Infection control is the mainstay of any healthcare facility. With the increasing number of Hospital Acquired Infections (HAI), it is imperative that every healthcare facility has impeccable infection control measures in place. Cleveland Clinic Abu Dhabi (CCAD) part of Mubadala's network of world-class healthcare facilities, is a multispecialty hospital in Al Maryah Island, known for providing a clean, safe and infection free environment for the patients, guests, visitors and the staff, thanks to their vigorous infection control programme.
The healthcare facility has won many awards including: the MEWAR Award 2018 in the category — Medical Waste Management Best Practice; Excellence in Care Award - Quality Week 2018 and the very recent MECHF Awards 2019 — in the category ‘Excellence in Infection Control in Healthcare’. We speak to Deepak Nair, Manager Environmental Services, Cleveland Clinic Abu Dhabi to understand the best practices followed in the hospital premises and their infection control programmes during the MECHF 2019 Awards ceremony. The facilities at CCAD combine state-of-the-art amenities and world-class service standards. The hospital is a 364 (expandable to 490) bed facility, with five clinical floors, three diagnostic and treatment levels, and 13 floors of critical and acute inpatient units. “Our infection prevention and control (IPC) programme is designed around five key measures which include: hand hygiene; prudent use of antimicrobial agents; isolation of infected patients and barrier precautions; decontamination of environment and decontamination of equipment and items,” says Deepak Nair.
An Infection Control Committee (ICC) is in place and jointly chaired by the Director of Infection Control and Infectious Disease Physician. The ICC has a multidisciplinary team that include, Infection Prevention Practitioners, Infectious Disease Physicians, Medical Microbiologists, Pharmacist, and Environmental Health & Safety officers to name a few. “The vision of ICC is to prevent avoidable infections and the goal is to prevent transmission of infections and reduce rates of HAI to minimum levels,” informs Nair.
A clean and hygienic environment that follows good infection control provides the right setting for good patient care practices. At CCAD, clinical and non-clinical areas are cleaned and disinfected at regular schedules depending on the risk categories that identify high, medium and low risks areas. All activities in housekeeping services are designed around infection control practices. Nair adds, “We have several structured training programmes for cleaning and disinfection which the entire staff (we call them caregivers) undergoes once they are on board. We also strictly adhere to all standards that are designed around infection control policies that are above and beyond minimum regulatory requirements. All cleaning and disinfection activities are undertaken by the trained Environmental Services’ (EVS) caregivers as well as regular inspections are undertaken by in-house EVS Supervisors who are trained and qualified on the infection control practices.”
The EVS has several Standard Operating Procedures (SOP) of cleaning for clinical and non-clinical areas. These SOP’s are reviewed by the infection control team and approved by the Chief Operating Officer. In high risk areas such as the Operating Room, ICU and ACU, specific SOP and cleaning programmes are implemented to ensure high quality of cleaning and disinfection is done before the next patient admission. For example, different SOP’s are available for OR between case, cycle and terminal cleaning, while in ACU & ICU, SOP’s are available for regular patient rooms and isolation discharge cleaning. EVS has been consistently delivering highquality services of cleaning and disinfecting the entire hospital which has led CCAD to become the number one in cleanliness and infection-free hospital in the UAE region, says Nair. “IPC independently conducts several audits to verify the integrity of housekeeping procedures and EVS has consistently scored above 96.24 per cent in IPC audits. One of the methods used by IPC to assess the cleanliness is fluorescent gel and black light method,” he further adds.
Another major operation apart from housekeeping is the laundry services. CCAD laundry follows Hospital Laundry Accreditation Council guidelines (HLAC) which is focused on infection control principles. The IPC team provides oversight to the laundry services at CCAD through consultation on best practice and regular audits of laundry services. Medical equipment cleaning services as well is bound by IPC that has developed several policies for cleaning and disinfecting different medical devices following IPC guidelines.
The hand hygiene programme
Apart from the above discussed procedures, the failure to perform appropriate hand hygiene could also lead to HAI and the spread of Multi Drug Resistance Organisms (MDRO) which has been recognised as a significant contributor to outbreaks. Therefore hand hygiene is at the vanguard of all the efforts for preventing HAI and is practiced to reduce patient morbidity and mortality from HAI. From the standpoint of spreading HAI, CCAD recognised that long and varnished nails are the areas of greatest contamination. Regardless of colour, nail varnish is prohibited for CCAD staff with direct patient contact or who work in areas where direct patient contact takes place. It is the responsibility of all CCAD caregivers to comply with strict hand hygiene practices. Hand hygiene compliance audits in each clinical area are undertaken weekly by local infection control champions.
The facility’s General Services department have structured a training programme which ensure caregiver competency to carry out day to day work. Refresher trainings and annual competency are also conducted and recorded. This programme is developed around regulatory standards such as JCI, DOH and OSHAD requirements. CCAD also has an electronic self-training module called LMS (Learning Management System) that push mandatory trainings to all clinical and non clinical caregivers for learning and conducting periodic evaluations. Participation, evaluations and passing is mandatory in these courses which talk about infection control in healthcare organisations, its control and prevention.
Besides, CCAD has also implemented a systematic, active on-going observation and documentation of the frequency of occurrence of HAI. This targeted, priority-directed and continuous surveillance includes the observation of events and/or conditions that increase or decrease the risk of HAI. “The Infection Prevention Practitioners are responsible for the collection, analysis and reporting of surveillance data to the appropriate Caregivers within CCAD. All safety surveillance is logged electronically using a sophisticated software called “RL solution”,” explains Nair.
No country, no health-care facility, even within the most advanced and sophisticated healthcare systems, can claim to be free of the problem of health care-associated infections. The need for having IPC programmes nationally and at the facility level is clearly reinforced within the WHO 100 Core Health Indicators list. CCAD has set a benchmark with their infection control programme in the region for others to follow.