Czech Presidency conference « The microbial threat to patient safety in Europe » France OPTIMAL CONCEPT OF INFECTION CONTROL FOR PATIENT SAFETY IN HOSPITALS The French comitment Dr Valérie SALOMON Head of Department E2 “healthcare quality and safety in hospitals » Directorate for hospitalization and care organization Ministry of Health and Sport Ministry of health, France, Dr V Salomon
The case of nosocomial infections France The french context Nosocomial infections : hospital acquired, related to care proceedings A reducing frequency, already among the lowest in Europe Results showing that action is worth it How to improve quality through information on care procedures ? Ministry of health, France, Dr V Salomon
What are the objectives France � Prevention of nosocomial infections � Improvement of the quality of care procedures � Transparency and public disclosure � Building confidence Ministry of health, France, Dr V Salomon
A challenge turned into a national policy (1/3) France � A finely turned multilevel organisation : • public and private healthcare services, • local committees (ICCs - 1988), • infection control teams (ICT), [93%, n=2792, 2007] • program (surveillance, reporting, …) [96%] • follow-up annual reports, [99,5%] • users involved, • regional and interregional coordinating centres (1982) for expertise implementation and evaluation of the national policy • national : Ministry of Health (hospital and care organization) � Implementation of the surveillance : INVS (French institute for public health surveillance) [61%] Ministry of health, France, Dr V Salomon
A challenge turned into a national policy (2/3) France � Reporting procedures (alert and actions) [94%], INVS (French institute for public health surveillance) [80/month] � Evaluation procedures • accreditation agency (French national authority for health - HAS) • national policy for internal quality control : practice audits [81%] • public reporting (performance measures on infection prevention : a board of 5 indicators) � National inspection plans on sanitary safety Ministry of health, France, Dr V Salomon
A challenge turned into a national policy (3/3) France � Budgets implemented � Definition of national reference standards (100 recommendations - 1999) � Ensuring adequate training for every kind of health professionals [332630 pers, 1 million hours, n=2792, 2007] � Patient’s rights enforced by law (2002) : information and indemnities in case of medical accident � Sharing the information and the targets with the public (information leaflet of every healthcare structure, board of indicators, « hand washing day », etc.) � A specific mission for the Mediator of the Fench Republic : dealing with claims about patient ’s rights, quality and safety of healthcare services (2009) Ministry of health, France, Dr V Salomon
A national programm (2005-2008) France For every target, involving every relevant level and healthcare actor, with quantified objectives Board of indicators ( objective : improve healthcare procedures and inform the public on results) 1. Adapt structures to promote the most effective organisation to reduce nosocomial infections 2. Improve healthcare procedures and practices 3. Optimize collecting and using the data issued from the surveillance and alert system 4. Optimize information of, and communication with patient on healthcare related infection risk 5. Promote research on mechanisms, impact, prevention and public awareness Ministry of health, France, Dr V Salomon
Performance measure available for everyone (board of indicators) France March 2003 Why did we start by nosocomial infections data ? � A public demand / handled by national health authorities � A multilevel organization � An information system ready to use � Experts available � A national programm (transparency, practices improvement and quantified objectives) � Control of collected data � Testing before implementing � Structures meant to support the healthcare services in their improvement process 2006 February, « I CALI N » feedback for 2832 health services Ministry of health, France, Dr V Salomon
A composite index for a nosocomial infections reductions goal France Indicators on processes, ressources and activities : ICALIN Measures the comitment of the healthcare services : � Which organization ? � Which ressources ? � Which actions put up ? to prevent nosocomial infections � A set of 34 weighted items (OMA), an annual report, electronic data collection from year 2000 on, automatic calculation of the score A top score of 100 � marked out in 7 « classes » (from top « A » to down « F ») � with regard to the type of healthservice (size, activity, public or private status, etc.) Ministry of health, France, Dr V Salomon
Communication France � Organized feedback to the healthcare services � Annual press conference hold by the Ministry of health � Front page of the Ministry website : www.sante.gouv.fr Results available through a cartography and search engine � Various headings Your questions - our answers National results Technical information about how the score is calculated The annual agenda � A dedicated « hotline » telephone Ministry of health, France, Dr V Salomon
Ministry of health, France, Dr V Salomon France www.icalin.sante.gouv.fr 6 février 2006
Ministry of health, France, Dr V Salomon France www.icalin.sante.gouv.fr 6 février 2006
Ministry of health, France, Dr V Salomon France www.icalin.sante.gouv.fr 21 janvier 2009
Results France � Improving results / Evolution d'ICALIN entre 2004 et 2007 Nearly 100% 70% healthcare services 60% participating 50% 2004 40% � The board of 2005 2006 30% indicators has 2007 20% become a 10% successful 0% F E D C B A management tool / Used all along the Classe de performance Année contract line (local, F E D C B A 2004 11,8% 5,5% 13,2% 34,8% 23,1% 11,6% regional, national 2005 2,4% 2,8% 6,5% 24,6% 31,1% 32,5% 2006 0,9% 1,0% 3,1% 14,3% 24,6% 56,1% levels) 2007 0,5% 1,1% 2,0% 10,6% 18,3% 67,5% � Reduction of Ministry of health, France, Dr V Salomon nosocomial infections
How to impulse and achieve more ? France • A new national programm 2009-2012 : � with 2 new orientations : – promote a shared culture for quality and safety – foculs on anticipation and detection of emerging pathogen agents with epidemic potential � performance indicators to be reached by 2012, aiming at : • 25% reduction in incidence rate of central line associated bloodstream infections per 1000 device days in intensvie care unit • 25% reduction in incidence rate of surgical site infection per 100 surgical act • 25% reduction in incidence rate of blood and body fluids exposures per 100 beds • 25% reduction in incidence rate of MRSA infections per 1,000 pds • Proportion of Glycopeptide-resistant enterococci stays below 1% � ressources and process indicators to be reached, among which : • use of bundles for invasive devices (central line catheter, urinary tract catheter, surgical act…) • antiobiotherapy or vaccination…. Ministry of health, France, Dr V Salomon
Conclusion France • Make sure the objective is known and understood • Learn to share the information • Launch a dialogue between care users and professionals on sturdy and concrete facts → To achieve effective improvement in quality and safety for the patients Thank you for your attention Ministry of health, France, Dr V Salomon
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