Transcript Document

Infection Prevention & Control
Annual Report 2007/08
(2008/09 update)
Dr Patricia O’Neill
Director of Infection Prevention & Control
25th September 2008
Overview
• Major change in our approach to Healthcare
Associated Infections
• Huge investment of time and resource by all staff
• Working with partners in PCT and external
experts
• MRSA bacteraemia target was not achieved but
25% reduction on previous year’s figure
• C difficile target was achieved
• On target to achieve both in 2008/09
Change of approach to HCAI
Classic Style
Infection Control team responsible for HCAI
Seen as experts who advised on policy and gave
education and sorted out problems
Importance of HCAI recognised by trust but lack of
ownership at ward level
Surveillance and audit carried out by ICT but small
number of audits and not empowered to make change
happen
Emphasis was on dealing with problems ie CONTROL
New Style
Emphasis on PREVENTION not Control
Identify risks and take action to prevent them
Ownership from “Board to Ward” – high profile
Responsibility for action now with Divisions not IPCT –
monitored through clinical governance
Audits of hand hygiene and other interventions now done by
ward staff and massively increased in number
IPC team still experts, writing policies and educating but more time spent assessing risks and monitoring
performance of others
Weekly multidisciplinary operational group
Monthly Infection Control Committee chaired by CEO
MRSA Bacteraemia 2007/08
Target was to have no more than 23 cases
Challenging target
60% reduction from 2003/04 baseline of 58
SaTH had 36 cases in 2007/08 so did not achieve target but
25% reduction on 06/07 (48 cases) and 14 were pre 48
Rate per 1000 bed days was 0.12 – national average
Average for large acute trusts in West Midlands 0.18
Of 19 trusts in West Midlands only 5 achieved MRSA target
Of these 4 were single specialty trusts
MRSA Bacteraemia 2007/08
MRSA Bacteraemia Cases 07-08
40
35
30
25
Cases per month
20
Cumulative total
Profile
15
10
5
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
What have we done? – risk assessment
Specialty
Source
Medical
11
Central Lines
8
General Surgery
11
Urinary Tract
Infection
5
Urology
4
Peripheral lines
4
Renal Unit
3
Surgical Wound
3
Oncology
3
Endocarditis
3
Cardiothoracic
Surgery
2
Percutaneous
feeding tube
1
Vascular
Surgery
2
Skin & Soft Tissue
2
TOTAL
36
Respiratory
2
Contaminants
4
Unknown
4
TOTAL
36
(Surgery in North
Staffs)
Time sample taken after admission
<48 hours
14
>48 hours
22
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 Haematuria
o Removal of catheter with balloon inflated
Brenda Maxton, Clinical Risk Advisor, Ext: - 1448
Chris Beacock
Rod Warren
July 2007
What have we done? – actions
• Strengthening of Root Cause Analysis on each case of MRSA
bacteraemia, led by the clinical team involved
• Focus on reducing MRSA bacteraemia in augmented care (ie ITU and
the Renal Unit) – particularly intravenous line infections
• Increased MRSA screening
• Introduction of a cohort ward for isolation of patients with MRSA
• Introduction of twice daily visual inspection of all intravenous line sites
to monitor for development of phlebitis
• Expansion of “High Impact Intervention” audits so that all wards are
auditing their insertion and care of intravenous lines
• Introduction of a Care Pathway for patients with MRSA
• Increased Hand Hygiene audits
MRSA Bacteraemia 2008/09
25
20
15
10
5
0
Apr
May
Jun
Jul
Aug
Cases per month
0
0
2
2
1
Cumulative total
0
0
2
4
5
Target
2
4
6
8
10
Sep
Oct
Nov
Dec
Jan
Feb
Mar
12
14
16
18
20
22
23
C difficile >65 yrs Shropshire Health
Economy 2007/08
350
300
250
Cases Per
Month Shrops
Cumulative
Cases Shrops
Target
200
150
100
50
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
What have we done?
Introduction of increased cleaning, including use of chlorine
based disinfectants, the Deep Clean Programme and
refurbishment of bathrooms, and purchase of new beds
and commodes
Improved diagnosis with the introduction of rapid testing
available 7 days a week
Tighter antibiotic control
Improved care of patients with C difficile with an updated
management protocol and care pathway
Rapid isolation of patients with diarrhoea
Increase in hand hygiene audits and emphasis on the need
to use soap and water, not hand gel, with C difficile
C difficile cases and recurrences over 2yrs old 2008/09 - SATH
Responsible
250
200
150
100
50
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Cases per mont h
7
9
16
7
6
0
0
0
0
0
0
0
Cumulat ive
7
16
32
39
45
Target
19
38
57
76
95
114
133
152
171
189
207
225
Hand Hygiene
Probably most important single step in preventing HCAI
Previously audited by IPC team
In June 2007 wards started to do their own audits
Number of “observations” increased from 10 to 1000 per
month
By March 08 compliance was 88% - now 95%
Taking part in “cleanyourhands” and “It’s OK to ask”
“Bare below the elbows” introduced
Hand Hygiene education and road shows continue
SATH Hand Hygiene Compliance
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Jun-07
Jul -07
A ug-07
Sep-07
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
M ar -08
A pr -08
M ay-08
Jun-08
Jul -08
A ug-08
High Impact Intervention Audits
“Saving Lives” gives advice on key steps in prevention of
infection for 7 common interventions, including
intravenous line care, urethral catheter care, dialysis etc
Also contains tools so that staff can audit against the
standard advice – High Impact Intervention Audits
In 2007/08 we rolled out use of these audits by ward staff
concentrating on intravenous line audits
Helped pick up issues we were not aware of
Now extending programme to other audits
Insertion of Central Lines
Central Line Insertion Audit SATH 2007-08
120%
100%
80%
60%
40%
20%
0%
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Mar-08
Environment
A Deep Clean of all wards and clinical areas ward carried out between
November 2007 and March 2008
Refurbishment of bathrooms and purchase of new beds and commodes
Introduction of chlorine based products for disinfection of the
environment for C difficile
New colour coding system for cleaning equipment introduced in line with
new national standards
Roll out of ”Productive Ward” continued.
Additional DH monies for prevention of HCAI were bid against
successfully to enable the funding of a Rapid Response Cleaning
Team, steam cleaners, placement of additional hand wash basins and
improved signage for hand gel stations
Environment Inspections
PEAT – RSH and PRH awarded “Excellent” by NPSA in
areas of Environment, Food, Privacy and Dignity
Health Care Commission Inspection Jan 08 – reported July
Management
Green
Environment
Amber
Isolation
Green
Areas for improvement included need for upgrade of CSSD,
cleaning checklists, care of linen, and documentation of
training – now addressed
2008/09 ICP Programme
•
•
•
•
•
•
•
•
Sustainability is key
Review new implementations – streamline if possible
Further strengthen ICP team and management systems
Roll out other components of High Impact Intervention
Audits
Repeat Deep Clean and continue refurbishment
programme
Empower Modern Matrons to control cleanliness
Continue plan to commission new CSSD with other
partners
Continue to work with PCTs
M ay0 7
▲Central line insertion
audits
July 0 7
▲Clinell wipes
introduced
Aug 0 7
▲Hand hygiene
audits
Dec 0 7
▲Introduced Tristel for
terminal/daily cleaning
▲Peripheral line audits
Sept 0 7
▲M RSA screening
introduced for emergency
admissions and elective
inpatient surgey at PRH
40
Jan 0 8
▲Launch of Yr3
CleanYourHands
▲Deep Clean carried out
across the Trust
Oct 0 7
▲7 day testing for C.dff
▲Wards responsible for
Route Cause Analysis on
bacteraemia
Nov 0 7
▲C.diff HII audit
35
M arch 0 8
▲RSH M RSA screening of emergency admission.
▲17/3/08 Cohort ward opened RSH
▲Clinical site meetings with Infection Control team
▲M RSA and C.diff care pathways introduced
▲Chloraprep introduced
▲ Introduction of data packs from Consultant
M icrobiologist
▲Central venous catheter ongoing care
▲Renal catheterisation audit
Feb 0 8
▲New beds & commodes
▲Antibiotic pharmacist 2
afternoons a week RSH.
▲Productive ward programme
30
Aug/ Sept 0 8
▲SM ART cycler for rapid
M RSA testing
▲M atron appointed for
Infection, Prevention and
Control
▲Service Improvement
M anager in post
M ay 0 8
▲Daily review of C.diff patients at RSH by Ward
22C doctor
A pril 0 8
▲Introduce Tristel cleaning of toilets and
bathrooms daily.
Weekly Consultant M icrobiologist treatment
review of cdiff patient RSH & PRH.
▲Antibiotic pharmacist PRH started 1/4/08
25
20
15
MRSA Bacteraemia
Cdiff
10
5
0
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Aug-08