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Journal of the Academy of Hospital Administration
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Quality Dimensions in Hospital Infection Control
Author(s): Shakti K Gupta*, Sunil Kant** Vol. 14, No. 1 (2002-01 - 2002-06)

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In a survey conducted in UK in the 1980's, the cost of post operative sepsis alone was 5 million $ per year2 . As is evident from Fig 1 {unavailable}a well coordinated HAI control programme will be beneficial to the patient as well as the hospital staff.

Quality and HAI-A Means End Relationship
Quality means conformance of specification/standards 3 . To achieve an effective HAI control programme it is essential that a continuous monitoring is done to establish standards, achieve these and reestablish enhanced standards. All components of quality may be applied funtionally and operationally to attain effective efficiency in HAI programmes. These include quality control which comprises qualitative measurement of adequacy and acceptance of performance, quality assurance which is the application of a series of quality control steps at multiple stages of a procedure to verify that all aspects of the procedure are of acceptable quality, continuous quality improvement in which quality is more than an absence of adverse events, it is a continues quality improvement process always striving for and seeking new ways of improving processes. A Plan-Do-Check-Act(PDCA) as applicable to HAI is depicted in fig 2.

FIG 2. PDCA CYCLE

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This is a performance measure that identifies an individual event that triggers further analysis and investigations. Types of Indicators Sentinel event indicators. sincere efforts. Rate based indicators. The following must be taken into consideration. All dimensions of quality viz accessibility. tenfold increase in mortality in neonatology nursery. It has been aptly said "quality is not a number rather it is a function of positive perceptions". Indicators . 3. Ignac F Semmelweis. control could be accomplished.g. JCAHO also has an online software programme Need Assessor' for assessment for quality evaluation and implementation.Sua Quo-Non for Quality Assurance An indicator is a valid and reliable quantitative process or outcome measure related to dimensions of performance such as effectiveness and appropriateness.php?jour… 2/5 . intelligent direction and skilful execution. This measures performance along a continuous scale e. His observations remain sufficiently cogent today5 . effectiveness and efficiency must receive due weight.com/journals.Journal of the Academy of… Almost 150 years ago in 1847.g. Joint Commission Accreditation of Health Care Organization (JCAHO) Quality Assurance Model 4 as applicable to HAI is depicted in Fig.g. Application of PDCA cycle and the JCAHO model will greatly help in reducing the incidence of HAI. This expresses proportion of number of occurrences to the entire group within which the occurrence could take place e. Quality Assurance Model (JCAHO) www. then young assistant to Johann Klein. Fig 3. identified medical practices within hospitals as a major source and mode of spread of infections and demonstrated that with modification of such practices. zero incidence of post op sepsis during six months. Continuous variable indicators. Professor of Obstetrics at University of Vienna. it is always the result of good intentions. appropriateness. Quality Indicators. incidence of post operative incision sepsis. This may be gainfully employed by healthcare institutions. Quality is never an accident.S. through series of clinical observations. The U. It usually occurs in frequently and is undesirable in nature e. continuity.indmedica.20-04-2011 Indmedica .

Normative Weighted Criteria A patient or his relatives. process or outcome affiliation. isolation rooms. drainage etc. If a person coming to a health care institution pays nothing but has a high risk of acquiring HAI. Has a functional hospital infection team incorporating microbiologist. clinician and a nursing administrator.indmedica. This will also aid hospital administrators and policy makers at various levels to direct activities for improvement of facilities. Structure Criteria Has a well enunciated hospital Infection control committee incorporating a hospital administrator. wishing to utilize a healthcare institutions should have a known predetermined quality standard available for guidance. he would certainly refuse of utilize the facility. The mentioned weighted credits are the maximum that may be granted to a particular parameter. One of the major elements in the service area is the concept of consideration. Physical facilities are conducive for prevention of hospital infection such as ward design bed spacing. Reducing consideration is thus an important quality indicator and an essential parameter to achieve continuous quality improvement (CQI). housekeeping staff and an epidemiologist. measurable and achievable. divergent with a drastic difference in standards for urban and rural areas. understandable. These are now been gradually replaced by he elements of consideration. House keeping services and biomedical waste management are appropriately incorporated in thehospital infection control programme. Usually cost and price are important parameters. 5 5 5 5 5 www. The parameters have been clubbed as per their structure. waiting time. Accreditation is the catalyst for quality care. microbiologist. measuring performance and identifying areas for improvement. Accreditation aids in establishing standards. Consideration is price plus loss of dignity.Journal of the Academy of… The health care system in India is diversified. flooring. The following parameters related to HAI have been weighted as their related importance.20-04-2011 Indmedica .php?jour… 3/5 . nursing staff.com/journals. Accreditation and assessment of health care institutions have been recognized as the must be relevant. anxiety etc. Thus quality indicators must appropriately be enunciated and implemented. There exists specific job description for each personnel of above committee/team.

Internal and external audit for laboratory investigations. Staff and patient satisfaction. Total Credit Points 10 5 5 100 5 5 5 5 5 5 5 5 5 5 5 The grading may be done as follows Credit Point 80-100 70-80 60-70 50-60 Below Gradings A++ Outstanding A+ A B C V. Satisfactory internal and external laboratory audit. Comprehensive documentation exists. policies and procedures related to hospital infection control.php?jour… 4/5 .20-04-2011 Indmedica . Till a comprehensive accreditation system for health care services is organized. Good Good Average Below average These are suggested credit parameters and gradings. These may be modified appropriately for various health care Institutions Need of the Hour-Certification of Services and Newer Techniques India does not have an organization like JCAHO of USA. Training and reorientation programmes being conducted related to HAI. quality system certification by such agencies as BIS and STQC must be undertaken. An important feature of an epidemiologic evaluation is the determination of clonality of the suspected pathogen regardless of the mode of transmission. and routes of spread. ISO 9000 series certification for healthcare institutions will be helpful in evaluating and improving methods. CSSD and dietary. housekeeping disinfectants. universal precautions. Outcome Hospital infection rate viz-a-viz incidence at local/national/international levels. investigations during outbreaks etc. protective vaccinations vis hepatitis. Process Criteria Scientific data collection and analysis related to hospital infection control programme during surveillance and investigation for HAI. Activities aimed for achievement of CQI.indmedica. Cost evaluation analysis for antibiotic usage. Has a functional antibiotic policy. use of disposables. The rapid advancement of genotypic typing techniques in the last few years has helped in www. third party. laundry. HAI etc. handing of specimens barrier and reverse barrier nursing. Existence of comprehensive standing operative procedures (SOPs) for hospital infection control programme including disinfection and sterilization of equipment. Has an interactive inter departmental coordination in reference to hospital infection control programme including services such as housekeeping. surveillance for infection.Journal of the Academy of… Procedures and Policies Has well enunciated principles of hospital infection control such as to eliminate sources of infection. Awareness levels amongst various staff personnel regarding HAI. tetanus and gas gangrene. Scientific sample collection and laboratory investigation Molecular methods are being utilized in laboratory investigations for HAI.com/journals.

Templeton NS.md. JAMA 1993. journals and organizations are available which deal exclusively and extensively with hospital infections. Medical Journal Armed Forces India 1998.net/ * Add. Bureau of Indian Standards Quality Management and Quality and Quality System Elements: Guidelines for Services: 14004 (Part-2). Rai R. 3. Molecular methods such plasmid profile analysis (PPA). No. CDC. 1992:58-72. 1998. Apart from the Need Assessor' of JCAHO some the other related products/journals/ organization are American journal of Infection Control available on internet at site http://www.Advertise On Indmedica . Kant S. 8. of Hospital Administration.Conditions of Usage .icpa. restriction endonulease analysis (REA). Hospital Acquired Infection.cdc. of India About Indmedica . Lupski JR. Molecular Epidemiology and its Clinical Applications. Deptt. If these techniques are made available to the hospitals at affordable cost. AIIMS. In: The Diagnostic Molecular Pathology.com/journals. 1992. 94-97.Contact Us Copyright © 2005 Indmedica www. The software may also be utilized to investigate infection outbreaks. Bishop C: Health Care TQM: An overview: Asian Hospital. References 1. 2. Quality and Hospital Housekeeping: Emerging Issues and Future Dimensions. 6. Q Trendz' is an add on to AICE programmes which plots control charts as surveillance data using predetermined indicators 8 .htm. AICE! Millennium and Century Long Term Care' software monitor and analyze hospital infections.indmedica. AICE ' an software product is being utilized for Infection Control Quality Improvement of healthcare facilities. Precis on Hospital Administration. 5. New York: Raven Press.be/didac/hosp/infon. 4. 270:1363-4.gov/ncidod/hip/. Armed Forces. 7. ** Office of DGMS (Army) Ministry of Defence Govt. analyze risk factors and benchmark data.ac.php?jour… 5/5 . Prof. 54: 174-81. pulse field gel electrophesis (PFGE) are becoming more useful when combined with epidemiologic analysis of infectious disease outbreaks 6. the agencies involved in prevention and control of hospital acquired infection can develop better prevention strategies 5 .Journal of the Academy of… understanding the epidemiology of the various pathogens especially frequently encountered in the hospital-acquired infection. Software products. New Delhi. JK Science Vol 3.2. 2001. methods and applications. 1988.ucl. The polymerase chain reaction: history. With these tools hospital epidemiologist with laboratory help can rapidly diagnose an otherwise difficult to detect pathogen and thus initiate specific infection control measures promptly7 . Chander Y. 1994: 68-69. Gupta S. Atlanta guidelines available on net site http:/www.20-04-2011 Indmedica . http://www.