Transcript Document

Infection Prevention and
Control
Jo Lickiss Nurse Consultant
Infection Prevention and Control
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 microorganisms 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
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
Where we were - MRSA Bacteraemia

2007/2008 MRSA Bacteraemia
– Target of 26
– Performance 40
MRSA Bacteraemia 2007 - 2008
45
40
35
30
2007/8 Monthly Trajectory
25
Cases
2007 Monthly Performance
2007/8 CumulativeTrajectory
20
2007 Cumlative Performance
15
10
5
0
April
May
June
July
August
September
October
November
December
January
February
March
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
MRSA Bacteraemia 2008 - 2009
30
25
Target 2008
20
15
Cumulative Target 2008
10
Cumulative Performance
2008
5
pr
il
M
ay
Ju
ne
Ju
l
A y
ug
S
ep us
te t
m
b
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ct
o
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ov r
e
D mb
ec er
em
b
Ja e r
nu
a
Fe ry
br
ua
ry
M
ar
ch
0
A
Cases
Performance 2008
Month
Initiatives in place to reduce MRSA
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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
Clostridium Difficile
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First identified in 1935
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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
BLACKPOOL ACUTE TRUST CDI 2008 - 2009
300
250
BVH Monthly Performance
BVH MonthlyTarget
150
BVH Cumulative Target
BVH Cumulative Performance
100
50
0
Ap
ril
M
ay
Ju
ne
Ju
A u ly
Se gus
pt
em t
b
Oc er
to
No b er
ve
De mbe
r
ce
m
b
J a er
nu
Fe ar y
br
ua
ry
M
ar
ch
Cases
200
Date
GP/PRE-48HR CDI CASES 2008 - 2009
120
100
2008 Primary Care/Pre 48hr
80
60
PCare/Pre 48hr Cumulative
Target
40
PCare/Pre 48hr Cumulative
Performance
20
0
Ap
ril
M
ay
Ju
ne
Ju
A u ly
Se gu
s
pt
em t
b
Oc er
t
No o be
ve r
De mbe
ce
r
m
b
Ja e r
nu
Fe a ry
br
ua
ry
M
ar
ch
Cases
Primary Care/Pre-48hour target
Date
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
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.
Initiatives in place to reduce all HCAI
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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”.
Initiatives in place to reduce HCAI (cont)
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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.
Infection Prevention and Control Team
July 2008
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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
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.