Annual Report Infection Prevention and Control. RDaSH. Helen Dabbs Deputy Chief Executive/Director of Nursing & Partnerships

Transcription

1 RDaSH Infection Prevention and Control Annual Report L-R: Karen Foltyn - Senior Clinical Nurse Specialist IPC, Rachel Millard - Head of Clinical Effectiveness, Emma Stables - Senior Clinical Nurse Specialist IPC,Helen Dabbs - Deputy Chief Executive/Director of Nursing & Partnerships Helen Dabbs Deputy Chief Executive/Director of Nursing & Partnerships Rachel Millard Head of Clinical Effectiveness

2 Contents 1. Executive Summary Introduction...4 GOVERNANCE ARRANGEMENTS 3. Infection Prevention and Control Governance Arrangements Review of Infection Prevention and Control Policies and Procedures Infection Prevention and Control Team Arrangements...6 OPERATIONAL APPROACH 6. Operational Arrangements Infection Prevention and Control Web Pages Infection Prevention and Control Clinical Audit Programme Use of Antibiotics in line with Antibiotic Prescribing Guidelines Audit Infection Prevention and Control Digipen Pilot Good practice and areas for improvement - themes identified through...10 the process in 2013/ Maximiser reports Domestic Services Review Microbiology Arrangements Evidence Folders (Yellow Folders) /14 Quality, Innovation, Productivity and Prevention (QIPP) Plans...12 Consultation 11. Clinical Leadership Link Champions Training Additional support to clinical care...14 SURVEILLANCE 14. Healthcare Associated Infection Surveillance Outbreaks Meticillin Sensitive Staphylococcus aureus (MSSA) bacteraemia Meticillin Resistant Staphylococcus aureus (MRSA) bacteraemia MRSA Post Infection Review (PIR) Clostridium difficile (C.diff) infection Escherichia coli (E.coli) bacteraemia...18 PATIENT EXPERIENCE 15. Patient-Led Assessments of the Care Environment (PLACE)...19 WORK PLAN 16. Progress against Work Plan Priorities for 2014/ Conclusion Glossary

3 Executive Summary 1. Executive Summary This report covers the period 1 April 2013 to 31 March The key points highlighted below are further explored within the main body of the report. The Trust has had 1 incident of Meticillin Resistant Staphylococcus aureus (MRSA) bacteraemia in this year. There have been 0 diarrhoea and vomiting outbreaks. There has been 1 Clostridium difficile infection across the Trust during the year. Arrangements for Infection Prevention and Control (IPC) services are in place, with a significant amount of work undertaken to provide the service in-house. The Trust implementation of the IPC audit programme provides assurance on the effectiveness of the operational approach to IPC. This has proven to be a useful vehicle for increasing engagement and ownership of IPC in clinical areas. The leadership around IPC has been strengthened via the relationships with Modern Matrons, the IPC Team, the IPC Link Champions approach and Facilities department. Training has achieved the required target of 100% for hand hygiene with a staff hand hygiene leaflet attached to all payslips in June All new starters receive the leaflet at Trust induction. All patient admissions to the Trust are assessed for Healthcare Associated Infections (HCIAs) and documentation has been embedded in practice. All IPC policies have been reviewed and are up to date. 3

4 Introduction 2. Introduction Infection prevention and control (IPC) continues to be a high priority for Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH). The Chief Executive holds ultimate responsibility for providing effective IPC arrangements across the Trust, however this duty of care is delegated to the Director of Infection Prevention and Control, this being the Deputy Chief Executive / Director of Nursing and Partnerships. IPC is a complex area, with a remit that encompasses the whole health care community and associated environments. Deputy Chief Executive/ Director Nursing and Partnerships, Helen Dabbs This report serves to provide assurance of the activities and mitigation of risks related to the prevention and control of Healthcare Associated Infections (HCAIs). The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance highlights the importance of good IPC practices across health and social care as a key part of the quality and safety agenda for patient care. The code emphasises the importance of strong leadership, management and governance arrangements, the design and maintenance of the environment and devices, the application of evidence based clinical protocols and education, training and communication playing a part in reducing the risk of acquiring HCAIs. The Code of Practice states that effective IPC of HCAIs has to be embedded into everyday clinical practice and applied consistently by everyone. Throughout 2013/14 there has been a considerable amount of work and activity carried out with regard to IPC. This annual report outlines how, during 2013/14, RDaSH has demonstrated compliance with the Health and Social Care Act 2008 and Care Quality Commission (CQC) Essential Standards of Quality and Safety, Outcome 8 Cleanliness and Infection Control. 4

5 Governance Arrangements 3. Infection Prevention and Control Governance Arrangements The key roles with regard to IPC have continued to be fulfilled throughout 2013/14. The Governance Structure relating to IPC is provided in the diagram below. DIRECTOR OF INFECTION PREVENTION AND CONTROL Helen Dabbs BOARD OF DIRECTORS DEPUTY DIRECTOR OF NURSING Operational IPC Lead Deb Wildgoose / Christine Prewett CLINICAL GOVERNANCE GROUP HEAD OF CLINICAL EFFECTIVENESS Managerial IPC Support Rachel Millard INFECTION PREVENTION AND CONTROL COMMITTEE INFECTION PREVENTION AND CONTROL CLINICAL NURSE SPECIALISTS Operational Delivery Emma Stables, Alison Swift, Karen Foltyn, Christine Tomes LINK CHAMPIONS Front line staff throughout the Trust Infection Prevention and Control Committee, 4th April 2014 INFECTION PREVENTION AND CONTROL TEAM MEETING INFECTION PREVENTION AND CONTROL LINK CHAMPIONS MEETING Governance Arrangements 5

6 Governance Arrangements 4. Review of Infection Prevention and Control Policies and Procedures All of the Trust IPC policies and procedures have been reviewed and are up to date. They are available to staff via the Trust s internal intranet and are published externally on the Trust s internet site. Policies reviewed in 2013/14 are listed in the table below. Aseptic Technique and Aseptic Non Touch Technique Policy Policy for the Management of Patients with Glycopeptide Resistant Enterococci (GRE) Diarrhoea and / or Vomiting policy for patients and staff Sharps policy Safe use and disposal of Sharps and Management of Contamination Injuries. Trust Cleaning Systems and Processes for the Environment, Patient Equipment and Medical Devices Infectious Diseases in Day Care Nurseries The IPC team have also had involvement in the following Standard Operating Procedures (SOP s) and scope packages. Clinical skills training Peripheral venous cannulation Administration of IM injections IV therapy Subcutaneous injections Blood pressure monitoring NICE contributions and gap analysis 5. Infection Prevention and Control Team Arrangements A dedicated team of three Senior Clinical Nurse Specialists and one Clinical Nurse Specialist with secretarial support is managed on a day to day basis by the Head of Clinical Effectiveness who reports directly to the Deputy Director of Nursing. The process for this is detailed in Section 6 of this report. 6

7 Operational Approach 6. Operational Arrangements The Trust has its own IPC Team, working on a hub and spoke model where allocated nurses in the IPC team work within each of the Trust localities. This approach has allowed for better allocation of resources across the Trust and increased flexibility to respond to issues arising in the Trust, based on need. Tangible outcomes achieved throughout 2013/14 are: Clinical Nurse Specialists are more visible in inpatient areas. - contributing to care plans. - allocated specific ward areas. Managing complex cases timely and effectively. Improved networking. More engagement with staff and patients. Quality audit tool developed and in use. Ward staff taking ownership of action plans from the audit. Audit results are reported at IPC committee. Good communication between the team. Improved relationships with the Modern Matrons. Improved way of staff booking on training. The IPC team has allocated areas to oversee, covering Doncaster, Rotherham, Manchester, North and North East Lincolnshire. This facilitates improved visibility and networking as well as building better collaborative relationships and a more consistent approach. Rotherham Doncaster Senior Clinical Nurse Specialist IPC Senior Clinical Nurse Specialist IPC Senior Clinical Nurse Specialist IPC Clinical Nurse Specialist IPC North Lincolnshire Manchester North East Lincolnshire Operational Approach 7

8 Operational Approach 6.1 Infection Prevention and Control Web Pages During the year 2013/14 the IPC web pages have undergone a complete overhaul and update. There are now dedicated intranet pages for: IPC News and updates Meet the team IPC contact details - in and out of hours Hand hygiene information for staff Training times and dates Links to IPC E-learning IPC Committee minutes Link Champions Yellow Evidence Folder resource page 7. Infection Prevention and Control Clinical Audit Programme For the second consecutive year the IPC team have undertaken a programme of inspection based audits and walkarounds of inpatient areas and community bases. The audits are unannounced and utilise an indepth audit tool based on best practice national guidance and Trust policy standards. Verbal feedback is given at the time of the audit and a written report is sent to the clinical manager and Assistant Directors within 5 working days of the audit taking place. Action plans are formulated by the managers of the inpatient area to address any deficits within a specified time frame. The audits, outcomes and progress are shared at the IPC Committee. The table on page 9 shows the final audit results for 2013/14. 8

9 Operational Approach Infection Prevention and Control audit outcomes for 2013/14 by Ward and Business Divisions All areas are compliant at year end 88.4% 90.3% 90.6% 92.2% 92.2% 92.6% 94.2% 89.1% 85.9% 87.4% 87.7% 83.1% 62.6% 49.9% 63% 71.4% 52.8% 91% 92.1% 93.9% 88.4% 87.2% 89% 85.4% 83.3% 95.4% 88.8% 86.3% 92.5% 94.2% 90.6% 80.1% 77.5% Brodsworth Ward Coral Lodge Cusworth Ward Emerald Ward Goldcrest Kingfisher Mulberry Ward Osprey Sandpiper Skelbrooke Ward Amber Lodge Jubilee Close Sapphire Lodge Brambles Coniston Lodge The Ferns The Glades Laurel Ward Windermere ECT Suite Hawthorn Ward Hazel Ward Magnolia Ward New Beginnings Compliant 85% and above Non Compliant less than 85% All areas requiring improvement are escalated via IPC Committee; action planned and addressed at re audit and via IPC team clinical visits Adult Mental Health Forensic Services Doncaster Community Integrated Services Learning Disabilities Drug and Alcohol Services Older People s Mental Health Service 7.1 Use of antibiotics in line with antibiotic prescribing guidelines audit This audit was undertaken Trustwide to coincide with the European antibiotic awareness week in November It is clear from the audit results that the initial prescribing and rationale for antibiotic prescribing does, on the whole, follow local guidelines, the lower standards achieved generally relate to the review of antibiotic use. Action has been taken to improve the review process and is monitored by the Pharmacy team and Modern Matrons. 7.2 Infection Prevention and Control Digipen pilot For 2013/14 the IPC team piloted the use and practicality of using Digipens to compile and complete the audit tool while undertaking the inspection based audits. After extensive use over a period of 3 months it was concluded that the varied nature of the audits as well as the inconsistent technology were not conducive at this time to utilise the Digipens on a permanent basis. The learning has been fedback to inform future plans for the use of digipens within the Trust. Operational Approach 9

10 Operational Approach 7.3 Good practice and areas for improvement - themes identified through the audit process in 2013/14 Good Practice 4 Staff were aware of the importance of infection control and were honest and willing to learn if they did not know the answers to questions asked 4 Prompt turn around for action plans and addressing issues. Significant improvement of re-audit scores from some of the areas 4 Staff follow hand hygiene best practice (bare below the elbows) 4 Patients voiced to auditors that they felt cleaning was good and praised the staff on the ward. Areas needing improvement 7 Slight damage and wear and tear on fabric of building. A number of wards are due for redecoration soon. 7 Inappropriate storage of items in store rooms e.g. equipment and/or patient clothing stored alongside food. 7 Lack of storage facilities. Senior Clinical Nurse Specialist, IPC Karen Foltyn 7.4 Maximiser Reports During 2013/14 the Domestic Services Monitoring Team undertook 189 audits across RDaSH properties. Although there are no national targets for cleaning percentages within the National Specification of Cleanliness (2007), good practice suggests the following targets to work towards: Very high risk areas 98% High risk areas 95% Significant risk areas 85% Low risk areas 75% The cleaning audits comprise of 49 element standards which are used when calculating the scores. All audits are recorded and calculated using Maximiser software. This programme is currently under review within domestic services and in 2014/15 it is anticipated that an alternative monitoring system will be introduced. The domestic monitoring results for 2013/14 overall was 92.9% 10

11 Operational Approach 7.5 Domestic Services Review The primary drivers of the review are to realign the domestic/housekeeping service provision to the needs of the Trust and to recommend a service which meets the National Specification for Cleanliness in the NHS. The review is being undertaken in two phases, phase one being the review and restructure of the Domestic Supervision, and phase two being the review of the domestic hours, rotas, and working practices. The proposed changes to the service are: Implement standardised working rotas across the Doncaster and Rotherham sites Create a domestic rapid response team to undertake deep cleans and unexpected incidents which require immediate attention by domestic services Ensure that the domestic establishment meets the needs of the service with cover for annual leave and sickness absence factored in Revise the domestic/housekeeping job description to better reflect the needs of the service Align all domestic/housekeeping posts to the one job description and banding Have a dedicated trainer for domestic personnel 8. Microbiology Arrangements Microbiology service SLAs are in place with locality based Trusts to provide this service at a local level. Rotherham Foundation Trust and Doncaster and Bassetlaw NHS Foundation Trust provide microbiology support for the 3 localities, including out of hours cover. 9. Evidence Folders (Yellow Folders) Updating and maintaining the folders is the responsibility of the IPC link champions. These are held at ward /departmental level for use as an information resource and as a record of training and audit undertaken within the clinical areas. They also serve as compliance evidence for IPC standards of good practice. Compliance is monitored via the IPC team. An internal re audit of the evidence folders was undertaken in November Operational Approach 11

12 Operational Approach /14 Quality, Innovation, Productivity and Prevention (QIPP) Plans Consultation The IPC Clinical Nurse Specialists continue to be involved with a programme of review of equipment / supplies and the renewal of contracts for the decontamination of podiatric reusable instruments and/or progressing to single use equipment. Cleaning and disinfectant products are currently being reviewed with the aim to have a standardised product and best value for the whole Trust. 11. Clinical Leadership IPC Clinical Nurse Specialists work directly with staff caring for patients where there are issues relating to IPC, advising and contributing to care plans. The specialist nurses regularly has a presence within clinical areas thus acting as an easily accessible resource as well as a role model for staff. Modern Matrons, through A Matron s Charter: An Action Plan for Cleaner Hospitals (DoH 2004), have responsibilities for monitoring standards of cleanliness within clinical areas and are expected to take the lead role on infection prevention and control. The IPC team work closely with Modern Matrons and Service Managers on IPC issues focusing on the delivery of high quality care, and supporting and challenging them in their leadership relating to IPC Link Champions Our well established link champion programme has continued this year and there are in excess of 100 link champions across the organisation, including registered nurses, healthcare assistants, physiotherapists, podiatry staff, school nurses, ward managers, occupational therapists, mental health staff, LD registered homes and supported living homes. Link champions are responsible for quarterly audits, training and cascade of information in their own areas as well as raising issues with the IPC team at quarterly meetings and via ad-hoc telephone calls. Each meeting contains an educational session on a current topic. This year the sessions have included; hand hygiene competence assessment, diarrhoea and vomiting outbreak management and outcomes from the Francis report. Each meeting is reported through the Infection Prevention and Control Committee. The Link Champions help create and maintain an environment which ensures the safety of the patient, visitors and health care workers. The Link Champions utilise their IPC knowledge and skills to support compliance with national standards. In addition, there are information boards if appropriate in most clinical areas and these are maintained and updated by the Link Champions on a regular basis. 12

13 Operational Approach The Link Champions have also contributed to the IPC audit process by completing quarterly audits of sections selected from the environmental audit tool. In areas where full compliance has not been achieved Link Champions have assisted their managers to make the necessary improvements. IPC Link Champion Doneena Salmon, Community Learning Disability Nurse was presented with a highly commended accolade in the national Schülke Hand Hygiene Champions of Doneena has helped develop a tool to highlight to service users how effective their hand hygiene technique is. She has now been invited to be involved in developing this tool nationwide with help from the Infection Prevention and Control team. The Link Champion Terms of Reference and Role Profile were further developed in 2013/14 in partnership with each Business Division in order to ensure that the roles and responsibilities for Link Champions are clearly identified. RDaSH community learning disability nurse and IPC Link Champion Doneena Salmon (left) with Claire Wilson of Schülke UK Ltd at the Hand Hygiene Awards Training IPC training is mandatory. Training was provided for all new staff at Corporate Trust induction. Following significant work with Learning and Development the IPC team helped review the induction training and corporate booklet, the training needs analysis matrix and staff training requirements. Standard precautions training is carried out at localities. For 2013/14 the IPC team developed the Hand Hygiene information booklet for staff which in June 2013 was attached to every wage slip in the organisation. Staff starting after June 2013 were each given the information booklet at induction. Hand Hygiene assessments for clinical staff is also delivered in localities by the IPC Team and Link Champions. Training attendance is monitored and a process is in place to follow up any non-attendees via their line manager by the Research Education and Development Centre. Operational Approach 13

14 Operational Approach Standard Precautions training session with Senior Clinical Nurse Specialist, IPC Karen Foltyn Hand Hygiene education with Clinical Nurse Specialist, IPC Chris Tomes and children from the Warren Nursery. The hand hygiene activities link in with the World Health Organisation s Save Lives: Clean your hands campaign which took place on 5 May. Standard Precautions training is required to be undertaken once every 2 years. The total number of staff undertaking training in 2012/13 and 2013/14 is illustrated below. Standard Precautions Training 2012/13 Standard Precautions Training 2013/ Face to Face e-learning 756 Face to Face e-learning Total number of staff trained Total number of staff trained Additional support to clinical care The Clinical Nurse Specialists continue to be actively involved in advising on modernisation and new build projects Trust wide in 2013/14. Significant work has been undertaken in the new build / refurbishment of St John s Hospice, plus initial input into the Children and Young People s Mental Health Service (CYPMHS) new build and Oak Close. The IPC team monitor Department of Health alerts. These have been cascaded to all relevant staff for information throughout the year and are reported through the IPC committee. 14

15 Surveillance 14. Healthcare Associated Infections Surveillance Surveillance is an essential component of the prevention and control of infection. It consists of the routine collection of data on infections among patients or staff, its analysis and the dissemination of the resulting information to those who need to know so that appropriate action can result. Surveillance also forms part of clinical audit and clinical governance; it assists in reducing the frequency of adverse events such as infection or injury. Surveillance of organisms is required to understand the extent, cost and effects of healthcare associated infection. It is the foundation for good infection control practice and improving patient care. Surveillance forms the basis of infection prevention and control interventions, education and policy development Outbreaks There have been 0 diarrhoea and vomiting outbreaks across the Trust during this year. Surveillance 15

16 Surveillance 14.2 Meticillin Sensitive Staphylococcus aureus (MSSA) bacteraemia There have been no cases of MSSA bacteraemia across the Trust this year Meticillin Resistant Staphylococcus aureus (MRSA) bacteraemia There has been 1 case of MRSA bacteraemia, jointly attributable to RDaSH and Doncaster Clinical Commissioning Group (DCCG) for 2013/14. The IPC team led and contributed to the new Post Infection Review (PIR) process for this case involving multi-agency and multidisciplinary teams across the Doncaster healthcare community. An in depth investigation was undertaken involving all staff providing care and PIR meetings were held and an action plan formulated based on recommendations from the investigation. All staff involved in this investigation found it a positive experience and have changed practice as a result. 16

17 Surveillance 14.4 MRSA Post Infection Review (PIR) The IPC team contribute to DCCG PIR meetings where the root cause for all Doncaster district wide MRSA bacteraemia and Clostridium difficile infections are discussed and the decision made by the meeting members to whether the infection occurred through a lapse in care or was unavoidable. If there is a lapse in care an action plan is developed by the provider involved. Community acquired MRSA bacteraemias are investigated by the IPC team using root cause analysis tools. The Deputy Director of Nursing is informed of the findings and actions taken. This is then taken to the IPC Committee for assurance Clostridium difficile (C.diff) infection There has been 1 case of C.diff infection. Following a thorough investigation it was discovered the patient was previously C.diff positive and had relapsed due to underlying medical conditions and had antibiotics prescribed. A RCA was undertaken, lessons learnt and discussed at IPC Committee and DCCG PIR meeting. Surveillance 17

18 Surveillance 14.6 Escherichia coli (E.coli) bacteraemia There has been 1 case of E. coli bacteraemia in Rotherham in February Following an investigation using the RCA approach it was concluded that E.coli was endogenous from the patient and not as a result from cross infection or poor standards of practice. 18

19 Patient Experience 15. Patient-Led Assessments of the Care Environment (PLACE) April 2013 saw the introduction of Patient-Led Assessments of the Care Environment (PLACE), which is the new system for assessing the quality of the patient environment, replacing the old Patient Environment Action Team (PEAT) inspections. A crucial component of the assessment process is the involvement of patient assessors. This term covers all people whose experience of the site/organisation is as a user rather than as a provider, and so encompasses relatives, carers, friends, patient advocates, volunteers, Trust member and Trust governors. PLACE teams consist of patient (at least 50%) and staff assessors who will assess how the environment supports patient s privacy and dignity, food, cleanliness and general building maintenance. It focuses entirely on the care environment and does not cover clinical care provision or how well staff are doing their job. Results from the 2012/13 PLACE assessments for RDaSH are shown below. RDaSH scored above average for all the criteria except food and hydration, which looks at the menu choices, portion sizes, quality and taste of food available where it scored below the national average. Following the PLACE visits menus have been reviewed with dietitians looking closely at the nutritional value of each meal as well as more choices being offered. From January 2014 a pilot scheme has been undertaken of a ward hostess system, the hostess being present for the evening hot meal period and oversee the process at meal times, setting tables, cleaning the dining area after meals and taking orders for the next day. This is being monitored and further developed by the facilities team. 100% Cleanliness 98.3% National Average 95.86% Food 77.71% National Average 88.62% Privacy, dignity & wellbeing 93.12% National Average 89.05% Facilities 95.35% National Average 88.62%% Patient Experience 19

20 Work Plan 16. Progress against Work plan The Trust s Infection Prevention and Control Committee Work Plan for the year 2013/14 and progress against it are provided in the work undertaken and achievements against this Work Plan are reflected across this Annual Report. The objectives and position at year end are summarised below: Objective Position 1 Implement the revised Infection Prevention and Control Audit Completed tool across the Trust 2 Pilot the use of Digipens to record audit findings Completed 3 Use the computer base Maximiser cleaning auditing tool to ensure that standards of cleanliness and hygiene are maintained. Completed 4 Continue to embed the service based in cleanliness and Infection Completed Prevention compliance evidence folder 5 To ensure all Infection Prevention and Control policies due for Completed review are reviewed, up to date and available on the policy section of the Trust website 6 Review published NICE guidance and ensure implementation Completed 7 Monitor the Infection Prevention and Control Link Champions Completed Programme, and feedback to the bi monthly Infection Prevention and Control Committee 8 Deliver IPC training and implement a streamlined training Completed matrix for IPC 9 Enhance the Infection Prevention and Control web pages for Completed public and staff 10 Monitor for Alerts and new guidance on IPC Completed 11 Produce an annual Infection Prevention and Control report Completed 20

21 Work Plan 17. Priorities for 2014/15 The Trusts IPC priorities for 2014/15 have been identified and the following key points will be included in the work plan: Governance Streamline and refine the current IPC audit process, utilise learning from previous audit programmes and strengthen the approach for continuous improvement Formulate and implement a robust IPC monitoring and audit system for Learning Disability Community Services Monitor for alerts and new guidance on IPC Support clinical teams to respond to the new CQC regulatory model Develop a web based evidence folder Operational Approach Enhance the quality focus for the team and broaden the scope of interventions with clinical teams Monitor cleanliness with the facilities team following the outcome of Domestic Service review Review published NICE guidance and ensure implementation Utilise learning from previous audit programmes and strengthen the support to clinical teams to improve outcomes Training Review the link champion role and training/support requirements Deliver IPC training and implement emergent best practice initiatives Work Plan 21

22 Conclusion 18. Conclusion This report outlines the work that has been carried out in order to provide assurance that the Trust is meeting its Infection Prevention and Control duties under both the Health and Social Care Act (2008) and CQC outcome 8 requirements (Cleanliness and Infection Control). The services of the Trust have performed well over the year. Plans are in place with identified key priorities for next year 2014/15. Infection Prevention and Control remains a key priority for the Board of Directors and the Trust is committed to providing safe, effective, well led care. The monitoring and governance arrangements which are in place will provide continued assurance to the Board of Directors. 22

23 Glossary 19. Glossary Bacteraemia - bacteria in the bloodstream. Clostridium difficile (C diff) - Clostridium difficile is an anaerobic bacterium that is present in the gut of up to 3% of healthy adults and 66% of infants. However, Clostridium difficile rarely causes problems in children or healthy adults, as it is kept in check by the normal bacterial population of the intestine. Endogenous when an organism is spread by the person from one part of their body to another part. Healthcare associated infections (HCAIs) are infections that occur: as a direct result of treatment in, or contact with, a health or social care setting as a direct result of healthcare delivery in the community as a result of an infection originally acquired outside a healthcare setting (for example, in the community) and brought into a healthcare setting by patients, staff or visitors and transmitted to others within that setting (for example, Norovirus) IPC link champion ward based or department level staff within the Trust who promote and support best practice in relation to infection prevention and control (IPC) with a common goal of zero tolerance towards avoidable infections under the guidance of the Clinical Nurse Specialists. Microbiology - The branch of science that deals with microorganisms. Microorganisms - A microscopic organism, especially a bacterium, virus, or fungus. MRSA - Staphylococcus aureus is a common bacterium that lives harmlessly on the skin and nose of about a third of the population. Meticillin resistant Staphylococcus aureus (MRSA) is a form of Staphylococcus aureus that has become resistant to some common antibiotics. Glossary 23

24 RDaSH DP7756/12993/06.14