Audits in InfectionPrevention and Control

Learning objectives

1. Explain the relevance of audit in IP&C practice

2. Identify audit tools and methods3. Describe the main principles of audits

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Time involved

• 40 minutes

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Key points

• Audit means checking practice against a standard • Improves by providing information about

practices • Use for risk assessment, strategic planning, and

root cause analysis• Essential to have an audit team• Results need to be known by decision makers

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Introduction• Healthcare-associated infections (HAI) are due to

multiple factors• Prevention depends on surveillance and

infection prevention and control (IP&C) practices • Practices are outlined in guidelines, policies, and

procedures

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Audit objectives• Reporting of noncompliance or issues

of concern • Identifying where improvement is

needed• Monitoring and evaluating the

effectiveness of the organisation’s risk management process

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Risk Management• Set objectives • Identify, analyse and respond to risks that

could impact the organisation• Internal auditors can offer advice and

help risks

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The PDSA cycle

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The PDSA cycle

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Audit tools • Templates to evaluate implementation of the

standard• Can focus on

• Procedures • hand hygiene, isolation, cleaning, disinfection or

sterilisation

• Practices • personal protective equipment, insertion and care of

intravascular, respiratory and urinary devices, hair removal, prophylactic antibiotic

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Audit Tools

• Audit tools must match the recommended practices and resources of the institution

• The audit can be performed by the IP&C team or other designated staff

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Audit Method

• Select areas • Focus on a few important ones

• Report should include• Description of the physical layout• Observation of practices• Action taken/Practice changed• Collection of local audit data• Analysed audit data

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Audit plan

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Annual audit plan

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Preparation of Audit Team• All staff must be included• Need to understand its purpose is to improve

practice • Not punitive or to identify weaknesses

• Pre-audit meetings essential • Consistence and anonymity• Identify leaders in the area• Knowledge assessment

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Toolkits to Complete Audits Available from Community and Hospital Infection Control Association-Canada and World Health Organization

•Hand hygiene •Standard precautions/routine practices•Use of isolation/precautions•Use of personal protective equipment•Monitoring of sterilisation equipment•And many others………..

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Routine Reports

• Weekly reports• Rapid feedback on incidental issues

• Monthly reports • Audit results, education, training, and consultations

• Quarterly reports • Formal reports including recommendations and

management

• Annual reports • A summary of audits carried and the resulting

improvement

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Behavioural Change• Behavioural theories and interventions

insufficient• Interventions must account for different levels • Interdependence of factors, environmental

constraints, and institutional climate taken into account

• Factors necessary for change1. Dissatisfaction with the current situation 2. Perception of alternatives 3. Recognition, of the ability and potential to change

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Basic principles: Bundles• Multi-model structured way of improving

processes and outcomes • Collection of processes needed to effectively

and safely care for patients• Interventions “bundled” together and when

combined, improve outcomes • Consists of small (3-5) set of procedures,

determined by robust evidence• Successfully completing each step is a

straightforward process and can be audited

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Bundle pack

• A statement of commitment• A cause-effect chart• Standard operating procedures • Data collection sheet• Explanation for staff

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Cause and effect diagram

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Guidelines

• Written guidelines for each procedure• Updated, acceptable, practical• An audit checks if guidelines are being

followed

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Summary

• Data derived from audits used to inform the IP&C program

• The intent of audits is to promote good practice, improve patient care, and ensure safety

• A key person must be identified in each area to help facilitate implementation of any recommendations

• Auditing is relatively simple, but time-consuming • Important to plan and develop an audit calendar

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References• Millward S, Barnett J, Tomlinson D. A clinical infection

control audit programme. J Hosp Infect 1993; 24: 219-232.

• Bryce EA, Scharf SL and Walker MM: Infection control practitioner audit form for patient/resident service units. Canadian J Infect Control 2002; 17:23-26.

• Yokoe DS, et al. A compendium of strategies to prevent healthcare associated infections in acute care hospitals, Infect Control Hospital Epidemiol 2008; 29 (Suppl 1): 12-21.

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Quiz1. Audits have demonstrated improvement in processes and

outcomes. T/F2. An audit tool helps evaluate

a) Practice against a standard b) Health care behaviourc) Surveillanced) Epidemiological investigation

3. Regarding audits, it is incorrect that:a) The intent of audits is to promote good practice, improve patient

care, and ensure safety. b) Audit means checking practice against a standardc) It is punitived) There needs to be a plan

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International Federation of Infection Control• IFIC’s mission is to facilitate international networking in

order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe .

• The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise.

• For more information go to http://theific.org/

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