RDaSH Infection Prevention and Control Annual Report Helen Dabbs Deputy Chief Executive/Director of Nursing & Partnerships Dr Deborah Wildgoose Deputy Director of Nursing and Standards Rachel Millard Head of Quality and Standards Emma Stables Senior Clinical Nurse Specialist, Infection Prevention and Control 2014-2015 28 28
Contents Executive Summary...3 Introduction...4 GOVERNANCE ARRANGEMENTS Infection Prevention and Control Governance Arrangements...5 Infection Prevention and Control Team Arrangements...6 Review of Infection Prevention and Control Policies and Procedures...6 OPERATIONAL APPROACH Microbiology Arrangements...8 Website...8 Short Film...9 Link Champions...9 Evidence Folders (Yellow Folders)...11 Infection Prevention and Control Training...11 Going Viral...12 Emergency Planning...12 Domestic Monitoring Programme...12 Domestic Services Review...13 Quality, Innovation, Productivity and Prevention (QIPP) Plans...14 Quality Review...14 Patient safety Healthcare Associated Infection Surveillance...15 Clostridium Difficile Infection (CDI)...15 Escherichia coli (E.coli) bacteraemia...16 Meticillin Sensitive Staphylococcus aureus (MSSA) bacteraemia...16 Meticillin Resistant Staphylococcus aureus (MRSA) bacteraemia...16 Post Infection Review (PIR)...16 Outbreaks...16 WHO Saves Live: Clean Your Hands Campaign...17 clinical effectiveness Infection Prevention and Control Clinical Audit Programme...18 Good Practice and Areas for Improvement...21 Patient-Led Assessments of the Care Environment (PLACE)...22 Public Health Contract...23 Prince s Trust...24 Apprentices...25 Estates Leaflet...25 Annual Work Plan 2014/15...26 Annual Workplan 2015/16...27 Conclusion...28 Glossaryn...29 2
Executive Summary This report covers the period 1 April 2014 to 31 March 2015. The key points highlighted below are further explored within the main body of the report. There have been 3 outbreaks of Norovirus within the inpatient areas The Trust has had 0 incidents of Meticillin Sensitive Staphylococcus aureus (MSSA) bacteraemia and Escherichia coli (E. coli) bacteria The Trust has had 0 incidents of Meticillin Resistant Staphylococcus aureus (MRSA) bacteraemia this year The Infection Prevention and Control Team (IPCT) has completed 16 post infection reviews (PIR) for Clostridium difficile infection (CDI). The Trust Infection Prevention and Control (IPC) audit programme provides assurance on the effectiveness of the operational approach to IPC Training has achieved the required target of 100% for hand hygiene with a staff hand hygiene leaflet link by email in June 2014 All IPC policies have been reviewed and are up to date Domestic Services review has been completed and the new service has been implemented The new cleaning monitoring tool mirrors that of the IPC audit document and the results now give assurance ratings based on the standards of cleanliness found 3
Introduction Infection prevention and control 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 (DIPC), this being the Deputy Chief Executive / Director of Nursing and Partnerships. Deputy Chief Executive/Director Nursing and Partnerships, Helen Dabbs. This report from the DIPC is the annual report to the Trust Board of Directors on healthcare associated infections (HCAIs) and the progress of the annual programme. This report serves to provide assurance of the activities and mitigation of risks related to the prevention and control of 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 and 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 2014/15 there has been a considerable amount of work and activity carried out with regard to IPC. This annual report outlines how, during 2014/15, RDaSH has demonstrated compliance with the Health and Social Care Act 2008 and Care Quality Commission (CQC) Standards. The report highlights the continued excellent performance for IPC within the Trust. 4
Governance Arrangements Infection Prevention and Control Governance Arrangements The key roles with regard to IPC have continued to be fulfilled throughout 2014/15. 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 CLINICAL GOVERNANCE GROUP HEAD OF QUALITY AND STANDARDS Managerial IPC Support Rachel Millard INFECTION PREVENTION AND CONTROL CLINICAL NURSE SPECIALISTS Operational Delivery Debra Eyre, Emma Stables, Alison Swift, Karen Foltyn, Christine Tomes LINK CHAMPIONS Front line staff throughout the Trust INFECTION PREVENTION AND CONTROL COMMITTEE INFECTION PREVENTION AND CONTROL TEAM MEETING INFECTION PREVENTION AND CONTROL LINK STUDY DAYS Governance Arrangements 5
Governance Arrangements 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 Quality & Standards who reports directly to the Deputy Director of Nursing. L-R: Debra Eyre - Senior Clinical Nurse Specialist IPC; Chris Tomes - Clinical Nurse Specialist, IPC; Alison Swift - Senior Clinical Nurse Specialist IPC; Tim Buckle - Team Secretary; Karen Foltyn - Senior Clinical Nurse Specialist IPC; Rachel Millard - Head of Quality and Standards; Emma Stables - Senior Clinical Nurse Specialist IPC. Review of Infection Prevention and Control Policies and Procedures Trust IPC policies and procedures have been reviewed and are up to date. They are available for staff via the Trust s internal intranet and are published externally on the Trust s internet site. Policies reviewed in 2014/15 are listed below: Decontamination policy Isolation policy Meticillin Resistant Staphylococcus aureus policy Management of Outbreak of Infection policy Standard Precautions policy Surveillance, Prevention and Management of Infections Policy The IPCT has also had involvement in the development of numerous scope packages and non IPC policies. 6
Operational Approach The Trust has its own IPCT, working on a hub and spoke model where allocated nurses in the IPCT 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. Tangible outcomes achieved throughout 2014/15 are: Clinical Nurse Specialists are more visible in inpatient areas Management advice and support of complex patients with infections Improved networking Engagement with staff and patients Quality audit tool used Ward staff and IPCT jointly developing and updating action plans from the audit Audit results reported at IPC committee Good communication between the team Good relationships with Modern Matrons and Service Managers New training method involving group work and scenarios discussion Good relationships with Facilities and Estates team The IPCT covers Doncaster, Rotherham, Manchester, North and North East Lincolnshire localities and the Clinical Nurse Specialists have allocated areas to oversee. This facilitates improved visibility and networking as well as building collaborative relationships and a more consistent approach. Chris Tomes, Clinical Nurse Specialist IPC, discusses the IPC clinical audit process with staff from St John s Hospice. 7Operational Approach
Operational Approach Microbiology Arrangements Microbiology/infection control service agreements are in place with locality based Trusts to provide this service at a local level. The Rotherham Foundation Trust and Doncaster and Bassetlaw NHS Foundation Trust provide microbiology/infection control support for the 3 localities, including out of hours cover. Website There are 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 Evidence Folder resource page 8
Operational Approach Short Film The IPCT have made a short film to highlight their day to day work across RDaSH. It gives a snapshot of the key components of quality and standards that are crucial in promoting and maintaining patient safety and excellent standards of patient care. A Day in the Life of the Infection Prevention and Control Team. View on YouTube via the following link http://youtu. be/5z50dv8-i00. Link Champions We have in excess of 90 link champions across the organisation, including registered nurses, healthcare assistants, physiotherapists, podiatry staff, school nurses, occupational therapists, mental health staff, registered care home staff and drugs and alcohol services staff. 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. Recognised by colleagues for their unique function and contribution, and with support from their managers, these roles support patient safety strategies through the dissemination of knowledge and best practice in health care settings. Link champions complete hand hygiene assessments of their clinical colleagues annually and in addition 5 spot checks are undertaken monthly to ensure staff are complying with the hand hygiene policy and procedure. The results of the spot checks are presented at IPC committee. In 2014/15 we reviewed the link champions role profile and meetings. Instead of having quarterly two hourly meetings, a full study day was developed. Operational Approach 9
Operational Approach The IPC link champions attended a full day study session on 8th September 2014, 29th September 2014 or 25th February 2015. A total of 90 attended. Topics covered included: Legislation and governance The chain of infection Susceptible patients The care environment Roles and responsibilities Feedback from the sessions was extremely positive with the majority of evaluations rating the day as excellent or good. The group work activities rated especially well with requests for more activity centred sessions in the future. The majority of the link champions appreciated the update relating to decontamination and the use of hard surface wipes. Comments included: a great opportunity to network and share opinions and common practice. All of the day provided learning or refresher points in all areas. I feel better supported to question and teach staff members. The general consensus was that the full day was of more benefit than the previous format of quarterly meetings. Rachel Millard, Head of Quality and Standards welcomes all the delegates to the IPC link champions Study Day. 10
Operational Approach 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 IPCT. Infection Prevention and Control Training IPC training is mandatory. Following significant work with the Learning and Development team the IPCT helped review the induction training and corporate booklet, the training needs analysis matrix and staff training requirements. Hand Hygiene Level 1 The Hand Hygiene information booklet was emailed to staff as a link in June 2014. Staff who do not have access to emails were given the booklet by their line manager. The booklet is also given to staff on induction. Standard Precautions Level 2 Standard precautions training for role specific clinical staff is completed in localities and at team bases. For 2014/15 the IPCT changed the way that standard precautions training was delivered. Sessions offered more engagement with those attending, using photographed scenarios from different settings (using Trust staff) including in the home, wards and departments. This helped generate discussion and interaction whilst looking at best practices and practices which could cause a lapse in care. The sessions evaluated very positively and staff preferred this method of training. Chris Tomes, Clinical Nurse Specialist, IPC facilitating a Standard Precautions Level 2 training session. Training attendance is monitored and a process is in place to follow up any nonattendees via their line manager by the Research Education and Development Centre. Operational Approach 11
Operational Approach Going Viral For 2014/15 the IPCT developed a quarterly newsletter which is sent Trust wide to staff via the daily email system. The newsletter updates staff on IPC topics including local, national and international issues e.g. Ebola, conferences for staff, antibiotic awareness and Flu campaigns. There was a competition to find a name for the newsletter and the winning entry Going Viral was chosen from a number of entries. The winner of the competition was Donna Perry from the Quality Improvement Team. Karen Foltyn (left) presents Donna Perry (right) with her prize for naming the IPC Newsletter, Going Viral. Emergency Planning The IPCT works proactively with the Emergency Planning Officer. During 2014/15 updates and bulletins were sent out Trust wide in response to the Ebola outbreak in West Africa. Whilst the risk of the infection occurring in the UK is extremely small, it was important to keep staff informed of any risks and contingency plans. Weekly bulletins have been issued by the World Health Organisation (WHO) and Public Health England (PHE) and new information has been reviewed, actioned where necessary and disseminated to staff via the IPCT. Domestic Monitoring Programme During 2014 the domestic monitoring programme was reviewed. The Trust Monitoring Team worked in partnership with the IPCT to develop a new monitoring tool which covered the 49 standards of cleanliness. The new monitoring tool mirrors that of the IPC audit document and the domestic monitoring results now give assurance rating based on the standards of cleanliness found: 12
Operational Approach Full Assurance can be provided. The system of internal control has been effectively designed to meet the National Cleaning Standards and controls are consistently applied in all areas reviewed Significant Assurance can be provided. There is a generally sound system of control designed to meet the National Cleaning Standards. However, some weakness in the design or inconsistent application of controls put the achievement of particular objectives at risk Limited Assurance can be provided. Weaknesses in the design or inconsistent application of controls put the achievement of the National Cleaning Standards at risk in the areas reviewed The new monitoring tool identifies which area of responsibility any required actions sits with. These areas could be Estates and Facilities, Nursing, Contract Providers (PFI), etc. The new system has been in place since January 2015 and a quarterly report will be tabled at the IPC committee meetings detailing the audits undertaken, and the level of assurance given for each area and business division. Domestic Services Review In 2014 a significant piece of work was undertaken in domestic services in delivering an in-house review. The purpose of the review was to realign the domestic service with the needs of the Trust, and a key focus was on: The standardisation of working rotas To review the establishment to ensure adequate staffing levels for all areas if we were to work to the national specification of cleaning standards in the NHS To revise and standardise job descriptions and have one banding for domestic staff across the Trust To develop a structured domestic training programme A formal consultation commenced with the180 domestic personnel in August 2014 and concluded in December 2015, with the changes coming into effect from the 4th January 2015. One shift rota pattern was introduced to areas where there is a 7 day service. Having one rota system allows for more effective use of staffing resources and freeing up supervisors time to become more visible out on the wards. Three months into the service following the review there have been noted changes in the service with improvements in the standards of cleanliness. Operational Approach 13
Operational Approach Quality, Innovation, Productivity and Prevention(QIPP) Plans The IPC Clinical Nurse Specialists continue to be involved with the review of equipment and supplies. Cleaning and disinfectant products are currently being reviewed with the aim to have a standardised product and best value for the whole Trust. A trial of products from three companies is near completion. The chosen product will replace a number of different products. There will be education/training on the correct use of the new product. This will increase compliance of use and reduce confusion on which product to use. In line with QIPP there will also be a cost saving, increased effectiveness and efficiency. Quality Review The IPCT has completed quality review training to become quality reviewers. Quality Review consists of a team of people from different services looking at other services and how the service is doing against nationally agreed standards. These standards look at whether services are safe, effective, caring responsive and well led. The way they do this is by looking at existing information, talking to people who use the service, talking to people who run the services, looking at records, noticing how care is being delivered and looking around the service. Good ways of working are shared and ways to make services better are agreed so that everyone learns. Qualities and abilities required for a reviewer include: The ability to build relationships and engage people Understanding of the quality review process Having a patient focused attitude Taking personal responsibility The ability to be open and honest Showing genuine concern for others Having a genuine commitment to personal development and supervision The ability to problem solve Self-esteem and self-efficacy The ability to work as a team and values team working Quality Review Training. Following the quality reviewer training two members of the IPCT have taken part in quality reviews of services within the Trust. One review involved the learning disability community services and the other review was a mental health inpatient area. Both members of the team thought the quality review process was a very positive learning experience. 14
Patient Safety Healthcare Associated Infections Surveillance Surveillance of organisms is required to understand the extent, cost and effects of HCAI. It is the foundation for good IPC and improving patient care. Surveillance forms the basis of IPC interventions, education and policy development. Figure 2: Healthcare Associated Infections 2012/13 to 2014/15 Clostridium difficile Infection (CDI) The IPCT has completed 16 post infection reviews (PIR) for CDI (Figure 2). The number has increased from 2013/14 due to a change in the method of reporting. Cases are attributed to NHS Doncaster Clinical Commissioning Group (CCG) and apportioned to RDaSH as the lead provider of care with responsibility for completing the post infection review. On completion of the investigations it was identified that there was only 1 case of CDI where there was a lapse in care from RDaSH for which an external PIR meeting was held. The main overarching contributory factors relating to this case were that the patient had an extensive stay in hospital thus increasing the risk of contact with CDI, however it was not possible to determine where this was acquired. A number of recommendations and actions were identified: Improve record keeping to ensure for antibiotic prescribing is always clearly documented in patient notes Review of training to ensure correct antibiotics are prescribed only when appropriate Increase awareness of antibiotic use, relevance and duration of treatments to empower staff to challenge inappropriate prescribing practices Review appropriateness of community antibiotic prescribing guidelines for patients on wards A pro-active approach to reviewing antibiotics prescribing Patient Safety 15
Patient Safety Escherichia Coli (E.COLI) Bacteraemia There have been 0 cases of E. coli bacteraemia across the Trust during 2014/15. Meticillin Sensitive Staphylococcus Aureus (MSSA) Bacteraemia There have been 0 cases of MSSA bacteraemia across the Trust during 2014/15. Meticillin Resistant Staphylococcus Aureus (MRSA) Bacteraemia There have been 0 cases of MRSA bacteraemia across the Trust during 2014/15. Post Infection Review (PIR) The IPCT contribute to Doncaster CCG PIR meetings where the root cause for all Doncaster district wide MRSA bacteraemia and CDIs are discussed and the decision made by the meeting members to whether the infection occurred through a lapse in care or there was no lapse in care. If there is a lapse in care an action plan is developed by the provider involved. The Deputy Director of Nursing is informed of the findings and actions taken. This is then taken to the IPC committee for assurance. Outbreaks There have been 3 outbreaks of diarrhoea and vomiting across the Trust during 2014/15: Norovirus was confirmed across all three wards at The Woodlands, Rotherham Older Peoples Service in February 2015 affecting 14 patients and 30 staff members. The unit managed the situation well especially as there was a planned closure of one ward for repair work at the time of the outbreak. Two separate outbreaks were confirmed on Hazel Ward. These began on 2nd March, affecting 14 patients and 8 staff members and 23rd March, when 9 patients were affected. Some concerns regarding possible cross infection were noted and follow up actions instigated. 16
Patient Safety Who Saves Lives: Clean Your Hands Campaign The WHO s annual campaign took place on 5th May 2014 with this year s focus being on the importance of hand hygiene in fighting and preventing the spread of antimicrobial resistance. This follows on from the clinical audit undertaken by the pharmacy team last November to encourage responsible use of antibiotics as part of European Antibiotic Awareness Day. During the week of the 5th May 2014 members of the IPCT visited inpatient areas to carry out hand hygiene assessments and to look at how micro-organisms are transferred around the ward/to inanimate objects via the healthcare workers hands. A variety of methods were used and feedback from staff involved was positive as they felt this showed them immediately how micro-organisms are spread quickly and over a large area. It also highlighted the need for staff to moisturise hands regularly to ensure skin remains intact. The hand hygiene assessments identified hand hygiene best practice and good hand washing techniques. Work was undertaken to encourage hand hygiene with the children who attend the Warren nursery at the Tickhill Road site in Doncaster. A variety of activities took place, including the children learning a song about hand washing, undertaking group activities that showed them how microorganisms are transferred from one person to another, and discussions about when it is important for them to wash their hands. World Health Organisation Save Lives Clean Your Hands Campaign 2014 Patient Safety 17
Clinical Effectiveness Infection Prevention and Control Clinical Audit Programme During 2014/15 the IPCT has undertaken a programme of inspection based audits and walkarounds of inpatient areas and community bases. The audits were unannounced and utilised an in-depth audit tool based on best practice national guidance and Trust policy standards. The IPC audit process was reviewed and changed for 2014/15. Red, amber, and green (RAG) rating scores highlighted areas of noncompliance which needed immediate and intermediate actions. Inpatient areas were notified 4 5 weeks in advance of the audit and were required to complete a pre-audit questionnaire which was given to the IPCT on the day of the audit. Results of the audit were judged as giving full, significant, limited or no assurance in line with clinical audit guidance. The IPCT then met with ward managers and domestic supervisors 5 to 10 days after the audit to formulate an initial action plan with review meetings 30, 60 and 90 days later (if required) to ensure progress and sustainability was maintained and to complete the audit cycle. The audit tool and action plan have been combined in to one document. The table on page 20 shows the audit results for 2014/15. Areas which had limited assurance from the initial audit have completed the actions from the action plans and significant assurance can now be given for these areas. The IPC clinical audit process is described in Figure 3. 18
Clinical Effectiveness Full Significant Limited No Figure 3: Infection Prevention and Control Clinical Audit Process Clinical Effectiveness 19
Diagram 4: Infection Prevention and Control clinical audit results 2014/15 Clinical Effectiveness 20
Clinical Effectiveness Good practice and areas for improvement Clinical Effectiveness 21
Clinical Effectiveness Patient-led assessments of the care environment (PLACE) The 2014 Patient Led Assessments of the Care Environment (PLACE) were undertaken between the 4th March and the 4th June 2014. The assessments took place over 11 days across all RDaSH in-patient service areas. The PLACE assessments were led by trained Patient Assessors from Governors, Volunteers and young people from the Prince s Trust programme, and were facilitated by trained staff assessors from Facilities, Quality Improvement Team and the IPCT. The PLACE assessments focused on four key elements: Cleanliness Food Privacy and Dignity Condition and Appearance The findings from the assessments were recorded by the Patient Assessors. The information was then inputted onto the Health and Social Care Information Centre (HSCIC) web site which calculates the scores. The 2014 audits took a different approach to the previous year, in that the audits were unannounced, and the assessors were trained and encouraged to lead the assessments. The results of the PLACE assessments were lower than in 2013, but it was felt that a fair and accurate reflection of the service was given. Action plans were developed to make improvements on the four key elements of the audits and this included the introduction of Ward Hostess to improve the patient meal time experience. Figure 5: PLACE results compared to national average 2014/15 22
Clinical Effectiveness Public Health Contract IPC plays a fundamental part in improving the safety and quality of care provided to patients, clients and service users across the spectrum of adult health and social care. The Director of Public Health has statutory responsibility and allocated budget for IPC across the Doncaster borough. In January 2015, following discussions with Public Health, RDaSH and Doncaster CCG it was agreed that IPC provision would be commissioned from RDaSH. The primary focus of this commissioned service is to provide IPC expertise for residents of nursing and residential homes across Doncaster. Further scoping of wider community IPC requirements will also be undertaken. This work stream and service will be undertaken by Debra Eyre, Senior Clinical Nurse Specialist for Infection Prevention and Control following secondment from Doncaster CCG. National policies for the control of MRSA bacteraemia and CDI have improved IPC measures in the UK, with associated reductions nationally in HCAI infection rates. However, there is still work required to maintain and improve these reductions and incidences of these and other HCAIs. This includes collaborative working with: Doncaster Metropolitan Borough Council (DMBC) Public Health Team NHS Doncaster CCG DMBC Contract Monitoring Team / CCG Overarching Care Home Strategy Group Public Health England (PHE) South Yorkshire Health Protection Team DMBC Environmental Health Team Private nursing and residential home providers Microbiology and IPC teams at DBHfT and RDaSH NHS England local area teams. Debra Eyre, Senior Clinical Nurse Specialist, IPC. Clinical Effectiveness 23
Clinical Effectiveness An annual work programme will be developed for 2015/2016 incorporating service delivery in line with best practice guidance and evidence inclusive of: PHE protocols, guidance and policy Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance (DH, implemented 2011, currently under review) Essential standards of quality and safety (CQC, 2010) and implementation of the fundamental standards and 5 key lines of enquiry (2014) Prince s Trust The Prince s Trust was established in 1976. Around one in five young people in the UK are not in work, education or training. Youth unemployment costs the UK economy 10 million a day in lost productivity, while youth crime costs 1 billion every year. The Prince s Trust addresses this by giving practical and financial support to the young people who need it most. They help develop key skills, confidence and motivation, enabling young people to move into work, education or training. RDaSH supports the work of the Prince s Trust and in May and October a number of young people completed a 4 week placement working with RDaSH staff. The IPCT talked to the young people from the Prince s Trust about IPC. The talk included: How infections spread How to protect yourself from acquiring infections whilst working in the Trust The first aid actions to take if you get a needle stick injury, scratch injury or bite injury Hand hygiene best practice The hand hygiene session included a practical element. A special lotion (representing organisms) was applied to the hands and the hands were inspected under an ultra violet light. The hands were then washed and re-examined under the ultra violet light to visually demonstrate any flaws in the hand washing technique. This generated a lot of discussion and questions. Feedback from the session was very positive. The IPCT were also available to support the Prince s Trust volunteers during their clinical visits. Karen Foltyn, Senior Clinical Nurse Specialist, IPC (left) with delegates from The Princes Trust. 24
Apprentices In 2014/15 RDaSH employed 21 apprentices aged 17-33. These NHS apprenticeships are in administration, clinical areas covering health and social care, cleaning and working in the Estates Team. Besides on the job training the apprentices will also study for a relevant qualification, called the Apprenticeship Framework, via Barnsley College. As part of their induction the IPCT talked to the apprentices about IPC and how to reduce the risk of cross infection whilst working in the Trust. The talk included: Facts about HCAIs CQC requirements How infections spread The risk of picking up an infection whilst working at RDaSH How to protect themselves and others from acquiring infections by using standard precautions Importance of cleaning The first aid actions to take for a needle stick injury, scratch injury or bite injury Hand hygiene best practice Hand washing practical session This talk generated a lot of discussion and questions and feedback from the session was very positive. The IPCT was also available to support the apprentices during their clinical visits. Estates leaflet Effective IPC must be part of everyday practice and be applied consistently by everyone. The Trust has a responsibility to ensure, so far as is reasonably practicable, that staff are free of and are protected from exposure to infections at work and that all staff are suitably educated in the prevention and control of infection. The IPCT has developed IPC guidance for estates staff in the form of a leaflet. This booklet has been developed to minimise the Photo from IPC Estates leaflet. risk of staff acquiring an infection by raising awareness of IPC. The leaflet will also be given to contractors before they commence work within the Trust. Clinical Effectiveness 25
Annual Workplan 2014-2015 The Trust s IPC Committee Work Plan and progress against it for the year 2014/15 are reflected across this annual report. The objectives and position at year end are summarised below. 26
Annual Workplan 2015-2016 The Trusts IPC priorities for 2015/16 have been identified and the following key points will be included in the work plan: Annual Workplan 27
Conclusion The Trust has continued to implement a robust plan of IPC in collaboration with a dedicated IPCT and clinical colleagues. This is evidenced by the small number of HCAIs reported including outbreaks of Norovirus. This report outlines the work that has been carried out in order to provide assurance that the Trust is meeting its IPC duties under both the Health and Social Care Act (2008) and CQC Essential Standards, outcome 8 requirements (Cleanliness and Infection Control). Plans are in place with identified key priorities for 2015/16. IPC 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. 28
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 Escherichia coli (E-coli) is the name of a bacteria that lives in the intestines 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 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 MSSA - Meticillin Sensitive Staphylococcus aureus - Staphylococcus aureus is a common bacterium that lives harmlessly on the skin and nose of about a third of the population MRSA - Staphylococcus aureus is a common form of staphylococcus aureus that has become resistant to some common antibiotics Glossary 29
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