1. Every Cloud has a Silver Lining Ms Maire Bermingham Assistant Director of Corporate Support Services Dr Naomi Baldwin Senior Infection Prevention and Control Nurse

2. INTRODUCTION Post outbreak Clostridium difficile Combined multi-disciplinary approach to reduce Healthcare Associated Infections Regain public confidence Ensure effective systems of communication and accountability for Infection Control Challenges and changes Environmental Hygiene Infection Prevention and Control

3. NHSCT Domestic Services The Science of Cleaning in a Healthcare Environment Ms Maire Bermingham

4. HOSPITAL CLEANLINESS Hospital cleanliness is a vital ingredient in the fight against HCAIs but is also important in its own right as patients expect to be cared for in an environment that is clean, safe and fit for purpose. Hospital cleanliness is everyones responsibility and everyone needs to play their part, not just the cleaners.

5. BOARD TO WARD APPROACH Sustained success requires: A Board to Ward approach. Highly visible leadership. A multi disciplinary team approach involving Domestic Services, Infection Control, Nursing and Estates Staff. Ensuring the culture of the organisation supports continuous improvement with staff supported to review, challenge, and feedback on performance and behaviours. Proactive and not reactive.

6. ASSURANCE FRAMEWORK - CLEANING MEASURES Intensive cleaning process. Daily cleaning audits signed off by Ward Manager – accountability. Cleanliness Matters audits. Managerial cleaning audits. Competency assessment review - Domestic Assistants.

7. ASSURANCE FRAMEWORK- TRAINING FOR CLEANING STAFF Cleaning in a hospital environment is a highly skilled role where staff need to understand how to complete the many and varied cleaning tasks. Importance of a well trained and knowledgeable team of cleaning staff British Institute of Cleaning Science accredited training. Infection Control training for cleaning staff

8. Infection Prevention and Control Dr Naomi Baldwin

9. MEDIA CHALLENGE / PUBLIC PERCEPTION Issues Pressure to staff Negative impact on morale Loss of public confidence Trust approach Education / knowledge Empowerment to staff Communication Information/leaflets

10. Infection Prevention and Control Challenges Engagement Isolation pressures Letting go Restructure of team and accountability structure for Infection Control Change and introduction of new strategies; High Impact Interventions Root Cause Analysis

11. Infection Prevention and Control Review of IPCN role/duties On call On call Introduction of Infection Risk Assessment Tool (IRAT) Equipment decontamination – assurances Education and training –Link Nurses DVD e-learning High visibility in clinical areas Review of audit process Shift of responsibilities

12. Infection Prevention and Control Moving Forward Communication - board to ward approach Collaborative effort More engagement Vision – advise, support and facilitate staff Much work to be done

13. HCAI Targets Trust achieved targets for reduction in C.diff and MRSA bacteraemias (2009-2010). New targets set for 2010-2011; further reduction of 18%. Must sustain and develop strategies for ongoing success.

14. SUMMARY Clostridium difficile outbreak allowed the Trust to focus on what was needed to deliver real improvements for Infection Prevention and Control standards. Sustained success requires a Board to Ward approach where cleanliness and safe practices are at the forefront of everyones minds, with everyone playing their part. Infection control everyones responsibility