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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

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
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
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
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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