New approaches to infection prevention and control: implementing a risk-based model regionally.

Quality Issue: Infectious disease outbreaks result in substantial inconvenience to patients and disruption of clinical activity.

Initial Assessment: Between 1 April 2008 and 31 March 2009, the Vancouver Island Health Authority (Island Health) declared 16 outbreaks of Vancomycin Resistant Enterococci and Clostridium difficile in acute care facilities. As a result, infection prevention and control became one of Island Health's highest priorities.

Choice Of Solution: Quality improvement methodology, which promotes a culture of co-production between front-line staff, physicians and Infection Control Practitioners, was used to develop and test a bundle of changes in practices.

Implementation: A series of rapid Plan-Do-Study-Act cycles, specific to decreasing hospital-acquired infections, were undertaken by a community hospital, selected for its size, clinical specialty representation, and enthusiasm amongst staff and physicians for innovation and change. Positive results were incorporated into practice at the test site, and then introduced throughout the rest of the Health Authority.

Evaluation: The changes implemented as a result of this study have enabled better control of antibiotic resistant organisms and have minimized disruption to routine activity, as well as saving an estimated $6.5 million per annum. When outbreaks do occur, they are now controlled much more promptly, even in existing older facilities.

Lessons Learned: Through this process, we have changed our approach in Infection Prevention and Control (IPAC) from a rules-based approach to one that is risk-based, focusing attention on identifying and managing high-risk situations.