Anne Bialachowski, Network, Coordinator for the Central
South Regional Infection Control Network
talks to members of the Quality Healthcare Network
about what they have to do to be successful on MRSA

Quality Healthcare Network's Question:
First Anne, let me thank you for taking the time to talk to our members
about MRSA. As the Central South Infection Control Network Coordinator,
one of the first RICNs to take root in 2004 out of funds from the
Ontario government to coordinate infection prevention and control
activities and promote standardization in health care facilities across
Ontario you’ve been working on MRSA for awhile. What do
organizations need to do to be successful on MRSA?

Anne Bialachowski's Answer:
You need to have the support of senior management. The organization has
to believe in its infection control program as a whole and fully support
their initiatives. The organization has to devote adequate resources to
infection prevention and control. In general, the organization has to
have a well-resourced infection control unit. And the organization has
to provide regular education to staff so that they can implement the
infection control best practice at the front line.

Question:
Is there one place you would lead people to get the basic information
they need for success?

Answer:
Yes. Absolutely. Your members can just go to www.pidac.ca and access the
Best Practices For Infection Prevention and Control of Resistant
Staphylococcus aureus and Enterococci document published by the
Provincial Infectious Diseases Advisory Committee (PIDAC).

I sit on PIDAC and one of the things we talked about was; before we tell
people what they have to do, we need to tell them what they have to have
in place before they can effectively implement best practices. There is
a summary of assumptions and general principles for Infection Prevention
and Control in the front of each of the best practice documents. The
Best Practices for Infection Prevention and Control Programs in Ontario
in All Health Care Settings that was recently released provides even
further detail.

As organizations move forward with the MRSA bundle it is critical that
patient safety and infection control work closely together.

There is sometimes a disconnect between these two groups in
organizations and they aren't always seen  as interlinked and they
really should be.

So I think its really important that first and foremost any patient
safety indicator intervention that you are talking about implementing
you need to be able to say that infection control and patient safety are
working together and there is a strong infection control program within
your organization.

People sometimes think of these things as just a group of interventions
and consider pieces here and there, but if you don’t have a complete
program you are not going to be able to sustain the measures you are
hoping to implement.

Question:
You say that there is sometimes a disconnect between patient safety and
infection control, do have any suggestions for organization struggling
to make this connection internally?

Answer:
You need to ensure that senior management, right from the CEO down,
values your infection and control program and that they interact with
infection control individuals on a regular basis and provide a forum for
them, whether its regular presentations for them at the board or other
senior management tables.

If your senior management really buys into your infection and control
program they will understand the importance of ensuring that patient
safety and infection prevention and control interventions are intimately
interwoven and they are not two separate sets of interventions. When
these teams work well together they can achieve tremendous success.

Question:
One of the recommendations in PIDACs best practice documents is to
provide regular education to staff, do you have any suggestions for
organizations?

Answer:
The education has be to be focused on the basics of hand hygiene,
routine practices, and additional precautions as well as including
information on cleaning and disinfection, proper use of personal
protective equipment. The MOHLTC has released a series of three core
competency training modules which can be used to train staff through
e-learning. More of these modules are expected in the near future. This
information should be provided during general orientation and as part of
annual reviews. To keep the learning interesting and fresh it is
important that organizations share their innovative ideas with each
other. One of my RICN colleagues for example recently developed a DVD
called" The Grand Prix of PPE". It is a fun teaching tool that we have
all adopted and are sharing with our stakeholders to use.

Again, I'd like to refer your members to the best practice document that
tells you exactly what should be included in an infection prevention and
control education program.

Question:
As part of the Ontario government’s plan to
create an unprecedented level of transparency in Ontario’s
hospitals, all hospitals will be required to publicly report on
Methicillin-resistant Staphylococcus aureus (MRSA) on Dec. 31, 2008. Do
you think public reporting is going to improve patient safety?

Answer:
I’m not sure that public reporting is going to improve patient
safety simply by organizations having to report, but I think there will
be some real benefits from it.

What we are already starting to see is that hospitals are now
reporting on a monthly basis. Those organizations where senior management
was not previously engaged and didn’t really understand what
infection, prevention and control did, are now much more aware and trying to
look at what their programs are doing and how to make them more
effective.

There is defiantly going to be some positive fall out from this. If
nothing else, it’s the attention to those programs that have been
working on patient safety initiatives for a very long time, like the
Ontario organizations that have been participating in surveillance
mechanisms before now, like the Canadian Nosocomial Infection
Surveillance Program. These programs have been woefully underfunded in
the past.

Question:
What do you say to people that ask, ‘why should we care about MRSA?’

Answer:
That’s a common question actually.

We are starting to see some really serious infections in countries where
they haven’t put internationally recognized measures in place to
control MRSA.

In Canada we have found that if you don’t put the attention up
front, there are some significant infections that the patients go on to
develop.

So it really does make a difference to do the measures that are in the
bundle; we know that they are making a difference.

One of the countries that really didn’t do a lot related to MRSA
for a very long time was the United States and they are now doing a
complete about face. They are starting to look at these measures with a
whole new set of eyes.

For years many states ignored the learnings that other countries had
found; that if you spend the money upfront to do things like admission
screening and isolating your colonized patients; it really does
pay off in the end in terms of the amount of transmission that you see
in your organization.

Question:
What other supports would you recommend for people in Ontario?

Answer:
Well, as I have mentioned, PIDAC is a great resource for organizations
getting started on this work and the best practice documents that they
have produced for MRSA and VRE are excellent resources.

The RICNs are also a great resource. We provide a lot of support with
questions that come into the network. We provide workshops, fact sheets
and a range of other tools. We’ve created a tool kit for long-term
care and antibiotic resistant organisms which includes a policy,
interactive games and teaching tools that the long-term care staff
responsible for infection prevention and control can use to teach other
staff in their facilities.

We do a lot of mentoring with infection control staff in all healthcare
sectors. We've developed an orientation package for infection
prevention and control staff in acute care and long-term care.

The Community and Hospital Infection Control Association-Canada (CHICA)
has chapters within the province of Ontario that regularly meet and they
are a great forum for sharing of information and understanding best
practice.

Question:
What’s your take home message for organizations in Ontario
working towards a successful MRSA prevention and control program.

Answer:
Begin first with ensuring that you have a strong infection prevention and
control program and then embrace the bundle philosophy of taking a
approach. Include representatives from departments across the
impacted by MRSA interventions. Your  program needs to include expert
infection prevention and control staff, the resources to support the work
of these staff and the bundle team and an organizational culture that values
patient safety and infection prevention and control.

When these things are in place you can take a systematic approach to
patient safety. Its not simply about one intervention or another, its
about building a strong foundation and the common interventions in each
of the bundles like surveillance or education can be considered a
pillar.

For more information about this interview please contact Tanya Flanagan
at tanya.flanagan@qhn.ca. Or contact Anne Bialachowski at bialach@HHSC.CA.