Importance of Policies and Guidelines in Infection Control

1. Importance of Policies and Guidelines in Infection Control Dr Tamer Said Infection Control Specialist, IEIP, U.S. Naval Medical Research Unit No3(NAMRU-3), Cairo Egypt

2. Guidelines, Policies, and Procedures • Guidelines: any document that aims to streamline particular processes according to a set routine. By definition, following a guideline is never mandatory • Policies plan or course of action, intended to influence and determine decisions, actions, and other matters • SOPs detailed, written instructions to achieve uniformity of the performance of a specific function

3. Example : Driving and the traffic • Guidelines • Types of cars • Driving styles • Traffic law and policies • Right and wrong • Procedures • Go left and go right

4. International Guidelines • When national guidelines are missing or up-dated • International public health problem e.g. Pandemic • Should be adapted (not translated !!) • International organizations. • WHO , CDC, APIC • http://www.cdc.gov/ncidod/dhqp/guidelines.html • http://www.apic.org/AM/Template.cfm?Section=Practice • http://www.who.int/csr/resources/publications/ICHC_booklet_FINAL.pdf

5. National Guidelines • Important core component of national IC program • Form reference for all local policies and procedures at the facility level • National IC organization supported by the government • Develop (adapt) national guidelines • Official documentations

6. Guidelines to develop IC Guidelines • Identify topic • Form task force group (local and international experts) to search scientific resources, assess local data and write 1st draft • IC professionals , Microbiologists, ID specialists • Clinical staff (Doctors, nurses, Surgeons) • Discuss 1st draft among national IC steering committee • Distribute 2nd draft to select users (pilot) • Modify according to feedback and international review • Implement definitive version • Revaluate (up-date) after 3 years or with any major need

7. National Guidelines of Infection Control : Egypt Experience • Review of existing guidelines • Group of local and international experts • Development of draft • Review of the draft (Local and International) • Consensus workshop • Development of final draft • Review at CDC • Final form review and translation • Distribution of 1st edition 2004 • 2nd Edition 2008 http://www.drguide.mohp.gov.eg/NewSite/E-Learning/InfectionControl/infctrl.asp

8. Contributors • Task force group (local and international experts) • MOHP – NICU Egypt (coordination) • Faculties of medicine and nursing, Egyptian medical syndicate • Many international contributors • CDC, APIC, IFIC, CIC • NAMRU – 3

9. Basic set of IC guidelines • Standard precautions • Hand Hygiene • Instrument reprocessing • Prevention and management of sharp injuries • Early detection of disease and isolation precautions • Patient placement and environmental sanitation • Use of PPE • Aseptic techniques • Tailored according to national scope of practice • Waste management Infection Prevention and Control in Health Care Informal Network ,Report of the Second Meeting, June 2008

10. Formulationof Policies and Procedures

11. What is a policy? • A policy is a broad statement that guides action toward a goal. • Policies define general principles that are to be followed. Many different actions can be taken as long as the principles are respected • It is written to help define what we are trying to accomplish. • Written to be applicable for many unforeseen situations.

12. What is a procedure or work instruction? • Specific steps to take that should be followed exactly without deviation • They describe how, who, when the policy is operationally put into action.

13. Example : hand washing policy and procedure • Policy: before entering the NICU, staff will do an antiseptic hand wash to remove endogenous and exogenous germs • Procedure: before entering the NICU, at the beginning of the shift, staff will remove jewelry, roll up sleeves and wash hands with soap and water and dry them. Then use 1.5 ml of 62% alcohol antiseptic for hands and rub until dry. ETC

14. Example : PPE policy and procedure • POLICY: Staff will use and have access to personal protective equipment that prevents contamination of person and clothing, exposure to harmful chemicals, body fluids, and infectious agents including respiratory pathogens. • PROCEDURE : Janitors will wear protective rubber boots, gloves, hospital uniform. Goggles and aprons are available when washing floors

15. Is this a policy or a procedure? • Wear a personal respirator inside a TB patient’s isolation room. • Staff shall wear masks to protect themselves when patients may have infectious respiratory pathogens, and during cough inducing procedures.

16. Policies and procedures work together to communicate standards • The procedures are simple steps to take that workers can use for 90% of the circumstances. (Stepping stones) • Policies help guide actions when the exact steps do not apply. (Handrails outlining a path) A policy says “go East” The procedure says “turn left, then right then left”

17. Why does the hospital need policies and procedures? • To communicate exactly what is expected to all staff • To standardize care to use practices known to be effective • To help answer questions when supervisors are not around • To help orient new staff to facility-specific practices • To avoid degradation of practices from safe to unsafe • To look good!!

18. Who formulates policies • IC policies are usually formulated by the IC Team on behalf of management • Clinical staff and specialists are consulted • Verified by the IC Committee • Goes to Top Management for verification • Comes back as an official policy

19. Policies and procedures Development Scheme of process • Study • related guidelines • Available local data Build a team Pick topic Disseminate Monitor compliance Revaluate • Accommodate to • Existing policies • Needs • Available resources Develop P & P Obtain approvals

20. How to formulate a policy • Revise reference guidelines • Find out what exists • Establish the aim of the policy • Establish the objectives • Look for current resources and how these can be applied • May need to carry out surveillance or research into that particular aspect.

21. Pitfalls !! • Adopting a policy from another country which has a different resource base to yours (Budget, culture, training) • Not enough local data or surveillance information to formulate a policy • Policy too complicated • Unclear procedures

22. Policies and Procedurescore content • Specific Title • Date written, date revised, date to be reviewed • To whom it applies • References, sample forms • Where to go for questions, comments, additional information • Who is the responsible department • Policy statement • Standard operating procedures

23. Writing policy • Write a draft • Consult with the users of the policy • Ask for their input • Find out what is currently happening • Discuss improvements with them • Rewrite the draft • Discuss with management • Finalise policy • Circulate for consultation • Get WRITTEN APPROVAL

24. Working policy • Set a date for when the policy will be put into place • Call a meeting and go through the policy with everyone • Ask for comment • Start training on the new policy • Monitor the outcome of the new policy • Difficulties in implementation • Provide support • Revise aspects that do not fit into the work pattern

25. Working policy (2) • Make sure a copy of the policy is available in each health working area or unit • Revise the policy after 12- 18 months • Document revisions and circulate. • Monitor policy

26. Update Policies and Procedures • Procedures need to be updated for changes in equipment, supplies, new diseases, when past procedures were unclear etc. • Try to answer the most common questions with the procedures. “Safe” “Appropriate” don’t answer questions. • Generally update policies and procedures every two years or when needed.

27. Summary • Find out what the policy is needed for? • Make sure there is enough evidence • Write a draft • Consult widely • Provide training • Send out a written document • Monitor compliance • Revise frequently.

28. Thank You