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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 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

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  1. Infection Control Progress Report to the Trust Board Nizam Damani Clinical Director: Infection Prevention & Control 28th May 2009

  2. Priorities for Action Target(35% reduction)

  3. MRSA Bacteraemias

  4. MRSA bacteraemias in Southern Trust

  5. Southern Trust New cases of MRSA Jan 2008 –26th May 2009 5 5

  6. Southern Trust New cases of MSSA Jan 2008 –26th May 2009 6 6

  7. MSSA

  8. 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

  9. 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. 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

  11. 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

  12. Swine Flu

  13. Summary of the Trust Infection Interventions C difficle, MRSA & MSSA

  14. Antibiotic Stewardship

  15. Expenditure on Antibiotics Recurrent Saving of ~ 25,000 £ per month

  16. Expenditure on Medical & Surgical wards Impact of Antibiotic ward rounds in Medical wards

  17. 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

  18. Zero tolerance toCatheter-related Bloodstream Infections (CR-BSI

  19. 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

  20. 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

  21. SouthernTrustZero tolerance toCatheter-related Bloodstream Infections (CR-BSI) 21

  22. 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

  23. Southern Trust to Lead the development of Regional Guidelines on the Management of Central line infections in Paediatrics

  24. 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

  25. C difficile

  26. C difficile

  27. C difficile Source: CDSC May 2009

  28. 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

  29. RCAs Findings

  30. Six bedded bay

  31. Ward toilet

  32. Ward toilet

  33. Ward toilet www.tfihealthcare.com

  34. Side room with NOen-suite toilet Sluice Area Ward toilet

  35. Side room with en-suite toilet Spread of C.difficile spores is contained C.difficile spores

  36. C difficile disease transmission & impact on hospital & Community 4 3 2 1 Less than 1 to eliminate disease

  37. Southern Trust New cases of C diff Jan 2008 – 18th May 2009 37 37

  38. Run Chart Pre-intervention period 1st quarter Nov 08 – Jan 09 Post-intervention period 2nd quarter Feb – April 09

  39. 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

  40. RCA analysis: C difficile28th Oct – 31st March 09: n =74 Average length of stay : 6.5 weeks NHS average : 3 weeks

  41. 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

  42. 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

  43. Need data on individual ward compliance on all elements of the bundle

  44. 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

  45. Thank you

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