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Infection Control Progress Report to the Trust Board. Nizam Damani Clinical Director: Infection Prevention & Control 28 th May 2009 . Priorities for Action Target (35% reduction). MRSA Bacteraemias . MRSA bacteraemias in Southern Trust .

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infection control progress report to the trust board

Infection Control Progress Report to the Trust Board

Nizam Damani

Clinical Director: Infection Prevention & Control

28th May 2009

10 point plan to control staph aureus infections
10 Point Plan to control Staph aureus infections
  • Hand hygiene

- Campaign started in Dec 08

- Compliance monitored

- Installation of hand wash basins

2. Cleaning & Decontamination of environment/equipment

- Compliance monitored

- Investment of > 400 k to improve clinical environment and achieve high standard of cleaning

- 155 commodes replaced

10 point plan to control staph aureus infections9
10 Point Plan to control Staph aureus infections

3. Device Related Infections

  • Central Venous Catheter Bundles
  • Peripheral IV Bundles
  • Urinary Catheter Care bundles

4. Blood cultures : Reduce contamination & ‘ false positive’

- Training of Junior doctors

- Introduce blood culture pack

- Competencybased training

- Audit of Blood culture contamination

5. Root Cause Analysis : MRSA & MSSA Bacteraemias

- Training completed on 23rd March and 24th April 09

10 point plan to control staph aureus infections mrsa
10 Point Plan to control Staph aureus infectionsMRSA
  • Antibiotic Stewardship
    • Prudent use : restricted use of Quinolones & 3rd generation Cephalosporins since Dec 2008
  • Screening of high risk individuals /units
    • ICU, NNU, Orthopaedics & Vascular, Renal, known positive etc
    • Resource consequences if screening is extended to other groups of patients
10 point plan to control staph aureus infections mrsa11
10 Point Plan to control Staph aureus infectionsMRSA
  • Isolate patients in a side ward.

- If not available , carry out risk assessment

- Six bedded isolation unit is ready

  • Implement contact precautions for infected and colonized patients
  • Decolonize patient and give Vancomycin as surgical prophylaxis
expenditure on antibiotics
Expenditure on Antibiotics

Recurrent Saving of ~ 25,000 £ per month

expenditure on medical surgical wards
Expenditure on Medical & Surgical wards

Impact of Antibiotic

ward rounds in Medical wards

antibiotic s tewardship
Antibiotic Stewardship
  • Feedback to individual consultants on compliance and antibiotic ward rounds
  • Extend Antibiotic ward round to other Medical & Surgical wards
    • Resource issues: medical, microbiologists & pharmacist
  • Audits of surgical prophylaxis
  • Engagement of General Practitioners antibiotic stewardship and use of Proton Pump Inhibitors
    • Training at three SALT seminars in October 2008
    • Meeting with the GPs Lead
  • Continuing Education of medical staff
zero tolerance to catheter related bloodstream infections cr bsi19
Zero tolerance toCatheter-related Bloodstream Infections (CR-BSI)

NNIS Benchmark : 3.3 infections per

1000 line days for CVC

Daisy Hill Hospital

No CR-BSI for past 19 months

19

19

19

southern trust zero tolerance to catheter related bloodstream infections cr bsi
SouthernTrustZero tolerance toCatheter-related Bloodstream Infections (CR-BSI)

NNIS Benchmark : 3.3 infections per

1000 line days for CVC

NO CR-BSI in Intensive Care Unit

for past 7 months

20

zero tolerance cr bsi
Zero tolerance CR–BSI

*CR-BSI costs £6,209 per patient :Dept. of Health NHS. Saving lives, 2007

** Soufir L et al . Infect Control Hosp. Epidemiol. 199; 20 (6): 296-401.11

slide23
Southern Trust to Lead the development of

Regional Guidelines on the

Management of Central line infections

in Paediatrics

iv peripheral line
IV: Peripheral Line

Training of Junior doctors in aseptic technique

Awareness training by dedicated member of ICT

Peripheral & Central Line Bundle

Training of the Infection Prevention and Control Link group on ‘IV Bundle’ and audit tool

Audit of peripheral line practices by ICT both pre and post training

Documentation: New dedicated documentation chart

Regional tender: Port-less cannula / pack for insertion

Standardise needle free systems

Introduced competency based training programme for all clinical staff

24

c difficile27
C difficile

Source: CDSC May 2009

slide28

Cohort ward open

Restrict unnecessary movement of patients

1st Dec 08

Hand hygiene Campaign

New antibiotic Guidelines Cephalosporins & Quinolones removed

RCA started

Improved compliance

HH, antibiotic, cleaning

10 point plan

June 2008

28

slide33

Ward toilet

www.tfihealthcare.com

side room with no en suite toilet
Side room with NOen-suite toilet

Sluice Area

Ward toilet

c difficile disease transmission impact on hospital community
C difficile disease transmission & impact on hospital & Community

4

3

2

1

Less than 1 to eliminate disease

run chart
Run Chart

Pre-intervention period

1st quarter Nov 08 – Jan 09

Post-intervention period

2nd quarter Feb – April 09

is it worth investing in prevention of healthcare associated infection
Is it worth investing in prevention of Healthcare Associated Infection ?

Cost saving : 62 x £ 4000 * = Total saving of £ 248,000 achieved

Cost saving : 62 x £ 8000 = Total saving of £ 496,000 ?

No. of bed days : 62 x 21* days = Total of1302 bed days released

No. of bed days : 62 x 47 days = Total of2914 bed days released

*Dept of Health, 2007

rca analysis c difficile 28th oct 31st march 09 n 74
RCA analysis: C difficile28th Oct – 31st March 09: n =74

Average length of stay : 6.5 weeks

NHS average : 3 weeks

findings of rcas on c difficile 1
Findings of RCAs on C difficile…1
  • Review all patients onProton Pump Inhibitors (PPIs)
    • Review started at DHH
  • History of bowel habits must be documented as part of routine medical history
  • Risk assess all patients with diarrhoea at A&E
  • Guidelines on sending specimen for C difficile for patients on laxatives and other agents which can cause diarrhoea
  • All confirmed C difficile infection patients must be isolated in side ward with en-suite toilet facilitieswithin 2 hrs
findings of rcas on c difficile 2
Findings of RCAs on C difficile…2
  • Symptomatic patients with previous history of C difficile infections must be admitted to a side ward with en-suitetoilet facilities
  • Inter & intra-hospital movement must be kept to absolute minimum
  • Patient flow issues
  • Communication to wards/ hospitals/ambulance /nursing home/GPs/CCDC/ services must be documented
  • All staff must be trained in RCA analysis
  • Trust wide forum to shared learning from RCA & MM
  • 30 days mortality: Agree process to review and document
challenge
Challenge

Sustainability !

‘ …it takes all the running …to stay at the same place.

If you want to get somewhere else, you must run at least twice as fast as that.

  • Lewis Carol
  • Through the looking Glass

44