1. The Never ending story……… Beating the bugs Cheryl Etches, Director of Nursing and Governance Royal Wolverhampton Hospitals NHS Trust

2. August 2005 “Infection what??” Culture ……Can’t do “Target unrealistic and not statistically sound” MRSA Bacteraemias03/04 - 38 04/05 - 66 05/06 - 83 Infection Control Team and function

3. August 2005 – changes commenced Launch of Saving Lives Executive Lead Infection Prevention Infection Prevention Board Leadership of IPT changed Review of IP Strategy and annual plan of work 100 new commodes - guess what………………. C.Diff reduced!

4. May 2006 – DoH team engagement meeting The credo commenced……………..

5. I Action planning - systematic Leadership Accountability Policy Information TrainingAudit

6. Staff and patient involvement Communication strategy PPI Forum Staff side involvement Local press Complainants NED champion

7. Matrons lead Ward Declutter programme Domestics training delivered by IPT Bed space checklists introduced Commode replacement Mattress replacement RCA for all c diff cases introduced Antibiotic review commenced Grand Round presentation High Impact Intervention No 6 introduced Medical division training Commode Audit Commode re-Audit &feedback

8. Impact………… A rollercoaster year…………. But the overall results have been encouraging…….

14. What made the difference? CEO active support Leading from the front Consistent message Align structures, processes with outcomes Pre-empt knock backs – keep the faith Engage Drs very early on – but don’t hold up the campaign until all there Be determined Celebrate success publicly

15. How the improvement is being maintained Objectives and KPIs Inclusion in all job descriptions Consultants’ objectives/appraisal New mattresses – audit process Capital programme Training - domestic staff/junior Drs Full implementation and audit of HIIs Audit processes - environment - cleaning regimes Regular performance reporting

16. Success? Culture change From Board to ward Impact on all HAIs Consultant objectives Not seen as a nursing problem only IPT of the year 2007!

17. But there are blips……….. So we have refocused our efforts: High Impact interventions Seek out the cause Increase supervision and audit Re-engage medical staff New dress code

18. Summary Infection prevention elevated to a high priority Leadership and accountability Action focused & outcome orientated Whole system approach – not just MRSA, not just “problem” areas Executive lead →operational engagement – made a reality by IPT