1Healthscope, Melbourne, Australia.
Infection prevention is a critical part of an overarching quality and safety clinical governance system. However, as with all aspects of clinical governance, there is a dilemma about what exactly should be reported, monitored and improved. There are hundreds of potential clinical indicators and systems needing improvement, and varied opinions about which are the highest priority.
When selecting priorities, the following factors need to be considered:
- The consumer perspective
- The highest risks in a particular healthcare setting
- Requirements of funders, government & external stakeholders
- Industry standards
- Board/Executive preferences
- Available data collection systems
Obstacles to an optimally designed infection prevention program include prescriptive standards, accreditation, mandatory training and attention in areas that may not otherwise be a priority. We grapple with externally imposed indicators and targets by multiple jurisdictions with variable definitions and data collection methods for the same measure. Health services can spend inordinate amounts of time on external ideas of quality, rather than problems that are more locally relevant. The focus on aggregated measures of quality can result in oversimplification of infection prevention into one or two indicators reported publicly, or at Board or funder level.
Healthscope has selected Hospital Acquired Complication (HAC) rate as a core measure of clinical outcome. The HAC measure attempts to aggregate adverse outcomes across multiple areas, including healthcare associated infection. However this system also has some flaws:
- Reliance on coding and clinical documentation
- Inconsistency between infections recorded via coding, incident reporting and surveillance databases.
- Difficulty determining if infection condition onset was prior to or after admission
- Risk adjustment methodology is controversial
- Use of administrative data for clinical interpretation