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

1. Infection Prevention & Control Annual Report 2007/08(2008/09 update) Dr Patricia O’Neill Director of Infection Prevention & Control 25th September 2008

2. 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

3. 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

4. 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

5. 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

6. MRSA Bacteraemia 2007/08

7. What have we done? – risk assessment

9. 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

10. MRSA Bacteraemia 2008/09

11. C difficile >65 yrs Shropshire Health Economy 2007/08

12. 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

14. 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

16. 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

17. Insertion of Central Lines

18. 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

19. 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

20. 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