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  • Writer's pictureLilian Chiwera

How robust/effective are your current HCAI surveillance programs?

I couldn’t resist the opportunity to present to university students in Zimbabwe given my already overflowing infection prevention and control (IPC) surgical site infection (SSI) #SSIPrevention passion. Students had varying professional backgrounds, ranging from theatre nurses, IPC coordinators, environmental health officers, hospital laboratory technologists, prison nurses and midwives. IPC surveillance is not yet fully developed in Zimbabwe, and I believe the picture is the same in some developed and many developing countries.

My focus on the first day was on generic IPC Healthcare Acquired Infection (HCAI) surveillance. What does robust and effective even mean in generic terms? How about in IPC terms? Prior to my sessions, I had to search for definitions, so I knew exactly what I was going to speak about. I also asked IPC colleagues via Twitter so they could help me prepare. When something is said to be robust, it is ‘strong and healthy’ or ‘vigorousEffective is defined as ‘successful in producing a desired or intended result’. Surveillance is a 'close observation' of something, in this case healthcare acquired infections. Wow! There you have it - so how robust is your own IPC surveillance program, i.e., if you even have any at all? Is it strong and healthy? Does it give you intended results? How do you even define intended results – in a patient’s perspective or healthcare facility perspective?

At the start of my sessions, I asked students to tell me what IPC surveillance programs they already have in their settings? Some of the responses I got when I asked what IPC surveillance students were doing really opened my eyes. The breaths of surveillance covered in different areas of the country varied depending on where individuals worked and perhaps reflected how well resourced the facilities were. I am certain that this pattern of having varied surveillance programs in different parts of a country is replicated globally. During my talks, I reiterated on the importance of students taking ownership and/or the first step to convince policy makers. Financial resources are required to sustain robust IPC surveillance programs, but IPC teams must demonstrate human and economic costs of HCAI to leadership teams to acquire initial funding. In my experience of undertaking SSI surveillance over many years, I have demonstrated a guaranteed return in investment. Some of the initial responses I got from students regarding breaths of existing IPC surveillance programs are shown below.

As you can see above, most people are currently not doing robust/effective HCAI surveillance that covers some of the infection control challenges that we face in healthcare globally. More collaborative work is required to ensure our patients are kept safe from avoidable harm.

Patient advocacy

I have always been an advocate for clinical ownership and involving our very senior leadership teams in IPC surveillance programs. For those wanting to start their IPC surveillance journey, clinical ownership and senior leadership are critical components of robust/effective programs. I believe and have proven that surveillance data can be effectively used to inform and improve clinical practice. It is important to remember that in any HCAI surveillance, patients make up your data therefore they must be involved always. My key theme in all my IPC surveillance talks were always going to be centered around a patient’s perspective and the fact that prevention is better than cure…

Judith Tanner has highlighted the importance of listening to patients’ voices and using them to improve patient safety. In her work she has interviewed patients on their experience of developing a surgical site infection, and it was clear that a lot of work still needs to be done in SSI surveillance and prevention. My aim is to promote safe care for all and ensure patients have a good experience after contact with healthcare settings. I, for one would love to receive the best care possible if I were a patient. As a patient’s advocate, I should therefore promote good quality care for all and will continue to spread IPC surveillance messages far and wide. I am thankful for the many IPC resources that are available via the World Health Organization (WHO) and have used these for my talks. One thing that I encourage everyone to consider when I deliver IPC surveillance talks is to think about what’s happening in their own settings.

Undertaking that gap analysis is an important step that is required before setting up any SSI surveillance program. It also helps one to determine surveillance priorities using available resources with an aim to then build on as more data is generated and fed back to clinicians and senior leadership teams. I encouraged my students to design robust HCAI surveillance programs by learning lessons from global IPC experts.…

In England, we’re privileged to have Public Health England (PHE) managing the national HCAI surveillance systems including issuing relevant IPC guidelines. Although great with alert organism surveillance, it is generally felt that uptake of SSI surveillance programs can be improved. An area that is also becoming a global focus is antimicrobial resistance. This requires urgent action through robust antimicrobial stewardship programs as well as robust IPC programs. One of the reasons why organizations don’t undertake IPC surveillance is thought to be a lack of resources; this is even more pronounced in low- and middle-income countries. My messages are always, ‘well infections cost so much more’….

I shared a reflection that Jon Otter did on the English MRSA miracle and felt this work was very similar to what I now decided to call the Guy’s & St Thomas’ SSI miracles in adult cardiac surgery and caesarean section. Similarities existed on the interventions utilized over several years to achieve significant reductions in MRSA or SSIs. These kinds of lessons should always be shared widely, to encourage others to be inspired to undertake similar work. All I can say is that if you want to go further faster as Jon put it, then think along some of these terms …

As I prepared for my talks, I happened to listen to very interesting podcasts which were coordinated by Martin Kiernan (UK) & Brett Mitchell (Australia). I had never heard of the word #Compassionics despite my obsession with #KindnessMatters & #LoveConquersAll. I highly recommend these #InfectionPreventionMatters podcasts to anyone, so much to learn! The ones that really inspired me to share with the students were those when Julie Storr & Claire Kilpatrick (WHO IPC consultants) discussed the importance of compassion and minding one’s language in infection control and healthcare. In other words, Compassion and Infection Prevention are not mutually exclusive! I couldn’t finish my talk without mentioning an inspirational leader in Neil Wigglesworth who is very passionate about human factors. In one of his talks, he said ‘training is a weak safety intervention’. Thus, although training is important, it loses value when used alone without due consideration for system design elements.

My second talk was on my favorite subject SSI surveillance, if you want to hear more about it, you need to contact me but will leave you with the presentation title below 😊.

Student feedback

In the spirit of defining terms used in this blog, this is a best fit definition I could find for feedback - ‘information about reactions to a product, a person’s performance of a task, etc. which is used as a basis for improvement’. This was very important not only to me, but for students as well as we aimed to build long lasting relationships that would enable us to be improving HCAI surveillance globally, together.

I was absolutely delighted to get positive feedback from students after my talks. They felt confident to speak to their managers when they returned to their settings and would jump organizational charts if necessary to get key IPC surveillance messages up to senior leadership levels. I leave you with some of their quotes:

Sooooo, I’m sure we can all agree on one thing as far as IPC HCAI surveillance is concerned, it will always be…

Another thing we must not forget is that #IPCWithoutBorders rocks. Thank you Infection Prevention Society (IPS) for the International Engagement stream. But IPC work beyond our borders will only rock when our house is in order – so very much looking forward continuing my SSI surveillance and prevention campaigns across the UK more than ever before. #BringItOn 😊😊.

I value all my infection control friends and colleagues very much. I have to say that coming with a suitable conclusion for my talk was easy. After asking for ideas for my talk from my #IPCFamily on Twitter, see conclusion below for my first talk which was on point for the IPC surveillance topic I was covering.

Now, go review your own organization's IPC HCAI and make sure its' ‘strong and healthy’ or ‘vigorous’ ; and that it's ‘successful in producing a desired or intended result’.

Disclaimer: Most of the pictures used in this blog are not mine, they were searched on the internet.
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