Infection Prevention & Control Annual Report 2007/08 (2008/09 update) Dr Patricia O’Neill Director of Infection Prevention & Control 25 th September 2008

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 Overview

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

What have we done? – risk assessment SpecialtySource Medical11Central Lines8 General Surgery11Urinary Tract Infection 5 Urology4Peripheral lines4 Renal Unit3Surgical Wound3 Oncology3Endocarditis3 Cardiothoracic Surgery 2(Surgery in North Staffs) Percutaneous feeding tube 1 Vascular Surgery 2Skin & Soft Tissue2 TOTAL36Respiratory2 Time sample taken after admissionContaminants4 Unknown4 <48 hours14 >48 hours22TOTAL36

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

C difficile >65 yrs Shropshire Health Economy 2007/08

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

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

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

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