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Infection Control Annual Report 2006/07 (2007/08 update)

Infection Control Annual Report 2006/07 (2007/08 update) . Tom Taylor Chief Executive 29 th November 2007. Healthcare Acquired Infections:- MRSA Clostridium Difficile ESBL E Coli Primary and Secondary Care challenge DoH Team invited to inspect by SaTH. DoH Team Visit January 07.

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Infection Control Annual Report 2006/07 (2007/08 update)

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  1. Infection Control Annual Report 2006/07(2007/08 update) Tom Taylor Chief Executive 29th November 2007

  2. Healthcare Acquired Infections:- • MRSA • Clostridium Difficile • ESBL E Coli • Primary and Secondary Care challenge • DoH Team invited to inspect by SaTH

  3. DoH Team Visit January 07 • Positive report on hospital cleanliness and high level support • but the team suggested we focus on: • Root Cause Analysis (RCA) • MRSA bacteraemias in augmented care • Lack of ownership of Infection Control at lower levels of the organisation • Infection Control Team seen as solely responsible for Infection Control • Understanding of roles and responsibilities • High Impact Interventions • Improved screening and antibiotic use

  4. Constraints • Trust undergoing structural reorganisation and turnaround - many key players only recently in post • Changes of Director of Infection Prevention and Control and Infection Control Staff • Dr Graham Harvey • Dr Rod Warren • Dr Patricia O’Neil • Vacancies/ resources in Infection Control Team • Also an opportunity!

  5. Positive Signs • Bacteraemias in augmented care. No cases in Renal Unit since January 07. No avoidable cases in ITU/HDU since June 2007 • Total bacteraemia figures are coming down over the last four months. Last three out of last five cases analysed were pre 48 hours • Since April 07 44% have been pre 48 hours

  6. All line related bacteraemia – Renal Unit

  7. What have we implemented - people • STICC now monthly – chaired by Chief Executive • Debbie Shaw/ Patricia O’Neil weekly meetings with key people • Roles and responsibilities defined – currently being embedded • Infection control being discussed at all levels from ward to Trust Board • Key staff in divisions trained in Root Cause Analysis (RCA) • Increased resource in Infection Control Team • Letter to all Consultants from CEO

  8. What have we implemented - communication • Monthly Infection Control Update issued to all staff (email, noticeboards etc.) • Infection Control messages feature in Team Brief every month (for oral cascade to all staff) • Infection Control messages being included in telepath results reporter (with all pathology test results) • Infection Control highlighted on the front page of the intranet • DH funding to be used to increase visibility and impact of infection control messages to staff, patients and visitors following forthcoming review of ward and hospital environment

  9. What have we implemented - performance • Infection control being monitored at all levels from ward to Trust Board • “Datapack” has been sent out for July and August • Pre 48 hour cases – protocol agreed with PCT • Pursuing cases transferred from other acute Trusts

  10. What have we implemented - processes • Bed management: • Cohort ward opened for mup R MRSA at PRH Oct 2007 • Screening and decolonisation will follow • RSH cohort ward to follow early 2008 • MRSA screening at RSH to be increased at that point

  11. What have we implemented - practices • Updated antibiotic policy is now on intranet • MRSA pre-operative and admission screening operational in PRH ahead of cohort ward opening in PRH - then RSH • MRSA screening in place in special units e.g. RU ITU • Increased decolonisation will follow • MRSA policy updated • Central line policy updated

  12. What have we implemented - practices • Hand hygiene audits now being carried out weekly by wards • High Impact Interventions – just getting started. Have concentrated on line care • RCAs – completed within 5 days and actions taken forward

  13. Future Developments • RSH cohort ward to follow early 2008 • MRSA screening at RSH to be increased at that point • Roll out of calendar of High Impact Intervention audits • Remove some antibiotics from ward stocks to improve compliance with policy • Antibiotic pharmacist to audit compliance with policy • “Short” antibiotic policy being developed • Embed infection control at all levels of the organisation • “Deep Clean” both hospitals by March 2008

  14. High Impact Interventions – Calendar

  15. DoH Monies • Increased hand wash basins and new commodes • Rapid Response cleaning teams • Rapid MRSA screening by PCR for ITU (with RJAH) • Medical staff for cohort wards • Antibiotic pharmacists • “Short” antibiotic policy • IT system development • Promotional material/signage • PCT increasing wound care nurses, continence care and essential steps

  16. What has been easy and difficult? • Easier • Targeting specific units for focused intervention • Engaging high level management • Harder • Changing culture of staff • Moving responsibility from ICT to local control • Continuing Risks • Still a long way to go • Loss of momentum • Failure to embed change • Don’t lose sight of other bugs!

  17. Thank you • To staff at all levels in the organisation for their time and enthusiasm in moving this forward

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