Joint Commission International Accreditation

The Joint Commission International (JCI) is a U.S based accreditation body dedicated to improving healthcare quality and safety around the world. The accreditation is an international gold standard for hospitals.

The Apollo hospitals group achieved the unique distinction of achieving accreditation for its hospitals at Delhi, Chennai, Hyderabad, Ludhiana, Bangalore,  Kolkata and Dhaka. Indraprastha Apollo Hospitals, Delhi, became the first hospital in India, while Apollo Hospitals, Chennai, became the first hospital in South India to achieve this unique and coveted accreditation.

JCI works directly with healthcare organisations to achieve their goals of providing quality clinical care and services in safe, efficient and well-managed facilities.

JCI assesses through a rigorous on site survey process, a healthcare provider’s quality in the following key areas -

• Access to health care
• Health Assessment and care processes
• Education and rights of individuals
• Management of information and human resources
• Safety of facility
• Infection control
• Collaborative integrated management
• Facility management
• Performance Measurement
• Education & Rights of Patients

For more information on the JCI accreditation please log on to http://www.jointcommission.org/

NABH accreditation

National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programmes for healthcare organizations. The board is structured to cater to much desired needs of the consumers and to set benchmarks for progress of health industry. Apollo Speciality Hospitals ,Madurai and Apollo Speciality Hospitals Chennai were accredited by the NABH .

For more details on NABH , PLEASE CLICK ON http://www.qcin.org/nabh/

NABL Accreditation

Apollo Hospitals, Chennai WAS assessed & accredited in accordance with the Standard ISO 15189 : 2003 "Medical Laboratories - particular requirements for Quality & Competence" for its facilities in the field of Medical Testing.

ISO 9002

The International Organisation for Standardisation (ISO) is a network of the national standards institutes of 151 countries, on the basis of one member per country. A Central Secretariat based out of Geneva, Switzerland, co-ordinates the system.

Apollo Hospitals, Chennai was the first hospital in India to be awarded an ISO 9002 certification.

The ISO 9000 series is concerned with 'quality management'. It is a certification affirming the organization's ability to enhance customer satisfaction by meeting customer and applicable regulatory requirements and continually to improve its performance in this regard.

The ISO standards are a guarantee of quality across boundaries and geographies. They are an assurance to the international patient of the safety and reliability of Apollo's services against global benchmarks.

For more information on the ISO accreditation please log on to http://www.iso.org/iso/en/ISOOnline.frontpage

Superbrand

The Indian Consumer Superbrands Council includes some of the most eminent marketing, media and advertising professionals. As the council members agree, "Obtaining Superbrands' status puts the brand in the circle of an elite group that is seen to represent the best practices in brand management. Ultimately it can be likened to a brand oscar. Apollo Hospitals entered the 'Superbrand' category in 2004.

For more information on the ISO accreditation please log on to http://www.superbrandsindia.com/

Clinical excellence is a core requirement for successful performance of any healthcare organization. It cannot be emphasized enough that clinical excellence is probably the most vital and differentiating factor for people to choose their hospital.

Whatever is measured tends to improve. Keeping this in mind, ACE @ 25 - a balanced scorecard focusing on clinical excellence that addresses provision of evidence based quality care, a safe environment to our patients and strengthening the functional efficiency of our hospitals has been introduced across the Apollo Group.

Concept

ACE @ 25 is a clinical balanced scorecard focusing on clinical excellence, and incorporates parameters which are mission critical for the clinical milieu of our organization. This balanced score card focuses on providing evidence based quality care and a safe environment to our patients and strengthening the functional efficiency of our hospitals, stimulating quality improvement while reducing variations.

Methodology

For the purpose of ACE @ 25 reporting, the Group hospitals have been divided into three groups depending on their bed strengths, location and services offered as Group A, B and C. For each hospital, the scorecard consists of 2 sets of indicators. For Group A hospitals, each hospital reports 23 common parameters whereas 2 parameters are location specific depending upon the services offered by the organization .For Group B Hospitals, 13 parameters are common and 2 are location specific whereas for Group C hospitals, 8 are common and 2 are location specific. Each indicator has been lucidly defined and the numerators and the denominators have been clearly delineated. Benchmarking defines our Group expectations with weighted scores for the outcomes. The scoring system ensures that the segments measure up to a statistically significant range of figures which are further color coded as green, orange and red. The cumulative score achievable is capped at 100.

Architecture

The ACE @ 25 balanced score card has been developed online, with live capabilities using our Apollo Lighthouse platform for monthly inputs with relevant data, using the Dot Net architecture hosted out of a central server at one of our locations. The mechanism is so devised to maintain the integrity and confidentiality of data with respect to each of the Apollo Hospitals.

Few indicators are given below as examples:

Indicator	Benchmark	Range	Score
CABG mortality rate	0.60%	≤0.80	4
	Cleveland Clinic	0.81-1.2	3
		1.21-1.6	2
		1.61-2	1
		>2	0
Ventilator Associated Pneumonia (VAP)	4.16	≤4.16	5
	National Healthcare	4.17-4.99	4
	Safety Network	5.00-5.99	3
		6.00-6.99	2
		7.00-7.99	1
		>7.99	0

Implementation

Thirty two locations of the Apollo Hospitals Group are reporting data currently. Monthly summary of the performance is reviewed by the oversight committee and the individual locations draw action plans on improving scores in parameters scoring low. Trends in scores in individual parameters are identified quarterly; six monthly and annually to look for consistency in good or poor performance, identify improvement or decline and irregular fluctuations. Consistent low performance, decline or fluctuation in scores for any parameter becomes the focus area of the hospital and is aggressively worked upon for improvement.

Apollo Hospitals has had a robust infection control program for many years because we recognize that the control and prevention of infection in our patients and the staff who care for them , is an absolute moral commitment and responsibility. Therefore, each hospital in the Apollo Group has a comprehensive infection prevention and control program.

The Infection Control program covers policies on hand hygiene, occupational health, isolation, infectious diseases notification, clinical sample collection, environmental hygiene, antibiotic usage and infection prevention in practice settings and visitor areas. It also focuses on prevention of nosocomial infections especially ventilator associated infection, surgical site infections, UTI and Intravascular device related infections and also on control of communicable diseases by policies on patient care related activities.

The policies and guidelines laid down are evidence based on current scientific knowledge and recommendations from National and International societies and organizations.

The Infection Control program is supported by information management in relation to microbial surveillance and notifiable diseases. Guidelines for periodic audits are also provided so that evaluation and quality control is undertaken.

The overall aim of the Program is to guide doctors and health care workers on minimizing patients' infection risk and ensuring safety.

The salient features of the program are:

Standard or Universal Precautions to ensure safety of healthcare workers

Practice of Universal and Standard Precautions, are stringently followed. Orientation and teaching/training programs are carried out at the time of induction and on a regular basis for all employees on Standard Precautions and also on key Infection control norms such as Hand Hygiene practices . Our Staff health policy ensures that all staff is vaccinated or has immunity to Hepatitis B and Varicella. Screening and appropriate vaccination of food handlers is also done.

Hand Hygiene Initiative

Safe water supply in all patient care areas for hand washing and alcohol based hand rubs at all patient beds are ensured and vigilant observational audits are performed periodically to ensure high compliance to hand hygiene at patient care areas.

Use of Clinical practice guidelines and protocols

Guidelines are followed for usage and care of intravascular devices , catheters and in the usage of other such invasive devices. Care of equipment, linen disinfection, air conditioning for operating rooms and CCUs as well as management of blood spills and needle stick injuries is done according to International protocols. We also have an established waste management policy and lab safety program

Management of antibiotic resistance in microorganisms – the antibiotic stewardship program

With advent of newer antibiotics there has been a progressive rise in the incidence of antibiotic resistance. While antibiotic resistance is a worldwide phenomenon, the nature of antibiotic resistance varies widely from country to country. Even though this is an undesirable and inevitable trend, recognizing, curtailing and managing this is an important aspect of the Infection control program at Apollo Hospitals. We have been following an Antibiotic Stewardship program wherein antibiotic prescription, dosage and appropriateness are strictly monitored and rationalized and resistant organisms identified , tracked and followed up meticulously. We also have stringent guidelines on antibiotic use and procedures on monitoring antibiotic use, as well as protocols for isolation of those affected with such organisms.

Isolation protocols

Communicable disease identification and prevention of spread is outlined, and so are isolation protocols and procedures and barrier nursing.

Environmental sampling

Environmental monitoring of Operating rooms , Critical care units and other patient care areas is done through air sampling. Additionally, disinfection and sterilization processes are monitored, drinking water and dialysis water analysis is done and food safety standards and guidelines are laid down and followed.

Visitor Control

We have a visitation protocol and all visitors are alerted on infection control practices through guidelines written on visitor passes.

Tracking Infection control data

Each of the hospitals in the Apollo group tracks infection control parameters month after month and these are benchmarked with standards and variations and values are thoroughly analyzed. Periodically clinical studies on infection control, pathogens and other related areas are also carried out .All infection control parameters are tracked as part of the ACE 25 CLINICAL EXCELLENCE initiative of Apollo hospitals where key Quality parameters of each hospital in the Apollo group are entered on an Online Dashboard, scored and reviewed by the highest Leadership of the group each month.

The Team

The responsibility of Infection Control at the Apollo Hospitals falls into the hands of a Hospital Infection Control Committee (HICC), whose primary duty is formulating and implementing policies to effectively manage infection control issues and outbreaks of infection. The HICC comprises of senior leaders, physicians and administrators in the organization thereby emphasizing the highest importance that the organization places on Infection Control.

Every Apollo location also has an Infection control Team headed by the Senior consultant in Infectious diseases. The team consists of Infection control nurses and other key staff from various departments who play a pivotal role in implementing all aspects of the hospitals Infection Control program, drive all the Infection control initiatives , motivate and create awareness among the hospital staff by campaigns and special programs and sustain compliance.

Infection control is a critical and key initiative in every Apollo hospital and it not only helps us in meeting international norms in Infection control but also assures excellent world class clinical outcomes and exceptional patient safety and satisfaction.

Policies and Guidelines that are part of the Apollo Infection Control Program

• Patient Safety policy
• Antimicrobial policy guidelines
• Provision of resources for hand hygiene and practices and protocols related to it.
• Staff health and safety guidelines
• Disinfection and sterilization policy
• Surveillance activity for Catheter Related Blood Stream Infections(CR-BSI), Hospital associated pneumonia including Ventilator Associated Pneumonia (VAP) and indwelling catheter related Urinary Tract Infections (CR-UTI) and for Surgical Site Infections(SSI)
• Guidelines for monitoring of Disinfectants
• Protocol for Sterile Supply and CSSD including Bacteriological monitoring of Autoclaves, Ethylene Oxide etc.
• Protocol for Management of needle-stick injury, accidental inoculation and percutaneous mucus membrane exposure to blood and body fluid substances
• Screening guidelines for food handlers
• Bacteriological analysis of Drinking water
• Bacteriological analysis of Dialysis water
• Policy for the restricted antimicrobials and their usage
• Environmental Cleaning and disinfection guidelines
• Endoscopes and bronchoscopes - usage and care
• Indwelling medical device usage and care
• Management of spills of body fluids, blood and Microbiology cultures
• Guidelines Protocols for Linen and Laundry
• Dialysis protocols
• All relevant engineering processes including mechanical, HVAC of OT, ICU and other critical areas and patient and staff areas
• Food and Beverages' processes and hygienic kitchen management
• Protocols for Care of patients with communicable diseases
• Protocols for Care of bleeding patients
• Isolation policy and procedures and Barrier Nursing with special reference to multi drug resistant organisms and highly virulent organisms
• Management of Emerging community based communicable diseases and specific recommendation for cases of epidemics and disasters in the community
• Guidelines for Protection of immuno-suppressed and Immunocompromised patients
• Protocols for Provision and appropriate usage of personal protective equipment including gloves, gowns, masks, goggles/visors etc. in prevention and control of infections
• Guidelines for antimicrobial prophylaxis
• Waste management policy and procedures on discarding and disposal of hospital waste including sharps and needles
• Mortuary management guidelines and handling of cadavers
• Visitor's and attendant's protocols