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Health and Alberta Health Services—Infection Prevention and Control at Alberta Hospitals

Infection prevention and control is one of the central aspects of healthcare delivery and is critical for managing patient safety risk in a hospital setting. Such concepts as proper hand washing and cleaning of medical devices appear basic, yet they are fundamental for preventing the spread of infections. The increasing proliferation of microorganisms resistant to antibiotic medications is a threat to the health of Albertans. Infection prevention and control (IPC) has an important role to play in managing this threat.

What we examined

Our audit had two objectives:

  • determine whether the Department of Health has adequate systems to demonstrate successful implementation of the 2008 Alberta Infection Prevention and Control Strategy, and the 2008 Alberta Hand Hygiene Strategy
  • determine whether Alberta Health Services (AHS) has adequate systems to demonstrate the success it has in managing health risk in hospitals through the following IPC activities:
    • hand hygiene practices
    • cleaning, disinfection and sterilization of multiple-use medical devices
    • management of patients with antibiotic-resistant organisms (AROs)

What we found

There has been a stronger focus on IPC at hospitals over the last several years and AHS, with the department’s support, has introduced important provincial IPC systems that fill critical gaps in all three areas we selected for our audit.

During our hospital visits we did not observe instances where there was an immediate and significant risk to patient safety. Although there have been many improvements in hospital IPC during recent years, we found weaknesses in management systems to ensure implementation of the provincial IPC strategy and the hand hygiene strategy, as well as weaknesses in AHS systems to manage IPC risk within hospitals.

The main theme of our three recommendations to AHS is the following:

  • availability of the hospital IPC data has improved
  • AHS does not yet have adequate systems at the organizational level to use this data to focus management attention on areas of high risk and evaluate existing hospital IPC practices to support evidence-informed service delivery    

What needs to be done

We made one recommendation to the Department of Health and three to Alberta Health Services.

Recommendation 1: Oversight and accountability for infection prevention and control

We recommend that the Department of Health:

  • determine clear implementation responsibilities of each partner identified under the infection prevention and control strategy and the hand hygiene strategy
  • improve its systems to monitor implementation progress and publicly report on the success of both strategies

Recommendation 2: Cleaning, disinfection and sterilization of medical devices

We recommend that Alberta Health Services establish clear oversight and accountability for medical device reprocessing within and across zones to ensure consistent processes and accountability for reprocessing activities in Alberta.

Recommendation 3: Prevention and control of antibiotic-resistant organisms

We recommend that Alberta Health Services improve its systems to manage risk posed by antibiotic-resistant organisms at hospitals by:

  • developing an evidence-informed approach for evaluating and aligning antibiotic-resistant organism policies and procedures in hospitals
  • developing an approach to provide antibiotic stewardship in hospitals across the province

Recommendation 4: Hand hygiene practices

We recommend that Alberta Health Services improve its systems for hand hygiene by:

  • clarifying responsibility and accountability for improving hand hygiene compliance across hospitals
  • using available data, on a risk-focused basis, to identify hospital units with poor compliance, and take appropriate remedial action strengthening the infection prevention and control orientation and training provided to hospital healthcare workers

Why this is important to Albertans

Healthcare-acquired infections affect hospital patients and often lead to serious complications. Infections acquired while in a hospital have more significant negative outcomes than infections acquired in the community, result in longer hospitalizations and represent an added cost to the healthcare system. Many healthcare-associated infections are preventable.

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