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
O er
ct
o
N be
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
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
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
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
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)
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
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.