Clinical audits Some practical considerations The Swedish Society for Infectious Disease Physicians (www.infektion.net) Clinical audits Some practical considerations How accurate are the data we get…? Per Follin, Linköping, Sweden

Swedish ID resources 21 counties ( 5-6 regions) 28 ID departments 820 ID beds* 395 single-bed (isolation) rooms (48%) * Internal Medicin hospitalized ID patients not included

ID beds / Department

Swedish ID-departments >40 beds 20-40 beds 15-20 beds

Swedish ID-departments >40 beds 20-40 beds 15-20 beds

Swedish ID-departments >40 beds 20-40 beds 15-20 beds

ID beds/1000 inhabitants

Previous problems (in the 2005 EUNID inventory) Accuracy of numbers Obtaining data from all the facilities in a country Understanding what information is being asked for Complicated answers Silly computer errors

(preliminary results) Swedish inventory 2005 (preliminary results) I Rooms with controlled negative pressure? >40 beds 20-40 beds 231 5-20 beds 1-5 beds Are these numbers correct? II Isolation rooms with ICU capacity? (within ID ward or ICU) 57* * Stockholm not included

EUNID 2005 definitions ** 54% of al single-bed rooms Data from Sweden Negative pressure (  6 air changes per hour) + anteroom direct connection with lab area (HIU) Negative pressure (  6 or not defined air changes per hour) Negative pressure ( 6 air changes per hour) (HIU without lab) ( 6 or not defined air changes per hour) ( 6 air changes per hour) ( 6 or not defined air changes per hour Current Hospital 1 20 (13 verified*) Hospital Beds 3 2 215** (190 verified*) ** 54% of al single-bed rooms * By telephone interviews / inquiries

What are the adequate standards we are asking for? Negative pressure: To have a controlled negative P (to get a constant flow) 1-10, 25 or 50 Pa? - certain problems with low/high negative pressure - NB the influence of different weather conditions! Easy to claim - but harder to prove.. Air change per hour: standards when building Swedish hospital is 4-6 (therefore al our rooms have < 6 changes/h)

Other aspects: Locked anteroom? Single / double anterooms (separated entrance and exit)? Exhaust air separate or in connection with other rooms? HEPA filtered? Sealed…verified that there is no leakage (i.e. can a low negative pressure be reached?) Verification by Instruments / Gauge / manometers / ascending pipes? Does the anteroom have positive pressure compared to the corridor?

Clinical audits – practical problems Standardized protocol Sound facts (EB-infection control) Bias (What we want, is not the same as, What we got - testing is required) Long distances – hours of traveling required? In old buildings – who has the information? Should recourses be scattered or centralized? Lowest standard – highest standard

Problems / experiences More details – less reply Relevant Q – (i e what EB-standards should we look for) Inventory by questionnaire easiest telephone inquiry on site observations time consuming / costly professionals (non-bias) - “ - rotations / triangular visits… 2006 Independent examiner will perform an audit of the Swedish HIU, initiated by The National Board of Health and Welfare. (interviews, revision of SOP´s, economics, education, drills, in -/ inter hospital cooperation, preparedness ets.) Suggestion for future national agreements / priorities / improvements

Thank You!