Trust Board Meeting Meeting Date: 14 th December 2011 Agenda Item: 16 Subject: Author: Presented by: Infection Control Six Monthly Report Debbie Pinkney Lead Infection Control Nurse Oliver Shanley Exec Director Quality and Safety For Publication: Yes Approved by: Oliver Shanley Purpose of the report: To inform the Board of: The progress that has been made regarding reducing the risks associated with healthcare associated infections. Infection prevention and control remains a national priority and all NHS trusts are required to demonstrate leadership in ensuring that it is considered at the highest levels of the organisation. The six monthly report before members today, sets out how HPFT manages infection prevention control and how staff continue to positively respond to both local and national guidance. Action required: To ensure the Board continues to fulfil its responsibilities regarding infection prevention and control and for keeping the risks of infection to a minimum, the Board is asked to: Discuss the progress made within the Trust, given the information provided within this report. Agree that appropriate arrangements are in place to manage infection prevention and control within the Trust. Summary and recommendations to the Board: The following information is provided within this report: Alert Organism Surveillance Untoward Incident Reporting Suspected outbreaks of infection Education and Training data Cleaning Operational Update This report highlights the progress that the Trust has made during the last 6 months. The Trust is aiming to achieve 100% completion of the criteria within the infection control programme. To date, 72% of the criteria have been successfully completed, 23 % of the action points 1
have been partially completed and 5% of the actions have not been commenced. Relationship with the Business Plan & Assurance Framework (Risks, Controls & Assurance): Management of the risks associated with HCAIs is a key aspect of the Trusts business and is reflected in the Assurance Framework to control against risks affecting quality and patient safety. Summary of Financial, Staffing & Legal Implications: There are no overt financial implications in this report. The Trust continues to ensure that its workforce is appropriately trained and the report identifies that we need to continue ensuring our staff meet the training requirements. Equality & Diversity and Public & Patient Involvement Implications: N/A Evidence for NHSLA/RPST; Information Governance Standards, other key targets/standards: This reports provides assurance to the various regulatory bodies of how we meet national standards Seen by the following committee(s) on date: Finance & Investment/Integrated Governance/Executive/Remuneration/Board/Audit Infection Control Committee 12 th October 2011 2
: Quarter 2 July-Sept 2011-2012 Infection Prevention and Control Report The 2011-2012 Infection Control Programme identified the infection control priorities that Hertfordshire Partnership NHS Foundation Trust had to implement to ensure that the risk of service users, staff and visitors, acquiring a healthcare associated infection was kept to a minimum. The objectives that were set were based on the criteria that were specified in the Health and Social Care Act 2008. This report highlights the progress that the Trust has made during the last 3 months. The Trust is aiming to achieve 100% completion of the criteria within the infection control programme. To date, 72% of the criteria have been successfully completed, 23 % of the action points have been partially completed and 5% of the actions have not been commenced. Alert Organism Surveillance Surveillance of alert organisms continued to be collected by the Infection Control Team. This includes monthly data statistics of new isolates of MRSA and Clostridium difficile. Name of Organism Herts Herts North Essex North Essex L.Plum MRSA bacteraemia 0 0 0 0 0 0 0 MRSA 3 1 0 0 0 0 4 colonisation/infection Clostridium difficile 0 0 0 0 0 0 0 MSSA bacteraemia 0 0 0 0 0 0 0 E-coli bacteraemia 0 0 0 0 0 0 0 Shingles 1 3 0 1 0 0 1 (unrelated) Whooping Cough 0 0 0 1 0 0 1 Suspected Pulmonary Tuberculosis A member of staff was suspected of having pulmonary tuberculosis. This incident was fully investigated by the Respiratory Team. After the appropriated investigations, it was concluded that the member of staff did not have Pulmonary Tuberculosis. L.P TOTAL 3
Alert Organism Surveillance July-Sept 2011 Alert Organism / Condition Surveillance Service streams Number reported 9 8 7 6 5 4 3 2 1 0 MRSA bacteraemia MSSA bacteraemia Clostridium difficile E-coli bacteraemia MRSA infection/coloni sation Shingles Whooping cough Urine infections Name of Organism/Condition Specialist LD Acute Community The Healthcare Associated Infection ceiling rates for HPFT have been set. They are as follows MRSA bacteraemia 0 Clostridium difficile infection 2 Untoward Incident Reporting Staff are required to report all infection control untoward incidents to the Risk Department. In total, sixty six incidents were reported during quarter 2. Following each incident, the Risk Department staff distribute the incident data to the relevant member of staff and any appropriate follow up action is implemented. This includes follow up action/reporting of the occupational health advisors following accidental inoculation injuries. During this quarter, one unit had a service user who was identified as regularly self harming, using broken cups. This pattern of behaviour was noted and the appropriate Modern Matron and Lead Nurse were informed and advice was given to reduce this type of incident on this service user from occurring again. It should also be noted that one service user in particular had a high number of self harming incidents recorded, by scratching himself. The cause of sharp objects which resulted in injury was also investigated to minimise the risks of a similar incident occurring again in the future. The causes included: Knives Lock from a wardrobe Service user breaking a light fitting Service user breaking an electric fan Service user breaking a plastic plate 4
Service user breaking cups Razor blades Breaking wood off furniture Service user breaking a radiator Screw protruding through chair Staple from a chair Bottle top Summary of Incidents Reported Infection control incident Needlestick Injury (contaminated needle) Needlestick Injury (not contaminated needle) Sharp object ( causing a break in the skin) Scratch (causing a break in the skin) Scratch ( unsure if the skin was broken) Bite ( causing a break in the skin) Bite (unsure if the skin was broken) Splash of body fluids ( into mucous membranes) Splash of body fluids (unsure if the body fluids entered the mucous membranes) Failure to implement infection control guidelines/procedures Herts Herts North Esse x NE Little Plumste ad 2 0 0 0 0 0 1 0 0 0 0 0 11 18 1 1 1 1 10 8 2 0 0 0 18 24 7 5 0 0 0 4 2 0 2 0 1 0 5 1 0 1 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 LP Outbreaks of infection 0 0 0 1 0 0 Outbreaks of Infection. Two suspected outbreaks of infection were reported to the infection control nurses. One unit completed an incident form. Both were fully monitored and investigated. 5
Lexden Hospital one service user and two members of staff reported symptoms of diarrhoea and vomiting over a 24 hour period. The possible cause of the service users symptoms may have been attributed to a recent change in medication. No stool specimens were obtained. Forest House 7 members of staff reported symptoms of gastro intestinal illness. No service uses were affected. No stool specimens were obtained. Infection Control Incidents Incidence 26 24 22 20 18 16 14 12 10 8 6 4 2 0 Needlestick Injuries Scratch (causing break in skin) Scratch (?causing break in skin) Sharp object (causing break in skin) Sharp object (?causing break in skin) Splash-into mucous membranes Splash-?into mucous membranes IncidentReported Bite (causing break in skin) Bite (?causing break in skin) Outbreak of infection Specialist Learning Disability and Forensic Acute andrehab Community o Education and Training Education and training remains an integral part of reducing and controlling the risks of infection. Training can be completed either by face to face training or by accessing the NHS E-learning package or implementing the DVD and workbook. Despite the training packages that are available, the numbers completing infection control training has been low. Training (April - June 2011) % Compliance Quarter 1 43% Does not meet Meets requirement Requirement Grand Total 1578 823 6
Quarter 2 01 Jul 2011-30 Sep 2011 % Compliance Quarter 2 48% 01 Jul 2011-30 Sep 2011 Does not meet requirement Meets Requirement Grand Total 1450 903 Infection Control Compliance 2011/12 70% 60% 50% 43% 48% 40% % Compliance 30% 20% 10% 0% Quarter 1 Quarter 2 Figure 1 The tables and graph ( Figure 2) below represent the uptake of training via the various methods over the past 2 quarters. infection control training 04/11-09/11 figures 700 600 500 400 300 200 100 0 Taught Course E-learning DVD Total method of learning Series1 7
Figure 2 Taught Course 390 E-learning 205 DVD 66 Total 661 The tables and graph (figure 3) below represent the trusts overall compliance in infection control over the last 2 quarters in the various business streams. Business Stream Quarter 1 Quarter 2 Acute & Rehab 36% 48% Community 27% 31% Learning Disability & Forensic 44% 40% Specialist 28% 38% Infection Control Compliance by Business Stream 2011/12 60% 50% 48% 44% 40% 36% 40% 38% 30% 27% 31% 28% Quarter 1 Quarter 2 20% 10% 0% Acute & Rehab Community Learning Disability & Forensic Specialist 8
Figure 3 The tables and graph (figure 4) below represent the trusts overall compliance in infection control over the last 2 quarters in the corporate services. CORPORATE SERVICES Quarter 1 Quarter 2 Quality & Medical Leadership 40% 20% Quality & Safety 38% 50% Finance & Performance Improvement N/A N/A Service Delivery & Transformation N/A N/A Strategy & Organisational Development N/A N/A o Cleaning Operational update for the period July 2011 to September 2011 The average cleaning score for the Trust from July 2011 to September 2011 is 95.92% an increase of 2.06% from the last quarter. Under the terms of the Trust s contract with WhiteOaks no Rectification notices (which are the mechanism by which payment is linked to the standard of cleaning proved) were issued. The standards reported by Trust Units and WhiteOak s Managers are supported by the Trust s Monitoring Officer who undertook a number of unannounced and planned audits during this quarter. Audits with Modern Matrons have also been conducted in Older Peoples Services in the north and the west. Deep cleans have been carried out in SRS, TATs and on Mayflower in Norfolk. SRS and TATs had no periodic cleans carried out in August but extra cleaning completed in September to compensate. Temporary cover and a one off clean arranged for TATs units. Further replacement equipment purchased to effectively clean new floor surfaces and to replace ineffective or worn out equipment. Negotiations have commenced with regard to extending the current contract with WhiteOaks until 2015. This will bring the domestic contract in line with the current maintenance contact (currently awarded to Carillion). There will then be sufficient time for both the hard and soft FM services to be tendered as one exercise and by this time the size, location and requirements of the Trusts buildings should be known following this period of transformation. Prior to this retendering, agreement has been reached to move as many sites currently cleaned in house or by other providers onto the WhiteOaks contract as long as the current budgets are not exceeded. Initially this will include some of the community sites so that NHS standards can be delivered and roles responsibilities will clearly defined in Service Level Agreements. Negotiations have also commenced to move 1-7 Forest Lane cleaning Service to WhiteOaks. Outcome will depend on TUPE information and the current budget level. Following the Infection Controls Committees decision to implement the PAS 4758 (Specification for the planning, application and measurement of cleanliness service in hospitals) the Trust has undertaken some preparatory work outlining the steps, requirements and evidences needed. Work has commenced on updating the monitoring framework and the Trust Cleaning Premises Plan. 9
PEAT One million pounds from the capital budget has been allocated across the Trust to carry out environmental improvements across inpatient units. Inaugural Local PEAT meeting held at Lexdon hospital Essex and future meetings will coincide with unit s infection control meetings to enable greater representation. Standard agenda to include cleaning issues. Debbie Pinkney -Lead Infection Control Nurse Gary Inman Monitoring Officer Susan Mills Facilities Monitoring Manager October 2011 10