Developing and Implementing a Province-wide Infection Prevention and Control Surveillance Network: Barriers and Benefits

Background: In April 2008, health care service delivery in Alberta was amalgamated into one service called Alberta Health Services (AHS).  Access to health care is universal.  AHS serves a population of 3.63 million who are distributed in 5 zones across a geographic area of 661,848 km²  with 65% living in urban areas and 35% living in rural or remote areas. Nine regional Infection Prevention and Control (IPC) programs were moved into centralized surveillance model with about 130 infection control professionals (ICPs) and clerical support persons. 

Objective: To describe the barriers and benefits to developing and implementing a province-wide IPC surveillance network across all healthcare settings and to identify some of the solutions used to address the barriers. 

Methods: Survey all process and outcome surveillance activities; identify the definitions and data collection tools used; and assess the surveillance and technological expertise of the ICPs throughout the province.

Results: Hospital size varied from 25 beds in rural areas to 1000 beds in urban areas. The survey of surveillance activities identified that there was core set of surveillance programs for healthcare-acquired infections (HAIs) were found to be common to all nine of the former regional programs including surveillance for methicillin-resistant S. aureus, Clostridium difficile infection, and hospital-wide bacteremia. However, different surveillance definitions were being used.  Four (44%) of the 9 former IPC programs were using paper tools for data collection and had limited ability to generate a report on their surveillance.  Two (22%) additional regions used electronic data collection but had limited ability to extract and manipulate the data. ICPs in the rural and remote areas had little or no experience in developing and evaluating surveillance programs. Interventions developed to address these barriers includes: (1) starting a Data Quality Working Group with responsibility for developing a common understanding and interpretation of standardized surveillance definitions among ICPs, mentoring of inexperienced ICPs and establishing a data quality audit system; (2) province-wide IPC Surveillance Committee for IPC physicians and management with responsibility for priority-setting and oversight of the surveillance network; (3) identifying the technological barriers to data transfer including the security issues associated with the lack of a province-wide intranet; and (4) starting the process for developing centralized database management that will address local, zonal and provincial IPC issues and reporting.

Conclusions: A significant core set of common surveillance programs were identified that are the foundation for a province-wide surveillance network in Alberta. Technological and political barriers to developing the surveillance were identified that required multi-faceted interventions.