Professor Lyn Gilbert1
1Westmead Institute for Medical Research and Sydney Health Ethics, University of Sydney
IPC programs share, with other preventive/public health programs, the problem that the more effective they are, the less visible they are and the more likely it is that resources will be reduced, unless effectiveness can be proven.
Resources: IPC programs rarely have enough resources, but some succeed with relatively few. A single, inexperienced, inadequately trained part-time ICP is almost guaranteed to fail no matter how resourceful and hard-working s/he is but even an apparently adequate number of ICP/FTEs will struggle to run an effective program without support – the more of which there is, the more can be achieved with available resources.
Support is essential: from hospital administration, which a) regards IPC as a priority; b) makes it clear to all staff that consistent non-compliance with IPC policies is unacceptable; c) ensures systems are in place to make compliance – e.g. with hand hygiene, PPE, aseptic technique policies etc. – as easy as possible.
The program also needs practical – as well as in-principle – support from medical, nursing and allied health leadership, e.g. by devising and taking responsibility for relevant (unit/department-specific) carrots and sticks to encourage and measure improvement, in collaboration with the IPC team.
Information: “you can’t fix what you can’t measure”. Serious life-threatening HAIs are relatively uncommon and less serious ones often discounted, although highly significant and costly for the patient. Hospitals need to monitor patient outcomes as efficiently as they measure throughput and hospital costs.
Consistent surveillance of MRO transmission and HAIs depends on integrated laboratory, clinical, patient movement, administrative and outcome data, sophisticated data analysis and timely feedback of results to frontline staff. A well-designed reliable electronic surveillance system will be highly cost-effective and provide a basis for well-designed improvement/intervention studies, in collaboration with the IPC unit.
Flexibility: IPC policies are often ignored or bypassed because “rules” are impracticable, inapplicable to frontline situations and/or too rigidly applied. We need to engage frontline staff in devising ways to apply rules safely in the context in which they work and respect local expertise.
In summary, an effective, co-ordinated IPC program will have adequate resources, whole-of–hospital-support; consistent surveillance and data-feedback; and flexibility to respond to variable frontline needs.