Implementation of the Infection Risk Scan (IRIS) in nine hospitals in the Belgian-Dutch border region (i-4-1-Health project)
Authors: Verelst Martine , Willemsen Ina , Weterings Veronica , De Waegemaeker Pascal , Leroux-Roels Isabelle , Nieuwkoop Ellen , Saegeman Veroniek , van Alphen Lieke , van Kleef-van Koeveringe Stefanie , Kluytmans-van den Bergh Marjolein , Kluytmans Jan , Schuermans Annette ,   the i-4-1-Health study group, van Alphen Lieke , van den Braak Nicole , Broucke Caroline , Buiting Anton , Coorevits Liselotte , Dequeker Sara , Dewulf Jeroen , Dhaeze Wouter , Diederen Bram , Ewalts Helen , Goossens Herman , Gyssens Inge , den Heijer Casper , Hoebe Christian , Jamin Casper , Jansingh Patricia , Kluytmans Jan , Kluytmans-van den Bergh Marjolein , van Kleef-van Koeveringe Stefanie , De Koster Sien , Lammens Christine , Leroux-Roels Isabel , Masson Hanna , Nieuwkoop Ellen , Van Oosten Anita , Selva Natascha Perales , Postma Merel , Raven Stijn , Saegeman Veroniek , Savelkoul Paul , Schuermans Annette , Sleeckx Nathalie , van der Slikke Krista , Stegeman Arjan , Tobias Tijs , Tolsma Paulien , Veenemans Jacobien , van der Vegt Dewi , Verelst Martine , Verhulst Carlo , De Waegemaeker Pascal , Weterings Veronica , Wijkmans Clementine , Willemse-Smits Patricia , Willemsen Ina 
Published: February 2022

Abstract
Background
A tool, the Infection Risk Scan has been developed to measure the quality of infection control and antimicrobial use. This tool measures various patient-, ward- and care-related variables in a standardized way. We describe the implementation of this tool in nine hospitals in the Dutch/Belgian border area and the obtained results.

Methods
The IRIS consists of a set of objective and reproducible measurements: patient comorbidities, (appropriate) use of indwelling medical devices, (appropriate) use of antimicrobial therapy, rectal carriage of Extended-spectrum beta-lactamase producing Enterobacterales and their clonal relatedness, environmental contamination, hand hygiene performance, personal hygiene of health care workers and presence of infection prevention preconditions. The Infection Risk Scan was implemented by an expert team. In each setting, local infection control practitioners were trained to achieve a standardized implementation of the tool and an unambiguous assessment of data.

Results
The IRIS was implemented in 34 wards in six Dutch and three Belgian hospitals. The tool provided ward specific results and revealed differences between wards and countries. There were significant differences in the prevalence of ESBL-E carriage between countries (Belgium: 15% versus The Netherlands: 9.6%), environmental contamination (median adenosine triphosphate (ATP) level Belgium: 431 versus median ATP level The Netherlands: 793) and calculated hand hygiene actions based on alcohol based handrub consumption (Belgium: 12.5/day versus The Netherlands: 6.3/day) were found.

Conclusion
The Infection risk Scan was successfully implemented in multiple hospitals in a large cross-border project and provided data that made the quality of infection control and antimicrobial use more transparent. The observed differences provide potential targets for improvement of the quality of care.