Table 1

The multidimensional quality improvement initiative

Intervention (implementation date)Description of interventionIntervention typeRationale
A (May 2008)‘Stop the Bugs’ campaignEducationLocal infection prevention initiative to increase hand hygiene and reduce transmission by faecal-oral route
B (from late 2008)Extended IPCT working hoursStaffingProvide a comprehensive reactive service modelled on patient need
IPCT staff trained to assess risk; obtain a clinical history; perform a physical examination; and provide proactive clinical management to stabilise vulnerable patients and minimise symptomsEducationDifferentiation of infectious/non-infectious symptomatic patients. Reduction in patient morbidity. Reduction and source control to reduce environmental contamination and patient-to-patient transmission
Emphasis on single-room isolation; and identification and removal of the index caseSpaceRemoval of index source and reservoir
Ward hand-hygiene audits and peer review of hand hygiene complianceAuditReduce direct and indirect transmission through faeco-oral route
Out-of-hours outbreak management transferred to IPCTStaffingProactive (often onsite) cover out-of-hours by infection prevention specialist to manage ‘suspected’ outbreaks
Whole ward measures for enhanced cleaning, with special emphasis on touch point cleaning. Detergent and hypochlorite preparation used for cleaning all suitable surfacesEnvironmentalReduce bio burden in ward environment and reduce direct and indirect transmission
Drinking water jugs emptied and washed in a dishwasher; Replenish regularly with fresh water; clean drinking fountainsEnvironmentalSource control of water as a possible vector for norovirus
Opened patient and staff food discarded. Beverage bays cleaned. Microwaves and fridges cleanedEnvironmentalReduce transmission via contaminated food
IPCT visits at least twice daily. Ward ‘attack’ rate monitoredStaffingMonitor success of interventions, upscale or downgrade as required
Staff and patients information leaflets distributedEducationInform on control measures to enlist greater compliance with outbreak measures
Additional healthcare support worker employedStaffingProvide ward staff and patients with IPCT support
C (June 2009)New hospital block opensSpaceIncrease in the number of single use occupancy, newer environment easier to clean
D (April 2010)IPC-Manager SoftwareInformation systemTimely electronic surveillance of suspected cases of viral gastroenteritis
  • IPC Manager, Infection Prevention & Control Manager; IPCT, Infection Prevention and Control Team.