Infection Prevention and Control

1. Infection Prevention and Control Jo Lickiss Nurse Consultant Infection Prevention and Control

2. Health Care Associated Infections • Are infections that are acquired in hospitals or other health care settings as a result of healthcare interventions. There are a number of factors that can increase the risk of acquiring an infection, but high standards of infection prevention and control practice minimise the risk of occurrence. • Most are caused by the patients own micro-organisms • The widespread use of antibiotics to treat infection, particularly in hospitalised patients, encourages antibiotic-resistant micro-organisms to emerge.  These can cause infections that are more difficult to treat. • Caring for many patients together in hospitals provides opportunities for micro-organisms to spread between patients

3. What is MRSA Bacteraemia? • MRSA found in blood & grown in blood specimens • Reportable to the Department of Health • Annual Trajectories are set between Trust & PCTs • 2007 – 2008 BFW NHS Foundation Trust set at 26

4. Where we were - MRSA Bacteraemia • 2007/2008 MRSA Bacteraemia • Target of 26 • Performance 40

6. Where we are now • 2008/2009 MRSA Bacteraemia Target - 26 • April - 0 • May - 1 Pre 48hr • June - 1 Pre 48hr • July - 1 Acute Trust • August - 1 Acute Trust • September – 1 – Contaminant • October – 2 – Acute Trust • November – 1 Blackpool PCT • December - 0 Total = 8

8. Initiatives in place to reduce MRSA • MRSA universal screening elective and emergency • Decolonisation of known positive patients on admission • PCR Testing –Medical and Surgical Emergency admissions – 6 month trial – now adopted permanently • Reviewed MRSA policy • MRSA care pathway • Quarterly Audits – Compliance with MRSA Policy, Screening and Treatment • A positive MRSA B/C instigates a full inspection • Incident meeting with relevant Division – Senior Nursing and Medical involvement – Action Plan formulated • Lessons Learnt feedback

9. Clostridium Difficile • First identified in 1935 • 2004 mandatory surveillance was instigated for people over 65 with CDAD • 2007 all patients over the age of 2 with CDAD must be reported • Annual trajectory set between Acute Trust and PCTs

12. Clostridium Difficile Patients most at risk • Elderly patients • Prolonged hospital stay • Immuno-suppressed patients (increased susceptibility to infection) • Numerous courses of antibiotics – destroys normal gut bacteria – Clostridium Difficile can flourish • Poor diet or assisted feeding • Carried in the bowel of 3% of healthy people

13. Measures to reduce Clostridium Difficle • Whole Health Economy approach • Antibiotic prescribing in the community impacts on patients in the hospital and vice versa • Antibiotic formulary • 48 hour/5 day stop policy • Education and awareness • Emphasis on environmental and equipment cleaning • Close working relationship with the Domestic Service provider • Visiting other Trusts who have reduced their rates – Cohort Ward, changing cleaning product on the ward.

14. Initiatives in place to reduce all HCAI • Board to Ward engagement • Letter to all staff detailing commitment to Infection Prevention and Control and for individuals to sign and return to manager. • Mandatory Infection Prevention road shows • Organisational change in culture • Performance Management of Divisions in regards to Infection Rates and Hand hygiene compliance. • ‘Ban the Bug’ Campaign • Desktop caption “ 40 days since last Bacteraemia. Have you washed your hands”.

15. Initiatives in place to reduce HCAI (cont) • Quarterly Saving Lives Audits (DoH) • ANTT (Aseptic Non Touch Technique) project commenced April 2008 – over 900 staff trained – all disciplines • ‘Bare below the elbows’ (DoH) • Weekly Hand Hygiene Audits • Change of shape of catheter bags – landscape to portrait. • New Intravenous line insertion packs • Increase in the Infection Prevention and Control Team.

16. Infection Prevention and Control Team July 2008 • Nurse Consultant • Senior Clinical Nurse Specialist • Infection Prevention Nurse x 2 • Consultant Microbiologists x2 Now • New Infection Prevention Nurse • Audit and Surveillance Nurse • Information and Data Analyst Post Additionally • 4 New Pharmacists appointed

17. Conclusion • No one measure has succeeded in reducing Health Care Associated Infections in the Trust • There has been a change of culture across the Organisation which continues to be embedded • Each new measure introduced has had an impact and it would be difficult to pinpoint one individual measure as the main cause • Need to continue the work – this is not for the short term.