Infections due to Clostridium difficile, MRSA or VRE: Clinical and System Reviews, Incident Analyses

Public
Healthcare worker

In addition to surveillance and outbreak investigation a system review maybe indicated to identify potential causes of outbreaks and determine appropriate recommendations.

Occurrences of harm are often complex with many contributing factors. Organizations need to:

Measure and monitor the types and frequency of these occurrences.
Use appropriate analytical methods to understand the contributing factors.
Identify and implement solutions or interventions that are designed to prevent recurrence and reduce the risk of harm.
Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in Hospital Harm Improvement Resources Introduction.

If your surveillance, outbreak investigation or system review reveals that your cases of C. difficile, MRSA or VRE are linked to breaks in infection prevention and control practices, these resources maybe helpful:

Organizations

Canadian

Infection Prevention and Control Canada: Resources and Publications https://ipac-canada.org/resources.php
Provincial Infection Control Network of British Columbia (PICNet): Guidelines and Toolkits https://www.picnet.ca/guidelines/
Public Health Agency of Canada, Infection Control Guideline Series https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections.html
Public Health Ontario: Infection Prevention and Control https://www.publichealthontario.ca/en/health-topics/infection-prevention-control

International

World Health Organization: Infection Prevention and Control https://www.who.int/infection-prevention/en/
Association for Professionals in Infection Control and Epidemiology: Practice guidance for infection prevention https://apic.org/Professional-Practice/overview/
Centers for Disease Control and Prevention (CDC) : Infection Control https://www.cdc.gov/infectioncontrol/index.html

Infection Prevention and Control Programs

Canadian

Government of Manitoba. Routine practices and additional precautions: Preventing the transmission of infection in health care. Winnipeg, MB: Government of Manitoba; 2012. Available at: https://www.gov.mb.ca/health/publichealth/cdc/docs/ipc/rpap.pdf
Health Quality Ontario. Improvement map: Infection prevention and control. Available at: http://www.hqontario.ca/portals/0/Modals/qi/en/imap/infection.html
Provincial Infectious Diseases Advisory Committee (PIDAC). Best practices for infection prevention and control programs in Ontario. Toronto, ON: Public Health Ontario; 2012. Available at: https://www.publichealthontario.ca/en/eRepository/BP_IPAC_Ontario_HCSettings_2012.pdf

International

National Institute for Health and Care Excellence (NICE). Healthcare-associated infections. 2016. Available at: https://www.nice.org.uk/guidance/qs113
NICE. Infection prevention and control. 2014. Available at: https://www.nice.org.uk/guidance/qs61

World Health Organization (WHO). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. 2016. Available at https://www.who.int/infection-prevention/publications/ipc-components-guidelines/en/

Routine Practices and Additional Precautions

Canadian

Public Health Agency of Canada (PHAC). Routine practices and additional precautions for preventing the transmission of infection in healthcare settings. 2017. Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/routine-practices-precautions-healthcare-associated-infections.html
Provincial Infectious Diseases Advisory Committee (PIDAC). Routine practices and additional precautions in all health care settings. Public Health Ontario; 2012. Available at: https://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf

Hand Hygiene

Canadian

Health Quality Ontario. Improvement map: Hand hygiene. Available at: http://www.hqontario.ca/portals/0/Modals/qi/en/imap/hand.html
Provincial Infectious Diseases Advisory Committee (PIDAC). Best practices for hand hygiene in all health care settings. 4^th Ed. Toronto, ON: Public Health Ontario; 2014. Available at: https://www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf

International

Centers for Disease Control and Prevention (CDC). Hand hygiene guideline. CDC; 2002. Available at: https://www.cdc.gov/handhygiene/providers/guideline.html
World Health Organization (WHO). WHO guidelines on hand hygiene in health care. Geneva; WHO: 2009. Available at: http://www.who.int/gpsc/5may/tools/9789241597906/en/

Best Practices in Environmental Cleaning

Canadian

Provincial Infectious Diseases Advisory Committee (PIDAC). Best practices for environmental cleaning for prevention and control of infections in all health care settings. 3^rd Ed. Toronto, ON: Public Health Ontario; 2018. Available at: https://www.publichealthontario.ca/en/eRepository/Best_Practices_Environmental_Cleaning.pdf
Provincial Infection Control Network of British Columbia (PICNet). British Columbia best practices for environmental cleaning for prevention and control of infections in all healthcare settings and programs. Vancouver, BC: PICNet; 2016. Available at: https://www.picnet.ca/wp-content/uploads/British-Columbia-Best-Practices-for-Environmental-Cleaning-for-Prevention-and-Control-of-Infections-in-All-Healthcare-Settings-and-Programs.pdf

International

Centers for Disease Control and Prevention (CDC). Environmental cleaning and disinfecting for MRSA. CDC; 2016. Available at: https://www.cdc.gov/mrsa/community/environment/index.html

Best Practices in Hospital Surveillance and Screening for Patients at High Risk for Presence of MRAS and/or VRE

Canadian

Canadian Agency for Drugs and Technologies in Health (CADTH). Methicillin-resistant Staphylococcus aureus (MRSA) screening and discontinuation of precautions in hospitals: Clinical effectiveness and guidelines. CADTH; 2011. Available at: https://www.cadth.ca/methicillin-resistant-staphylococcus-aureus-mrsa-screening-and-discontinuation-precautions-hospitals
Provincial Infectious Diseases Advisory Committee (PIDAC). Best practices for surveillance of health care-associated infections. Toronto, ON: Public Health Ontario; 2014. Available at: https://www.publichealthontario.ca/en/eRepository/Surveillance_3-3_ENGLISH_2011-10-28%20FINAL.pdf
Provincial Infectious Diseases Advisory Committee (PIDAC). Annex A: Screening, testing and surveillance for antibiotic-resistant organisms (AROs). Toronto, ON: Public Health Ontario; 2013. Available at: https://www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Annex_A_Screening_Testing_Surveillance_AROs_2013.pdf

International

Lee TB, Montgomery OG, Marx J, Olmsted RN, Scheckler WE. Recommended practices for surveillance: Association for Professionals in Infection Control and Epidemiology (APIC). AJIC. 2007; 35: 427-440. doi:10.1016/j.ajic.2007.07.002. Available at: http://www.apic.org/Resource_/TinyMceFileManager/Practice_Guidance/AJIC-Surveillance-2007.pdf

Best Practices for Outbreak Management

Canadian

Population and Public Health Division, Ministry of Health and Long-Term Care. Institutional/facility outbreak management protocol, 2018. Government of Ontario; 2018. Available at: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Inst_Fac_Outbreak_Protocol_2018_en.pdf

Provincial Infectious Diseases Advisory Committee (PIDAC). Annex C: Testing, surveillance and management of Clostridium difficile in all health care settings. Toronto, ON: Public Health Ontario; 2013. Available at: https://www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Annex_C_Testing_SurveillanceManage_C_difficile_2013.pdf

International

Campbell, EA. Chapter 12: Outbreak investigations. APIC Text of Infection Control and Epidemiology. Reston, VA: APIC; 2014. http://text.apic.org/toc/epidemiology-surveillance-performance-and-patient-safety-measures/outbreak-investigations
Centers for Disease Control and Prevention (CDC). Healthcare-associated infection (HAI) outbreak investigation toolkit. CDC; 2013. Available at: https://www.cdc.gov/hai/outbreaks/outbreaktoolkit.html
World Health Organization (WHO). Infection prevention and control in health care for preparedness and response to outbreaks. Geneva; WHO: 2014. Available at: http://www.who.int/csr/bioriskreduction/infection_control/publications/en/

Antimicrobial Stewardship

Canadian

Do Bugs Need Drugs? www.dobugsneeddrugs.org
Nakamachi Y, West S, Dresser L, Morris AM. Developing and expanding hospital antimicrobial stewardship: The Ontario experience. CCDR Suppl. 2015; 41S-4. https://doi.org/10.14745/ccdr.v41is4a04. Available at: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2015-41/ccdr-volume-41-s-4-june-18-2015/ccdr-volume-41-s-4-june-18-2015-4.html
Public Health Ontario. Antimicrobial stewardship. Available at: https://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/AntimicrobialStewardshipProgram/Pages/Antimicrobial-Stewardship-Program.aspx

International

Centers for Disease Control and Prevention (CDC). Core elements of hospital antibiotic stewardship programs. CDC; 2017. Available at: https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html

Interagency Coordination Group on Antimicrobial Resistance (IACG). Future global governance for antimicrobial resistance: IACG discussion paper. World Health Organization; 2018. http://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_Future_global_governance_for_AMR_120718.pdf
National Institute for Health and Care Excellence (NICE). Antimicrobial stewardship. NICE Quality Standard; 2016. Available at: https://www.nice.org.uk/guidance/qs121
NICE. Antimicrobial stewardship: Systems and processes for effective antimicrobial medicine use. NICE Guideline; 2015. Available at: https://www.nice.org.uk/guidance/ng15/

Best Practices for IPAC for Clostridium difficile (C. difficile), MRSA and VRE

Canadian

Health PEI. Prince Edward Island infection prevention and control methicillin-resistant staphylococcus aureus (MRSA) guideline. Prince Edward Island Department of Health and Wellness; 2016. Available at: https://www.princeedwardisland.ca/sites/default/files/publications/pei_mrsa_guideline_sep_2016.pdf
Prince Edward Island (PEI) Department of Health and Wellness. Provincial vancomycin-resistant enterococci (VRE) guideline. PEI Department of Health and Wellness; 2009. Available at: https://www.princeedwardisland.ca/en/publication/provincial-vancomycin-resistant-enterococci-vre-guideline
Provincial Infection Control Network of British Columbia (PICNet). Antibiotic resistant organisms prevention and control guidelines for healthcare facilities. Vancouver, BC: PICNet; 2013. Available at: https://www.picnet.ca/wp-content/uploads/PICNet_ARO_Guidelines_March2013.pdf
Provincial Infectious Diseases Advisory Committee (PIDAC). Review of literature for evidence-based best practices for VRE control. Toronto, ON: Public Health Ontario; 2012. Available at: https://www.publichealthontario.ca/en/eRepository/PIDAC-IPC_VRE_Evidence-based_Review_2012_Eng.pdf
Public Health Agency of Canada (PHAC). Clostridium difficile infection: Infection prevention and control guidance for management in acute care settings. Ottawa, ON: PHAC; 2013. Available at: https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/clostridium-difficile-infection-prevention-control-guidance-management-acute-care-settings.html

International

Association for Professionals in Infection Control and Epidemiology (APIC). Guide to the elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) transmission in hospital settings, 2^nd Ed. Washington, DC: APIC; 2010. Available at: http://www.apic.org/Resource_/EliminationGuideForm/631fcd91-8773-4067-9f85-ab2a5b157eab/File/MRSA-elimination-guide-2010.pdf

Patient Education and Engagement

Canadian

Patient Engagement Action Team. 2017. Engaging Patients in Patient Safety – a Canadian Guide. Canadian Patient Safety Institute. Last modified February 2018. Available at: www.patientsafetyinstitute.ca/engagingpatients
Canadian Patient Safety Institute (CPSI). Hand hygiene: Working with patients and families. Edmonton, AB: CPSI; 2016. Available at: http://www.patientsafetyinstitute.ca/en/toolsResources/pages/patients-their-families.aspx

International

Centers for Disease Control and Prevention (CDC). Methicillin-resistant Staphylococcus aureus (MRSA): Information for patients. CDC; 2016. Available at: https://www.cdc.gov/mrsa/healthcare/patient/index.html
CDC. Clostridium difficile infection information for patients. CDC; 2015. Available at: https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html

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Back to Overview

Hospital Harm Measure
- Hospital Harm Improvement Resource

Organizations

Canadian

International

Infection Prevention and Control Programs

Canadian

International

Routine Practices and Additional Precautions

Canadian

International

Best Practices in Environmental Cleaning

Canadian

Best Practices in Hospital Surveillance and Screening for Patients at High Risk for Presence of MRAS and/or VRE

Canadian

International

Best Practices for Outbreak Management

Canadian

International

Antimicrobial Stewardship

Canadian

Best Practices for IPAC for Clostridium difficile (C. difficile), MRSA and VRE

Canadian

International

Patient Education and Engagement

International

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