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Implications for the DTC
DTCs have the potential to manage formularies, improve the selection of medicines, identify medicine use problems, and implement strategies to improve the use of medicines. IC committees and programs assist in the control of infectious diseases and nosocomial infections within hospitals and primary care clinics. These two organizations can work together to significantly improve health care outcomes by controlling infectious diseases and ensuring appropriate medicine use at all levels. The synergy between the two committees can be dramatic in overall health care benefits, including significant cost savings.
• In cooperation with the ICC, implement the Infection Control Assessment Tool (ICAT) to understand current infection control practices. Where an ICC is not functioning, the DTC (through an Infection Control Subcommittee) can provide basic IC programs and advocate for developing a formal IC program within the hospital setting. Because the consequences of not having a committee are many but the benefits are well known, DTCs have every reason to start an IC program within the available resources of the health care setting. Adequate training in this field is critical, and DTC members are encouraged to obtain comprehensive education. The Internet has a number of websites for obtaining information and online training (see annex 1). For example, the U.S. Centers for Disease Control and Prevention (CDC) website (www.cdc.gov) provides lists of protocols, and the EngenderHealth (www.engenderhealth.org) has an online training program that can serve as instructional materials for basic IC techniques. Management Sciences for Health (MSH) has recently developed, through its Rational Pharmaceutical Management (RPM) Plus Program, a tool to assess IC practices and implement interventions to advance practices through a quality improvement (QI) mechanism. The ICAT and quality improvement program provides a standardized approach by combining an IC self-assessment tool (ICAT) and rapid cycle quality improvement (RCQI) (or rapid team problem solving) methods to improve hospital IC practices. RCQI is a quality improvement approach in which a multidisciplinary team collaborates on improving an identified situation. The team identifies and prioritizes areas that need improvement, agrees on specific goals for improvement, and uses QI (or problem solving) tools to analyze available data about existing systems. The team then develops, tests, and implements a series of focused and affordable changes that can be implemented locally in the system to improve the situation and achieve the agreed-upon goals. The strength of RCQI is in synergizing team ideas in learning about systems and developing appropriate solutions to improve them. The methodology has been applied in various health care settings around the world. This IC tool also provides resources for quality improvement activities and internationally recognized guidelines for infection control practices.
Infection control is a critical component in hospitals and primary health care clinics. Likewise, Infection Control Committees are important for both providing the policies and procedures and monitoring the activities of an active IC and prevention program. Many simple, inexpensive strategies can prevent infections. Ample evidence shows that Infection Control Committees and practices are cost- effective. Cost savings from a decreased rate of nosocomial infections will more than pay for IC activities. By focusing on IC and DTCs, health care systems can lay the foundation for more comprehensive quality improvement programs that will improve patient outcomes.
DTCs can support many IC activities, such as—
• Hand washing and the use of appropriate antiseptics and disinfectants
• Monitoring IV and injection preparation and administration
DTCs should actively promote better use of antimicrobials through the following—
• Guidelines for treatment and surgical prophylaxis
• Selection of appropriate antimicrobials for the formulary
• Antimicrobial use reviews
ICCs, when functioning effectively, will achieve the following—
• Reduce the spread of infectious diseases
• Decrease morbidity and mortality
• Maintain employee health and morale
• Decrease the incidence of AMR
• Decrease health care cost