INFECTION PREVENTION AND CONTROL ANNUAL REPORT. Prepared by: Provincial Health Services Authority Infection Prevention & August 2017

Transcription

1 1 INFECTION INFECTION PREVENTION AND CONTROL PREVENTION ANNUAL REPORT Prepared by: April 2016 March 2017 Provincial Health Services Authority Infection Prevention & August 2017

2 s 2 Table of Contents Table of Contents... 2 Executive Summary... 3 PHSA Infection Prevention and Control Program... 5 Knowledge Translation Research Activities Hand Hygiene Program Surveillance Outbreak Management Quality Improvement Strategic Plan Appendix A - PHSA IPAC Organizational Chart Appendix B - Definitions... 30

3 Executive Summary 3 At the Provincial Health Services Authority (PHSA), the safety of patients, staff and visitors is of ultimate importance. To help meet this commitment, the PHSA Infection Prevention and Control (IPAC) Service was formed in 2006, reporting to the PHSA VP of Quality and Safety. The IPAC team works collaboratively with other groups within PHSA, other health authorities, the Provincial Infection Control Network of BC (PICNet), and regional and national health services in supporting best practices to prevent and control infections at PHSA facilities. The IPAC team is involved in a variety of activities that include: Knowledge translation (education and research) Hand hygiene program Surveillance Outbreak management Construction consultation Cleaning, disinfection, and sterilization consultation Quality improvement initiatives Policies and procedure development During , the IPAC team participated in several new projects and initiatives including: Accreditation Canada surveys of 3 agencies (BC Centre for Disease Control, Forensic Psychiatric Hospital, and BC Children s & Women s Hospitals & Health Centre) Implementation of a new sibling health screening process in the BCW NICU Risk-based screening for carbapenemase producing organisms (CPO) of new patient referrals to BCCA-Fraser Valley Cancer Centre in an outpatient setting. The following table highlights trends in health care-associated infection (HAI) rates for : Indicator Rate Rate PHSA Overall Hand Hygiene Compliance 92% 94% PHSA HA-CDI Rate 6.4 per 10,000 inpatient days 7.7 per 10,000 inpatient days PHSA HA-MRSA Rate 2.9 per 10,000 inpatient days 3.1 per 10,000 inpatient days PHSA HA-VRE Rate 1.7 per 10,000 inpatient days 0.2 per 10,000 inpatient days CLABSI Rate in PICU 1.6 per 1, per 1,000 catheter days catheter days CLABSI Rate in NICU 5.0 per 1, per 1,000 catheter days catheter days *HA = health care-associated; CDI = Clostridium difficile infection; MRSA = methicillin-resistant Staphylococcus aureus; VRE = vancomycin-resistant

4 enterococci; CLABSI = central line-associated bloodstream infection; PICU = pediatric intensive care unit; NICU = neonatal intensive care unit 4 *NOTE: The decrease in HA-VRE is statistically significant, while the other rate changes are not statistically significant.

5 5 PHSA Infection Prevention and Control Program Our Vision Empowering everyone to prevent infections! These words paint a picture of the world the Infection Prevention and Control (IPAC) Service seeks to create. Our vision captures the notion that each person in the health care team has a role to play in the prevention of infections. Our goal is to ensure that everyone has the knowledge and confidence to participate in infection prevention. Our Mission Our mission is to ensure the protection of patients, staff and visitors from preventable infections. We aim to achieve this through: A proactive approach to current and evolving challenges Facilitating implementations and solutions Expert consultation based on applicable regulations, evidence and best practice Collaborating with local, provincial, and national partners Our Services Knowledge Translation creating and sharing IPAC knowledge with internal and external stakeholders Hand Hygiene Program monitoring and improving hand hygiene compliance among team members, patients, and family/visitors Surveillance monitoring for health care-associated infections and identifying opportunities for improvement Outbreak Management investigating clusters of infections and controlling and preventing outbreaks Construction Consultation providing advice to minimize the infectious risks associated with construction and renovation projects and promoting compliance with Canadian/provincial standards Cleaning, Disinfection, and Sterilization Consultation advising stakeholders on reprocessing issues and promoting compliance with best practices Quality Improvement implementing projects and initiatives to improve IPAC practices and prevent infections Policies and Procedures developing and revising agency-specific IPAC manuals

6 6 Our Team Georgene Miller, RN, MSN Vice President Quality Safety and Outcome Improvement Jocelyn Srigley, MD, FRCPC Corporate Director, PHSA IPAC Medical Microbiologist Ghada Al-Rawahi, MD, FRCPC IPAC Medical Lead, BCCA Medical Microbiologist Simon Dobson, MD, FRCPC Infection Control Officer Infectious Diseases Specialist Peter Tilley, MD, FRCPC Infection Control Officer Medical Microbiologist David Goldfarb, MD, FRCPC Infection Control Officer Medical Microbiologist Robyn Hunter, RN, CIC PHSA IPAC Coordinator Jun Chen Collet, MSc IPAC Epidemiologist Viola Tang, RN Clinical Lead, Medical Device Reprocessing Julita Sienkiewicz, RN Infection Control Practitioner, BCCH & BCWH Alison Chant, RN, CIC Infection Control Practitioner, BCCA Kimberly Mallory, RN, CIC Infection Control Practitioner, BCCA Sheetal Kainth, RN Infection Control Practitioner, BCCA Kristie Harding, RN Infection Control Practitioner, BCCA Judy Tearoe, RN Infection Control Practitioner, BCCA Adriana Ezelyk, RN, CIC Infection Control Practitioner, BCCA Ron Morley, RPN Infection Control Practitioner, Forensics Lisa Young, RN Leader, IPAC, BCEHS Javairia Raza Hand Hygiene Auditor, Co-op Student Katelyn Muir Hand Hygiene Auditor, Co-op Student Sarah Wells, BHSc, CIC IPAC Construction Specialist Baljinder Sidhu, RN, CIC Infection Prevention Specialist - Reprocessing and Auditing Louise Holmes, RN Clinical Project Lead Redevelopment Marney Hunt, RN Infection Control Practitioner, BCCH & BCWH Charina Rivas, RN Infection Control Practitioner, BCCH & BCWH Michelle Chang, RN Infection Control Practitioner, BCCH & BCWH

7 Team Photos Children & Women's 7 BC Cancer Agency

8 Our Facilities 8 BC Centre for Disease Control: New Westminster & Vancouver Clinics Annual outpatient visits TB Clinic: 14,425 Annual outpatient visits STD Clinic: 18,931 BC Children s Hospital Acute care beds: 102 Annual admissions: 6,205 Annual outpatient visits: 129,836 BC Children s Hospital Acute care beds: 102 Annual admissions: 6,205 Annual outpatient visits: 129,836 BC Child and Youth Mental Health Acute care beds: 39 Annual admissions: 376 Annual outpatient visits: 14,847 BC Child & Youth Mental Health Acute care beds: 39 Annual admissions: 376 Annual outpatient visits: 14,847 Sunny Hill Health Centre for Children Acute care beds: 14 Annual admissions: 145 Annual outpatient visits: 11,785

9 9 BC Cancer Agency Vancouver Island Centre* Acute care beds: N/A BC Annual Women s admissions: Hospital N/A Annual & Health outpatient Centre visits: 75,976 Acute care beds: 130 Annual admissions: 16,324 Annual outpatient visits: 62,676 BC Women s Hospital Acute care beds: 130 Annual admissions: 16, BC Cancer Agency Vancouver Centre* Acute care beds: 26 Annual admissions: 699 Annual outpatient visits: 125,425 BC Cancer Agency Vancouver Island Centre* Acute care beds: N/A Annual admissions: N/A Annual outpatient visits: 75,976 BC Cancer Agency Abbotsford Centre* Acute care beds: N/A Annual admissions: N/A Annual outpatient visits: 43,454

10 10 BC Cancer Agency Centre of the Southern Interior* Acute care beds: N/A Annual admissions: N/A Annual outpatient visits: 52,353 BC Forensic Psychiatric Hospital Acute care beds: 190 Annual admissions: 327 Annual outpatient visits: 2,747 BC Cancer Agency Centre of the North* BC Emergency Health Services (A division Acute supported care beds: by N/A PHSA) # Ambulances Annual admissions: dispatched: N/A 571,000 # Air Annual ambulance outpatient annual visits: calls: 18,195 7,000 BC Cancer Agency Fraser Valley Centre* Acute care beds: N/A Annual admissions: N/A Annual outpatient visits: 61,146 BC Forensic Psychiatric Hospital Acute care beds: 190 Annual admissions: 327 Annual outpatient visits: 2,747

11 11 BC Emergency Health Services Ambulances dispatched: 569,000 Patients transported by air ambulance: 6,800 N/A indicates that this activity is not applicable. *The outpatient visits for BCCA are the sum of the radiation therapy visits, systemic therapy visits and chemotherapy visits. Source: Data provided by PHSA Performance Measurement and Reporting Group.

12 Knowledge Translation 12 Education for Team Members, Volunteers, Patients, Families, and Visitors During , IPAC provided hours of educational sessions for 3,000 team members, including staff, physicians, students, and volunteers. Infection Control Week (October 17-21, 2016) This was another opportunity to provide education to team members, volunteers, patients, families and visitors. This year s activities included the launch of new province-wide Additional Precautions signage, profiles of all IPAC team members, and an article in PHSA News entitled Infection control is everyone s business. Information on IPAC topics is available for team members, volunteers, patients, families, and visitors through the new C&W epops website ( as well as on the PHSA intranet. Continuing Education for the IPAC Team IPAC team members attended various learning opportunities including the 2016 IPAC Canada Annual Conference (Niagara Falls, ON), provincial educational days (Provincial Infection Control Network [PICNet], IPAC-BC), the BC Patient Safety Quality Council Forum, Canadian Standards Association seminars, web tele-classes, Infectious Diseases/Medical Microbiology rounds at C&W, and Oncology rounds at BCCA. At C&W, ICPs took the opportunity to complete educator and leadership training.

13 13 Professor Didier Pittet, an international authority of infection control, is with Marney Hunt, PHSA Infection Control practitioner Robyn Hunter, Marney Hunt, Alison Chant, Julita Sienkiewicz at the IPAC Canada Conference Alison Chant, Robyn Hunter, and Dr. Jocelyn Srigley at the IPAC Canada conference

14 Research Activities 14 Peer-reviewed publications Bader MS, Brooks AA, Srigley JA. Postexposure management of infectious diseases. Cleveland Clinic Journal of Medicine 2017;84(1): Mertz D, Fadel SA, Lam P, Tran D, Srigley JA, Asner SA, Science M, Kuster SP, Nemeth J, Johnstone J, Ortiz JR, Loeb M. Herd effect from influenza vaccination in non-healthcare settings: a systematic review of randomised controlled and observational studies. Eurosurveillance 2016;21(42). Srigley JA, Furness CD, Gardam M. Interventions to improve patient hand hygiene: a systematic review. J Hosp Infect 2016;94(1):23-9. Corace KM, Srigley JA, Hargadon DP, Yu D, MacDonald TK, Fabrigar LR, Garber GE. Using behavior change frameworks to improve healthcare worker influenza vaccination rates: A systematic review. Vaccine 2016;34(28): Conference Abstracts Chant A, Al-Rawahi G, Hunter R, Goodwin F, Clyne-Salley S, Harding K, Mallory K, Mendes A, Tearoe J. Moving beyond Ebola preparedness: a positive side-effect of the West African Ebola outbreak. Poster presented by Alison Chant at the IPAC Canada Annual Conference, Niagara Falls, ON. May Wells S, Al-Rawahi G, Chen Collet J, Dobson S, Rassekh R, Holmes L, Thomas E. Mitigating risk to immunocompromised patients during major hospital construction. Poster presented by Sarah Wells at the IPAC Canada Annual Conference, Niagara Falls, ON. May 2016.

15 15 Lu D, Paquette V, Kang CT, Dobson S, Osiovich H, Tilley P, Roberts A, Ting JY. Outcomes of nonbacteraemia infection or colonisation with Multidrug-Resistant Gram-Negative Enterobacteriaceae in the Neonatal Intensive Care Unit. Poster presented at the Pediatric Academic Societies Meeting, Baltimore, MD. May Lu D, Paquette V, Kang CT, Dobson S, Osiovich H, Tilley P, Roberts A, Ting JY. Outcomes of nonbacteraemia infection or colonisation with Multidrug-Resistant Gram-Negative Enterobacteriaceae in the Neonatal Intensive Care Unit. Poster presented at the 28th International Congress of Pediatrics, Vancouver, BC. August Hait V, Stewart T, Bolton M, Hunt M. Utilizing visual cues: engaging parents and siblings in a health screening process. Poster presented at Quality Forum 2017, Vancouver BC. March Awards BCEHS IPAC Leader Lisa Young won the 2016 BC Patient Safety Quality Council Everyday Champion Award. Collaborations Several IPAC team members have taken on new roles in national and provincial IPAC associations. Reprocessing specialist Bal Sidhu is the president of IPAC-BC, and BCCA ICP Kristie Harding is co-chair of the IPAC Canada Oncology Interest Group. Epidemiologist June Chen Collet is on the Executive and Training Committees of the BC Surveillance and Epidemiology Community of Practice (SurvEpiCoP). C&W continues its membership in the Canadian Nosocomial Infection Surveillance Program (CNISP), and participated in a national point prevalence survey in February Dr. Jocelyn Srigley has taken on a role as co-chair of the CNISP central line-associated bloodstream infections (CLABSI) group. The IPAC team also continues to be actively involved with various PICNet committees, and Dr. Al- Rawahi has joined the PICNet Scientific Operations Advisory Committee. Robyn Hunter provided a voice over for the new PICNet IPAC online education modules.

16 16 Hand Hygiene Program Following the immense success of the 2008 Stop the Spread campaign, the PHSA IPAC team launched the Hand Hygiene Refresh Campaign in the fall of 2016; Thumbs Up for Clean Hands

17 17 In 2016, IPAC teamed up with Emily Carr students to create a Hand Hygiene refresh campaign and involved staff, patients and families in voting for their favorite design and message! The Thumbs Up for Clean Hands was the most popular design! This campaign features a new logo and posters while still maintaining the same principles as the previous campaign. Third party audits of hand hygiene practices among clinical staff in acute care and outpatient settings are used to measure hand hygiene compliance based on the 4 moments for Hand Hygiene to ensure PHSA is meeting best practice standards for hand hygiene.

18 18 Hand hygiene compliance for all PHSA facilities has greatly increased since the establishment of the hand hygiene campaign in Overall PHSA hand hygiene compliance has increased from 40% in the Fall of 2008 to 86% in Spring of 2013, meeting the Ministry of Health s target of 80% hand hygiene compliance ahead of the 2015 deadline. In addition, overall compliance rates (inpatient and clinic settings only) reached a record breaking 94% in the fall of 2016, bringing us closer to our goal of obtaining 100% compliance. Visit the Infection Prevention and Control POD page to access hand hygiene tools for staff BCEHS Hand Hygiene Program BCEHS recognizes the importance of hand hygiene in pre-hospital care. Observational auditing of hand hygiene practice through the duration of a patient transport call commenced in The IPAC Leader initiated the auditing, but a team of peer auditors has developed over the past few years. Provincial hand hygiene compliance has improved from 31% in 2014 to 56% in With frontline staff now taking part in the hand hygiene audits, we have more than doubled the number of hand hygiene opportunities observed. This means that the increased hand hygiene compliance rate is more representative of practice. To share the information with frontline staff in a new and innovative manner, the BCEHS IPAC Program introduced infographics to present the data in a bright, colourful, graphic format. Posters are sent to each station, with accompanying information to support Unit Chiefs in starting conversations about hand hygiene and how staff can improve their practice. Through a new initiative started this year, one district of BC has achieved a hand hygiene compliance rate of 76%. Example of infographic Unit chiefs in one district of BC have taken an active role, championing the monthly hand hygiene audits and engagement with their staff. This new initiative allows them to see their local data and provides the opportunity to discuss the importance of hand hygiene. Using their observations from doing the audits and their own data, they talk with their staff on practice improvements. The Unit chiefs use catchy phrases to make their message resonate, such as the thumb on the dominant hand is often the dirtiest which, is also the digit used to grip a sandwich. They believe that practice is not only expected, but also demonstrated, so they incorporate hand hygiene into their own daily routines.

19 Staff Education 19

20 Cases per inpatient days 20 Surveillance Clostridium difficile Infection (CDI) During the 2016/17 fiscal year, 94 patients were admitted at PHSA acute care facilities with laboratory-confirmed CDI. 42 (45%) of those were classified as healthcare associated-cdi cases (HA- CDI). The overall PHSA HA-CDI rate increased to 7.7 cases/10,000 patient days (95% CI: ) from 6.4 per 10,000 inpatient days (95% CI: ) in 2015/16. Compared to 2015/16, the HA-CDI rate at BCCA decreased, while the HA-CDI rate at BCCH increased. However, these changes were not statistically significant. There have been no HA-CDI cases identified at BCW since The rate of HA-CDI at PHSA is driven by oncology patients (25/42), who are at high risk for CDI due to frequent broad-spectrum antibiotic treatments and compromised immune systems. Furthermore, increasing evidence demonstrates that many patients carry the organism in their intestines asymptomatically on admission rather than acquiring it in a health care facility. The PHSA IPAC team is involved in ongoing efforts to prevent HA-CDI occurrence and minimize transmission through multidisciplinary collaborative work, including 1) hand hygiene promotion; 2) stringent environmental cleaning/disinfection including implementation of a UV disinfection machine; 3) timely implementation of Contact Precautions for suspected and confirmed CDI patients; 4) audits using a CDI tool kit whenever there was a trigger alert; 5) antimicrobial stewardship. Figures 1-3: HA-CDI Rates and Trends by Facility from 2009/10 to 2016/17 Figure 1: BC Cancer Agency _Vancouver Centre / / / / / / / /17 HA-CDI Rate

21 Cases per inpatient days Cases per inpatient days 21 Figure 2: BC Children's Hospital / / / / / / / /17 HA-CDI Rate Figure 3: BC Women's Hospital & Health Centre / / / / / / / /17 HA-CDI Rate Methicillin-Resistant Staphylococcus aureus (MRSA) In 2016/17, 79 new MRSA cases (including colonization and infection) were identified among patients admitted to PHSA facilities. 27 (34%) of these cases were classified as health care-associated MRSA (HA-MRSA). The PHSA HA-MRSA rate slightly increased to 3.1 cases/10,000 patient days (95% CI: ) from 2.9 per 10,000 inpatient days (95% CI: ) in 2015/16; however, the rate change was not statistically significant.

22 Cases per inpatient days Cases per inpatient days 22 Figures 4-6: HA-MRSA rates and trends by facility from 2009/10 to 2016/17 Figure 4: BC Cancer Agency Vancouver Centre / / / / / / / /17 HA-MRSA Rate Figure 5: BC Children's Hospital / / / / / / / /17 HA-MRSA Rate

23 Cases per inpatient days Cases per inpatient days 23 Figure 6: BC Women's Hospital & Health Centre / / / / / / / /17 HA-MRSA Rate Vancomycin-Resistant Enterococci (VRE) In 2016/17, 15 new VRE cases (colonization only) were identified among patients admitted to PHSA facilities. 2 (13%) of them were classified as health care-associated VRE (HA-VRE). The overall PHSA HA-VRE rate has decreased significantly to 0.2 cases/10,000 patient days (95% CI: ) from 1.7 per 10,000 inpatient days (95% CI: ) in 2015/16. Compared to 2015/16, the rates decreased across all three facilities (BCCA, BCCH and BCW). The trend of VRE infection across the three facilities is slightly upwards despite the rate reduction observed this year (Figure 7-9). Figures 7-9: HA-VRE rates and trends by facility site from 2009/10 to 2016/17 Figure 7: BC Cancer Agency _Vancouver Centre / / / / / / / /17 HA-VRE Rate

24 Cases per inpatient days Cases per inpatient days Figure 8: BC Children's Hospital / / / / / / / /17 HA-VRE Rate Figure 9: BC Women's Hospital & Health Centre / / / / / / / /17 HA-VRE Rate Carbapenemase-Producing Organisms (CPO) Screening for CPO among inpatients began in 2012 at BCCA and 2014 at BCCH/BCWH. In 2016/17, two CPO cases were identified at BCCH and one case was reported by BCCA Vancouver Centre. None of these cases were health care-associated with the reporting facilities. Central Line Associated Blood Stream Infection (CLABSI) In 2016/17, one CLABSI case was identified in pediatric intensive care unit (PICU). Since 2009/10, the CLABSI rate in PICU has remained low with a clear downward trend. In the neonatal intensive care unit (NICU), 26 CLABSI cases were identified. The rate in 2016/2017 was similar to the rate the year before, and the overall trend was slightly downward.

25 25 Figures 10-11: CLABSI rate Cases per 1000 line days Figure 10: CLABSI rate in PICU / / / / / / / /17 CLABSI Rate Figure 11: CLABSI rate in NICU Cases per 1000 line days / / / / / / / / /17 CLABSI Rate Surgical Site Infections (SSI) Over the past few years, the IPAC team has been working collaboratively with the Department of Obstetrics and Gynaecology at BCW to establish a reliable and sustainable caesarean section (C-section) surveillance system. Since 2016, the IPAC team has used a mixed case finding approach that includes enhanced surveillance once a week (on Monday's) plus routine case capture through weekly rounds and laboratory reports to monitor SSI development after C-section procedures at BCW. In 2016/17, 2246 C-sections procedures were performed at BCW. IPAC surveillance identified 21 SSI cases, including 19 superficial incisional and 2 organ space infections.

26 # of SSI cases 26 Figure 12: C-section SSI cases identified at BCW in 2016/17 5 C-section associated SSI cases identifed at BC Women's Hospital & Health Centre Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

27 27 Outbreak Management There were 4 gastroenteritis outbreaks at PHSA agencies in The management and containment of the following outbreaks relied heavily on collaborating with clinical and support staff for each unit. Restriction of admissions and transfers were put in place, while patients exhibiting symptoms of infection were quickly placed on isolation or discharged home where possible. Below are the outbreaks that occurred within PHSA in Gastroenteritis Outbreaks Facility Patients/Staff Affected Organism Length of Outbreak Burnaby Center for Mental Health and 17 None identified 8 days Addictions Forensics 9 None identified 8 days BC Mental Health and Substance Use 5 None identified 5 days Services Sunny Hill Health Centre for Children 6 None identified 4 days ARO Colonization Outbreaks Facility BC Women's Hospital & Health Centre Patients/Staff Affected Organism Length of Outbreak 4 MRSA 29 days

28 28 Quality Improvement BCCH & BCW Sibling Health Screening in the NICU Sibling health screening (SHS) prior to entering the NICU is critical to avoid communicable disease exposures to vulnerable NICU infants. The NICU at BCW utilized a SHS process that was found to be unsuccessful due to inconsistent practices; an audit done over the summer of 2016 indicated that only 70% of SHS forms were completed. A working group comprised of the IPAC Service, Quality and Safety, and NICU leadership was struck to develop a new SHS process. The new process commenced in October 2016, consisting of: a) nurses completing the initial SHS with families and incorporating education on the importance of SHS and hand hygiene; b) engaging families to complete subsequent SHS; and c) introducing a visual cue in the form of a sticker of the day (e.g. Monday Monkey) for siblings to wear as a signal that the SHS was completed. An updated audit indicated 60% of siblings were wearing stickers; the other 40% missing a sticker triggered the nurse to complete the SHS. This project demonstrated that: a) engagement of all stakeholders in a process is key to success; b) performing SHS engages families and helps facilitate IPAC education; c) IPAC-led group initiatives can be fun and improve patient safety. BCCA CPO screening Initiative at FVC The spread of Carbapenemase-Producing Organisms (CPO) is fast becoming a major international infectious disease concern. Due to patient travel to countries with a high risk of CPO transmission in the region feeding the BCCA-Fraser Valley Cancer Centre and the vulnerability of the patient population, the BCCA IPAC program has initiated risk-based screening of new patient referrals in an outpatient setting. The results of this initiative are intended to inform further preventative activities and measures in the agency. Oncology Interest Group The IPAC Canada Oncology Interest Group is a venue for ICPs with responsibility for Oncology patients to discuss shared issues and areas of interest with the goal of developing position statements or practice recommendations. The group has not been active for several years however a call for interest in reviving the Interest Group was sent out by Kristie Harding, BCCA ICP, last fall and received a very positive response. Since then, 2 national teleconferences have been held and participants have established 2 key areas of interest to begin focusing their work: Management of VZV and Respiratory Illnesses among oncology patients.

29 2827 Strategic Plan We continue striving to achieve our vision of empowering everyone to prevent infections. Our priorities for and beyond are aligned with our mission statement and include the following: A proactive approach to current and evolving challenges Teck Acute Care Centre One of the major projects for will be the move to the new Teck Acute Care Centre building at the C&W campus. This will require new IPAC processes and interventions, and it provides an exciting opportunity for evaluation and research. Facilitating implementations and solutions Hand hygiene A patient hand hygiene intervention is underway at C&W, with results expected to be presented during We aim to expand that intervention and start projects at other agencies in the future. We also plan to reassess the hand hygiene compliance auditing process and pilot a patient as observer program in Infection control manuals An online version of the BCCA manual is planned for Expert consultation based on applicable regulations, evidence and best practice BC Best Practices for Environmental Cleaning A PHSA-wide working group has been formed to implement phase 1 of the new provincial guidelines by early 2018, with IPAC team members playing a key role in advising on and implementing the recommendations. Accreditation The IPAC Service will be involved in advising on and implementing best practices during the upcoming accreditation survey at BCCA. Collaboration with local, provincial, and national partners BCMHSUS and BC Corrections There will be opportunities for a more active role in BCMHSUS facilities, with plans to move their infection control programs to the PHSA IPAC service during PHSA will also be taking responsibility for health care services at BC Corrections as of October 1, 2017, and we will be involved in developing a new IPAC program for those facilities.

30 2928 Appendix A - PHSA IPAC Organizational Chart

31 3029 Appendix B - Definitions Colonization: The presence, growth, and multiplication of an organism without observable clinical symptoms or immune reaction. The patient is asymptomatic. Infection: Invasion by and multiplication of a microorganism in body tissue resulting in clinical manifestations of disease. VRE case: Laboratory confirmation of vancomycin-resistant enterococci from specimens indicative of colonization or infection. This includes: o Cases identified for the first time during their hospital admission. o Cases identified previously at outpatient clinics but currently the patients being admitted with positive VRE isolates. o Cases identified in the emergency department that are admitted subsequently (during the same day). MRSA case: Laboratory confirmation of methicillin-resistant Staphylococcus aureus from specimens indicative of colonization or infection. This includes: o Cases identified for the first time during their hospital admission. o Cases identified previously at outpatient clinics but currently the patients being admitted with positive MRSA isolates. o Cases identified in the emergency department that are admitted subsequently (during the same day). CDI case: Laboratory confirmation (positive toxin or culture with evidence of toxin production) of Clostridium difficile in an unformed stool specimen (does not include patients <1 year old). CPO case: Laboratory confirmation of carbapenem resistance/reduced susceptibility caused by a carbapenemase in specified Gram negative organisms, including Enterobacteriacae and Acinetobacter spp. Health care-associated VRE or MRSA: A VRE or MRSA case (as defined above) identified greater than 3 calendar days after admission, OR a VRE case identified 3 calendar days or less after admission, but is related to a previous admission within the last 12 months Health care-associated CDI: A CDI case (including primary and relapse CDI cases) with symptom onset greater than 3 calendar days or more after admission, OR a CDI case with symptom onset in the community or 3 calendar days or less after admission, provided that symptom onset was less than 8 weeks after the last discharge.

32 3031 Central Line Associated Blood Stream Infection (CLABSI): A laboratory-confirmed bloodstream infection (BSI) where a central line was in place for >2 calendar days on the date of the positive blood culture, with day of device placement being Day 1. Patient with BSI has met one of the following criteria: OR o A recognized pathogen cultured from one or more blood cultures and unrelated to an infection at another site. o At least one of: fever (>38 C), chills, hypotension (if aged < 1 yr: one of fever (> 38 C), hypothermia (< 36 C), apnea, or bradycardia) AND infection signs and symptoms/ positive laboratory results are not related to an infection at another site AND common skin contaminant cultured from 2 or more blood cultures drawn on separate occasions. The central line includes: Non-tunneled CVC, coated or non-coated (e.g. pulmonary artery catheter) Tunneled infusion device (e.g. Hickman, Broviac, tunneled hemodialysis line) Peripherally inserted central catheter (PICC line) Implanted vascular access device (IVAD) Gastrointestinal outbreak: Three or more cases of gastroenteritis among patients, residents, or staff, that cannot be explained by admitting diagnoses or by non-infectious causes of symptoms (i.e. recent use of laxatives or stool softeners, chronic diarrhea, etc.), within a fourday period in the same unit or patient care area. Respiratory outbreak: Two or more cases of influenza-like illness (fever, chills, headache, myalgia, sore throat, cough, nasal congestion, etc.) among patients, residents, or staff within a one-week period in the same unit or patient care area. Patient days: Patient days are used as denominators in the calculation of rates to adjust for length of stay. It is calculated by the number of patients admitted (counts are usually conducted at midnight) and multiplied by the number of days of hospitalization in a given time period.