title: New approaches to infection prevention and control: implementing a risk-based model regionally.
abstract: Infectious disease outbreaks result in substantial inconvenience to patients and disruption of clinical activity.
  
  
  METHODS
  Between 1 April 2008 and 31 March 2009, the Vancouver Island Health Authority (Island Health) declared 16 outbreaks of Vancomycin Resistant Enterococci and Clostridium difficile in acute care facilities. As a result, infection prevention and control became one of Island Health's highest priorities.
  
  
  METHODS
  Quality improvement methodology, which promotes a culture of co-production between front-line staff, physicians and Infection Control Practitioners, was used to develop and test a bundle of changes in practices.
  
  
  METHODS
  A series of rapid Plan-Do-Study-Act cycles, specific to decreasing hospital-acquired infections, were undertaken by a community hospital, selected for its size, clinical specialty representation, and enthusiasm amongst staff and physicians for innovation and change. Positive results were incorporated into practice at the test site, and then introduced throughout the rest of the Health Authority.
  
  
  RESULTS
  The changes implemented as a result of this study have enabled better control of antibiotic resistant organisms and have minimized disruption to routine activity, as well as saving an estimated $6.5 million per annum. When outbreaks do occur, they are now controlled much more promptly, even in existing older facilities.
  
  
  CONCLUSIONS
  Through this process, we have changed our approach in Infection Prevention and Control (IPAC) from a rules-based approach to one that is risk-based, focusing attention on identifying and managing high-risk situations.
authors.affiliation: Medical Affairs & Research, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC V8R 1J8, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Wale
authors.affiliation: Department of Laboratory Medicine, Pathology, & Medical Genetics, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC V8R 1J8, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kibsey
authors.affiliation: Infection Prevention and Control, British Columbia Emergency Health Services, Provincial Health Services Authority, 700-1380 Burrard St, Vancouver, BC V6Z 2H3, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Young
authors.affiliation: Infection Prevention and Control, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC V8R 1J8, Canada.
authors.forename: Beverly
authors.initials: B
authors.lastname: Dobbyn
authors.affiliation: Engagement and Experience, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC V8R 1J8, Canada.
authors.forename: Jana
authors.initials: J
authors.lastname: Archer
mesh_terms: D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000517:prevention & control; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000458:organization & administration* / Q000592:standards; D055624:Methicillin-Resistant Staphylococcus aureus; D015279:Organizational Culture; D010343:Patient Admission / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D065507:Vancomycin-Resistant Enterococci
keywords: additional specialities and/or keywords; complications; disease categories; healthcare-associated infections; infectious disease; laboratory; patient safety; professions; quality improvement; quality management; risk management