title: Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS).
abstract: BACKGROUND
  We developed a standardised method to assess the quality of infection control in Dutch Nursing Home (NH), based on a cross-sectional survey that visualises the results. The method was called the Infection control RIsk Infection Scan (IRIS). We tested the applicability of this new tool in a multicentre surveillance executed June and July 2012.
  
  
  METHODS
  The IRIS includes two patient outcome-variables, i.e. the prevalence of healthcare associated infections (HAI) and rectal carriage of Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-E); two patient-related risk factors, i.e. use of medical devices, and antimicrobial therapy; and three ward-related risk factors, i.e. environmental contamination, availability of local guidelines, and shortcomings in infection prevention preconditions. Results were categorised as low-, intermediate- and high risk, presented in an easy-to-read graphic risk spider-plot. This plot was given as feedback to management and healthcare workers of the NH.
  
  
  RESULTS
  Large differences were found among most the variables in the different NH. Common shortcomings were the availability of infection control guidelines and the level of environmental cleaning. Most striking differences were observed in the prevalence of ESBL carriage, ranged from zero to 20.6% (p < 0.001).
  
  
  CONCLUSIONS
  The IRIS provided a rapid and easy to understand assessment of the infection control situation of the participating NH. The results can be used to improve the quality of infection control based on the specific needs of a NH but needs further validation in future studies. Repeated measurement can determine the effectiveness of the interventions. This makes the IRIS a useful tool for quality systems.
authors.affiliation: Laboratory for Microbiology and Infection Control, PO Box 90158, 4800 RK, Amphia Hospital, Breda, The Netherlands.
authors.forename: Ina
authors.initials: I
authors.lastname: Willemsen
authors.affiliation: Department for Infection Control and Microbiology, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Jolande
authors.initials: J
authors.lastname: Nelson-Melching
authors.affiliation: Laboratory for Microbiology and Infection Control, PO Box 90158, 4800 RK, Amphia Hospital, Breda, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hendriks
authors.affiliation: THEBE, Healthcare Organisation including Nursing Homes, Breda, The Netherlands.
authors.forename: Ans
authors.initials: A
authors.lastname: Mulders
authors.affiliation: THEBE, Healthcare Organisation including Nursing Homes, Breda, The Netherlands.
authors.forename: Sandrien
authors.initials: S
authors.lastname: Verhoeff
authors.affiliation: Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kluytmans-Vandenbergh
authors.affiliation: Laboratory for Microbiology and Infection Control, PO Box 90158, 4800 RK, Amphia Hospital, Breda, The Netherlands ; Department for Infection Control and Microbiology, St. Elisabeth Hospital, Tilburg, The Netherlands ; Department for Medical Microbiology and Infection control, VUmc Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Kluytmans
keywords: Antimicrobial resistance; Healthcare associated infections; Infection control; Nursing homes; Quality improvement; Surveillance