Infection prevention control annual report 2007 08 2008 09 update
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Infection Prevention & Control Annual Report 2007/08 (2008/09 update). Dr Patricia O’Neill Director of Infection Prevention & Control 25 th September 2008. Overview. Major change in our approach to Healthcare Associated Infections Huge investment of time and resource by all staff

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Infection Prevention & Control Annual Report 2007/08 (2008/09 update)

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Infection prevention control annual report 2007 08 2008 09 update

Infection Prevention & Control Annual Report 2007/08(2008/09 update)

Dr Patricia O’Neill

Director of Infection Prevention & Control

25th September 2008


Overview

Overview

  • Major change in our approach to Healthcare Associated Infections

  • Huge investment of time and resource by all staff

  • Working with partners in PCT and external experts

  • MRSA bacteraemia target was not achieved but 25% reduction on previous year’s figure

  • C difficile target was achieved

  • On target to achieve both in 2008/09


Change of approach to hcai

Change of approach to HCAI

  • Classic Style

  • Infection Control team responsible for HCAI

  • Seen as experts who advised on policy and gave education and sorted out problems

  • Importance of HCAI recognised by trust but lack of ownership at ward level

  • Surveillance and audit carried out by ICT but small number of audits and not empowered to make change happen

  • Emphasis was on dealing with problems ie CONTROL


New style

New Style

  • Emphasis on PREVENTION not Control

  • Identify risks and take action to prevent them

  • Ownership from “Board to Ward” – high profile

  • Responsibility for action now with Divisions not IPCT – monitored through clinical governance

  • Audits of hand hygiene and other interventions now done by ward staff and massively increased in number

  • IPC team still experts, writing policies and educating - but more time spent assessing risks and monitoring performance of others

  • Weekly multidisciplinary operational group

  • Monthly Infection Control Committee chaired by CEO


Mrsa bacteraemia 2007 08

MRSA Bacteraemia 2007/08

  • Target was to have no more than 23 cases

  • Challenging target

  • 60% reduction from 2003/04 baseline of 58

  • SaTH had 36 cases in 2007/08 so did not achieve target but 25% reduction on 06/07 (48 cases) and 14 were pre 48

  • Rate per 1000 bed days was 0.12 – national average

  • Average for large acute trusts in West Midlands 0.18

  • Of 19 trusts in West Midlands only 5 achieved MRSA target

  • Of these 4 were single specialty trusts


Mrsa bacteraemia 2007 081

MRSA Bacteraemia 2007/08


What have we done risk assessment

What have we done? – risk assessment


What have we done actions

What have we done? – actions

  • Strengthening of Root Cause Analysis on each case of MRSA bacteraemia, led by the clinical team involved

  • Focus on reducing MRSA bacteraemia in augmented care (ie ITU and the Renal Unit) – particularly intravenous line infections

  • Increased MRSA screening

  • Introduction of a cohort ward for isolation of patients with MRSA

  • Introduction of twice daily visual inspection of all intravenous line sites to monitor for development of phlebitis

  • Expansion of “High Impact Intervention” audits so that all wards are auditing their insertion and care of intravenous lines

  • Introduction of a Care Pathway for patients with MRSA

  • Increased Hand Hygiene audits


Mrsa bacteraemia 2008 09

MRSA Bacteraemia 2008/09


C difficile 65 yrs shropshire health economy 2007 08

C difficile >65 yrs Shropshire Health Economy 2007/08


What have we done

What have we done?

  • Introduction of increased cleaning, including use of chlorine based disinfectants, the Deep Clean Programme and refurbishment of bathrooms, and purchase of new beds and commodes

  • Improved diagnosis with the introduction of rapid testing available 7 days a week

  • Tighter antibiotic control

  • Improved care of patients with C difficile with an updated management protocol and care pathway

  • Rapid isolation of patients with diarrhoea

  • Increase in hand hygiene audits and emphasis on the need to use soap and water, not hand gel, with C difficile


Hand hygiene

Hand Hygiene

  • Probably most important single step in preventing HCAI

  • Previously audited by IPC team

  • In June 2007 wards started to do their own audits

  • Number of “observations” increased from 10 to 1000 per month

  • By March 08 compliance was 88% - now 95%

  • Taking part in “cleanyourhands” and “It’s OK to ask”

  • “Bare below the elbows” introduced

  • Hand Hygiene education and road shows continue


High impact intervention audits

High Impact Intervention Audits

  • “Saving Lives” gives advice on key steps in prevention of infection for 7 common interventions, including intravenous line care, urethral catheter care, dialysis etc

  • Also contains tools so that staff can audit against the standard advice – High Impact Intervention Audits

  • In 2007/08 we rolled out use of these audits by ward staff concentrating on intravenous line audits

  • Helped pick up issues we were not aware of

  • Now extending programme to other audits


Insertion of central lines

Insertion of Central Lines


Environment

Environment

  • A Deep Clean of all wards and clinical areas ward carried out between November 2007 and March 2008

  • Refurbishment of bathrooms and purchase of new beds and commodes

  • Introduction of chlorine based products for disinfection of the environment for C difficile

  • New colour coding system for cleaning equipment introduced in line with new national standards

  • Roll out of ”Productive Ward” continued.

  • Additional DH monies for prevention of HCAI were bid against successfully to enable the funding of a Rapid Response Cleaning Team, steam cleaners, placement of additional hand wash basins and improved signage for hand gel stations


Environment inspections

Environment Inspections

  • PEAT – RSH and PRH awarded “Excellent” by NPSA in areas of Environment, Food, Privacy and Dignity

  • Health Care Commission Inspection Jan 08 – reported July

  • Management Green

  • Environment Amber

  • Isolation Green

  • Areas for improvement included need for upgrade of CSSD, cleaning checklists, care of linen, and documentation of training – now addressed


2008 09 icp programme

2008/09 ICP Programme

  • Sustainability is key

  • Review new implementations – streamline if possible

  • Further strengthen ICP team and management systems

  • Roll out other components of High Impact Intervention Audits

  • Repeat Deep Clean and continue refurbishment programme

  • Empower Modern Matrons to control cleanliness

  • Continue plan to commission new CSSD with other partners

  • Continue to work with PCTs


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