DIRECTOR OF INFECTION PREVENTION AND CONTROL ANNUAL REPORT

Transcription

1 DIRECTOR OF INFECTION PREVENTION AND CONTROL ANNUAL REPORT APRIL MARCH 2007

2 CONTENTS PAGE 1) Executive summary Overview of infection control 1&2 activities in the Trust 2) Description of infection control arrangements Infection control team 3-5 Infection control committee 6 Reporting line to the Trust Board 7 3) DIPC reports to the Trust Board summary Number and frequency 8&9 Annual Action Plan 8&9 Board decisions 8&9 Outbreak reports 10 4) Budget allocation to infection control activities Staff 11 o Medical o Nursing o Administrative Training 11&12 5) HCAI statistics Results of mandatory reporting o MRSA bacteraemia 13 o GRE bacteraemia 14 o Clostridium difficile 14 o Orthopaedic surgical site infection 15 Trends in HCAI statistics 16 SSIS 16 Untoward incidents including outbreaks 17 Antimicrobial resistance 17

3 6) Hand hygiene and Aseptic protocols Implementation of cleanyourhands o Timing 18 o Coverage in Trust 18 o Future plans 19&20 7) Decontamination Arrangements 21 Audit 21 Incidents/failures investigated 21 8) Cleaning services Management arrangements (in-house or contracted out) 22 Monitoring arrangements 22 Budget allocation 22 Clinical responsibility 22 PEAT/Patient forum inspection results 22 9) Audit Extent of audit programme 23 Reasons for audit focus 24 Changes and benefits as a result of audit 25 Antibiotic prescribing (report from Antimicrobial 26 Pharmacy Technician) 10) Targets and outcomes For SHA performance management o MRSA bacteraemia 27 o Winning Ways and Towards Cleaner Hospitals 27&28 implementation Cleaner hospitals (PEAT scores) 28 11) Training activities Induction for all staff 29 For infection control specialities 30 12) Infection Control programme for 2007/

4 1. Executive summary Overview of infection control activities in the Trust Executive Summary Essex Rivers NHS Trust continues to treat infection prevention and control as a top level priority. Overall levels of MRSA have remained stable. However, given the challenging target of 14 MRSA bacteraemias for this year the Trust was over its target trajectory with 24 bacteraemias for 2006/7; 12 of these patients had MRSA isolated within 48 hours of admission. The coming year sets a target of 12 cases. Levels of Clostridium difficile isolates give cause for concern, nationally, regionally and locally. The Trust has a Cdiff rate that lies in the middle of trusts within the Eastern Region. The management structure of the trust changed during the year. With the continued efforts to implement the Saving Lives programme within the Trust, there is an increased emphasis on infection control being the responsibility of all clinical teams to monitor and audit practice within their own areas. As each Division develops its infection control structures the emphasis will be on integration within the Divisions core processes and governance arrangements. The Infection Control Committee was slightly re-structured to reflect the overall management changes; Dr P Dixon representing medicine and the Emergency Division and Mr T Arulampalan representing surgery and the Planned Care Division. Infection Control became a standing item at the Clinical Executive Board to reflect the whole organisation s commitment to good infection control practice. Dr G Urwin and Claire Allen continued their successful work with antimicrobial prescribing. The ICT held another successful annual conference for local healthcare staff (doctors, nurses, healthcare scientists) with 85 delegates attending. We were honoured and pleased that the Chief Nursing Officer, Professor Christine Beasley and the Inspector of Microbiology Professor Brian Duerden were among the guest speakers. They are the Department of Health s clinical leads for tackling Healthcare acquired infections and their presentations were extremely informative. Key achievements CleanYourHands campaign - the Trust has completed its second year which continues to see an upward trend in the usage of alcoholic handrub all clinical areas are undertaking local hand hygiene audits Infection Control policies and guidelines - funding has been secured to increase the risk groups who are sampled for MRSA together with an updated policy and integrated care pathway Page 1 of 31

5 Developments in the prudent use of antibiotics - Guidelines have been reviewed and will continue to be reviewed regularly. Monthly antibiotic usage within the Trust is monitored and any high use areas are investigated to ensure that treatment is appropriate. Participated in the Third Prevalence national Survey for healthcare acquired infection 525 patients were surveyed as part of the survey the national prevalence rate was 8.19% and ERHT rate was 3.6% Surgical site infection surveillance Continue to come in under national average on number of infections in most categories surveyed with a significant reduction to come under the national average for small and large bowel surgery Secured funding to invest in integrated computerised surveillance system Annual Mandatory updates for all staff the uptake continues to increase year on year On-going work To work towards reducing the number of patients with MRSA and Clostridium difficile Saving Lives continue to embed throughout the organisation To install and implement the use of the integrated surveillance system generating timely information for clinical teams Mandatory annual updates for all Trust Staff Develop further the Infection Control Web page Dr Tony Elston Director of Infection Prevention and Control /Consultant Microbiologist & Infection Control Doctor Page 2 of 31

6 2. Description of infection control arrangements Infection control team Dr Tony Elston Consultant Microbiologist/Director of Infection Prevention & Control Dr Gillian Urwin Consultant Microbiologist Heather Dakin Senior Infection Control Nurse/Team Leader Michelle Hazell Infection Control Nurse Marcia Hirst Associate Infection Control Nurse Tracey Lacey Infection Control Audit/Surveillance Nurse Vicky Curtis Infection Control Team Secretary Page 3 of 31

7 Infection Control Team Activities The infection control team aim to be as accessible as possible with regular visits to as many clinical areas as possible on a regular basis. Members of the team are involved in the following committees/meetings: Infection Control Team Meeting Hospital Infection Control Committee Medicine Management Committee Clinical Product Review Group Matron meeting Policies and Procedures Committee Essential Services meeting Women, Children & Families meeting Risk Management Committee Senior Management Advisory Group Service review meetings for facilities management Clinical Executive Board Intravenous Management Group Wound Management Group Essence of Care Benchmarking Group Trust Clinical Governance Committee Surgical Governance meetings Medical Governance meetings Patient and Public Involvement Forum PEAT inspection team The Director of Infection Prevention and Control attends the following; Trust Clinical Governance Committee, Clinical Executive Board, Risk Management Committee and Medicines Management Committee. Page 4 of 31

8 Infection Control Enquiries A total of 2058 enquiries, (41% increase compared to the previous year) were received by the Infection Control Nurses, as detailed in the chart below. This enquiry database does not capture all enquiries put before the Infection Control Team but gives a reasonable representation. It is clearly demonstrated that there continues to be a year on year increase in involvement of the Infection Control Team throughout the organisation. Enquiries to Infection Control Team Percentages Apr Mar 2007 Misc D&V 4% 4% 5% MRSA 12% 4% Admin 0% Staff 5% 14% Teaching 2% Infectious Diseases Hand Hygiene 15% Equipment 14% Facilities 21% Decontamination Sharps Page 5 of 31

9 Infection Control Committee Meetings were held every two months. An attendance record is given as requested by the Trust Clinical Risk Committee. Out of 6 meetings held, attendance is given as follows: Chair: Consultant Microbiologist/Director of Infection Prevention & Control 6/6 Infection Control Nurses 6/6 Chief Executive/Deputy Chief Executive 5/6 Director of Nursing/Deputy Director of Nursing 6/6 Facilities Manager (or representative), Carillion 3/6 Head of Facilities - Trust (post vacant for 3 months) 5/6 Occupational Health representative 4/6 Pharmacy representative 5/6 Risk Management representative 1/6 Women & Children s Directorate Representative 4/6 Medical Directorate Representative 0/6 Surgical Directorate Representative 5/6 Essential Services Directorate Representative 6/6 Cancer Services Representative 5/6 Clinical Governance Manager 5/6 CCDC 3/6 The Committee agreed the Infection Control objectives for the year. These were to: Continue to embed Saving Lives within the trust Work to implement Department of Health initiatives for Healthcare Acquired Infections, including increasing the numbers of patients screened for MRSA Work towards improving the feedback of surveillance data to divisions and departments Page 6 of 31

10 Infection Control Team Organisational Structure and reporting line to the Trust Board Trust Board Clinical Governance Committee Risk Management Hospital Infection Control Committee Directorates Dr Tony Elston Consultant Microbiologist/Director of Infection Prevention & Control Dr Gillian Urwin Consultant Microbiologist Heather Dakin Senior Infection Control Nurse/Team Leader Michelle Hazell Infection Control Nurse Marcia Hirst Associate Infection Control Nurse Tracey Lacey Audit/Surveillance Nurse Victoria Curtis Infection Control Team Secretary Page 7 of 31

11 3. DIPC reports to the Trust Board - summary Infection Control Action Plan for the year and progress in implementation of Winning Ways; Towards Cleaner Hospitals and Lower Rates of Infection and Saving Lives The Infection Control programme for the year ahead will mainly be focused towards achieving the national and local targets, through action planning against: 'Winning Ways Strategy' (2003) Promoting the embedding of the Saving Lives (2005) programme within the organisation Action Area 1. Active surveillance and Investigation 2 Reducing the Infection Risk from the use of Catheters, tubes, Cannulae, Instruments and Other Devices 3. Reducing Reservoirs of Infection Progress ERHCT participates in all mandatory surveillance elements together with a number of voluntary elements see section 5 The roll out of the Saving Lives Programme has seen monthly reporting elating to key aspects of practice pertinent to the management of invasive medical devices. This will continue to inform improvements or sustaining best practice. ICT involvement in a number of new builds and upgrades within the hospital ICT involved in contracts for cleaning, catering and linen services Programme of maintenance of ventilation systems in place Legionella prevention programme in place and managed by Trust Estates Team Integrated care pathways being developed for specific infections including MRSA and Clostridium difficile Plan to implement July August High Standards of Hygiene in Clinical Practice Matrons and Ward managers undertake regular audits of the cleanliness of the environment Trust Ward Housekeepers undertake regular audits with the contract cleaning services from which action plans are implemented in order to address areas of concerns In- house monthly PEAT inspections are undertaken which is a collaborative process between members of Trust staff and contractor facilities staff PEAT inspection undertaken in February 2007 rated both CGH and ECH sites as PASS Page 8 of 31 Consultant Microbiologist)

12 5. Prudent use of antibiotics 6. Management and Organisation 7. Research and Development ratings 4-5. Facilities team has updated individual ward/department cleaning manuals and schedules Waste guidelines being updated together with and education programme for all Trust staff The investment in a programme of replacement of carpets with a more suitable flooring material in the Outpatients Department, Wivenhoe Ward and the Main Hospital thoroughfare at CGH has been completed in the past year. Guidelines have been reviewed and will continue to be reviewed regularly. Monthly antibiotic usage within the Trust is monitored and any high use areas are investigated to ensure that treatment is appropriate. Infection control is now a part of Integrated Governance within the trust management structure. Resources are not available to contribute to this area. Page 9 of 31 Consultant Microbiologist)

13 Viral Gastroenteritis Outbreak There were 5 wards fully closed due to confirmed or suspected outbreaks of viral gastroenteritis from April 2006 March There were a number of wards which have been closely monitored and in some areas bays have been cohorted. The high number of suspected cases to be investigated took a considerable amount of time from the usual day to day responsibilities of the Infection Control Team. Cases of viral gastroenteritis persisted on through the winter and into late spring. Page 10 of 31

14 4. Budget allocation to infection control activities Staff Medical Grade WTE budgeted WTE actual Consultant Nursing Grade AFC WTE budgeted WTE actual 8a Staffing budget for 2006/7 was Expenditure was The 4,300 under spend can be accounted for with the temporary and then permanent reduction in hours of one member of staff. Administrative Grade AFC WTE budgeted WTE actual Non-pay Stationary budget - 1,000. Expenditure , under spend of Training The budget for training and development is centrally administered within the Trust. The members of the ICT attended the following as part of their professional development 2006/2007. National Pandemic influenza update meeting - Royal College of Physicians (1) RAE Two day infection control annual conference - Sheffield (2) HD & MDH Page 11 of 31

15 Annual Infection Control Nurses Association Conference three day event Brighton (1) MAH BSc Infection Control University of Hertfordshire First Year in progress (1) MDH 1 day per week Training requirements for the Team in the coming year Funding and support for the second year of the infection control degree pathway at the University of Hertfordshire for one nurse has been applied for. Funding for the second infection control nurse to undertake the infection control degree/diploma will be sought. Attendance at the major annual updates by members of the infection control team is essential, in order to keep abreast of current evidence/information to best inform infection control practices at ERHT. Page 12 of 31

16 5. HCAI statistics An automated surveillance system (ICNet) has been purchased by the Trust to facilitate improved monitoring and reporting of healthcare associated infections. The plan to install the system is progressing. Results of mandatory reporting MRSA/Staphylococcus aureus Bacteraemia The year 2006/2007 was the sixth year for Healthcare Associated Bacteraemia Surveillance Staphylococcus aureus and Meticillin resistant Staphylococcus aureus scheme. The Department of Health is working towards all Acute Trusts achieving a 50% reduction of MRSA bacteraemia by 2007/2008 based upon their 2003/2004 figures. The aim for ERHT will be to achieve no more than 12 cases by 2007/2008 year end. To this end the target given to ERHT for 2006/2007 was 14 cases with 24 cases the actual rate. MRSA Bacteraemia Targets Essex Rivers NHS Trust 2001/02 Infections 2002/03 Infections 2003/04 Infections 2004/05 Infections 2005/06 Infections 2006/07 Infections Target 2007/ Process chart showing numbers of MRSA bacteraemia in Essex Rivers by quarter Quarterly MRSA bacteraemia Target Actual Data Lower Action Limit Upper Action Limit Lower Warning Limit Upper Warning Limit Quarter /06 Quarter /06 Quarter /06 Quarter /06 Quarter /07 Quarter /07 Quarter /07 Quarter /07 Quarter /08 Quarter /08 Quarter /08 Quarter /08 Page 13 of 31

17 GRE bacteraemia There were two unrelated cases in 2006/2007. Clostridium difficile Mandatory testing of all liquid stools from patients over the age of 65 and reporting of all positive for Clostridium difficile toxins started in January ERHCT figures remain comparable with other similar trusts. The NHS has become concerned at the general increase in numbers of cases of C diff over the last few years. This has been exacerbated by an apparent increase in severity of illness and of outbreaks in a small number of trusts. All trusts were asked to agree a target rate with their commissioning PCT. Within Essexrivers there were 305 cases 2006/07, a rate of 1.4/1000 bed days. We have agreed a target rate of 1/1000 bed days which would be 217 cases if our activity remains the same. Chart showing numbers of C diff in Essex Rivers by quarter, 2003 to F 1 03Q4 04Q1 04Q2 04Q3 04Q4 05Q1 05Q2 05Q3 05Q4 06Q1 06Q2 06Q3 06Q4 05 years or less Total 06 to 15 years Total years Total years Total 65 to 74 years Total 75 and above Total Grand Total The large increase in 2004, Q4 was due to a change in testing protocol. Data on new cases of Clostridium difficile on in-patients only are reported monthly in recent months via the Divisional meetings and Clinical executive board meeting. Clostridium difficile disease in the over 65 year age group is subject to mandatory reporting and data is available on the DoH website. The published figures for ERHT for 2006/2007 are 305 cases, giving an infection rate of 1.4 per 1000 bed days for patients over 65 years only. Page 14 of 31

18 Third National Prevalence Survey We participated in the Third National Prevalence survey of healthcare acquired infections. This was organised by the Hospital Infection Society, the Infection Control Nurses Association and the Department of Health. The definitions used were stringent and the results similar to the two previous reports. Local figures were; % HCAI Total Patients Surveyed Number of patients with Healthcare associated infection Prevalence rate National % Essex Rivers % % Clostridium difficile Infection Total Patients Surveyed Number of patients with Clostridium difficile diarrhoea Prevalence rate National % Essex Rivers % % MRSA Infections Total Patients Surveyed Number of patients with infections where MRSA was the causative organism MRSA Prevalence rate National % Essex Rivers % Page 15 of 31

19 Trends in HCAI statistics Orthopaedic surgical site infection Mandatory participation in at least one module within Orthopaedic surgery commenced in the year 2004/2005. The section highlighted in yellow is the area surveyed for mandatory purposes. Surgical site surveillance results for 2006/2007 Module CGH April June 2006 CGH July Sept 2006 CGH Oct Dec 2006 CGH Jan March 2007 All periods CGH at the end of March 2007 All Hospitals all periods at the end of March 2007 Large Bowel Surgery 7/87 8.0% 4/73 5.5% - 5/79 6.3% 61/ % Small Bowel Surgery 6/39 3/35-1/47 36/ % 8.6% 2.1% 12.0% Vascular surgery - - 1/33-10/260 3% 3.8%* Abdominal - - 0/51-0/122 Hysterectomy 0% 0%* Limb Amputation / %* Total Hip - 0/109 0/127 1/123 4/1072 Replacement 0% 0% 0.8% 0.4% Knee Replacement 0/111 2/129 0/121 0/114 4/921 0% 1.6% 0% 0% 0.4% Hip Hemiarthoplasty 0/32 0/31 1/36 1/39 7/234 0% 0% 2.8% 2.6% 3.0% 1575/ % 257/ % 599/ %* 261/ %* 333/ %* 1651/ % 812/ % 1461/ % NB: The national programme for surgical site surveillance suggest that at least 50 cases need to be surveyed in a three month period in order to obtain good quality figures which are statistically significant. Page 16 of 31

20 Serious Untoward Event There were two infection control related SUIs in this period of time. The first was the outbreak of Norovirus gastroenteritis reported on page 10. The second was reported from Elmstead. There was a possibility that two patients may have had a cystoscopic procedure without appropriate instrument decontamination. There was uncertainty about whether this had or had not happened but the patients were managed as if it had. Both procedures were low risk (from an infection control perspective) and the patients were informed, supported and followed up appropriately. An investigation was carried out and procedures tightened up to ensure no repetition occurs. Antimicrobial resistance The trust continues to experience MRSA infections. Three patients have had vancomycin resistant enterococci isolated whilst on ITU. Further typing suggested that two of these cases may have been linked but the third was different from the other two. Page 17 of 31

21 Hand Hygiene Campaign 6. Hand hygiene and Aseptic protocols Proposed Action Continue to promote the application of alcoholic hand rub for routine hand decontamination ( where hands are visibly clean) Support regular hand hygiene compliance audits in clinical areas utilising the cleanyourhands audit tool Monitor usage of alcoholic hand rub and feedback to departments Ensure regular cleanyourhands poster rotation Promotion of patient empowerment posters/leaflets Trust wide Achievements Highlighted in all hand hygiene training Included in practical one to one sessions Infection control awareness week Updated Hand Hygiene policy Matrons are taking the lead in ensuring that results are fed back to their local teams and the IC nurse who collate Trust wide reports Annual usage by division has been feedback on an annual basis for the past three years. It is proposed to feed this information back on a quarterly basis in the coming year Poster frames have been purchased by the Infection Control Team and are supporting each Ward/department to change the posters on a monthly basis. Through the patient survey and PEAT inspections patients have indicated that they have seen improvements in hand hygiene compliance amongst staff and members of the public. Timing The Trust implemented the cleanyourhands strategy in January 2005; joining this campaign has helped to strengthen the existing programme to continue to improve hand hygiene compliance for staff, patients and visitors. Coverage in Trust The poster campaign has continued over the past year, with some areas being quite innovative in promoting hand hygiene awareness. Self-auditing against hand hygiene compliance by wards/departments has improved significantly over the past year, but with more work to do in the coming year. Page 18 of 31

22 Future Plans To continue with the updating of posters within the clinical areas. The infection control team continuing to undertake regular hand hygiene observations together with the timely reporting of results to relevant clinical teams Self-auditing of hand hygiene practices has improved gradually over the course of the past year with some lively debate in some clinical areas. Hand hygiene results together with Saving Lives audit results to be discussed at Divisional Governance meetings. Hand Hygiene The availability of alcoholic hand rub has improved significantly throughout the Trust and the usage continues to increase by staff, patients and visitors. Alcoholic hand rub overall usage has continued to increase significantly as is illustrated in the charts below Page 19 of 31

23 Alcoholic hand rub by Division Point of use dispensers Medicine Surgery Essent serv W&C ECH Alcoholic handrub Usage by Division (wall Mounted dispensers) Medicine Surgery Essent Serv W&C ECH Application of aseptic no-touch clinical protocols Targeted audits have been completed in relation to the following areas: Central venous catheter management Hand hygiene observation and compliance with the Trust hand hygiene policy Action plans are being drawn up and will be audited against in the coming year. Aseptic technique in the process of being updated and then will be audited against after its adoption. Page 20 of 31

24 7. Decontamination Arrangements The Trust retains a HSDU, which is currently too small to provide a full manufacturing service. Therefore the Trust has entered into a joint venture collaboration with the Ipswich Hospital Trust under the guidance of the DOH to develop sterile services for both organisations. A project team and board are in place; the OBC has been completed and approved at both Trust boards. The OBC has been submitted for approval from the East of England Strategic Health Authority. Once approved the next step will be to being the formal tender process for this service. Endoscopes are processed in the Endoscopy suite, Elmstead Day Unit and at Harwich hospital using the Sterilox system and in theatres and outpatients by the Steris system. The Steris machines are in need of replacement and we are looking at the possibility of using just Sterilox throughout the trust. Audit The general infection control audits pick up decontamination of general nursing/medical equipment and indicate a year on year improvement in standards of cleanliness In line with the Trust s and the National Decontamination Strategy all of the bench top sterilizers have been removed from the Trust. All devices which require to be sterile are reprocessed by the Trust s HSDU or have been replaced with single use devices as appropriate Incidents/failures investigated None to report. Page 21 of 31

25 8. Cleaning services Management arrangements Contracted out to Carillion Plc. A new 3 year contract commenced in July 2004 with an option to extend for a further 2 years. Monitoring arrangements The Infection Control Team continue to support the Trust Facilities management team in the monitoring of the contracted services for catering, cleaning, waste management and estates through the following processes. Clinical responsibility PEAT inspection results PEAT inspection Colchester General Hospital February Pass Essex County Hospital - February 2007 Pass The inspection team were supported by a member of the Patient and Public Involvement Forum and an independent member of the public. Page 22 of 31

26 9 Audit Extent of audit programme The annual infection control audits have continued to focus upon the following: Annual infection control audit undertaken within each clinical area up to 14 standards audited against Targeted audits drawn from the high impact interventions set out in the Saving Lives Toolkit DoH (2005/06) Proposed Audit Compliance with MRSA policy Audit Environmental audits of wards/ departments Compliance with CVC policy audit Achievemen t 50 patients were randomly sampled and their notes/care plans audited against compliance with current policy. The results were fed back at the multidisciplinary audit meeting in March These continued to be undertaken annually and were undertaken in 54 clinical areas. The overall Trust average was 89% and remains constant over the past three years. See chart page 25 for average scores against each standard audited. The results were fed back at the multidisciplinary audit meeting in March With the introduction of the local audits within the implementation of the Saving lives Toolkit practice will be monitored regularly at a local level. Results are starting to be reported to governance meetings for each division Compliance with peripheral vascular device policy audit 200 patients were randomly selected to The results were fed back at the multidisciplinary audit meeting in March With the introduction of the local audits within the implementation of the Saving lives Toolkit practice will be monitored regularly at a local level. Results are starting to be reported to governance meetings for each division. Antibiotic prescribing audit See below under Antibiotic prescribing Urinary catheter management audit (page27) Unfortunately this audit will be carried over to be undertaken in 2007/2008. With the introduction of the local audits within the implementation of the Saving lives Toolkit practice will be monitored regularly at a local level. Results are starting to be reported to governance meetings for each division. Page 23 of 31

27 Infection Control Audits within clinical departments This is the seventh year of auditing against the nationally accepted infection control standards. A total of 54 clinical departments were audited throughout the Trust. The overall average score against all standards is 88%. This score overall has remained relatively static over the past three years, given the increasing work loads, and more complex procedures being undertaken then this is an achievement to maintain this relatively high standard. There are areas which need to be targeted as highlighted within this document. The key points to note are: Environment Score has improved gradually over the past four years achieving an overall average of 81%. Peripheral Vascular device management The average score achieved was 83% and it is hoped to improve upon this in the coming months with a number of initiatives directed at making compliance with procedures easier. Trust Wide Infection Control Audit Score comparisons % 100% 80% 60% % 20% 0% Over al l Scor e Shar ps Equi p Waste Ki tchens Envi r on Laundr y Hand Hygi ene Ur i nar y cath car e Resp equi p IV cannul ae Isolation car e PPE Enter al feed CVC mngmt % 93% 84% 88% 84% 82% 97% 94% 94% 93% 87% 97% % 89% 89% 87% 68% 76% 87% 96% 91% 96% 93% 98% 93% 93% 94% % 90% 89% 89% 79% 81% 92% 94% 90% 78% 99% 95% 93% 93% Reasons for audit focus The standards audited against within the ICNA audit tool continue to give a comprehensive overview of infection control practices throughout the Trust. The ICNA audit results together with the areas for action highlighted in the document Winning Ways (2003) and subsequently in Saving Lives DOH (2005) have informed the areas for audit. Page 24 of 31

28 Root Cause Analysis of MRSA Bacteraemia cases supported the need to focus upon peripheral line management. Changes and benefits as a result of audit The continued auditing relating to the environmental standards has seen a gradual improvement throughout the Trust. 1. There is a working group who are developing plans to improve the practice of Central Line placement and this includes: Development and introduction of a dedicated room for line placement which can also be utilised as a training area to further develop competency in this procedure. The development of a dedicated pack which has all of the necessary components to for the procedure. 2. Audits against High Impact Interventions are being carried out within local areas and these are now being discussed within clinical teams with progress against action plans expected to be taken to Divisional Governance meetings. 3. The planned introduction of Integrated Care Pathways for MRSA and Clostridium difficile patients to ensure all necessary elements of care are delivered. The care pathway for MRSA has been funded by the Trust for one year and then its effectiveness will be reviewed. 4. Increased usage of alcoholic hand rub once again would appear to support the view that hand hygiene is improving throughout the organisation with a marked increase in usage within the Medical Division this past year. 5. Continuing improvement in the quality of antimicrobial prescribing, with further cost reductions in antibiotic spend. Page 25 of 31

29 Antibiotic Prescribing Report from antimicrobial Pharmacy Technician The pharmacy department has continued to work closely with the Consultant Microbiologists and other Prescribers within the Trust to improve how antibiotics are used by producing guidelines and carrying out regular audits. The regular point prevalence audit was carried out in March and September and gave a general picture of how antibiotics were being used within the Trust and monitored the suitability of treatment and adherence to the current guidelines and protocols. From the results of the audit specific areas for further work are identified. Many audits have been carried out during the past year. Key areas focused on during period are: Clostridium difficile Urinary tract infections Surgical prophylaxis in Gastrointestinal surgery Surgical prophylaxis in Vascular surgery Surgical prophylaxis in Orthopaedic surgery Cellulitis Use of Teicoplanin COPD Guidelines have been produced and promoted throughout the year and a new summary specifically for initial treatment of common infections will be launched. It is hoped that this will assist doctors at the point of prescribing and improve initial antibiotic prescribing. Monthly antibiotic expenditure within Essex Rivers Healthcare Trust is monitored and any high use areas are investigated to ensure treatment is appropriate. Spend on therapeutic code 0501 against number of admissions number of admissions Jan-03 Feb-03 Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Amount spent Oct-04 Nov-04 Dec-04 Jan-05 Months Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Number of admissions Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Page 26 of K

30 10 Targets and outcome- for Strategic Health Authority performance management MRSA bacteraemia The MRSA bacteraemia target for this year was 14. We had 24 cases, in 12 the MRSA being isolated within 48 hours of admission. Winning Ways and Towards Cleaner Hospitals implementation The Infection Control programme for the past year has been predominantly focused towards fulfilling the 'Winning Ways and Saving Lives Strategies' at ERHCT. This included the following: 1. Action Surveillance & Investigation Participation in mandatory surgical site infections in orthopaedic surgery, MRSA bacteraemia, Clostridium difficile associated disease Voluntary participation in surveillance for Vascular surgery, all Orthopaedic surgical categories, Continuous Alert organism surveillance and management Pariticipation in the Third Prevalence Survey of Healthcare Associated Infections In Acute Hospitals ICNet integrated surveillance system has been purchased and the installation programme is underway. This was purchased from a successful bid to the DOH for money to be directed to the management of infections. 2. Reducing the infection risk from use of catheters, tubes, cannulae, instruments and other devices Updating policies in relation to invasive devices Auditing of relevant policies with feedback to relevant clinicians Working with nursing directorate to improve documentation of invasive devices 3. Reducing reservoirs of infection Auditing clinical and environmental factors which impact on infection control standards including decontamination standards The ICT should be automatically included in the earliest stages for any new, upgraded and rebuilding work within the Trust. Working with the FM contractor and Trust FM lead to ensure Trust catering provision complies with current food safety legislation, this includes auditing the premises of the main food provider to the Trust Page 27 of 31

31 4. High standards of hygiene in clinical practice Auditing environmental standards of cleanliness Working closely with Trust Facilities Management Team The ICT continue to be involved in undertaking formal annual and monthly in-house PEAT inspections. The Trust became Clean Your Hands partners in January 2005 and this programme has continued with regular feedback of self auditing of hand hygiene practices at local and divisional meetings across the Trust. Hand hygiene facilities/consumables have had an upgrade together more product dispensers made available throughout the Trust. Trials have been undertaken relating to a new hand hygiene product foaming alcoholic hand gel and was well received by staff and is currently being introduced throughout the Trust 5. Prudent use of antibiotics See section under Antibiotic Prescribing above (page 27) Cleaner hospitals (PEAT scores) PEAT inspection February 2007 Colchester General Hospital Pass Essex County Hospital February 2007 Pass Scores ranging from 4 5 with the majority of scores at 4. The standards, which achieved 5, related to the quality, choice and presentation of the food available to patients. A total of 23 patients were approached during the inspections and all comments were very positive. Matrons Charter The Action Plan against the Matrons Charter is regularly reviewed and updated by the speciality matrons in collaboration with ward managers. The Senior Nurse for Infection Control attends and reports to the monthly Matron Meetings. Two Matrons are core members of the Hospital Infection Control Committee. Page 28 of 31

32 11 Training activities Induction for all staff Total Number Registered Nurses and 309 Healthcare Assistants Junior Doctors 82 Facilities Staff 69 General The Infection Control Team continues to expand the provision of Infection Control training to as many staff groups as possible within the Trust. Ongoing regular sessions are delivered to the following groups. The ICT have delivered sessions to a total of 2480 members of Trust staff. Induction for Health Care Workers Monthly Induction for Trained Nurses - Monthly All facilities staff - Housekeeping, Estates, Portering and Catering twice a month Health Care Workers undertaking NVQ training at both Anglia Ruskin University (ARU) and Colchester Institute Tissue Viability Course - ERHT Induction Fayre for incoming medical staff twice a year Teaching for senior and junior medical staff Mandatory updates for Nursing Staff - Twice a month Maternity Services multidisciplinary updates - Monthly Theatre Nursing Course - ARU The Infection Control Team continues to provide numerous tailor-made teaching sessions for Wards/Departments within Essex Rivers on request. A total of 37 such sessions have been provided between 1st April 2006 and 31st March 2007 with a total of 515 attendees the main subjects covered included: 1. MRSA 2. Clostridium difficile 3. Hand hygiene 4. Basic Principles Infection Control 5. Saving Lives Pandemic influenza The trust Pandemic flu plan is being updated in conjunction with our local PCT. We will incorporate the most recent national guidance and ensure that the plans for each organisation are consistent and harmonious. Page 29 of 31

33 Mandatory Annual Updates for Infection Control Introduced 250 Nurses have attended mandatory sessions April 2006 March Link Nurses There are 60 link nurses and deputies. Topics covered: Clostridium difficile Saving Lives Needle free intravascular systems Induction Fayre The twice-yearly Induction Fayre for medical staff new to the Trust is an opportunity for the Infection Control Team to introduce the new medical staff to the current infection control guidelines. Infection Control Awareness Week Once again this initiative was a success with very positive feedback. A total of 297 staff and members of the public visited various road shows on both the Colchester General and Essex County Hospitals sites. Annual Trust Infection Control Conference The seventh annual conference took place in November 2006, 85 members of Trust staff attended and it was very well evaluated. The Trust were fortunate enough to secure presentations by the Chief Nurse Christine Beasley and Chief Microbiologist Professor Brian Duerden. Future Training Requirements Mandatory infection control education/training The infection control team continue to aim to facilitate compliance with annual mandatory training requirements for all staff by the provision of a number of methods, these include: Mandatory Nursing updates twice a month Promoting the national e-learning Infection Control programme easing access via Trust Intranet Ward/department based sessions as requested Carillion facilities staff However, compliance is patchy especially by medical staff. Fit Testing As per HSE requirements every user (of a respirator mask required for staff use in Pandemic Flu event within the hospital environment) should be fit tested and trained in the use of the respirator. The ICT led on cascading this training throughout the organisation with 1658 staff undergoing training in the past 12 months with a total of 58 trainers who are continuing to train within their areas. This includes supporting Carillion in training their staff. Page 30 of 31

34 IC Programme for 2007/2008 Key points Saving Lives audits Continue to support clinical teams in education of use of tools ICT to Collate monthly reports on collective data for relevant teams Annual IC audits Continue with annual rolling programme of all 51 clinical areas Urinary catheter care audit ICT to undertake June August 2007 Introduction of MRSA ICP Introduce June/July 2007 Audit of MRSA ICP 6 months after introduction Introduction of Cdiff ICP Introduce June/July 2007 Audit of Cdiff ICP 6 months after introduction Promote e-learning programme and Introduce and manage Infection audit uptake Mandatory annual updates for Infection Control for all staff groups Control e-learning Continue to provide participation in nursing mandatory updates and ad hoc sessions Continue to work with Carillion to deliver IC updates to their team Update IC policies MRSA TB Clostridium difficile Chicken pox/shingles CJD IC manual update Aim to update in coming months and change to Intranet version Install and implement ICNet surveillance system ICT to support installation Start to generate timely reports to clinical teams Continue with Surgical site surviellance Alternate with participation in relevant modules on a rolling programe including mandatory modules Page 31 of 31