The Art of Infection Prevention

& Control Audit

TRAIN THE TRAINERS ON INFECTION PREVENTION & CONTROL Workshop

24th-28th Jan 2020
Kabul, Afghanistan
 Outline
• Demonstrate the role of IPC team in conducting audit on IPC
practices

• Understand Practical IPC audit tools to assess implementation of

IPC programme and practices

• Explain simple KPIs to monitor IPC practices

• Know how to write an IPC audit report

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 Activity

• In your group, discuss the following questions :

1. What is the meaning of IPC auditing?

2. Why monitoring and auditing is one of the pillars of IPC

programme?

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 IPC Monitoring: Definition &
Aim
Monitoring is a process through which we track IPC activities in order
to:
• Ensure that practices of IPC are conducted in accordance with underlying guidelines
• To assess to what extent the IPC practices are implemented
• To provide a basis for re-planning
• Help minimize infections risk
• Engaging stakeholders
• Provides feedback

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 Who is Responsible For Monitoring of IPC practices?
• The success of the IPC monitoring program depends significantly
upon the selection of the right people
• Internal IPC audit is one of the core responsibility of IPC team in
health facility
• Criteria of a good IPC auditor
• Expert knowledge in IPC
• Good Communication and Interpersonal Skills
• Interviewing Skills
• Listen attentively
• Analytical Skills (analyze information and report results)
• Training and Experience
• Ability to think inside and outside the box
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 Who is Responsible For Monitoring of IPC practices?
• The success of the IPC monitoring program depends significantly
upon the selection of the right people
• Internal IPC audit is one of the core responsibility of IPC team in
health facility
• Criteria of a good IPC auditor
• Expert knowledge in IPC
• Good Communication and Interpersonal Skills
• Interviewing Skills
• Listen attentively
• Analytical Skills (analyze information and report results)
• Training and Experience
• Ability to think inside and outside the box
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Process of Monitoring and Audit of IPC Practices

A. Before conducting IPC audit

B. During conducting IPC audit

C. After completing the IPC audit round

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 A. Before Conducting IPC Audit
 Determine:
1. the department or departments
2. the activities which will be monitored
3. the problem according to it’s importance and urgency to improve it
4. the staff who will monitor, the responsibilities of each one
5. steps needed to do the work
6. a timetable and deadline

 Preparing an auditing tool for monitoring

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 Example areas to be monitored with process indicators
• Hand hygiene compliance (using the WHO hand hygiene observation tool or
equivalent)
• Percent of properly inserted intravascular catheter insertion and/or care
• Percent of proper wound dressing change
• Compliance to transmission-based precautions and isolation to prevent the
spread of MDROs
• Compliance to cleaning of the ward environment
• Compliance to disinfection and sterilization of medical equipment/instruments
• Consumption/usage of alcohol-based handrub or soap
• Compliance to waste management

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 Implementation manual and assessment
framework for the health facility level

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http://www.who.int/infection-prevention/tools/core-components/en/
 Examples of assessment tools

• The IPCAF is divided into 8 sections reflecting the

8 WHO IPC core components, which are then
addressed by a total of 81 indicators and have
been framed as questions with defined answers.
• Based on the overall score achieved in the eight
sections, the facility is assigned to one of four
levels of IPC promotion and practice
• http://www.who.int/infection-prevention/t
ools/core-components/en/ 11
www.who-ipc-survey.org
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 IPC health-care facility response
for COVID-19” monitoring tool

• The tool is designed for acute health-care

facilities (i.e. tertiary and secondary) but can be
modified for the use in long-term care facilities, to
identify, prioritize and address the gaps in IPC in
response to COVID-19
• Repeat assessments are recommended (i.e. once a
month), in order to correct actions and maintain
an adequate response to the COVID-19 outbreak.
• This tool does not replace IPCAF

https://apps.who.int/iris/rest/bitstreams/1313569/retrieve 17
Section example: IPC training & monitoring

• Each row contains three statements

related to targets for a specific response
facet. These three statements are
presented for each target, and describe
whether the facility meets the target (++
+, 3), partially meets the target (++, 2), or
does not meet the target (+, 1)
• Mark the points for each subsection in the
first line and add up the points at the end
of each section to assess overall
performance.

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 Interpretation of results
• Add up the points at the end of • At the end of the assessment, all items recorded as “No.”
each section to assess overall should be prioritized in the work plan below based on the
performance ease of addressing each gap, the availability of resources,
the impact of bridging the gap, and the local
epidemiological situation, along with a person(s)
responsible for implementing the activities with timeline

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Hand hygiene tools

• https://www.who.int/infection-prevention/tools/hand-hygiene/en/
• www.who-ipc-survey.org

•
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 IPC Practice assessment tools

• “Observation of Facility Practices Worksheet” recommended by Center for Disease Control and
Prevention (https://www.cms.gov/Medicare/Provider-Enrollment) can be used to assess IPC practices
• The tool is divided into four sections reflecting a total of 148 IPC practice standards. Each standard
was evaluated according to its presence or absence in addition to a column for technical comments

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 Tailoring of IPC monitoring checklists
• Checklist should focus on specific
procedure/s
• Checklist should include the
standards of infection control
practices
• Provide questions with clear answer
(yes/no) or clear quantity
• Provide sufficient space at each
question to Should be simple

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Process of Monitoring and Audit of IPC Practices

A. Before conducting IPC audit

B. During conducting IPC audit

C. After completing the IPC audit round

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B. During Conducting the IPC Audit
• Maintaining a low profile and staying
quiet throughout the observation
• Completing the relevant checklist as
possible
• Focusing only on the areas and
procedures determined before

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Process of Monitoring and Audit of IPC Practices
A. Before conducting IPC Monitoring

B. During the process of IPC monitoring

C. After completing the IPC audit round

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 B. After Completing the IPC Audit Round
• Provide the strengths as well as pointing out weaknesses
• Compare the actually done procedures against the guidelines
standards
• Decisions should be taken based on the used checklist
• If an employee has been monitored, give him the opportunity to
explain certain aspects of his/her performance
• Determine the departments that need improvement
• Determine the practices that need improvement
• Identify the employees requiring improving their skills

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 Reporting

Will include:
• The indicators of monitoring
• Any problems
• Actions taken or suggested to resolve
the problems
• Future plans

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 Reporting Flow
Director general of
the hospital

Head of the included

department

IPC
Committee
IPC Team
Feedback
Feedback refers to the comments on and reactions
to performance and work progress
• Why is feedback important?
– It raises awareness of strengths and weaknesses.
– It encourages further learning.
– It can strengthen relationships.
– It can motivate employees.

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Feedback.....cont.

• When we give feed back to staff?

 Immediate oral feedback
 Delayed written feedback

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Constructive Feedback
• Begins with the good points
• Is specific rather than general
• Directed towards something that the employee can
do something about.
• Offers alternative solutions to curable problems
• Is given in private without the presence of a third
party
• Considers available resources

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Remember that……
• Audits are not a quick look
• Audits are preventive, not detective
• Audits are planned, organized, and coordinated
• Audits are carried out for the benefit of the
company, not the auditor
• A single audit will not find all non-compliant practice
or potential problems
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References and resources, with web-links
• WHO Guidelines on Core Components of Infection Prevention and
Control programs, 2016. https://
www.who.int/infection-prevention/publications/cc_summary.pdf?ua=1
• WHO Interim Practical Manual Supporting Implementation of the WHO
Guidelines on Core Components of Infection Prevention and Control
programs, 2018.
http://www.who.int/infection-prevention/publications/core-
components/en
• WHO Guidelines Minimum Requirements for infection prevention and
control (IPC) programmes, 2019. https://
www.who.int/infection-prevention/publications/core-components/en

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THANK YOU