Mercia Spare - PowerPoint PPT Presentation

1 / 17
About This Presentation
Title:

Mercia Spare

Description:

Tools to support a reduction in Healthcare Associated Infection in Renal Patients ... worked through as an assessment tool or dipped in to' to address specific issues ... – PowerPoint PPT presentation

Number of Views:28
Avg rating:3.0/5.0
Slides: 18
Provided by: dh1
Category:
Tags: dipped | mercia | spare

less

Transcript and Presenter's Notes

Title: Mercia Spare


1
Tools to support a reduction in Healthcare
Associated Infection in Renal Patients
Workshop Thursday 8th March 2007
Mercia Spare Renal Project Lead Department of
Health
2
Workshop 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

3
Background 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)

4
Renal 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
5
Renal 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

6
Approaches 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

7
Renal 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

8
Renal 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

9
High 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

10
High 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

11
Mandatory 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.

12
Renal 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.

13
Information 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

14
Screen Shot of data fields
15
Denominator data fields
16
Collection 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

17
Conclusions
  • 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.
Write a Comment
User Comments (0)
About PowerShow.com