patient, family, and visitor hand hygiene at BC Children’s and BC Women’s. As part of their project, the students designed new posters targeted at pediatric patients and their families to encourage hand hygiene, particularly in shared areas on the units such as kitchens and playrooms.

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Infection Control Week (October 16-20, 2017) This is a yearly opportunity to provide education to team members, volunteers, patients, families and visitors. This year’s activities at BC Cancer included booths and roaming education carts. At the BC Children’s and BC Women’s Oak Street campus we spent Infection Control Week helping teams get ready for the big move to the new Teck Acute Care Centre(Teck ACC).

World Hand Hygiene Day At this year’s World Hand Hygiene Day, display tables featuring a world map were created! Visitors and staff were encouraged to place stickers on the map to show “Where in the world?” they have performed hand hygiene! Additionally, during both World Hand Hygiene Day and Infection Control Week our IPAC teams handed out activity sheets and created a fun challenge with prizes provided.

Staff was very excited for

“Move Day”

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Educational activities at BC Mental Health and Substance Use Services

• The onboarding for Correctional Health Services (CHS) staff included nine health fairs, with IPAC represented to introduce our services to the newly hired staff. The health fairs focused on availability of IPAC resources and an introduction to hand hygiene. There were many questions regarding process and the interrelationship with the corrections staff that were brought forward to CHS leadership. Two health fairs with IPAC representation were done for Heartwood Centre and Burnaby Center for Mental Health & Addiction.

• Work is ongoing to develop education specific to corrections for the CHS staff, correctional officers and housekeeping to ensure best practices are maintained for the safe care of patients and a safe working environment for staff.

Research Activities Peer-reviewed publications

1. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018 Mar;6(3):223-230.

2. Mokomane M, Kasvosve I, de Melo E, Pernica JM, Goldfarb DM. The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management. Ther Adv Infect Dis. 2018 Jan;5(1):29-43.

3. Furness CD, Srigley JA, Gardam M. How much do beds and mattresses sleep around? Automated measurement of bed frame and mattress movement in an acute care hospital. Canadian Journal of Infection Control 2017;32(4):222-4.

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4. Welch HD, Goldfarb DM, Moorad B, Mokomane M, Smieja M, Chakalisa U, Steenhoff AP, Finalle R, Coffin SE. Hospital-acquired gastroenteritis at a referral hospital in Gaborone, Botswana. International Journal of Infection Control. 2017; 13(2): 1-9.

Conference abstracts 1. Wong M, Xu YZ, Srigley JA. Improving patient and visitor hand hygiene in a pediatric acute care

hospital (poster presentation). Quality Forum 2018, Vancouver, British Columbia. February 2018

2. Collet JC, Hunter R, Evans H, Wells S, Tang V, Chatterjee R, Al-Rawahi G, Chant A, Chang M,

Ezelyk A, Dobson S, Goldfarb D, Harding K, Holmes L, Hunt M, Kainth S, Mallory K, Morley R, Rivas C, Sienkiewicz J, Tearoe J, Young L, Srigley JA. Ask then act: the path to continuous quality improvement (poster presentation). IPAC Canada 2017 National Conference, Charlottetown, Prince Edward Island. June 2017.

3. Harding K, Al-Rawahi G, Catt B, McCombie R, Chant A, Ezelyk A, Hunter R, Kainth S, Tearoe J.

Duration of precautions for methicillin-resistant Staphylococcus aureus in the outpatient oncology setting: A Canadian snapshot (poster presentation). IPAC Canada 2017 National Conference, Charlottetown, Prince Edward Island. June 2017.

4. Hunt M, Bolton M, Stewart T, Collet JC, Dobson S, Goldfarb D, Hunter R, Srigley JA, Hait V.

Utilizing visual cues and engaging families in the sibling health screening process (oral

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presentation). IPAC Canada 2017 National Conference, Charlottetown, Prince Edward Island. June 2017.

5. Rivas C, Hunter R, Collet JC, Chang M, Hunt M, Sienkiewicz J, Srigley JA. Spreading the light?

The challenges of introducing ultraviolet-C disinfection to our environmental cleaning process (oral presentation). IPAC Canada 2017 National Conference, Charlottetown, Prince Edward Island. June 2017.

6. Croxen M, Azana R, Brodkin E, Wong L, Wong T, Forrester L, Srigley JA, Chen JC, Wang B, Mori J,

Kibsey P, Ranns B, Hembroff D, Mateseje L, Han G, Gamage B, Mulvey MR, Hoang L. Genomic characteristics of travel related strains of blaNDM, blaOXA-48, blaKPC strains identified in BC (oral presentation). Association of Medical Microbiology and Infectious Disease Canada Annual Conference. Toronto, Ontario. May 2017.

7. Srigley JA, Peulde L, Thampi N, Vayalumkal J, Amaratunga K, Bush K, Collet JC, Ellis C, Embree J,

Forrester L, Frenette C, Henderson E, John M, Johnston BL, Langley JM, Lee BE, Lefebvre M-A, Lemieux C, McGeer A, Noseworthy E, Quach C, Richardson S, Science M, Smith S, So J, Suh K, Taylor G, and Canadian Nosocomial Infection Surveillance Program. Central line-associated bloodstream infections in Canadian pediatric and neonatal intensive care units: 2009–2015 (oral presentation). Association of Medical Microbiology and Infectious Disease Canada Annual Conference. Toronto, Ontario. May 2017.

8. Srigley JA, Cho S, O’Neill C, Lee C, Mertz D. Hand hygiene knowledge, attitudes, and practices among hospital inpatients: a mixed methods study (poster presentation). Association of Medical Microbiology and Infectious Disease Canada Annual Conference. Toronto, Ontario. May 2017.

9. Vayalumkal J, Pelude L, Lee BE, Amaratunga K, Durand J, Embil J, Embree J, Forrester L, Frenette C, Gittens C, Golding G, Ivany A, Katz K, Kibsey P, Langley J, Lefebvre M-A, McGeer A, Ormiston D, Quach C, Richardson S, Science M, Simor AE, Smith S, So J, Srigley JA, Stagg P, Thampi N, and Canadian Nosocomial Infection Surveillance Program. Methicillin-resistant Staphylococcus aureus (MRSA) infections in hospitalized pediatric patients in Canada 2008–2015 — Canadian Nosocomial Infection Surveillance Program (CNISP) (oral presentation). Association of Medical Microbiology and Infectious Disease Canada Annual Conference. Toronto, Ontario. May 2017.

Collaborations Dr. Jocelyn Srigley has joined the editorial board of the Canadian Journal of Infection Control. IPAC team members continue to collaborate with provincial and national groups including the Provincial Infection Control Network (PICNet), IPAC Canada, and the Canadian Nosocomial Infection Surveillance Program (CNISP).

Awards The PHSA IPAC team received two awards at the IPAC Canada National Conference in June 2017. Marney Hunt was awarded top oral presentation and Kristie Harding won the award for best poster.

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Continuing Education IPAC team members attended various learning opportunities including the 2017 IPAC Canada Annual Conference (Charlottetown, PEI), provincial educational days ( PICNet, IPAC-BC), Canadian Standards Association seminars, web tele-classes, infectious diseases/ medical microbiology rounds at the BC Children’s and BC Women’s Oak Street campus, and oncology rounds at BC Cancer.

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Surveillance IPAC conducts routine surveillance of health care-associated infections (HAIs) at BC Children’s Hospital BC Women’s Hospital + Health Centre , and BC Cancer - Vancouver and implements timely interventions to reduce HAIs. This section provides information on the incidence and trends of HAIs at PHSA facilities. Clostridium difficile Infection (CDI) In 2017/18, 76 patients were admitted at PHSA acute care facilities with laboratory confirmation of Clostridium difficile. Thirty (39 per cent) of those were classified as health care-associated CDI cases (HA-CDI), corresponding to a rate of 5.5 cases/10,000 patient days, which was lower than the 2016/17 rate. The rate of HA-CDI at PHSA is driven by oncology patients (18/30), who are at high risk for CDI due to frequent broad-spectrum antibiotic treatments and compromised immune systems.

At the facility level, BC Cancer - Vancouver showed a downward trend; BC Children’s rate has been stable and BC Women’s has maintained a very low rate since 2009/10.

Figures 1 - 4: HA-CDI rate by facility from 2009/10 to 2017/18

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Methicillin-Resistant Staphylococcus aureus (MRSA) In 2017/18, 69 new MRSA cases (including colonization and infection) were identified among patients admitted to PHSA facilities. Thirty-three (48 per cent) of these cases were classified as health care-associated MRSA (HA-MRSA). The PHSA HA-MRSA rate increased slightly to 3.6 cases/10,000 patient days. This rate increase was driven by BC Women’s, in which two clusters of MRSA were identified. Further investigation demonstrated multiple different MRSA strains, indicating there were different sources. The IPAC team worked closely with the unit on implementing prevention strategies for MRSA and reducing MRSA transmitted via health care workers, family members and other visitors.

Figures 5-8: HA-MRSA rate by facility from 2009/10 to 2017/18

Vancomycin-Resistant Enterococci (VRE) In 2017/18, 32 new VRE cases (colonization only) were identified at PHSA facilities. Nineteen (59 per cent) of them were classified as health care-associated VRE (HA-VRE). The overall PHSA HA-VRE rate has increased significantly to 2.1 cases/10,000 patient days from 0.2 per 10,000 inpatient days in last year. This rate increase was driven by one VRE cluster (total 15 cases identified through admission and prevalence screening) at BC Women’s.

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Figures 9-12: HA-VRE rate by facility site from 2009/10 to 2017/18

Carbapenemase-Producing Organisms (CPO) Screening of CPO among inpatients began in 2012 at BC Cancer and 2014 at BCCH/BCW. In 2017/18, three CPO cases were identified at BC Children’s and 9 cases identified at BC Cancer facilities. None of these cases were health care-associated with the reporting facilities.

Central Line-Associated Blood Stream Infection (CLABSI) Pediatric Intensive Care Unit (PICU) There were no CLABSI cases identified in PICU in 2017/18. Since 2009/10, the CLABSI rate in PICU has been maintained low with a clear downward trend.

Figure 13: PICU CLABSI rate

CLABSI rate in PICU

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Neonatal Intensive Care Unit (NICU) A downward trend in CLABSI rate has also been observed in NICU. In 2017/18, 10 CLABSI cases were identified in NICU, accounting for a more than two-fold CLABSI rate reduction compared to the previous year’s rate.

Figure 14: NICU CLABSI rate

2008/09

2009/10

2010/11

2011/12

2012/13

2013/14

2014/15

2015/16

2016/17

2017/18

CLABSI Rate 6.7 3.0 3.3 4.8 5.2 4.2 2.4 5.0 5.2 2.0

0.0

4.0

8.0

Case

s per

100

0 li

ne

days

CLABSI rate at NICU CLABSI rate in NICU

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Outbreak Management There were three GI outbreaks, one respiratory outbreak, and one VRE colonization outbreak at PHSA sites in 2017-18. The management and containment of the following outbreaks relied heavily on collaborating with clinical and support staff for each unit. Restriction of admissions and transfers were put in place, while patients exhibiting symptoms of infection were quickly placed on additional precautions. Below are the outbreaks that occurred within PHSA in 2017-2018.

Gastrointestinal Outbreaks

Facility Patients/Staff Affected Organism Length of Outbreak BC Women's Hospital 4 None identified 7 days BC Women's Hospital 5 Sapo Virus 5 days

Fraser Regional Corrections Center 3 None identified 6 days

Respiratory Outbreaks

Facility Patients/Staff Affected Organism Length of Outbreak Burnaby Centre for

Mental Health & Addiction

5 None identified 4 days

ARO Outbreaks

Facility Patients/Staff Affected Organism Length of Outbreak BC Women's Hospital 12 VRE 49 days

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Quality Improvement For the full PHSA IPAC Quality Improvement Plan, refer to Appendix C. BC Children’s Hospital and BC Women’s Hospital + Health Centre

BCCH Ambulatory Care Building clean supply and soiled utility room audits - After a Ministry of Health communique, audits were conducted by IPAC for all BC Children’s ambulatory clean supply and soiled utility rooms. Several common concerns were highlighted. Plans were developed by ambulatory leadership with IPAC support to create spaces that complied with best practice guidelines.

BC Cancer

A new infection prevention and control manual website - The BC Cancer IPAC team launched a new IPAC manual website in May 2017. The manual is designed in SharePoint format with a modern new look, user friendly navigation and improved searching functionality.

The new BC Cancer Infection Prevention and Control Manual is available at: http://our.healthbc.org/sites/BCCA_IC_Manual/Pages/default.aspx

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CPO screening Initiative at FVC: Update - Carbapenemase producing organisms (CPO) are bacteria resistant to carbapenem antimicrobials (e.g., imipenem, meropenem, ertapenem) through the production of carbapenemase enzymes (e.g. KPC, NDM).

As the population at BC Cancer - Surrey has been identified as being both at high risk for travel to CPO endemic countries and at higher risk for complications due to acquisition of these bacteria, a CPO screening initiative was started on September 19, 2016 with support from Fraser Health Authority edical Microbiology and PHSA IPAC. The screening initiative involves CPO testing of all new patients who have had healthcare encounters outside of Canada in the past 12 months.

As of February 6, 2018, there have been 173 new patient referrals that have answered ‘YES’ to having out of country health care exposure out of 5,009 new patient referrals. We have successfully identified four CPO colonized patients prior to entry into the building and one CPO case upon initial screening, allowing us to implement timely and appropriate infection control measures, limiting potential exposures to other vulnerable patients in the centre.

BC Mental Health and Substance Use Services – Correctional Health Services

Infection Prevention and Control Manual - We have been diligently working on a comprehensive infection control manual tailored to the needs in corrections, taking into account the population and environment. Work is ongoing for the development of a comprehensive Infection Control Manual for the correctional facilities.

Site visits- IPAC has been able to visit each site to assess and understand the needs of the health care units. IPAC has provided recommendations on standardizing products for hand hygiene and cleaning and disinfection. What has been noted is that staff are diligent in ensuring a clean environment; kudos to all for this important aspect of infection control! To comply with the Policy Communique 2016-04:Environmental Cleaning Best Practices, soiled utility rooms were also assessed during the site visits.

British Columbia Emergency Health Services

The cleaning and disinfection of ambulances is an infection prevention and control best practice and an Accreditation standard. BCEHS established a structured cleaning and disinfection process at the Central Reporting Station (CRS) in Victoria where 40 ambulances are returned for a daily cleaning and disinfection, or a scheduled deep clean. The scheduled deep clean encompasses the removal, cleaning and disinfection of all equipment and ambulance surfaces and restocking the vehicle ready for use. The CRS provided a model for other stations in the province. A pilot was initiated in select stations where paramedics were trained with classroom-based theoretical sessions and hands-on practical training in the ambulance. A cleaning and disinfection toolkit was developed that provides clear instruction on what and how things need to be cleaned and disinfected, and what product to use. The process was reinforced by the cleaning and disinfection policy and the development of standard operating guidelines to ensure cleaning and disinfection of all surfaces and equipment touched by the paramedic or the patient takes place following every call and a more thorough clean of the ambulance space takes place during each shift. Additionally, a scheduled deep cleaning program was tested specifically in Metro Vancouver to address the unique workflow of the Lower Mainland. The Lower Mainland deep clean program currently covers 136 vehicles. The results of this program are now being used to inform a provincial program utilizing logistics staff to perform the deep cleaning of all vehicles to ensure the safe and clean transportation of patients by BCEHS.

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A more thorough clean of the ambulance space takes place during each shift.

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Strategic Plan As we look towards 2018-19 and beyond, the PHSA IPAC team will be focused on improvement activities to achieve our vision of empowering everyone to prevent infections, including the following: A proactive approach to current and evolving challenges • Conducting a study of copper surfaces in the new Teck Acute Care Centre at BC Children’s and BC

Women’s Oak Street campus

Facilitating implementations and solutions • Implementing programs to improve patient/visitor hand hygiene at all PHSA sites • Implementing a timely data feedback platform on health care-associated infections to front line staff Expert consultation based on applicable regulations, evidence and best practice • Working with BC Cancer to ensure Accreditation Canada standards continue to be met in preparation

for the 2019 survey.

Collaboration with local, provincial, and national partners • Continuing to work with BC Mental Health and Substance Use Services to implement a new IPAC

program for Correctional Health Services, Burnaby Centre for Mental Health & Addictions and Heartwood Centre for Women and strengthen the IPAC program in the Forensic Psychiatric Hospital and Forensic Clinics

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Appendix A - PHSA IPAC Organizational Chart As of March 31, 2018

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Appendix B – Definitions

Colonization: The presence, growth, and multiplication of an organism without observable clinical symptoms or immune reaction. The patient is asymptomatic. Infection: Invasion by and multiplication of a microorganism in body tissue resulting in clinical manifestations of disease. VRE case: Laboratory confirmation of vancomycin-resistant enterococci from specimens indicative of colonization or infection. This includes: o Cases identified for the first time during their hospital admission. o Cases identified previously at outpatient clinics but currently the patients being admitted with positive

VRE isolates. o Cases identified in the emergency department that are admitted subsequently (during the same

day).

This does NOT include: o Cases identified in the emergency department but are not admitted. o Cases identified in outpatient clinics or other outpatient cases. o Case re-admitted with VRE

Health care-associated VRE: A VRE case (as defined above) identified greater than 3 calendar days after admission, OR a VRE case identified 3 calendar days or less after admission, but is related to a previous admission within the last 12 months

MRSA case: Laboratory confirmation of methicillin-resistant Staphylococcus aureus from specimens indicative of colonization or infection. This includes:

o Cases identified for the first time during their hospital admission. o Cases identified previously at outpatient clinics but currently the patients being admitted with

positive MRSA isolates. o Cases identified in the emergency department that are admitted subsequently (during the same day). This does NOT include: o Cases identified in the emergency department but are not admitted o Cases identified in outpatient clinics or other outpatient cases o Case re-admitted with MRSA.

Health care-associated MRSA: A MRSA case (as defined above) identified greater than 3 calendar days after admission, OR a MRSA case identified 3 calendar days or less after admission, but is related to a previous admission within the last 12 months.

CDI case: Laboratory confirmation (positive toxin or culture with evidence of toxin production) of Clostridium difficile in an unformed stool specimen (does not include patients <1 year old).

Primary CDI infection: The first episode of CDI ever experienced OR a new episode of CDI which occurs more than 8 weeks after the previous toxin-positive assay.

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Health care-associated CDI: A CDI case (including primary and relapse CDI cases) with symptom onset greater than 3 calendar days or more after admission, OR a CDI case with symptom onset in the community or 3 calendar days or less after admission, provided that symptom onset was less than 8 weeks after the last discharge.

CPO case: Laboratory confirmation of carbapenem resistance/reduced susceptibility caused by a carbapenemase in specified Gram negative organisms, including Enterobacteriacae and Acinetobacter spp.

Central line-associated bloodstream infection (CLABSI): A laboratory-confirmed bloodstream infection (BSI) where a catheter was in place for >2 calendar days on the date of the positive blood culture, with day of device placement being Day 1. Patient with BSI has met one of the following criteria:

o A recognized pathogen cultured from one or more blood cultures and unrelated to an infection at another site.

OR o At least one of: fever (>38°C), chills, hypotension (if aged < 1 yr: one of fever (> 38 °C), hypothermia

(< 36 °C), apnea, or bradycardia) AND infection signs and symptoms/ positive laboratory results are not related to an infection at another site AND common skin contaminant cultured from 2 or more blood cultures drawn on separate occasions.

Catheter includes: • Non-tunneled central venous catheter, coated or non-coated (e.g. pulmonary artery catheter) • Tunneled infusion device (e.g. Hickman, Broviac, tunneled hemodialysis line) • Peripherally inserted central catheter (PICC line) • Implanted vascular access device (IVAD)

Gastrointestinal outbreak: Three or more cases of gastroenteritis among patients, residents, or staff, that cannot be explained by admitting diagnoses or by non-infectious causes of symptoms (i.e. recent use of laxatives or stool softeners, chronic diarrhea, etc.), within a four- day period in the same unit or patient care area.

Respiratory outbreak: Two or more cases of influenza-like illness (fever, chills, headache, myalgia, sore throat, cough, nasal congestion, etc.) among patients, residents, or staff within a one-week period in the same unit or patient care area.

Patient days: Patient days are used as denominators in the calculation of rates to adjust for length of stay. It is calculated by the number of patients admitted (counts are usually conducted at midnight) and multiplied by the number of days of hospitalization in a given time period.

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Appendix C - PHSA IPAC Quality Improvement Plan 2017-2019

Goals Objectives Activities Sites Respon-sibility

Timeline

A proactive approach to current and evolving challenges

Process Monitoring

IPAC Auditing (e.g. MoH) reprocessing, pet therapy, PPE)

All ICPs Ongoing

Transition IPAC services to Teck Acute Care Centre

Reassessment of ICP portfolios and workflow; updates to infection control manual; new communication strategies among team

BC Children’s

and BC Women’s

BC Children’s and BC Women’s team

Fall 2017

Trial antimicrobial surfaces

Teck ACC copper study BC Children’s

and BC Women’s

Jocelyn, June, BC Children’s and BC Women’s Team

2017-18

C&W lab copper study (partnership with VGH and others)

BC Children’s

and BC Women’s

Jocelyn, ICOs

2017-18

CPO Surveillance

CPO Screening Initiative BC Cancer – Surrey and BC

Cancer - Abbotsford

BC Cancer team

2017-18

High Risk Infectious Disease Planning

High Risk Infectious Disease Response Directives

BC Cancer BC Cancer teams in collaboration with site leaders

2017-18

Facilitating implementations and solutions

Revise infection control manuals

Compile one PHSA-wide IPAC manual; add policy statements

All PHSA team 2019

Cerner implementation

New electronic health record

All All sites starting with BC Cancer

2018-19

Improve patient hand hygiene

Expand program at C&W; start initiatives at BCW, BC Cancer, and BCMHSUS

All PHSA team 2017-19

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HH compliance Annual HH education refresh for all staff & volunteers

All PHSA team Ongoing

Reassess hand hygiene compliance monitoring

Trial patient as observer program at BCCDC

BCCDC

Jocelyn, Bal, auditors, BCCDC ICP

2017-18

Trial electronic monitoring system at C&W

BC Children’s

and BC Women’s

Jocelyn, Bal, BC Children’s and BC Women’s Team

2018

UV disinfection Improve utilization of RD machine at C&W

BC Children’s

and BC Women’s

Charina, BC Children’s and BC Women’s Team

2017-18

Consider trial of UV disinfection lights in inpatient washrooms

BC Cancer Ghada, BC Cancer team

2017-18

Expert consultation based on applicable regulations, evidence, and best practice

Assist with implementation of BC Best Practices for Environmental Cleaning

Implementation of phase one recommendations (clean storage/soiled utility room audits, equipment cleaning)

All PHSA team January 2018

MRSA de-flagging review

Review of current PHSA guidelines in light of new SHEA recommendations

All PHSA team 2018-19

Future planning for Dentistry program

IC consultations re: design, work flow, reprocessing

BC Cancer - Abbotsford

BC Cancer team

2018

Accreditation preparation

Help to ensure that IPAC and reprocessing standards are being met

BC Cancer BC Cancer team

2019

Construction Standardization

Align with latest CSA guidelines

BC Cancer BC Cancer team

2018

Collabor-ation with local, provincial, and national

Implementation of BCMHSUS IPAC program

Hire new team members; develop manual; implement/ enhance programs for hand hygiene,

FPH, Burnaby,

HeartwoodBC

Corrections

Jocelyn, Robyn, BCMHSUS team

2017-19

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partners surveillance, reprocessing, etc.

Evaluate PHSA IPAC program

Repeat stakeholder survey (previous fall 2015)

All PHSA team Spring 2018

Improve communications with stakeholders

Revise IPAC POD and internet sites

All

Fran, PHSA team

2017-18

Review BC Cancer relationships with regional Health Authorities

BC Cancer

BC Cancer Team

2019

Networking with Community Partners

Collaborating with Canadian Cancer Society Lodge & Public Health re-new policy for lodgers with infections/AROs

BC Cancer BC Cancer Team

2018-19

Networking with Provincial & National Partners

Participating in PICNet working groups (surveillance, education steering committee), CNISP activities

All PHSA team Ongoing

Reinstating of the IPAC Canada Oncology Interest Group

BC Cancer BC Cancer team

2017-18

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