Improving Infection Control Practices in the Philippines Through a Multicenter Collaborative Evidence-Based Quality Improvement Program Marissa M. Alejandria, MD For the Philippine Quality Improvement-Infection Control (QI-IC) Study Group

Problem Statement Uptake of evidence based infection control and antibiotic prophylaxis guidelines into routine medical practice continues to be a challenge. Poor adherence to infection control practices and irrational antibiotic use promotes antimicrobial resistance, increases morbidity and costs of health care. Several implementation strategies of varying effectiveness have been tested.

Philippine Scenario CPG development by professional societies is a frequent activity Dissemination and implementation activities are not structured

Objective To test the effectiveness of the rapid quality improvement model as a strategy in improving the implementation of priority infection control practices

Methods

Model for Improvement Act Plan Study Do Define the goal Analyze the system Rapid-cycle small scale tests of changes in the system * Langley GJ, Nolan KM, Nolan TW. The foundation of improvement. API Publishing, 1992.

Process indicators improved from baseline in all five hospitals QI Intervention Process Indicator Baseline 6th Mo A public Teaching improve hand hygiene in the MICU % adherence to hand hygiene 7% 67% B private teaching in the ICU % adherence to hand hygiene 25% 71% C Provincial reduce unnecessary use of urine catheters % inappropriate urine catheter use 32% 15% D urban private optimize antibiotic prophylaxis for elective cesarean section % adherence to appropriate abx prophylaxis 0% 100% E public specialty center optimal timing of antibiotic prophylaxis for general surgery & urology procedures % adherence to appropriate preoperative abx prophylaxis 28% 52%

Percent adherence to hand hygiene Lecture + Poster + Handrub (Hospital A) Clerks/Interns Residents Nurses Health Care Worker Baseline Lecture Lecture + Poster Lecture + Poster + Handrub Clerks/Interns 31.25 16.7 Residents 42.1 40 Nurses 6.8 36.7 56 67

Adherence to appropriate antibiotic prophylaxis for elective caesarian section (Hospital D) memo to anes CS pack/ admit forms mailing/ distrbtn percentage feedback to OB memo to OB N=

Overall adherence to proper timing of preoperative antibiotic prophylaxis (Hospital E) Baseline Intervention Random Check 1. Meeting with surgeons 2. Hospital Order issued 3. Meeting with ICC 4. Streamlining of process of antibiotic administration Feedback Timing Total

Lessons Learned Key enablers of success Evidence based interventions Center specific strategies responsive to needs & resources Committed team of infection control advocates Hands on facilitation of the rapid QI cycle Co ownership of project through involvement of relevant stakeholders Immediate feedback

Implications Rapid PDSA QI strategy is a potentially efficient method for analyzing the health care system and implementing process changes in the system particularly for resource-constrained settings. Collaborative QI interventions can be used effectively to improve uptake of guidelines on rational antibiotic use and infection control.

Challenges Sustainability Institutionalization Economic assessment of QI interventions Association with patient outcomes Continued networking and collaboration

Thank you! Let’s all enjoy working to make patient care more effective, efficient, safe and friendly!