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