Infection Prevention and Control

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Infection Prevention and Control

• Jo Lickiss Nurse Consultant Infection Prevention
  and Control

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Health Care Associated Infections

• Are infections that are acquired in hospitals or
  other health care settings as a result of
  healthcare interventions. There are a number of
  factors that can increase the risk of acquiring
  an infection, but high standards of infection
  prevention and control practice minimise the risk
  of occurrence.
• Most are caused by the patients own
  micro-organisms
• The widespread use of antibiotics to treat
  infection, particularly in hospitalised patients,
  encourages antibiotic-resistant micro-organisms
  to emerge.  These can cause infections that are
  more difficult to treat.
• Caring for many patients together in hospitals
  provides opportunities for micro-organisms to
  spread between patients

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What is MRSA Bacteraemia?

• MRSA found in blood grown in blood specimens
• Reportable to the Department of Health
• Annual Trajectories are set between Trust PCTs
• 2007 2008 BFW NHS Foundation Trust set at 26

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Where we were - MRSA Bacteraemia

• 2007/2008 MRSA Bacteraemia
• Target of 26
• Performance 40

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Where we are now

• 2008/2009 MRSA Bacteraemia Target - 26
• April - 0
• May - 1 Pre 48hr
• June - 1 Pre 48hr
• July - 1 Acute Trust
• August - 1 Acute Trust
• September 1 Contaminant
• October 2 Acute Trust
• November 1 Blackpool PCT
• December - 0
• Total 8

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Initiatives in place to reduce MRSA

• MRSA universal screening elective and emergency
• Decolonisation of known positive patients on
  admission
• PCR Testing Medical and Surgical Emergency
  admissions 6 month trial now adopted
  permanently
• Reviewed MRSA policy
• MRSA care pathway
• Quarterly Audits Compliance with MRSA Policy,
  Screening and Treatment
• A positive MRSA B/C instigates a full inspection
• Incident meeting with relevant Division Senior
  Nursing and Medical involvement Action Plan
  formulated
• Lessons Learnt feedback

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Clostridium Difficile

• First identified in 1935
• 2004 mandatory surveillance was instigated for
  people over 65 with CDAD
• 2007 all patients over the age of 2 with CDAD
  must be reported
• Annual trajectory set between Acute Trust and
  PCTs

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Clostridium Difficile

• Patients most at risk
• Elderly patients
• Prolonged hospital stay
• Immuno-suppressed patients (increased
  susceptibility to infection)
• Numerous courses of antibiotics destroys normal
  gut bacteria Clostridium Difficile can flourish
• Poor diet or assisted feeding
• Carried in the bowel of 3 of healthy people

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Measures to reduce Clostridium Difficle

• Whole Health Economy approach
• Antibiotic prescribing in the community impacts
  on patients in the hospital and vice versa
• Antibiotic formulary
• 48 hour/5 day stop policy
• Education and awareness
• Emphasis on environmental and equipment cleaning
• Close working relationship with the Domestic
  Service provider
• Visiting other Trusts who have reduced their
  rates Cohort Ward, changing cleaning product on
  the ward.

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Initiatives in place to reduce all HCAI

• Board to Ward engagement
• Letter to all staff detailing commitment to
  Infection Prevention and Control and for
  individuals to sign and return to manager.
• Mandatory Infection Prevention road shows
• Organisational change in culture
• Performance Management of Divisions in regards to
  Infection Rates and Hand hygiene compliance.
• Ban the Bug Campaign
• Desktop caption 40 days since last
  Bacteraemia. Have you washed your hands.

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Initiatives in place to reduce HCAI (cont)

• Quarterly Saving Lives Audits (DoH)
• ANTT (Aseptic Non Touch Technique) project
  commenced April 2008 over 900 staff trained
  all disciplines
• Bare below the elbows (DoH)
• Weekly Hand Hygiene Audits
• Change of shape of catheter bags landscape to
  portrait.
• New Intravenous line insertion packs
• Increase in the Infection Prevention and Control
  Team.

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Infection Prevention and Control Team

• July 2008
• Nurse Consultant
• Senior Clinical Nurse Specialist
• Infection Prevention Nurse x 2
• Consultant Microbiologists x2
• Now
• New Infection Prevention Nurse
• Audit and Surveillance Nurse
• Information and Data Analyst Post
• Additionally
• 4 New Pharmacists appointed

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Conclusion

• No one measure has succeeded in reducing Health
  Care Associated Infections in the Trust
• There has been a change of culture across the
  Organisation which continues to be embedded
• Each new measure introduced has had an impact and
  it would be difficult to pinpoint one individual
  measure as the main cause
• Need to continue the work this is not for the
  short term.