Transforming Maternity Services Mini-Collaborative Reducing SSI following C/S

Transcription

1 Transforming Maternity Services Mini-Collaborative Reducing SSI following C/S WebEx Thursday 11 th July pm

2 Introducing SSI Where we are at (WHAIP) Baseline data Reliable (robust data since 2010) Many interventions taking place locally which has led to a reduction in the SSI rate What is happening, where and what should be happening?

3 All Wales surveillance compliance above 90% - all hospitals SSI rates over the time period ( ) monthly rates

4 Monthly rates from 2010 end 2012

5 Can we expect to achieve a further reduction?

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8 Wound assessment

9 Over to you.. Examples of what you may wish to share in your brief presentation: Information for women pre/post C/S shaving/waxing v clippers pre/peri/post op normothermia Skin prep antibiotic timings glucose control theatre environment is your C/S theatre part of general theatres or part of maternity Is there dedicated theatre staff team? What dressings do you use? Do you have wound management guidance? Do you liaise with your infection control team do your infection control team have a named lead for maternity? Some of the above may be part of WHO Safety Brief do you use this? Do you collect any process compliance data for any of the above? Anything else you can think of.

10 Feedback Abertawe Bro Morgannwg University Health Board Aneurin Bevan Health Board Betsi Cadwaladr University Health Board Cardiff and Vale University Health Board Cwm Taf Health Board Hywel Dda University Health Board Powys Health Board

11 ABMU

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14 Additional Info Betadine/iodine solution is used to skin prep Pre incisional antibiotics are given to women Temperature is recorded pre operative, intraoperative and post operative Both sites POW and Singleton have dedicated obstetric theatres however POW midwives scrub and Singleton have a dedicated theatre team. QUAD environmental audits were undertaken in both sites to identify any possible factors that may increase infection rates and actioned. Leucomed dressing are used that remain insitu for 48hrs unless saturated and wet. WHO maternity safety check is in place in both sites. We achieve > 95% return rate of surveillance forms across the health form. Current infection rate for first quarter of year is 3.5% POW and 6.8% singleton. All community midwives received information on correct identification of wound infections although the plan is to do some further work in line with the work undertaken by the all Wales group.

15 Aneurin Bevan Health Board

16 SSI worst in class ABHB had a history of the highest reported infection rates of SSI in Wales We questioned was this due to The extent of the infections The quality of the data process Or clinical practice

17 Concentrated on The quality of data This lead to an understanding of the extent and pattern of the infections Which lead to questioning clinical practice

18 In particular Defining an infection Taking a wound swab Evaluating care» Skin prep» Dressings

19 Resulting in Our results demonstrate a change from the highest to the lowest reporting of infection

20 So what? Did this actually improve the rate of infections per se? Did it only improve the quality of data?

21 Betsi Cadwaladr University Health Board

22 Betsi Cadwaladr University Health Board An integrated care pathway for Caesarean Sections was implemented October The overall objectives of the care pathway are: To provide standardised evidence based best practice guidelines To ensure standardised best practice for patients pre, intra and post operatively To assess the physical and psychological condition of the patient To minimise postoperative complications To ensure the patient understands what is happening at all times To ensure patient safety at all times

23 C/S care pathway Pre-operative: CS ICP commenced at least 2 days prior to surgery Pre op shower using soap Intraoperative WHO Safe Surgery checklist Hair removal using clippers with a disposable head Skin preparation- iodine solution Prophylactic antibiotics- appropriate antibiotics administered prior to incision Normothermia-above 36 degrees Surgical clips not used SSI form commenced by medical staff

24 C/S care pathway Postoperative Interactive wound dressing Wound dressing is removed after 24 hours. If clean and dry no further dressing is required and the patient may shower or bathe. Aseptic technique If the wound is displaying signs of infection wound swab must be taken and a fresh dressing applied then daily dressings until healed. The assessment is documented in the patient records. SSI form completed on discharge SSI form completed 28 days post operatively and returned to hospital Hand hygiene

25 BCU All inpatient infections following CS are reported monthly to Womens CPG Board via maternity dashboard and also to BCUHB Infection Control Performance group. Compliance with CS SSI is monitored via the monthly maternity dashboard and reported to the infection control performance group. All identified infections are subject to a route cause analysis with the aim of identifying any areas for learning and prevention. Public Health Wales via the Welsh Health Associated Infections Programme are in the process of developing a caesarean section wound care pathway with the objective of implementing in all maternity units in Wales. There is some evidence that skin preparation with 2% chlorhexidine in alcohol reduces the risk of SSI and this has been trialled in one area of the CPG however there has been insufficient evidence to support the actual reduction in infection. WHAIP are not directing that maternity units in Wales should be implementing skin preparation with chlorhexidine.

26 Additional info Information for women pre/post C/S- RCOG Leaflet given Theatre environment all CS performed in the obstetric theatres located adjacent to the labour wards. Complicated CS performed in main theatres e.g. grade 4 placenta praevia Is there dedicated theatre staff team? Yes for actual surgery. No dedicated recovery service in YGC this is undertaken by midwives Do you have wound management guidance? Draft SOP from WHAIP Do you liaise with your infection control team do your infection control team have a named lead for maternity? We regularly liaise with infection control team but do not have a dedicated named contact for maternity services. Also involve tissue viability specialist nurses in the event of wound infections to advise re: appropriate dressings Some of the above may be part of WHO Safety Brief do you use this? Yes for all EL LUSCS and all EM LUSCS apart from code 1 Sepsis bundle fully implemented Sepsis ambassadors identified on each ward/labour ward.

27 Cardiff & Vale

28 C&V Information for women pre/post C/S posters on ward advising washing hands before and after going to the toilet shaving/waxing v clippers shaving with clippers pre/peri/post op normothermia only routine - does not affect decision to continue - looking into warming iv fluids and checking intra operative temp Skin prep antiseptic videne antibiotic timings before k to s glucose control not unless diabetic - sliding scale theatre environment is your C/S theatre part of general theatres or part of maternity mat Is there dedicated theatre staff team? yes What dressings do you use? opsite honeycomb Do you have wound management guidance? not specific to maternity Do you liaise with your infection control team do your infection control team have a named lead for maternity? yes Some of the above may be part of WHO Safety Brief do you use this? yes Do you collect any process compliance data for any of the above? yes - audit in place Anything else you can think of.

29 Cwm Taf

30 Cwm Taf Local Health Board Patient Information In the process of agreeing the Eido information leaflet to be given to women pre op Women also given an in house leaflet with information on caring for your wound post op Cwm taf info for women

31 Electric clippers used if required and women advised not to shave when they attend for pre admission IV antibiotics administered 30 minutes before knife to skin Skin prep with chlorahexadine and disposable drapes used

32 pre/peri/post op temperature recordings taken Dedicated obs theatres Small team of designated theatre staff backfilled with midwives WHO safety checklist completed every case Luekomed T plus transparent wound dressing used post op removed day 5 by community midwife unless seepage or any signs of infection

33 Bi monthly directorate infection meetings held, members of this group include consultant microbiologist, named infection control nurse for department, senior midwife, clinical midwife lead Head of Midwifery and risk manager Monthly infection rates discussed and action plans put in to place to reduce SSI rate WHAIP team member and tissue viability nurse invited when required Minutes of this meeting and action plans shared with director of nursing

34 Hywel Dda

35 Info for women AN (elective) no shave/wax, soap bath shower no lotions etc /PN no bath, just shower, towel use, wound care Skin prep iodine Antibiotics after delivery paediatric objection Theatres are part of general Written guidance for wound care yes Use Safety brief yes Wound closure no clips Dressing on until home. Use Leukomed dressing Skin to skin contact currently exploring specific advice to women re above waist contact prior to cord off We have achieved a significant reduction in our SSi rate.

36 What next Tuesday 17th September. It will be a full day in Cardiff. Details will follow shortly. This will be suitable for HB SSI leads, surveillance leads, midwives hospital and community, obstetricians, student midwives, theatre staff, anaesthetists, infection control staff, managers. So gather your team to ensure it is in the diary!

37 Questions? If we can improve care for one woman, then we can do it for ten. If we can do it for ten, then we can do it for a 100. If we can do it for a 100, we can do it for a 1000 And if we can do it for a 1000, we can do it for every woman in Wales. Philip Banfield philip.banfield@wales.nhs.uk Catherine Roberts Maternity.collaborative@wales.nhs.uk