Title: Mercia Spare
1Tools to support a reduction in Healthcare
Associated Infection in Renal Patients
Workshop Thursday 8th March 2007
Mercia Spare Renal Project Lead Department of
Health
2Workshop Objectives
- Background to National HCAI programme
- Renal contribution to the MRSA burden
- Renal-specific Tools
- The Renal toolkit
- High Impact Intervention 2c
- Mandatory Enhanced Surveillance System Renal
MRSA project - Questions
- Hands on exploration of tools (In groups)
- Feedback
3Background to National MRSA Target
- MRSA bacteraemia has risen year on year between
1990 and 2003 and in addition the rates of other
HCAIs have shown an increase especially C.
difficile. - In 2004 the DH set trusts a target of 50
reduction in MRSA bacteraemia rates by 2008,
based on rates submitted to the Health Protection
Agency (HPA) in 2003/2004 - In line with this they introduced several
initiatives to support the reduction, which
included - Winning ways (2003)
- Towards Cleaner Hospitals (2004)
- Matrons Charter (2004)
- CleanYourHands (2004)
- Saving Lives (2005)
- Going Further Faster (2006)
- Essential Steps to Safe, Clean Care (2006)
- Health Act (2006)
4Renal Contribution to MRSA Rates
In 2005 the preliminary results of the Renal
Association UK Renal Registry vascular access
survey reported that patients on haemodialysis
may contribute between 8-10 of all cases of MRSA
bacteraemia in the UK1. A 2006 report from the
HPA confirmed that renal dialysis patients
contribute 8 to the National MRSA bacteraemia
burden2.
1UK Renal Registry Report 2005. Chapter 6. UK
Renal Registry, Bristol, UK 2Health Protection
Agency. Mandatory surveillance of health care
associated infection. July 2006
5Renal toolkit Rationale
- To provide renal healthcare professionals with a
tool that would support - A reduction in HCAI especially MRSA
- Analysis of practice in all aspects of the renal
patient pathway - Promote service development and practice
improvement - Provide resources that could be adopted or
adapted without the need to search for them
6Approaches to toolkit use
- Multidisciplinary project team or local focus
group - Systematically worked through as an assessment
tool or dipped in to to address specific issues - Can be used for performance management or to show
local improvement
7Renal toolkit development
- Step 1 A generic renal process map was used to
identify significant elements of the patient
pathway - 11 key focus areas were identified
- Vascular Access Pathway
- Catheter Maintenance
- Incident Management
- Demand and Capacity
- Surveillance
- Team Building and Training
- Care Bundles
- Policy and Guidance
- Role Design
- Patient and Visitor Engagement
- Environment
8Renal toolkit development
- Step 2 These key focus areas were placed within
the 9 challenges of the Saving Lives framework - Engage senior management (clinical and
non-clinical) - Appoint and train infection control leaders at
every level - Implement a local surveillance programme
- Adopt national evidence-based guidance
- Ensure the effective auditing of infection
control practices - Ensure that Trust employees have infection
control training and understand their personal
responsibility - Review patient journey for emergency and planned
patients - Review the status of the built environment and
efficiency of facilities management services - Implement robust Trust-wide policies for
decontamination of reusable devices - Self assessment
- High Impact Interventions
- Performance Management
9High Impact Interventions
- The High Impact Interventions are techniques to
improve the reliability of clinical processes. - They link the evidence base for a small number of
elements in a clinical process with a simple
method to determine whether those elements of
clinical care were performed or given. - The EPIC group identified them as precautions
which could be applied as standard principles by
ALL healthcare practitioners to the care of ALL
hospital in-patients, ALL of the time. - The High Impact Interventions assist clinical
governance by attempting to ensure that all
patients receive a consistent quality of care by
minimising unwarranted variation in the delivery
of clinical care. - In short they identify the essential steps in a
procedure that if performed consistently at each
undertaking will minimise adverse events
10High Impact Interventions
- Benefits
- Compliance rates illustrate adherence to
protocols and procedures - Identifies gaps in practice and knowledge
- Provides focus for resource and education
- When results are plotted shows clinical
improvement
11Mandatory Enhanced Surveillance System (MESS)
Renal MRSA project
- In 2001 the reporting of all MRSA bacteraemias
became mandatory for UK Trusts - A live database was developed to collect and
analyse the data from microbiology laboratories
(MESS) - In 2006 the database was adapted to enable a
renal MESS pilot project to take place - In October 2006 8 pilot sites in the UK tested
the renal page of the database for a three month
period.
12Renal MESS MRSA project
Aims of the pilot
- To develop a dataset for renal units to support
changes in vascular access - To support units to deliver "root cause analysis"
of bacteraemias. - To demonstrate to the Trusts Chief Executive that
Renal services have a commitment to making
quality improvements in their services and to
support the Trusts delivery of the national
Saving Lives agenda.
13Information collected
- Denominator data (Monthly on last dialysis
session) - MRSA bacteraemia data entered on MESS (Monthly)
- Problem/Issues encountered by the pilot sites
- A monthly report was forwarded to the steering
group containing the above information - A summary event took place in January 2007 where
a final report was presented to members of the
pilot sites and the National steering group
14Screen Shot of data fields
15Denominator data fields
16Collection of denominator data
- How has data been collected?
- Head count on census day
- Commercial software package
- Bespoke database
- CDC DSN programme
- Problems outlined by the pilots
- Difficult as not always routinely collected so
no-ones responsibility - Lack of adequate IT makes it difficult to collect
accurate detailed information - Validity of data
- Only as good as timing with which it is recorded
- Relevance of data
- Highly relevant to clinical improvement if
accurate and timely
17Conclusions
- Collection of denominator data was difficult due
to the variation in IT availability and the
absence of a named person responsible for
collection, collation of data and reporting
outcomes. - The majority of bacteraemias (69) occurred in
patients dialysing via a catheter. - The incidence of bacteraemia did not correlate
with the number of patients receiving dialysis
via a catheter suggesting that emphasis should be
placed on catheter management programmes. - Despite small numbers of bacteraemia the system
has been tested for data input. - A larger number of bacteraemias and feedback from
the wider renal community is required for the
design, content and delivery of a meaningful
report. - The majority of issues raised by the pilot sites
were easily rectified. - The problems reported by the pilot sites has
provided valuable lessons on which to design the
proposed National roll out of voluntary reporting
of MRSA bacteraemias for all English renal units
in April 2007.