Application of a Novel PM Model to Assess the Risk of Clostridioides difficile Infections in Medical Facilities as a Tool for Improving the Quality of Health Services and the Safety of Patients.

Zofia Maria Kiersnowska,Michał Zawadzki,Michał Marczak,Aleksandra Sierocka,Michał Michałkiewicz,Ewelina Lemiech-Mirowska

doi:10.3390/ijerph19010441

Abstract

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient’s health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital’s technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient’s stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment.

Highlights

A medical facility’s risk management strategy applied in emergency situations usually proves to correct
Due to the fact that in the study we focused on nosocomial infections associated with the C. difficile bacterium occurring in individual hospital wards, in the final part of the analysis we took the following categories into particular consideration—Assessment of a given ward, Assessment of technical facilities, Assessment of organizational factors, Assessment of explicit factors resulting from direct contact with the patient, due to the fact that they have a notable impact on C. difficile infections in the first place after the admission of a hospitalized patient
WithWith the use Proposed Model (PM),of wePM, have shown shown the dynamics of the of spread of nosocomial infections can be controlled the that thethat dynamics of the spread nosocomial infections can be controlled and the and critical critical level of infections can be minimized by demonstrating events contributing or factors conlevel of infections can be minimized by demonstrating the eventsthe or factors to tributing to the occurrence of adverse events

Summary

Methods

The aspiration goal of the model consists of all elements originating from the main core of the diagram to the outside, i.e., the categories of issues which have an impact on the level of patient safety in accordance with the PM’s concept. These include categories such as: Assessment of technical facilities (hospital failure rate); Assessment of organizational factors; Assessment of overt factors resulting from direct contact with the patient; Assessment of a given department (factors: human, technical); Assessment of risk factors related to the patient’s condition upon admission to the unit (and during their stay in the hospital) that may have a negative impact on the safety of the patient, contact patients, staff and the entire hospital environment; and Assessment of hospital determinants which decrease of the safety level of a patient undergoing hospitalization

Results

Discussion

Conclusion