1. Improving Infection Control Practices in the Philippines Through a Multicenter Collaborative Evidence-Based Quality Improvement Program
Marissa M. Alejandria, MD For the
Philippine Quality Improvement-Infection Control (QI-IC) Study Group

2. Problem Statement
Uptake of evidence based infection control and antibiotic prophylaxis guidelines into routine medical practice continues to be a challenge.
Poor adherence to infection control practices and irrational antibiotic use promotes antimicrobial resistance, increases morbidity and costs of health care.
Several implementation strategies of varying effectiveness have been tested.

3. Philippine Scenario
CPG development by professional societies is a frequent activity
Dissemination and implementation activities are not structured

4. Objective
To test the effectiveness of the rapid quality improvement model as a strategy in improving the implementation of priority infection control practices

5. Methods

6. Model for Improvement Act Plan Study Do Define the goal
Analyze the system
Rapid-cycle small scale
tests of changes in the
system
* Langley GJ, Nolan KM, Nolan TW. The foundation of improvement. API Publishing, 1992.

7. Process indicators improved from baseline in all five hospitals
QI Intervention
Process Indicator
Baseline
6th Mo A
public
Teaching
improve hand hygiene
in the MICU
% adherence to hand hygiene 7%
67% B
private teaching
in the ICU
% adherence to hand hygiene
25%
71% C
Provincial
reduce unnecessary use of urine catheters
% inappropriate urine catheter use
32%
15% D
urban private
optimize antibiotic prophylaxis for elective cesarean section
% adherence to appropriate abx prophylaxis 0%
100% E
public specialty
center
optimal timing of antibiotic prophylaxis for general surgery & urology procedures
% adherence to appropriate preoperative abx prophylaxis
28%
52%

8. Percent adherence to hand hygiene Lecture + Poster + Handrub
(Hospital A)
Clerks/Interns
Residents
Nurses
Health Care Worker
Baseline
Lecture
Lecture + Poster
Lecture + Poster + Handrub
Clerks/Interns
31.25
16.7
Residents
42.1 40
Nurses
6.8
36.7 56 67

9. Adherence to appropriate antibiotic prophylaxis for elective caesarian section
(Hospital D)
memo
to anes
CS pack/
admit forms
mailing/
distrbtn
percentage
feedback
to OB
memo
to OB N=

10. Overall adherence to proper timing of
preoperative antibiotic prophylaxis
(Hospital E)
Baseline
Intervention
Random Check
1. Meeting with surgeons
2. Hospital Order issued
3. Meeting with ICC
4. Streamlining of
process of antibiotic
administration
Feedback
Timing
Total

11. Lessons Learned Key enablers of success Evidence based interventions
Center specific strategies responsive to needs & resources
Committed team of infection control advocates
Hands on facilitation of the rapid QI cycle
Co ownership of project through involvement of relevant stakeholders
Immediate feedback

12. Implications
Rapid PDSA QI strategy is a potentially efficient method for analyzing the health care system and implementing process changes in the system particularly for resource-constrained settings.
Collaborative QI interventions can be used effectively to improve uptake of guidelines on rational antibiotic use and infection control.

13. Challenges Sustainability Institutionalization
Economic assessment of QI interventions
Association with patient outcomes
Continued networking and collaboration

14. Thank you! Let’s all enjoy working to make patient care more effective, efficient, safe and friendly!