26, March 2015
Partnering for Health: Practical Steps to Infection Control …..sharing healthcare best practices
March 2015 Workshop Report
N O 34, R AYMOND NJOKU STREET , OFF AWOLOWO ROAD , IKOYI , LAGOS .
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Workshop Report
This report provides a short summary of the recent workshop hosted by The Society for Quality in Healthcare in Nigeria at the Lagos Travel Inn, Ikeja, Lagos on the 26th of March, 2015. The main purpose of the workshop was to give its participants, a hands-on-experience, to practical solutions to the implementation of everyday infection control practices both at home and in the hospital. To also enlighten the participants on the importance of the appropriate segregate of medical waste all in the bid of improving infection control practices of patient safety and most of all, to impart knowledge.
This report, has been prepared for circulation to participants but it is also intended as a resource for those interested in Infection Control who were for one reason or another, unable to attend.
- Cross Section of Participants
A total of 34 Participants attended the Workshop and the attendance cut across Healthcare Personnel including medical practitioners, nurses, pharmacists, clinicians, and members of the society.
WORKSHOP THEME & OBJECTIVES - Cross section of Partcipants 1 The Theme of the Workshop: Partnering for Health: Practical Steps to Infection Control.
The specific Workshop objectives were: Dr. Oluborode giving the SQHN Opening We 1
1. To remind us infection control never ends 2. Understand the components of a successful hand hygiene program 3. Learn how to manage an outbreak in the hospital setting 4. Effective use of antibiotics 5. Prevention of health and environmental danger through medical waste management
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PROGRAMME
Meeting Name SQHN WORKSHOP THEME Partnering For Health: Practical Steps of Infection Control DATE & TIME 26TH March 2014; Time: 9:00am – 4:00pm Location Lagos Travel Inn, 39, Toyin Street, Ikeja, Lagos. Conference Objectives 1. To remind us infection control never ends 2. Understand the components of a successful hand hygiene program 2. Learn how to manage an outbreak in the hospital setting 3. Effective use of antibiotics 4. Prevention of health and environmental danger through medical waste management
CONFERENCE AGENDA & SCHEDULE TIME TOPIC FACILITATOR 8:30 – 9:00 Registration & Administration Mrs. Ehizogie Bridget am Welcome Remarks Mrs. Njide Ndili 9:00 – Welcome & Introduction Secretary, SQHN 9:30am SQHN Information
9:30 – Prof. E.A. Elebute Opening Remarks / Address 9:45am Chairman SQHN Session 1 Basics of Infection Control, how do we start? Dr. Oyinlola Oduyebo 9:45 – Challenges & Change Management for Infection Associate Professor 10:45am Control Microbiology Dept. LUTH 10:45 – Tea Break 11:05am Session II Dr. Mike Oji Consultant Orthopedic 11:05 – Surgeon Chairperson Antimicrobial Stewardship Programme 12:05pm Infection Control, Lagoon Hospitals
Session III Mr. Jide Onayiga
12:05 – Consultant Critical Medical Waste Management Practices in 12:40pm Medical Waste Infection Control Management, LAWMA
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12:40 – LUNCH 1:10pm Session IV
Dr. Benjamin Ohiaeri 1:10 – Infection Control : Medical Director 2:10pm First Consultants Experience of Ebola Virus Disease First Consultants Hospital, and Clinical Governance In Infection Control Lagos
Session V Patients & Families Responsibilities in Infection Dr. Bamidele Mutiu MBBS, 2:10 – control FMCPATH, Head of Medical 3:10pm Microbiology, LASUTH
3:10 – Question & Answer Session 3:40pm Dr. Adenike Adewakun 3:40 – Wrap up (Moderator) 4:00pm
INTRODUCTION
The registration process for the workshop kicked off at exactly 8:00am. The workshop started at about 10:30am and this was as a result of the heavy traffic experienced all over Lagos State on that day, which incidentally was 2days to the Presidential elections.
The opening welcome address and remarks was presented by the SQHN Executive Manager, Dr. Olawumi Oluborode, who had to stand in for Mrs. N. Ndili who was stuck in traffic, Dr. Oluborode, also stood in as moderator, for Dr. Adenike Adewakun who was also unavoidably absent.
Dr. Oluborode, welcomed the participants and briefed them on the expectations and agenda for the workshop. She gave more insight on what SQHN was all about, membership, activities and journey towards accreditation. Members of the Board that were present also made contributions. She then introduced the first speaker Dr. Mike Oji, of Lagoon Hospitals who presented the first paper on behalf of Dr. Oyin Oduyebo who was also unavoidably absent.
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- Dr. Oluborode giving the SQHN Opening Remarks
Session I:
Basics of Infection Control, how do we start? Challenges and Change Management for Infection Control – Dr. Mike Oji Dr Mike Oji had to stand in to present this paper on behalf of Dr Oyin Oduyebo who was unavoidably absent. He stated the objectives of the topic, which includes;
. Understand basic infection control (IC) concepts . Understand the causes of nosocomial infections . Understand the components of an infection control program . Understand how the Infection Control Committee and Drug Therapeutic Committee(DTC) can decrease the incidence of nosocomial infections and antimicrobial resistance (AMR)
The outline of the topic includes;
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. Key Definitions . Introduction . Epidemiology of Nosocomial Infections . Control and Prevention of Nosocomial Infections . Setting up an infection control committee and responsibilities . Core Strategies for Reducing the Risk of Nosocomial Infections . Implications for the DTC . Conclusion
He started by defining what infection control and nosocomial infections are, he also stressed the importance of Infection Control Infection control -The process by which health care facilities develop and implement specific policies and procedures to prevent the spread of infections among health care staff and patients Nosocomial Infection - an infection contracted by a patient or staff member while in a hospital or health care facility (and not present or incubating on admission)
Dr Oji also defined sterilization and disinfection and he pointed out the major differences between the two. The most common sites for nosocomial infections were stated as Surgical incisions, Urinary tract (i.e., catheter-related), Lower respiratory tract and Bloodstream (i.e., catheter-related). He also mentioned microorganisms that are involved in the transmission of infection. Infection Control Members may include; . Doctors . General physician . Infectious disease specialist . Surgeon . Clinical microbiologist . Infection control nurse . Representatives from other relevant departments . Laboratory . Housekeeping . Pharmacy and central supply . Administration He also went further to state the role and functions of Infection Control Committee. Hand hygiene was stated as the most important strategy of reducing nosocomial infections. The role of the Drug Therapeutic and Infection Control Committee is to monitor and control the use of antibiotics to prevent antimicrobial resistance. He summarized the presentation by stating that :
. IC procedures are vital to preventing nosocomial infections and for controlling hospital costs. . Simple, inexpensive strategies can prevent many infections. . DTC can support many IC activities: . Hand washing and use of appropriate antiseptics and disinfectants . Monitoring IV and injection preparation and administration . DTC should actively promote better use of antimicrobials: . Guidelines for treatment and surgical prophylaxis . Selection of appropriate antimicrobials for the formulary . Antimicrobial use reviews
. Infection Control Committees or programs, when functioning effectively, will
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. Reduce the spread of infectious diseases . Decrease morbidity and mortality due to nosocomial infections . Maintain employee health and morale . Decrease the incidence of AMR . Decrease health care costs
- Dr. Mike Oji answering questions
Session II:
Antimicrobial Stewardship Programme – Dr. Mike Oji (Consultant Orthopedic Surgeon Chairperson Infection Control, Lagoon)
The outline of the topic included: ●Introduction ●Definitions ●The Burden - Why a Stewardship Programme? ●Strategies for Anti-Microbial Stewardship Programme
He started his presentation by introducing antimicrobials as one of the most useful medicaments of the last 2-3 centuries, he also talked about the problem of abuse, emergence of resistance being a global problem and that we are presently running out of antibiotics and new ones may not be released soon.
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He defined and mentioned the differences between antimicrobials and antibiotics. Antibiotic resistance was likened to a time bomb that is about to explode and explained the extent of the burden with data and Nigeria has the highest figure of percentage of Methicillin Resistance Staphylococcus Aureus amongst other African countries. He stressed the importance of the Stewardship programme which includes abuse of antibiotics, misuse of antibiotics and improving antibiotic use improves safety and medical care.
Objectives of the antimicrobial stewardship programme ; best clinical outcome, minimize toxicity and ADR, reduce selective pressure on antibiotics, Reduce emergence of AMR strains, Reduce excessive cost. He also mentioned the components of Antimicrobial Stewardship Programme. Dr Oji also took the class through the practical steps of initiating an antimicrobial stewardship programme.
Session III
Critical Medical Waste Management Practices in Infection Control - Mr. Jide Onayiga Consultant Medical Waste Management, LAWMA
The outline of the topic is as follows;
•Definition and Types of Healthcare Waste
•Waste Management Plan
•Healthcare Waste Management Process
•Stakeholders and Responsibilities
•Recommendations
•Conclusion
–Generation
–Collection
–Temporary Storage (Internal / External) –Transportation –Disposal –Treatment
He defined healthcare wastes as wastes generated, discarded and not intended for further use in the hospital. An effective waste management is the first and foremost way to prevent unwanted diseases.
He classified hospital waste to include; general, pathological, infectious, sharps, pharmaceutical, chemical and radioactive wastes. Medical waste segregation was also discussed;
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• Yellow plastic bags for infectious waste (wastes contaminated with body fluids) e.g. dressings, swabs, incontinence pads, low risk noninfectious laboratory waste and dialysis waste.
• Red plastic bags for highly infectious wastes like Anatomical waste (body parts); Placenta, Blood -Highly infectious waste (normally from Infectious Diseases or similar Isolation Units); -Unrecognizable tissue (normally from non- surgical treatment)
• Black Plastic bags are for general wastes like paper, packages, food waste etc.
He mentioned that sharps must be disposed of appropriately using the sharps containers and these containers must be close to patient care site. He showed the participants a few pictures of inappropriate waste segregation and that about 75% of wastes generated in hospitals are non-infectious while the remaining 25% are infectious. Mr. Onayiga mentioned the rationale behind healthcare waste management which includes;
• injuries from sharps can lead to infection of hospital personnel and waste handler
• nosocomial infections in patients from poor infection control practices and poor waste management
• risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals • drugs which have been disposed of being repacked and sold off to unsuspecting buyers • Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash.
He also went on to mention the steps in Bio medical waste Management Process to include; Step1: Waste generation Step2: Waste Segregation Step 3: Collection Point Step 4: Storage Step 5: Internal Transport Step 6: External Storage Step7: Transportation Step8: Treatment Step9: Disposal
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- Mr. Jide Onayiga giving a presentation
He stressed the importance of compliance with the colour codes during waste segregation as this helps to ensure proper waste collection. He also pointed out risks associated with improper medical waste management to include; • On health: EBOLA Virus, AIDS, Hepatitis B and C, gastro enteric Infections, Respiratory infection and skin infection. • On environment: Pollution of underground Water, poor Aesthetics, Increased exposure to other risks and Public sensitivity. He mentioned that the Government, individuals/groups and healthcare facilities all have responsibilities towards strategies for bridging the gap that exists in medical waste management.
Session IV:
Patients & Families Responsibilities in Infection control - Dr. Bamidel Mutiu - Head of Medical Microbiology, LASUTH
Dr. Mutiu’s outline for this presentation is as follows: • Goals of Infection Prevention and Control • Infection Control Strategies • Chain of Infection Control Transmission • Standard Precautions • Preparation of different strengths of chlorine and methods of Cleaning • How droplets spread • Food Hygiene Dr. Mutiu stated that the goals of Infection Prevention and Control are to protect patients, staff, family, community and to prevent spread of diseases. He stated that infection control strategies involves breaking the 5 vital links of transmission; agent, source, mode of transmission, portal of entry to host and susceptible host. Factors contributing to transmission of an infection include:
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• Absence of appropriate information • Poor attention to hygiene • Overcrowding • Lack/ Poor use of PPEs • Lack of an effective infection control program • Absence of an Audit system • Ignorance
He mentioned that patients and families responsibilities in the prevention and control of infection include the application of standard precautions- hand hygiene and proper use of personal protective equipment. He further stressed the 5 steps of proper hand hygiene and steps in donning and removal of personal protective equipment. He also stated the appropriate concentration of chlorine that can be used in the cleaning of various surfaces or equipment. He mentioned the various ways in which aerosols spread and cause infection, the number of organisms expelled by the various ways. He also talked about droplet and airborne precautions.
- Dr Bamidele Mutiu presenting his paper
Dr. Oluborode O. the Executive Manager of SQHN in her closing remark gave a vote of thanks on behalf of the Society and reminded participants of the need to practice all they have learnt in the course of the workshop. She also informed the Participants of the Society’s upcoming events for the year 2015.
Evaluation of Conference:
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Feedback from evaluation forms was extremely positive. Participants enjoyed the opportunity of being able to share and discuss practical issues with the facilitators.
The evaluation report was designed to identify: Reaction to Conference Change in participant conference Participants use of Knowledge Improvement Recommendation General Comments Conclusions
Effectiveness of workshop
WORKSHOP EFFECTIVENESS
100% 62 71 62 68 50 90%
80%
70%
60% Strongly Agree 50% Agree 50 Neutral 40% 38 38 30% 26 24 20%
10% 5 5 0%
KEY: Showing the complete questions to the Table; 1. The Training was well organized 2. Training was an effective use of my time 3. The training will help my group improve infection control 4. I will be able to immediately use what I learned
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5. I am confident that I can perform the tasks that I was trained on.
Effect of workshop on Participant Confidence
% High Confidence Before & After the Workshop
My ability to segregate medical waste appropriately
My ability to start an infection control programme In a hospital Before Training My understanding of After Training patients & family responsibilities In Infection…
My understanding of Antimicrobial Stewardship Programme
0% 20% 40% 60% 80% 100%
Keys: Showing the complete questions to the Table; 1. My understanding of Antimicrobial Stewardship programme 2. My understanding of patients and family responsibilities in infection control in hospital 3. My ability to start an infection control programme in a hospital 4. My ability to segregate medical waste appropriately
What are your next steps in implementing what you have learned in the next 6 months? The below responses was received from participants; . I will pass all I have learnt to my colleagues . To draw up a guideline . Create leaflets and posters demonstrating best infection control practices . To be a role model to my colleagues and everyone around me . I will maintain and sustain good practice . Protection of self and others around me . I will ensure proper practice of infection control . To make sure medical waste is handled and segregated appropriately . To use the right antimicrobial at the right time . Hold regular staff meetings to help drive home the essences of all I have learnt . I will ensure that implementation and documentation is Key . To intensify efforts on IPC 3 waste management . Increase the awareness about ICP amongst colleagues
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What could make this training more effective? The collated responses from Participants are; . Keeping to time . Extend the workshop to other medical professionals . Getting this information to everyone grassroots inclusive . Creating more awareness for more people to attend . Reach out to more medical staff . Time management . Use of practical material when necessary . Get more stakeholders involved to make the programme more impactful . Make the training materials available for easy training of workforce . Create more publicity . Getting the information down to practitioners in the private and public settings . Organize the workshops more often and expand its reach to other states in Nigeria . Holding the workshops in a more centralized location . Nurses should also receive MCPDP too
Comments:
Other comments include; . It was a well-organized programme it is a shame that it’s a one day event . The workshop was very educative . Organize more workshops especially for public hospitals . Workshop was very impactful . Had a wonderful time and looking forward to the next workshop already . Programme was well organized and the facilitators performed really well
CONCLUSION:
Based on the findings, contained in the evaluation report, participants indicated that the workshop had achieved the intended objectives. Participants also reported; - a significant improvement in their overall knowledge/confidence after the training - also the vast majority reported being happy with the program in general
The workshop was a great success with 97% of expected attendance despite the busy traffic and political uncertainty experienced in the country as at that time. Even with the non-availability of two of the major Speakers. The situation was well managed.
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Recommendations:
Ideas Department In Charge
MCPDP points for Nurses and other necessary Board Approval health practitioners Creating more Awareness to other states and down Marketing Team to the grass root
More Pictures:
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