The multidimensional quality improvement initiative
| Intervention (implementation date) | Description of intervention | Intervention type | Rationale |
|---|---|---|---|
| A (May 2008) | ‘Stop the Bugs’ campaign | Education | Local infection prevention initiative to increase hand hygiene and reduce transmission by faecal-oral route |
| B (from late 2008) | Extended IPCT working hours | Staffing | Provide 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 symptoms | Education | Differentiation 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 case | Space | Removal of index source and reservoir | |
| Ward hand-hygiene audits and peer review of hand hygiene compliance | Audit | Reduce direct and indirect transmission through faeco-oral route | |
| Out-of-hours outbreak management transferred to IPCT | Staffing | Proactive (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 surfaces | Environmental | Reduce 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 fountains | Environmental | Source control of water as a possible vector for norovirus | |
| Opened patient and staff food discarded. Beverage bays cleaned. Microwaves and fridges cleaned | Environmental | Reduce transmission via contaminated food | |
| IPCT visits at least twice daily. Ward ‘attack’ rate monitored | Staffing | Monitor success of interventions, upscale or downgrade as required | |
| Staff and patients information leaflets distributed | Education | Inform on control measures to enlist greater compliance with outbreak measures | |
| Additional healthcare support worker employed | Staffing | Provide ward staff and patients with IPCT support | |
| C (June 2009) | New hospital block opens | Space | Increase in the number of single use occupancy, newer environment easier to clean |
| D (April 2010) | IPC-Manager Software | Information system | Timely electronic surveillance of suspected cases of viral gastroenteritis |
IPC Manager, Infection Prevention & Control Manager; IPCT, Infection Prevention and Control Team.