Human Resource Capacity Enabling IPC Capacity for AHS Staff and Physicians Education and Training The IPC program supports IPC education and training for AHS employees, medical and midwifery staff, students, volunteers, and those acting on behalf of AHS such as contracted service providers. Learning opportunities, including orientation programs and ongoing education modules, are developed, updated, and offered via multiple modalities including online access through the internal and external AHS websites, video conferencing, and simulations. It is expected that IPC involvement in simulation-based education will continue to grow as this is recognized as an expanding learning modality that has been shown to improve the learner s critical thinking and clinical reasoning in complex care situations. Simulation Training Modules Across all zones, face-to-face interaction continues to be one of the most important ways in which infection control professionals connect with AHS staff, managers, and physicians. These interactions include teaching informal and formal sessions initiated by IPC, and participating in education programs organized by clinical areas or AHS, such as employee orientation programs. Some areas are trialing innovative teaching strategies such as a walking orientation, where small groups of new staff walk together through clinical areas with infection control professionals to discuss the practical application of IPC principles and practices. 1
e-learning Modules Interactive modules allow for convenient and flexible education while promoting engagement of the learner. Since 2010/11, the IPC program has developed several e-learning modules that are offered through the AHS learning management system MyLearningLink. AHS staff and medical staff are encouraged to complete the modules through MyLearningLink as it is able to record information for learners and helps to quantify awareness and use of these modules (Figure 14). Medical staff access to MyLearningLink is managed through Medical Affairs. Figure 14: Number of AHS Staff Passing Online e-learning Modules through MyLearningLink, 2013/14 to 2017/18 100,000 10,000 1,000 Passes 100 10 1 2013/14 2014/15 2015/16 2016/17 2017/18 AHS Orientation Passport Hand Hygiene IPC Annual Continuing Education IPC: It s Everyone s Business IPC: Personal Protective Equipment and You Viral Hemorrhagic Fever (Ebola) Modules 1-5 The AHS New Employee Orientation program continues to improve IPC content by updating the use of pop-ups, links to videos and resources, and the use of the Corporate Online Orientation Passport. All new AHS employees are expected to complete this program. In 2017/18, the IPC Annual Continuing Education module was redesigned to be more engaging for learners as recommended by stakeholders in the AHS (2016) Evaluation of Annual Continuing Education Resources. Learners have the option to complete all of the modules or only those modules where scores from the pre-test questions were not 100%. The content of the module aligns with the core competencies for healthcare providers published by Infection Prevention and Control Canada, the national professional organization for those engaged in infection prevention and control. The content is designed to refresh learners IPC knowledge and teach learners where to find additional information when needed. Completion of the module is not mandatory, but increasing numbers of staff are accessing the information with nearly 50,000 AHS staff completing the module in 2017/18. The updated Hand Hygiene Interactive Module was released in May 2017. This module teaches frontline healthcare providers about where, when, and how to clean their hands, how organisms spread, and hand health. Completion of the module is strongly promoted, but not mandatory. 2
The updated Infection Prevention and Control (IPC) It s Everyone s Business module was released in September 2017. This module provides information about the IPC program structure and role, basic IPC principles, and how those principles relate to healthcare providers and their practices. The module was updated to align with changes in the IPC program and, based on feedback from users, flexibility within the module was increased, and certain sections were shortened. The Infection Prevention and Control: Personal Protective Equipment and You module was released in May 2017. This module explains the importance of personal protective equipment use for all healthcare providers who have direct patient contact and who have contact with the patient environment or patient equipment. Launched in 2016, in response to the Ebola outbreak in West Africa, the Viral Hemorrhagic Fever (Ebola) modules explain IPC strategies such as the use of personal protective equipment in caring for patients with suspect or confirmed viral hemorrhagic fever. These modules are designed to be accompanied by a demonstration and practice of donning and doffing of personal protective equipment. A small number of learners continued to access these modules in 2017/18 (Figure 14). For contracted service providers and others that do not have access to MyLearningLink, the modules are posted on the external AHS IPC website. This allows a very broad audience to access current IPC information. IPC Resources for Clinical Practice The IPC program develops resources to support evidence-informed practice and provide clinical direction. These resources are created in partnership with stakeholders and are reviewed at least every three years. AHS IPC program resources including manuals, information sheets, and best practice guidelines are available on the external AHS IPC website. In 2017/18, the Acute Care Resource Manual update was nearing completion. This manual includes content such as a diseases and conditions table, point-of-care risk assessment, and routine practices and additional precautions information sheets and signage. The Continuing Care Resource Manual, including similar content but tailored to the continuing care setting, was updated. Revisions to these manuals were done by a working group, with members from AHS and Covenant Health, who reviewed and revised materials to provide frontline staff with access to current IPC information and to incorporate frontline stakeholder feedback. All manuals are posted on the external AHS IPC website except the IPC Corrections Health Care Resource Manual, which is only available on the internal AHS IPC website, as directed by the Solicitor General of Alberta. In 2017/18, best practice guidelines and information sheets were developed and updated by various IPC working groups. The Continuing Care Working Group developed information sheets for: Use of Portable Bedside Air Conditioners in Facility and Supportive Living; Use of Portable Bedside Humidifiers in Facility and Supportive Living; and Use of Portable Fans in Healthcare. The Document Revision Working Group updated: Bedbug Management Protocols for Healthcare; Cleaning, Storage, and Selection of Mechanical Patient Lifts and Handling Aids; and IPC Principles for Environmental Cleaning and Disinfection. 3
The Document Revision Working Group is in the process of developing an information sheet on the use of medical gels and updating the best practice guideline on the Selection of Furniture and Other Non-Medical Devices in Patient Areas. IPC guidance for clinical practice includes an initiative to use routine practices, instead of additional precautions, for the management of patients with antibiotic-resistant organisms in ambulatory care settings across AHS. The purpose of using routine practices is to enhance the patient experience and improve patient flow in these settings, while ensuring patient and healthcare provider safety. The initiative, started in 2017/18, included the use of algorithms, educational components, and support for infection control professionals. An evaluation, which included a survey with responses from frontline healthcare providers, was completed to assess the outcomes of the initiative. Fifty eight percent of the healthcare provider respondents working in ambulatory care settings expressed agreement with success of the initiative and indicated the positive impact of the education, communication, and tools in meeting stated objectives. An important finding of the survey is that a high percentage of respondents expressed support for the principle of using routine practices for management of patients with antibiotic-resistant organisms in both their ambulatory care environment (83%) and other healthcare environments (69%). IPC Consultations Infection control professionals contribute to a safe patient care environment by sharing their experience and knowledge. Ongoing activities include review of documents that are internal and external to AHS. Covenant Health IPC engaged in collaboration and consultation with AHS on these activities. Responding to Requests for Expertise from the IPC Program 4
AHS Health Professions Strategy and Practice supports education, consultation, and guidance to assist frontline staff in providing evidence-informed patient-centered care. One way AHS Health Professions Strategy and Practice engages other AHS programs is to distribute draft documents and seek feedback on guidelines and standards developed by Alberta Health, AHS, or organizations such as the College and Association of Registered Nurses of Alberta. In 2017/18, the IPC program completed 12 reviews of guidelines and standards developed by external and internal groups. AHS Health Professions Strategy and Practice, in collaboration with AHS Clinical Knowledge and Content Management, also develops clinical practice guidelines for frontline staff. In 2017/18, the IPC program connected with these departments to discuss ways to strengthen collaboration and communication. Through this interaction, the IPC program became more aware of ongoing development of clinical practice guidelines and will have more opportunity to provide content expertise. In turn, Health Professions Strategy and Practice and Clinical Knowledge and Content Management became more aware of IPC resources that will be used to standardize practice recommendations. External AHS IPC Website The majority of IPC program resources such as best practice guidelines, information sheets, and manuals are available on the external AHS IPC website. Having related resources primarily stored in one location makes materials more accessible, especially for contracted service providers. This has been made possible by the work of the Website Working Group, who in collaboration with Communications, redesigned the external AHS IPC website. The website organizes information by topics such as Equipment Cleaning, Best Practice Recommendations, Hand Hygiene, Personal Protective Equipment, Resource Manuals, and Routine Practices. In 2017/18, topics on Education and Training as well as Surveillance and Reporting were added. Electronic access and the user experience are improved by technology that allows the information display to adapt to the electronic device used. For example, the information display on a computer will look different than the same information will look on a mobile device. Another improvement for the user is the redesign of the Posters webpage to include a thumbnail image of each poster to make identification easier. In 2017/18, the Website Working Group released a usability and user experience questionnaire to ask frontline users whether or not the redesigned website met their needs. Results are expected in 2018/19. With the public posting of materials, AHS IPC is often consulted by healthcare organizations outside of Alberta. In 2017/18, there were five copyright requests to adapt materials for use and 12 requests to share materials without adaptation. Examples of Copyright Requests 5
Enabling IPC Capacity for Infection Control Professionals The IPC program strives to align its human resources across the province to meet workload requirements and provide ongoing improvement in safe patient care. Professional development for infection control professionals has been enhanced to improve competency and staff satisfaction. IPC Program Staff and Structure The AHS IPC program is organized into five zone portfolios complemented by the provincial Surveillance and Standards team. There are 160 full-time equivalent positions assigned to IPC in AHS and 13 full-time equivalent positions assigned to IPC in Covenant Health, the majority of whom are frontline infection control professionals. Infection control professionals require the minimum of a baccalaureate degree and generally have one of four educational backgrounds: registered nursing; medical laboratory technology; environmental public health; or general science with a graduate degree in public health or healthcare epidemiology. Physician leadership to the IPC program is provided by the Senior Medical Director for IPC and physicians with IPC training and backgrounds in Infectious Diseases or Medical Microbiology in Calgary and Edmonton zones and by the Medical Officers of Health in South, Central, and North zones. There are 11 physicians at AHS and two physicians at Covenant Health with IPC responsibilities. IPC staff and physicians work closely with healthcare providers to follow best practices and manage challenges and outbreaks. Professional Development Opportunities for IPC Program Staff AHS IPC has developed a comprehensive orientation program for new infection control professionals which is refreshed on a three-year cycle, with staff supported in their learning by the senior clinical practice coordinators in each zone. As well, new staff are supported to take the Infection Prevention and Control Novice course endorsed or sponsored by Infection Prevention and Control Canada. This program consists of six distance education modules and a practicum. Additional educational programs are supported when applicable to the individual s scope of practice. An example includes the course offered by the Canadian Standards Association on design and construction. IPC Orientation Manual 6
Infection control professionals with two to three years experience in IPC are encouraged to complete their professional Certification in Infection Control. More than half of eligible staff currently hold certification, which provides a meaningful indicator of a standard scope of knowledge and level of expertise. IPC Face-To-Face Meeting Ongoing professional development of all staff is encouraged. This includes active participation in local chapter and national activities of Infection Prevention and Control Canada, with a number of AHS and Covenant IPC staff holding executive and committee leadership roles in this organization. The Infection Prevention and Control Canada 2018 National Education Conference will be held in Banff, Alberta in May 2018 and many IPC staff and physicians will be delivering plenary, oral, or poster presentations. Staff also have access to seminars through the University of Alberta Infectious Diseases Division Visiting Speakers Series, Webber Infection Control Telecasts, and various AHS educational programs. The IPC Preceptorship program launched in 2016, was evaluated in 2017, and found to be of benefit to individuals and the IPC program. The goal of the IPC Preceptorship program is twofold: to assist newer infection control professionals in reaching their full potential by building their confidence and refining their IPC knowledge and skill sets; and to provide professional development opportunities for experienced infection control professionals to act as mentors. In 2018, the program is scheduled to run again with support from the senior clinical practice coordinators. 7
In 2016, an IPC Education Community of Practice was established to provide an opportunity for IPC staff to build an identity as educators, develop expertise in learning and teaching, and provide a venue within the IPC program to practise. In 2017/18, the number of IPC staff that participated each month ranged from 28 to 42, with an average of 34 participants. Meetings are structured to include an education component and a sharing of practices and resources, with topics such as accessing learning and teaching resources through Knowledge Resource Service, introducing activities into teaching, models for designing teaching sessions, and using technology. IPC Community of Practice Access to Guidelines and Standards Infection control professionals can access the Canadian Standards Association standards through TechStreet and medical device manufacturer s instructions for use through OneSOURCE. In 2017/18, access to the 2018 Facility Guidelines Institute Guidelines for Design and Construction through MADCAD.com was added. A provincial process for requesting, approving, and monitoring access to standards is being refined to support a consistent streamlined approach throughout the province. Working with Knowledge Resource Service 8
Development of an IPC Disaster Checklist Healthcare services are an integral component of every community. In the event of a disaster (man-made or natural) availability of, and accessibility to, healthcare services becomes increasingly important to support first responders and those impacted by the disaster. The AHS Incident Management System structure is based on the Incident Command System, which enables rapid integration and connectivity between sites, services, zones, external partners, and stakeholders. It defines the roles and responsibilities of personnel and the operating procedures to be used in the management and direction of emergencies and disasters. The IPC program is represented at each level of the Incident Management System structure. IPC requirements are integral to establishing and commissioning temporary healthcare service delivery areas and structures used during the post-disaster period, such as an evacuation centre or a portable isolation containment system, and recommissioning of a hospital. In 2017/18, the IPC program started development of a series of checklists to support infection control professionals in the event of a disaster and these checklist are anticipated to be completed in 2018/19. Collaboration with Workplace Health and Safety Healthcare providers are at increased risk of acquiring communicable diseases such as measles, mumps, chicken pox, and pertussis and potentially transmitting these diseases to others because of their close contact with patients. IPC and Workplace Health and Safety collaborate on communicable disease management in healthcare settings. With the online portal MySafetyNet fully launched in 2017, Workplace Health and Safety is better equipped to manage records pertaining to healthcare provider exposures, screening, and workplace incidents. The Communicable Disease Assessment Policy requires new employees whose duties are at a patient care location to provide their immunization history at the time of hire. An Occupational Health Nurse compares the employee s immunization records with the AHS (2015) Standard for Immunization of Healthcare Workers and offers vaccinations as appropriate. This policy protects patients and healthcare providers by providing the organization with access to accurate employee immunization records in the event of a communicable disease exposure or outbreak. Implementation of the corresponding communicable disease assessment processes started in 2017/18. The first phase involved streamlining the Communicable Disease Assessment form submission and review process. As a result, the rate of submissions for new employees increased from about 35% to 90%. The application of the policy to non-employee groups such as volunteers and students has been completed, while work continues for other groups such as physicians, midwives, and existing employees. This policy will require modification before it can effectively be applied to third party contractors. Work on the final phase of policy rollout is underway. The focus of this phase is to improve provincial consistency and optimize immunization services delivered by Workplace Health and Safety. Process changes have been identified and piloting of these changes has started with the goal to implement at a provincial level in early 2018/19. 9
Workplace Health and Safety has introduced a provincial blood and body fluid exposure process ensuring all AHS healthcare providers receive standardized care. The process includes 24/7 access to an Occupational Health Nurse through an on-call system, standardized assessment, and harmonized follow-up and treatment for healthcare providers sustaining blood and body fluid exposures. Additionally, Workplace Health and Safety has collaborated with IPC in aligning blood and body fluid exposures criteria and enhancing communication between the two programs. The AHS Blood and Body Fluid Exposures Policy is currently undergoing legal review and is expected to be approved in 2018/19. The AHS annual influenza vaccine campaign has multiple partners including Workplace Health and Safety, Public Health, pharmacies, and family physicians. Workplace Health and Safety reports influenza vaccine uptake via the internal AHS website. In 2017/18, the immunization rate for AHS staff was 66%, with an immunization rate of 85% for IPC staff. Early in 2017/18, Workplace Health and Safety assembled an Occupational Health Council that serves as a forum to review processes and standards pertaining to occupational health in AHS. Ad hoc representatives such as IPC program experts are invited based on the nature of the topics discussed. 10