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

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

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!

SATH MRSA Bacteraemia against Profile 2006-07

60 50 40 30 20 10 0 Cases per month Cumulative cases Profile Apr 1 1 2.8

May 8 9 5.7

Jun 5 14 8.5

Jul 3 17 11.3

Aug 5 22 14.2

Sep 4 26 17 Oct 6 32 19.8

Nov 3 35 22.7

Dec 5 40 25.5

Jan 5 45 28.3

Feb 0 45 31.2

Mar 3 48 34 Cases per month Cumulative cases Profile

MRSA Bacteraemia Cases 07-08

25 20 15 10 5 0 Cases per month Cumulative total Profile Apr 3 3 1.9

May 4 7 3.8

Jun 6 13 5.8

Jul 1 14 7.7

Aug 2 16 9.6

Sep 2 18 11.5

Oct 3 21 13.4

Nov Dec 15.3

17.3

Jan Feb 19.2

21.1

Mar 23 Cases per month Cumulative total Profile

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

All line related bacteraemia – Renal Unit

9 6 5 8 7 4 3 2 1 0 Apr 06 May 06 Jun 06 Jul-06 Aug 06 Sep 06 Oct 06 Nov 06 Dec 06 Jan 07 Feb 07 Mar 07 Apr 07 May 07 Jun 07 Jul-07 Aug 07 Sep 07 Oct 07

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

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

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

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

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

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

C L I N I C A L R I S K A L E R T TO ALL CLINICAL STAFF Any patient with A history of MRSA in urine and has a Traumatic insertion/removal of urethral/supra pubic catheter or blocked catheter. 1. Start IV vancomycin (15mg/Kg bd) 2. Send a urine sample for cultures 3. Review with microbiology on receiving test result

Criteria for traumatic catheterization any one of the following o More than 2 attempts at catheterisation o Any instrumentation o o Haematuria

Brenda Maxton, Clinical Risk Advisor, Ext: - 1448 Chris Beacock Rod Warren July 2007

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

High Impact Interventions – Calendar

Month Week Date W/B

Peripheral intravenous cannula insertion Peripheral intravenous cannula ongoing care Urinary catheter insertion Urinary catheter ongoing care Central venous insertion Central venous ongoing care Renal dialysis insertion and ongoing care Care bundle to prevent surgical site infection Ventilation

October One Two Three

08/10/2007 15/10/2007 22/07/.07

November December Four

29/10/2007

One Two Three Four One Two

05/11/2007 12/11/2007 19/11/2007 26/11/2007 03/12/2007 10/12/2007

Three

17/12/2007 MAU 27 SAU PRH 23N TH PRH MEC 21 28 22S ORT ITU RSH ORT ICA PRH RSH A/E RSH 24 26U 4 A/E PRH H/N 11 22R ORT ITU PRH ORT ICA RSH Th RSH DayTh PRH Day Th RSH 6 Apley 10 26S ORT CCU RSH CCU PRH TH PRH ITU RSH 25/SAU 8 MAU 15 ORT THRSH 12/SAU Endoscopy 14 Gynae MEC 16 ORT THPRH Th PRH 28 ORT 23H CCU PRH PRH THRSH 21 9 Th RSH 14 24 26U ORT ORT SCBU CHEMO Rainbow 23N 27 SAU RSH 8 SCBU 2 Th PRH Th RSH DaythPRH ITU PRH

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

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!

Thank you

To staff at all levels in the organisation for their time and enthusiasm in moving this forward