BASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST BOARD OF DIRECTORS BNHFT. / DATE OF MEETING 28/05/ Report to: Board of Directors Meeting 28/05/ Title: Author: Purpose: Decision Sought: Infection Prevention and Control Report Dr Nicki Hutchinson To provide a six monthly update The Board is asked to note the hospital acquired infection data for the last year and to approve the annual infection prevention and control programme for 20 2011: Moving forward 1. Purpose The purpose of this paper is to: Update the board on the status of infection prevention and control in BNHFT since the last report in November To highlight the priorities for -11 2. Executive summary - Overview of infection control activities in the Trust Hospital acquired MRSA bacteraemia and C.difficile infection rates continue to fall. Further work is required as tough targets have been set for 20-11 (0 MRSA bacteraemia and 48 C.difficile). MRSA screening for all admissions needs to reach 0% by 31 st December 20. Implementation started Feb 20 but uptake is slow. Focus of the infection prevention and control has broadened. A urinary catheter care bundle is being piloted on D floor and a point prevalence study has been undertaken. The Trust has signed up to the Matching Michigan study to help reduce central line infections. Work continues on the promotion of good hand hygiene and most areas are now performing hand hygiene audits. However quality control audits and an audit for the WHO on hand hygiene unfortunately show compliance is poor in a number of areas. Because of high national incidence we have had a difficult winter due to Norovirus. However this has led to a significant loss of bed days and high patient moves. A plan needs to be in place before next winter. 3. Description of infection control arrangements 3.1 The Infection prevention and control team (IPCT) is led by the DIPC and includes an IV nurse specialist, a senior infection control nurse, an infection control nurse, the antibiotic pharmacist, a surveillance officer, an infection prevention assistant and an administrator. 3.2 The Infection control committee (ICC) is chaired by the elective divisional director with senior representation from the emergency and maternity and child health divisions, THE PRODUCTION DATE 28/05/ 1
corporate governance lead, estates manager, the health protection agency (HPA), the senior infection control nurse, the decontamination manager and the DIPC. The ICC meets quarterly, has defined terms of reference and reports to the board of directors via the DIPC. The DIPC reports directly to the CE and is a member of the Executive committee. The ICC has specialist subcommittees responsible for integrating infection prevention and control into the overall management of cleaning, waste, operations, decontamination, estates and specialist issues. 4. DIPC reports to the Trust Board 4.1 Number and frequency: twice/year since April 20 5. Budget allocation for infection control activities 5.1 Staffing: 354,003/year. Saving achieved with 2 x Band 3 HCA vice 1 x Band 6 and 0.5 x Band 8B. 5.2 ICNet user licence funded centrally at 13,691.88/year 6. HCAI statistics 6.1 Methicilin Resistant Staphylococcus aureus (MRSA) bacteraemia: Target not agreed with the PCT, we have proposed 3 and the PCT state our ceiling should be 0. 20- total 3 cases reported, 2 hospital acquired and one community acquired. Root cause analysis undertaken for all three cases Apr Mar, 3 cases of community acquired MRSA bacteraemia and 1 case attributed to the hospital have been treated at the Trust. MRSA: Rate per thousand bed days 6 Start Elective Screening 5 4 3 2 1 0 Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- Rate Mean 1SD Minus1SD (+) 2SD (-)2SD 6.2 Clostridium difficile (C.diff) infections: Apr to Mar : hospital acquired cases 46. Community Acquired Cases: 33 For this coming year our ceiling of Trust apportioned C.difficile cases has been reduced by the PCT to?64? 60 with an internal stretch of 48 (4/month).
C. difficile:accumulating Ceiling and Actual Performance: Apr 07-Mar, Apr -Mar & Apr to date 140 120 0 80 60 40 20 0 Ceiling Target Accumulating actual C. difficile: Trust apportioned, rate per thousand bed days 1.40 1.20 1.00 0.80 0.60 0.40 0.20 Introduction of rapid Response team Intoduction of Actichlor plus 0.00-0.20 Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- Rate Mean 1SD Minus1SD (+) 2SD (-) 2SD 6.3 Methicilin Sensitive Staphylococcus aureus (MSSA) bacteraemia: No national target 20-8 Hospital acquired cases 20-: 6 Hospital Acquired cases (27 MSSA bacteraemia in total) 2 cases were associated with line infection 6.4 Hospital Acquired Bacteraemia:
Significant Bacteraemia 30 25 20 15 5 0 Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- Total Bacteraemia HAI VAD 6.5 Outbreaks: 6.5.1 Swine flu H1N1 Influenza A 35 30 25 20 15 5 0 Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Hospitalised Lab Confirmed 6.5.2 Norovirus From November 20 until Easter 20 had wards closed due to Norovirus with 139 patients and 50 staff diagnosed with Norovirus. Significant disruption to patient care and loss of bed days. SUI is underway 7. Hand hygiene 7.1 The 5 moments for hand hygiene initiative was launched on the 1 st November after introduction during infection control week. This campaign concentrates on performing hand hygiene close to the patient and once this has been well established (and after the swine flu pandemic) the remote alcohol gel stations will be removed. Personal attachable alcohol gel dispensers and end of bed dispensers have been issued to improve hand hygiene.
8. Audit 8.1. Focus on commode audits over the past 2 months has led to a significant improvement in ensuring all commodes are cleaned appropriately. 9. MRSA screening programme 9.1 MRSA screening of emergency admissions began in February 20. By 30 th April compliance was <40%. We must reach 0% by the end of the year.. Staff training.1 From Nov to Apr the infection control team have held 119 training courses courses which have been attended by 857 delegates. Training on specialist topics/areas is also undertaken e.g. antibiotic training for junior medical staff. 11. Care Quality Commission (CQC) 11.1 The hygiene code was updated in December 20 with a new criterion being added about the dissemination of information. All policies have been reviewed to ensure we are complaint with the revised code 12. The annual programme for -11: see appendix 1 12.1 The IPCT drafted the annual programme for -11 with clear objectives and priorities. The priorities for the year ahead are: Embed 5 moments of hand hygiene into every episode of patient contact Maintain low levels of MRSA and C.difficile infections within the hospital Expand our focus to reducing other common hospital acquired infections including urinary tract infections and IV line associated infections. 13. RECOMMENDATION The Board is asked to support the priorities for -11 and make further recommendations if indicated.
Appendix 1 ANNUAL INFECTION CONTROL PROGRAMME 20-11: Moving Forward 1. INTRODUCTION The hygiene code of 20 1 sets out a frame work for the prevention and control of health care associated infections and a new version published in December 20 introduced an additional criteria regarding the dissemination of information between health and social care providers. From April 20 all health care providers have to be registered with the newly formed Care Quality Commission (CQC) in order to continue to provide healthcare. CQC will be inspecting trusts to ensure compliance with the criteria in the new hygiene code. Failure to comply with this code can have significant consequences. Reducing hospital acquired infections is still one of the key priorities for BNHFT. The -11 programme starts from a very strong point with MRSA, MSSA bacteraemia and C. diff infection rates at the lowest point since reporting began and surgical site infections below the national average. The IPCT took time out at the end of March 20 to reflect on the team s performance in the last year based on the last programme and to agree the way forward. This programme is designed to set objectives, identify priorities for action and ensure evidence is gathered to demonstrate compliance with the new code. The programme will form the basis for the DIPC s reports to the board of directors and corporate governance board. A more detailed programme that expands on these objectives is used by the infection control team to guide the day to day service. The main focus for this year s programme is; Embed 5 moments of hand hygiene into every episode of patient contact Maintain low levels of MRSA and C.difficile infections within the hospital Expand our focus to reducing other common hospital acquired infections including urinary tract infections and IV line associated infections. Hygiene Code: Criteria 1 Suitable and sufficient training for all relevant staff, contractors and others in infection prevention and control: Formalise updated training plan and audit effectiveness of e-learning. Ensure an audit programme is in place of key policies and practices: Continue implementation of Saving Lives programme. Finish UTI pilot on Orthopaedic Trauma and roll out trustwide. Policy on information sharing when admitting, transferring, discharging and moving service users within and between health and social care facilities: Development of infection status on electronic discharge summary. Work with community team to provide infection control training for care homes.
Infection prevention and control reporting by clinical directors and matrons: Work with divisional managers and governance facilitators on how they can access and report infection prevention and control data. Support modern matrons in their responsibilities under the hygiene code: Provide quarterly infection prevention update sessions for modern matrons Ensure appropriate action is taken to deal with occurrences of infection: Extend multi-disciplinary format root cause analysis to all infections. Publish baseline data. Adit use of care plans. Determine ceiling for catheter related blood stream infections. Review epidural infections and work with pain team Infection prevention and control infrastructure: Recruit to substantive post for infection prevention assistant. Review team structure at 6 months. Launch of Infection Prevention and Control team: Organise an Infection Prevention Fun week to promote infection prevention and control trustwide. Raise awareness of the staff and the public on the role of the IPCT and the vision for the year ahead. Launch of team to coincide with removal of excess alcohol gel stations and signs Team training and development: Carry out a team building exercise. Review use of office space. Attendance at IPS annual conference. Review personal development plans and appraisals. Improve internal communication: Ensure involvement with team and microbiologists in internal dissemination of information Joint working between staff in planning admissions, transfers, discharges and movements between departments and other health and social care providers: Intelligent Patient Placement training session April 20. Continue to audit and educate those involved in bed management issues. Analyse study of infection control impact on patient movements around the trust and feedback to Executive Committee Hygiene Code: Criteria 2 Effective arrangements for appropriate cleaning of equipment used at the point of care: Commode cleaning - continue with weekly audits undertaken by infection prevention and control team. Ensure processes in place to work with modern matrons and Director of Nursing to achieve 0% compliance. Premises and facilities should be provided in accordance with best practice: Continue carrying out programme of environmental audits. Arrangements for cleaning: Work with Andrew Buckley and Director of Nursing to develop protocols for different deep clean levels and requirements. Work with Supplies to develop agreed alternatives where regular product is not available. Develop guidelines for wards as to appropriate use of alternative cleaning products. Decontamination: Ensure all trust decontamination policies, practices and processes are in line with hygiene code working with TSSU Manager. Re-audit decontamination practices throughout the trust. Hygiene Code: Criteria 3 Provide suitable accurate information on infections to service users and their visitors: Ensure up to date information is available on the public website on the trust's infection rates and general arrangements for preventing and controlling hospital acquired infections. Continue to review and update patient information leaflets on specific infections.
Hygiene Code: Criteria 5 Devolve responsibility to those involved in delivering care: Information feedback - report UTI and staph surveillance data to clinicians Hygiene Code: Criteria 6 Ensure staff, contractors and others co-operate and are fully involved in infection prevention and control: Implement Hand Hygiene Audit protocol trustwide. Determine criteria for and implement an award system. Implement quality control hand hygiene audit programme trustwide. Improve take up of training in 5 Moments Hygiene Code: Criteria 7 Provide adequate isolation precautions and facilities to prevent or minimise the spread of infection: Liaise with divisional managers and Head of Governance to ensure effective infection prevention and control measures are put in place for winter planning. Hygiene Code: Criteria 9 Continue a rolling programme of policy audit and revision. Antimicrobial prescribing: Launch of new Outpatient Antimicrobial Therapy Service. Establish lead. Submit business case to divisional boards. Review data and establish trends and risks for antibiotics MRSA Screening: Achieve 0% compliance on all elective and emergency admissions (excluding paediatrics) by 31 December 20. Feedback data to SHA. Continue with policy audits of elective and emergency patients to ensure achievement. Surveillance and Data Collection: Plan and implement for C.section and surgical site infection surveillance. Continue to participate in the Matching Michigan project. Collect data and data submission to national database for ITU patients. Implementation of a PICC line service: Develop business case for provision of new line service and achieve funding. Extravasation care in CT: Establish a policy liaising with CT and Pharmacy. Implement an audit programme of CVC & PVC management by form PCT Infection Rate Ceilings: C.diff to be agreed MRSA bacteraemia to be agreed Monitor Annual Plan: Ensure that there are no avoidable HCAIs. Hospital acquired significant bacteraemia: reduce from 82 to 49 (40% over 2 years). Hospital acquired C.difficile: reduce from 69 to 41 (40% over 2 years)