Staffordshire and Stoke on Trent Partnership Trust Infection Prevention and Control team. Director of Infection Prevention and Control Annual Report

Staffordshire and Stoke on Trent Partnership Trust Infection Prevention and Control team Director of Infection Prevention and Control Annual Report April 215 to March 216 1

Executive Summary The Health and social Care Act (28), Code of Practice on the Prevention and Control of Infections and Related Guidance requires the Director of Infection Prevention and Control (DIPC) to produce an annual report on the Trust s performance on healthcare associated infections in the organisation. This report covers the period from April 215 to the end of March 216 and provides information on the progress being made to reduce Health Care Associated Infections (HCAI). 215-216 has been another challenging year for the control of Health Care Associated Infections (HCAI) for the Staffordshire and Stoke on Trent Partnership Trust, with new services set up and other services going through a transformation period. The safety of our patients remains paramount as we aim to keep our patients at the centre of all we do. The main focus of infection prevention activity was to control the levels of trust attributable Clostridium difficile and MRSA in blood samples known as bacteraemia acquired within the trust as well as improving preparedness for winter and Influenza season. The Trust experienced challenges relating to meeting the 215-16 trajectory for Clostridium difficile infection. Up to the end of March 216, 22 cases of Clostridium difficile were reported, the number of cases that were deemed unavoidable at a post infection review panel was 19 cases. Unavoidable means that there were no lapses in care that would have contributed to the patient isolating the bacteria. The Trajectory for Meticillin Resistant Staphyloccus aureus (MRSA) bacteraemia cases was set at zero avoidable cases for all NHS trusts nationally. No cases were identified. To support the reduction in bacteramias the Community Hospital medical and nursing staff have had a productive year reviewing guidelines and updating staff on new guidance and research relating to clinical procedures and invasive devices which are a considerable risk factor which contribute to bacteraemias. Additional highlights of the year include: A successful screening programme for elective and emergency admissions, with high compliance rates, with an average of 99.5% patients screened for MRSA on admission each month. Additional resources were agreed by The Partnership Trust to introduce an additional screen to look for a new bacteria called a Carbapenamase. The aim of the new screening programme was to be able identify the bacteria promptly and enable treatment on admission. This programme has been successfully rolled out 98-1% that fit the criteria have been screened. An extensive Capital Programme was completed incorporating a programme of work to improve the estates facilities in the community health centres. Additional resources were also agreed to improve the cleanliness of community hospital wards and health centres, which has had a positive impact on cleanliness, with areas consistently meeting suggested national targets. Educational infection control sessions have continued to be embraced by all Partnership Trust staff ensuring that at the end of the year the mandatory training compliance rate was over 89% In collaboration with colleagues in Estates and Microbiology the Infection Prevention and Control team Water Quality Group have completed a comprehensive programme of building risk assessments and water testing to detect the presence of Pseudomonas aeruginosa and Legionella in compliance with Department of Health guidance. The achievements and hard work that all Partnership Trust staff has shown over the last year has been tremendous. Staff as individuals and team members have shown their dedication in embracing zero tolerance towards HCAI. I would personally like to thank all staff for their hard work and dedication during 215-216 and thank them for supporting me in my role as the Interim Director of Infection Prevention and Control (DIPC) Thank you Rose Goodwin Director of Nursing and Quality/ Director of Infection Prevention and Control 2

Introduction The strategic and operational aim of the Infection Prevention and Control Services is to increase organisational focus and collaborative working to effectively maintain standards to ensure the Staffordshire and Stoke on Trent Partnership Trust (The Partnership Trust) meet the ten criteria presented in The Health and Social Care Act 28 (amended in 215) Code of Practice on the Prevention and Control of Infections and Related Guidance. The objective is to engage staff at all levels, through effective leadership, in order to develop and embed a culture that supports infection, prevention and control within the trust. The purpose of this annual report is to outline the progress made in prevention and control of HCAI by Staffordshire and Stoke on Trent Partnership Trust for the period April 215-March 216. The DIPC, Associate Director for Professional Leadership and the Infection Prevention and Control Team have worked in collaboration throughout the year with Operational Leads and members of the Nursing and Quality team to maintain an effective service that has delivered a broad infection control programme of work. The programme of work has been supported and monitored by the Infection Prevention and Control Committee. The Committee is accountable to the Quality Governance Committee and provides assurance to the Board via the DIPC. The following section of the report describes The Partnership Trust annual programme of work in terms of delivering and maintaining compliance with the ten criteria of the Code of Practice, in which all providers of healthcare and adult social care are required to demonstrate in order to register with the Care Quality Commission. Picture 1 The Health and Social Care act 28 booklet. 3

Code of Practice for the Prevention and Control of Healthcare Associated Infections Compliance Criteria 1 What a service provider will need to demonstrate Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them 2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections Provide suitable accurate information to service users and their visitors 3 4 5 6 Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection Provide or secure adequate isolation facilities 7 Secure adequate access to laboratory support as appropriate 8 9 Have and adhere to policies, designed for the individual s care and provider organisations that will help to prevent and control infections 1 Ensure, so far as is reasonably practical, that care workers are free of infection and are protected from exposure to infections that can be caught at work and that staff are suitably educated in the prevention and control of infection associated with the provision of health and social care. Table 1. 1 Criteria for the Hygiene Code 28 4

Criteria 1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them. It is the responsibility of all healthcare providers to ensure that organisations have in place appropriate arrangements for Infection Prevention and Control, to protect patients from the risk of acquiring Health Care Associated Infection (HCAI) and to ensure compliance with the Health and Social Care Act 28 (215). The Trust board members are committed to their responsibilities for minimising the risk of preventable infection. An annually updated Strategy and Programme of work was agreed by the Board April 215 outlining responsibilities of all staff within the organisation in reducing avoidable HCAI s. The Infection Prevention and Control Arrangements The Chief Executive accepts on behalf of the Trust Board responsibility for all aspects of infection prevention and control (IPC) within the Trust. This responsibility is delegated to the Director of Nursing and Quality/ Director of Infection Prevention and Control The Director of Nursing and Quality is the designated Executive lead and Director of Infection Prevention and Control (DIPC). She reports directly to the Chief Executive and the Board, and is chair of the Trust Infection Prevention and Control Committee. The DIPC works in collaboration with the Head of Infection Prevention and Control and Consultant Microbiologist/Infection Control Doctor. The Lead Consultant/Infection Control Doctor provides a source of expert microbiological and IPC advice and supports the DIPC and the Infection Prevention and Control Team in the production of policies and procedures The Head of Infection Prevention and Control has responsibility for the operational management of the IPC Team and ensuring Infection Prevention and Control is embedded within the Trust. The lead nurse also provides a source of expert advice and is responsible for on-going development and evaluation of communication strategies at Trust and divisional levels aimed at facilitating infection prevention policies, guidance and practice. The IPC Team operate from one main office, Springfields Health and Well being centre however due to the nature of the role, the team members use the hot desks available, throughout the Trust on a daily basis to allow them to be with front line staff. During 215 the team received lap tops which have significantly improved the way the Infection Prevention and Control Nurses can access files and has enabled remote working and flexibility. The Infection prevention and Control Team sit within the Nursing and Quality Directorate, together with the DIPC. The DIPC directly line manages the Head of Infection Prevention and Control. During 215 the IPCT successfully achieved the 6C s challenge award and were presented with the certificate in January 216. Picture 2. The team skill mix structure was reviewed October 215 and now consists of a 5

Head of infection Prevention and Control 2.8 WTE Band 7 Team leaders 2.6 WTE Band 6 1.5 WTE Band 3 5. WTE Band 5 The Service Level Agreements (SLA) remains in position for the Infection Control Doctor (ICD) advice. A Consultant Microbiologist from the University Hospital North Midlands (UHNM) Dr Banavathi and colleagues provide a 24hour service for the Partnership Trust. The IPCT provide an advice and education service to care homes in Staffordshire and Stoke on Trent, the contract includes providing monthly training sessions in central venues, running an Infection Control Link Practitioner course and completing audits following Large Scale Investigation reviews and incidents such as identification of infections. Advice on individual patient specimens continues to be sought from the laboratory in which the specimens are sent to for processing. Due to the organisations geographical area this refers to a number of acute trust hospital laboratories. The main hospitals are, Burton Hospitals Foundation Trust, University Hospital North Midlands and all the hospitals on the boundaries including The Royal Wolverhampton hospitals, Heart of England Foundation Trust and Dudley Group NHS foundation Trust. The work undertaken by the IPCT requires a flexible and responsive approach to spontaneous requests for infection control advice and support, whilst ensuring planned projects and deadlines are also met in a timely manner. The Infection Prevention and Control committee agreed that the service should be extended in 213 on a permanent basis, so that clinical teams can receive advice from the infection control nurses seven days a week. The seven day service continued in 214 and has been a great benefit during the winter supporting ward staff managing outbreaks. The Infection Prevention and Control nurses have continued to maintain skills and keep up to date with current research by being active participants in the Infection Prevention Society West Midlands regional group and Trent regional group. The team have assisted in the preparation and running of the West Midlands annual study day and contributed to writing Infection Prevention Society documents. All members of the team have developed their knowledge and skills further throughout the year. By attending in house training sessions which are held monthly within the team to facilitate team development and progress the team work plan, and external courses ran by the Infection Prevention society. A number of the team have attended the Public Health England, The County hospital Trust Infection Prevention and Control Team and University Hospital North midlands Microbiology laboratory for week secondments to update their skills, and improve collaborative working. Assurance framework The Partnership Trust has an active IPCT with an agreed annual programme of work, which is agreed by the Infection Prevention and Control Committee (IPCC). Members of the Committee include the Medical Director, Non-Executive Director, Consultant in Communicable Disease Control West Midlands North Public Health, Public Health Consultant, DIPC, Head of Infection Prevention and Control Commissioning, Head of Infection Prevention and Control The Partnership Trust and senior operational leads. (Full membership listed in appendix 2) The IPCC provides The PartnershipTrust Board of Directors and Commissioners with assurance that the Trust is compliant with the Code of Practice element of the Health and Social Care Act 28 (updated 215) by providing evidence and assurance in the form of 6

Infection Prevention and control surveillance data trends and analysis reports Compliance with audit programmes Matrons Dashboard Quarterly Cleanliness scores Annual Patient Led Assessments of the Care Environment (PLACE) Serious Incident and Internal Safeguard reporting Outbreak reports Route Cause Analysis action plans Criteria 2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections Facilities and Estates services are provided via a combination of Service Level Agreements and in house staff. The Partnership Trust Associate Director for Estates works closely with the Infection Prevention and Control Team. This ensures environments are fit for purpose. Sites are inspected using The National Standards of Cleanliness 27 audit tools and Infection Prevention Society national audit tools. Action plans are monitored by the Infection Prevention and Control Committee. Water Safety group A Water Quality group was developed in 213 and continues to meet on a quarterly basis, the group develop key policies and standard operating procedures such as the Legionella Policy and Standard Operating procedure for Flushing sinks. The Partnership Trust completed Water Legionella Risk Assessments for each building the Trust owns during 214 and have completed a programme of work, which includes sampling water outlets to ensure the standard of water in each building is maintained at an appropriate level. Environmental Health Kitchen inspections The Environmental Health Officers completed their annual audits in the five community hospital kitchens and Brighton house. All kitchens passed with no concerns raised. Patient Led Assessments of the Care environment (PLACE) Food, cleanliness and wellbeing standards for Staffordshire and Stoke-on-Trent s five community hospitals have been rated as excellent by patients in results published by the Health and Social Care Information Service 214, audits were repeated April to June 215, the results will be published nationally August /September 215. The Patient Led Assessment of the Care Environment (PLACE) programme focuses entirely on non-clinical issues and looks at how the care environment supports patients privacy and dignity, food, cleanliness and general building maintenance and decor. All our community hospitals - the Haywood, Longton Cottage Hospital, Leek Moorlands, Cheadle and Bradwell have achieved excellent results for cleanliness. D& Table 2; Results of the National PLACE inspection 215 The Partnership Trust have extended the PLACE audits internally to include six of the prison healthcare environments, following the successful introduction three years ago. The prison 7

healthcare audits are reported to the IPCC. From the audits an action plan has been developed to ensure that the high standards are maintained throughout the year. Criteria 3 Provide suitable accurate information to service users and their visitors Performance against Local Health Economy Trajectories: The Prevention and Control of HCAI s continues to be a major priority for the Partnership Trust as a provider of healthcare. We continue to ensure focused delivery on improvements in both the rates of infection and in the overall quality of care. The two key performance indicators that were originally set during 21/211 have continued and remained the main performance indicators associated with alert organism surveillance data. The performance indicators relate to the number of Meticillin Resistant Staphylococcus Aureus (MRSA) bacteraemias (in the blood) and the number of Clostridium difficile infections (CDI) cases in people over the age of two year old. In addition the Local Commissioners requested that the Meticillin Sensitive Staphylococcus Aureus (MSSA) and Ecoli bacteraemias isolates were reported to ascertain the number of positive specimens, within Staffordshire and Stoke on Trent. No reductions or trajectories were set for MSSA or E.coli Bactereamias. The root cause analysis were completed for all cases in conjunction with clinical teams and Acute Trust Infection Prevention and Control Teams, to ascertain themes and trends. MRSA bacteraemia The Partnership Trusts Community Hospital inpatient wards infection data was collected weekly. A local trajectory of zero MRSA bacteraemia cases was set by the commissioners to mirror the Acute Trusts national trajectory. In addition to mandatory reporting of MRSA bacteraemias the Partnership Trust is also reporting on the number of MRSA clinical isolates within the community hospitals inpatient beds. A clinical isolate is a swab taken from an area which has signs and symptoms of a local infection such as redness, heat, temperature, pain or a discharging wound. The specimen maybe taken from wound sputum or a urine specimen. 5 MRSA positive specimens were received from the community hospital wards; all patients received treatment and recovered well. Effective surveillance is essential in reducing healthcare associated infection (HCAI) rates and its associated harm and costs. Data routinely collected on HCAI s are monitored daily by the Infection Prevention and Control team (IPCT). The results are disseminated to clinical teams on a daily basis and to the management team and commissioners on a monthly basis. Wider team engagement has taken place. Tools such as the Trust weekly newsletter The Word and team brief have been used to distribute information, as well as presentations at professional district nurse forums and team leader meetings. Picture 3 and 4 below Examples of Trust newsletter. 8

A pre 48 hour MRSA bacteraemia is defined as a blood culture specimen taken within the first 48hrs of the patient s admission to an acute Trust or a sample taken by GP in their practice. These bacteraemia figures are not recorded against The Partnership Trust. The Partnership Trust IPCT take part in the Post infection review (PIR), if the PIR findings highlight that the patient has received care by a number of healthcare providers a joint PIR is completed. Between April 215 and March 216 a total of 21 MRSA bacteraemias were isolated across the health economy. Healthcare staff across the Health economy have been made aware of the signs of sepsis, through active education sessions and awareness campaigns and are actively seeking out cases that require prompt treatment. Table 3 The table represents the number of MRSA Bactereamias reported Within Staffordshire and Stoke on Trent and identifies who the case was apportioned too. April May June July Aug Sep Oct Nov Dec Jan Feb Mar Total East Staffs CCG 1 Cont,UA due to poor 1 CCG skin 2 SES CCG 1 skin UA,C CG 1 Acute 2 Stafford & Surrounds CCG 1 Acute 1 CCG Line 1 CCG 1 Acute 4 Cannock Chase CCG 1 CCG, AV, not decol 1 Acute 2 North Staffs CCG 1 CCG, AV, 1 Acute 2 Stoke on Trent CCG 2 Acute 1 CCG UA Billary sepsis 1 Acute 3 rd party 3 CCG (1x 3 rd party) 1 Acute 3 rd party 1 Acute 9 9

The MRSA Bacteraemias are segregated in to CCG s. The Partnership Trust IPCT investigated all CCG MRSA bacteraemias and supported a PIR with the relevant clinical teams as part of the infection control Service Level Agreement (SLA) with the commissioners. The probable source of the bacteraemia was identified for each case and actions were agreed to follow up any lapses in care. The RCA s have enabled lessons to be learnt across the Health Economy. Themes highlighted were poor environments, insufficient detailed documentation and evaluations and lack of knowledge relating to Urinary catheter maintenance care. To improve on these areas of care, contracts with care homes have been reviewed and strengthened and more sharing of information now takes place with commissioners and continence leads relating to audit and incident findings. Clostridium difficile infection The Partnership Trust Community Hospitals inpatients Between April 215- March 216, the Clostridium difficle toxin rates were 22 cases in total. Following the route cause analysis 19 cases were deemed unavoidable and had no lapses in care. The three remaining cases were deemed avoidable the first case the antibiotic history required more detail in the documentation, the second case the ward cleanliness had dropped to 93%, but was rectified immediately and the third case there was a delay in the sample being sent. There was one Period of Increase Incidence (PII) of Clostridium difficile infections reported this was at Leek Moorlands hospital, 3 cases were identified, 2 of which had the same ribotype the third case was later to found to be unconnected. To maintain low Clostridium difficile infection rates remains of high importance. The key achievements to minimising the number of avoidable cases have been due to The review of the antibiotic prescribing guidelines. Appropriate antimicrobial prescribing is a vital element in the prevention and control of Clostridium difficile infection. Improvement in documenting symptoms on the ward has aided communication and helped in the assessment off CDI cases Ward staff sending samples promptly, in particularly on admission when a patient is symptomatic Improvements in cleanliness on the wards have reduced the transmission of cases and reduced the risk of a period of increase incidents (PII). Table 4 The table represents the number of Clostridium difficile cases isolated between April 215 and March 216 in The Partnership Trust Community Hospital inpatient wards. Community hospitals Ap May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total 215=216 Day of admission plus four (Admission date is day 2 3 2 2 1 3 1 2 1 3 2 22 one) Running Total SSOTP 2 5 7 9 1 13 14 14 16 17 2 22 22 Avoidable/Unavoidable/ UU AU 19xU, Outstanding awaiting UU UUU UU AU U A - UU UU U U U 3xA panel Ward Cheadle ward 1/ Aynsley Broadfield / Saddler/ Cottage Broadfield/ Oak Saddler/Aynsley Grange Sneyd/ Jackfield/ Grange Saddler - Sneyd/ Grange Ward 1 Chatterley, Bennion, Oak Broadfield, Sycamore 1

Clostridium difficle in Care Homes As part of the Service Level Agreement with local Commissioners, the Infection Prevention and Control Team provided a 7 day advice service, educational and audit support to care homes. Between April 215 and March 216 two care homes were identified as having a period of increased incidence (PII) of Clostridium difficile. The home isolated two or more cases of Clostridium difficile over a short period of time. The care home was audited and supported educationally by the Infection Prevention Control Team. The support actions for all care homes includes providing Link worker training sessions, onsite training sessions, annual whole day study days, RCA for all MRSA and clostridium difficile cases with GP input, educational posters and sharing of the Partnership Trust Clostridium difficile policy and completing a CDI audit for each case. Outbreaks in The Partnership Trust Community hospitals Outbreaks of diarrhoea and/or vomiting can occur at any time during the year, but are particularly prevalent during the winter months. They are often referred to as winter vomiting illness. All outbreaks of infection are reported through The Partnership Trust Risk team and reported to the NHS England as a Serious Incident (SI.) SI s are subject to a root cause analysis investigation. Actions are then monitored through the Infection Prevention and Control Committee. During April 215 March 216, 14 Outbreaks were reported which resulted in a ward closure. 8 of the wards had Norovirus and a further 6 wards were closed due to Flu. The number of outbreaks had decreased from previous years due to their being lower levels in all areas across the country. Pictures 5 and 6. Criteria 4 Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion The criteria for the movement and transfer of patients who are known or suspected to have an infection was reviewed in May 212 and updated again July 213 following the Period of Increased Incidence (PII) of Clostridium difficile cases. The newly designed documentation contains details of infections and the treatment that the patient has been prescribed. The documentation aids communication between different wards and teams and allows the receiving team to provide for any continuing needs/ treatment and ensure that quality of care is not compromised during the transfer due to lack of information. Throughout the year the Medicines Management team has provided educational support to the non- medical prescribers such as nurses and therapists. This has supported in the reduction of high risk antibiotic prescribing and inappropriate prescribing within the community hospitals. The team has continued to issue a letter to prescribers if high risk 11

antibiotics were prescribed educating them of the risks. Following the establishment of the Partnership Trust the Pharmacists in the community hospitals have increased their engagement with the Infection Prevention and Control team, inputting into RCA process, maintaining antibiotic audits and following up of any inappropriate prescribing. The Medicines Management team and the Infection Prevention and Control team prioritised the plan of work, to concentrate on Medical staff prescribing within The Partnership Trust, three educational sessions took place with the Medical teams led by the Consultant Microbiologists. The Infection Prevention and Control Team have worked closely during the year with the Pharmacy teams in the Clinical Commissioning Groups (CCG), data from RCA s has been shared which has enabled the pharmacists to follow up inappropriate antibiotic prescribing for care home patients and General Practitioner (GP) samples. To support healthcare staff in providing patients with the appropriate information concerning treatment and management of specific infections. The IPCT has a catalogue of Infection Prevention and Control related leaflets. During 215 the team reviewed the patient and carer leaflets available with The Partnership Trust Communications team. All leaflets are available electronically for staff to access. The team regularly deliver training sessions, within the Trust training programme and externally, as invited speakers on Degree level courses at Staffordshire, Keele and Wolverhampton Universities, Infection Prevention and Control courses and The Masters in Public Health course delivered at the University of Birmingham. Criteria 5 Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people All patients admitted to the Partnership Trust Community hospitals are assessed for the risk of infection. Using a locally designed assessment tool on admission. The tool will demonstrate if the patient requires to be nursed in an isolation room or whether they can be nursed in a communal bay. All patients are screened on admission to Community Hospitals for MRSA. Elective patient admission screening figures are reported monthly to the ward Matron, the Infection Prevention and Control Committee, Management team. This information is also provided to our Commissioners each month at a Clinical Quality Review (CQR) meeting. A target has been set by the commissioners of 95% compliance. The Partnership Trust compliance rates have been excellent consistently scoring 98% or more each month. Criteria 6 Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection All Partnership Trust employees are required to act as a role model and take steps to prevent and control infection. This includes adopting bare below the elbow and standard infection control/ hygiene precautions. If staff are not compliant with following policies, initially this would be followed up by local team leaders and supported by Senior managers, matrons and heads of services. Performance is monitored via the appraisal route. The Link Worker Programme remains a strong forum, meeting on a quarterly basis. The meetings update staff on new policies and guidance issued by the Department of Health or 12

the Public Health England, which staff are asked to take back to their individual teams. The four dedicated link worker groups have continued this year and have worked well, General group Care home staff group Prison Healthcare Dental team The individual groups have enabled the meetings to focus on more areas pertinent to the individual services. The Annual Infection Prevention and Control study day took place in October 215 with 128 staff taking part. The study day brought together infection control link workers from all areas, this enabled staff to share ideas and innovations from all specialities relating to infection control. The day was opened by the Director of Nursing and Quality who gave a key speech to delegates on The Partnership Trusts vision relating to Healthcare infections and how each individual staff member can make a difference to the quality of care each patient/ client receives. Picture 7 and 8 Taken on the Annual Study day. Training continues to play a large role in bringing about change, ensuring staff are motivated and reminded of factors that can prevent or minimise risks of infection. All staff receive a basic training session when they commence working in the Trust as part of the Induction Programme. Picture 9 The training needs analysis template was updated in 215 in agreement with the Training Department. In addition to induction, all clinical staff are required to attend an annual update. The training is available to staff in several forms, face to face session, handbook or e 13

learning. Non-attendance is followed up by the Training Department and the individual managers. Attendance figures are reported to Infection Prevention and Control Committee, Quality Governance and Trust Board, at frequent intervals throughout the year. Attendance has consistently remained at between 89% and 92% throughout 215-216. The 215-216 mandatory training package emphasises standard infection control precautions required to work safely and has concentrated particularly on Clostridium difficile prevention and treatment and aseptic non touch technique (ANTT). ANTT has remained in the programme to help standardise practices across the Trust. In conjunction with the tissue viability team, clinical practice educators (CPE) team and the continence team, ANTT has been strongly re enforced as a standardised approach for dressings, cannualtions or any procedure requiring an aseptic technique procedure. This year the team have continued to use other methods of training to try and encourage more interaction during sessions. More ward and team based sessions have been carried out, together with Isolating Iris role plays in the Community hospitals which is a deliberate mistake scenario game. Staff have to watch the scenario and mark down all the good and bad practices they see. At the end staff can then talk through their answers and gain knowledge on the correct techniques that should happen. Picture 1 Isolating Iris. During 215 in addition to the mandatory training programme the Infection Prevention and Control nurses continued to support the band 5 and band 6 Registered Nurses development programmes. The IPCT continued to accept student nurse placements within the team, the allocations last for one week per student and throughout the team on average there are two student nurses attending per week. The evaluations from the student nurses have been very positive and enabled the students to receive one to one support and guidance around the infection control subject and individual infections, which will help them to gain more in depth knowledge of infection control prior to them qualifying. 14

Criteria 7 Provide or secure adequate isolation facilities Isolation of patients was monitored very closely by the clinical team and reported as part of the matron s dashboard. Patients requiring isolation were reviewed daily by ward staff and weekly during the Infection Control Nurse ward round. The Trust has 12 single rooms which can be used for patient isolation within the Community Hospital; this number has varied throughout the year depending on the number of wards open at the time. During January and February a new review process was agreed with University Hospital North Midlands the aim was to improve on the number of days patients were waiting to be transferred in to a side room, the process involves reviewing the patients needs on a daily basis and identifying infection risks early. Criteria 8 Secure adequate access to laboratory support as appropriate Due to the large geography of the Trust several laboratories services are used across Staffordshire and Stoke on Trent for processing microbiology samples. The main laboratories are University Hospital North Midlands, Burton Hospitals Foundation Trust, Heart of England Foundation Trust, Russell s Hall and New Cross Hospital Microbiology Laboratory. All of the laboratories used are nationally CPA accredited. Details of the accreditation can be found on the website www.cpa-uk.co.uk. Microbiology advice concerning the specimen results is obtained from the laboratory which processed the specimen. Criteria 9 Have and adhere to policies, designed for the individual s care and provider organisations that will help to prevent and control infections The Infection Prevention and Control team have continued to ensure that the Partnership Trust staff and patients have access to robust, evidence based up to date policies. During the year the Infection Prevention and Control Team have continued to update policies and standard operating procedures. During 215 Norovirus Toolkits and folders were reviewed in the Community hospitals and re launched. The folders comprise of posters, leaflets, cleaning schedules and data collection tools to be used during an outbreak.. Audit has driven the service forward to provide a systematic approach to infection control and ensures compliance with Trust policies and the ten criteria of The Health Act 28 Code of Practice for the Prevention and Control of Health Care Associated Infections (Revised 215) and National Health Service Litigation authority (NHSLA). The audits support the identification of areas for improvement. A rolling programme of infection control audits based on the Infection Control Nurses Association tool (211) have been completed in the Community hospital, departments, Community dental services, Prison Healthcare departments, Health Centres and a small number of GP buildings. Clinical audit can be used as a training aid as well as to monitor clinical effectiveness. It has shown to be an effective tool in monitoring standards and influencing change. The engagement with the Operational teams and link workers have been exceptional this year, the local teams have taken on board carrying out Infection control compliance audits to give themselves assurance that standards are being maintained within their teams as well as providing assurance for the Trust Board. Listed below are just a sample of some of Infection control audits completed during 215-216. 15

The Physiotherapist and Occupational therapist based in the South of the trust, Infection Control audit scores demonstrated excellent compliance with National Standards. The Prison Healthcare teams Infection control audits completed in 215, were on the whole high scoring, Featherstone Prison cleanliness and environments had deteriorated over time, but with a 1week improvement plan the department worked with the Prison s Estates team and improved the environment considerably. The Sexual Health teams complete a number of Infection Control audits throughout the year, the graph below demonstrates just one of the audits, the scores were reported by the North Service Sexual Health Infection Control Link Practitioner, the Link practitioners carry out the audits and discuss results with colleagues at team meetings and develop action plans for improvement 16

The Dental departments across the organisation have a number of Link practitioners who carry out hand hygiene, cleanliness and decontamination audits on a monthly basis, the link practitioners in the dental team share with colleagues any findings and are continually changing practice to improve standards. The graph below demonstrates the excellent Infection Prevention Society audit scores for all of the Dental teams in the buildings below, All areas met the Essential Quality requirements (EQR ) which are standards set nationally, in addition the majority of rooms audited also met the National Best Practice standard. The Community hospital team have over 38 staff members who carry out the Link practitioner role monitoring standards, acting as excellent role models, hand hygiene champions and sharing good practice across the wards and outpatient areas. The Link workers complete monthly audits on Hand hygiene, Urinary catheters and Peripheral catheters. The community hospitals also complete monthly and quarterly audits measuring cleanliness ensuring standards are maintained. Throughout the year all hospitals have maintained 95% compliance for cleanliness, except Leek which fell to 93% for one month and then improved following a quick intervention. Hand hygiene compliance has remained high at between 9-1% each month. Infection Prevention Society National audit all areas compliant with the standards and achieved over 85% Criteria 1 Ensure, so far as is reasonably practical, that care workers are free of infection and are protected from exposure to infections that can be caught at work and that staff are suitably educated in the prevention and control of infection associated with the provision of health and social care. During 215-216 the Occupational Health service was provided by Team Prevent. The service is accessed by all Trust staff. A range of services were available This included advice and information for staff when suffering from infections, Vaccinations, occupational health screening and risk assessments following inoculation injuries. Data relating to inoculation injuries reported to occupational health was presented at the Infection Prevention Control Committee. Team Prevent and the Infection Prevention and Control Team worked with the Communication team to deliver a Staff Flu vaccination programme between October 215 and January 216, 211 vaccinations were performed. The overall percentage was 51%. Allied health professionals were the highest group vaccinated 85% of staff in this group were vaccinated. The Director of Nursing and Quality showed support in the campaign. Agreeing to be photographed for the Trust communication news letter The Word during their vaccination 17

Picture 11 Rose Goodwin Director Of Nursing for Picture 1 Sue Jackson Professional Lead Adult Nursing Picture 13 The word flu promotion articles Picture 14 Flu promotion Picture 15 Peer vaccinators Picture 16 Peer vaccinators 18

The Partnership Trust IPCT work with independent contractors and Social Care Sector Care homes to provide advice and support on compliance with infection control standards as part of a service level agreement with the local commissioners. General Medical Practice Engagement The IPCT have continued to strengthen relationships with general practice teams. Training sessions for practice nurses and practice staff have been arranged on request. General Practitioners (GP s) have been encouraged to actively take part in the RCA of alert organisms which are reported through the national surveillance programme. Regular newsletters and updates to policies have been circulated to practice teams. Infection control policies are available on the external web site and Practice teams are advised to adapt these for use in their own teams. 128 Practice Nurses attended a number of Infection control training sessions held throughout the patch between 215-216, concentrating on Standard Precautions, clostridium difficile and carrying out a Infection Prevention Society audit and were asked to disseminated the information with their own teams. Care homes, hospices and care agencies Work in this area has continued to increase during 215 the SLA with commissioners was reviewed to include increased support to care homes, no further resources were available therefore annual General Practice audits were discontinued unless a specific concern had been raised, from a incident, complaint or positive microbiology sample. A large number of training sessions were held throughout the Health Economy for care home staff to attend. There were 723 care home staff in total who attended and took part in the sessions throughout the year. Staff were asked to cascade the information within their own care setting. The care home link worker programme has continued to go from strength to strength, with new link nurses form residential and nursing homes being added to the group on a weekly basis. Educational meetings are held on a quarterly basis. Picture 17 Care Home training 19

A Care Home Tool to aid compliance with CQC registration was re circulated by the IPCT to all homes across Staffordshire and Stoke on Trent geographical area. The outbreaks continue to be managed by the Public Health England team (PHE). Between April 215 and March 216, 126 infection control audits were completed in nursing homes and residential homes. The audits provided homes with up to date information and knowledge on working safely reducing the risk of infection for both patients and staff. The commissioners and Care Quality Commission have also used the evidence to support performance issues, raise standards of care and concerns highlighted for a small number of homes under scrutiny. There were three main audits carried out. An IPS audit was carried out, this is a general tool developed by the Infection Prevention Society, the tool covers all areas of the environment and includes observing practices, the second audit is a tool used during a Diarrhoea and vomiting outbreak, the tool asses if the home is compliant in managing an outbreak and has implemented control measures to reduce the spread and the third audit is only carried out when a care home is treating a patient who has Clostridium difficile. The aim of the tool is to ensure that the patient is receiving the most appropriate treatment and that precautions have been instigated to reduce the risk of cross infection. Data collection related to organisms isolated in care homes has continued as previous years. This includes all Clostridium difficile cases, MRSA bacteraemias, MSSA bacteraemias and E coli bacteraemias. Due to the amount of time a RCA takes to complete effectively only a small number are completed by the IPCT the data is used to ascertain trends, however care homes are encouraged to follow up on all of their own individual cases internally. Summary The strategic and operational aim of the Infection Prevention and Control services is to increase organisational focus and collaborative working to effectively implement and maintain The Health and Social Care Act 28 amended in 215, Code of Practice for the Prevention and Control of Infections. The year 215-216 has been a very productive year for the Trust. It is recognised that an increased engagement with different staff groups at all levels has taken place, collaborative working within the Trust with the Continence team, Tissue Viability team and the District Nurse Professional lead has enabled the trust to continue to develop and embed a culture further that supports and promotes infection, prevention and control within the Trust. Key highlights from some of the individual criteria for 215-216 2

The Trust were compliant with the hygiene code in 15/16 Criteria 5 (management of infection) Clostridium difficile 22 cases isolated of which 19 were unavoidable and 3 avoidable cases. MRSA against a trajectory of we had. Criteria 6 and 2- environment and staff involvement in prevention and control Environmental and nursing equipment cleanliness standards improved within the community hospitals from 65% to 95%. Criteria 7 provision of isolation facilities We reported 14 outbreaks in community hospitals- 6 flu and 8 Norovirus. compared to 27 outbreaks reported the previous year. Criteria 1- vaccination and education of staff We achieved 51% staff flu vaccinations. 85% Allied Health Professionals attended for vaccine. HCAI Annual Programme of Work, priorities for the Partnership Trust 216 217 21

Reduce avoidable CDI cases Prevent avoidable MRSA bacteraemia Review TB programme in East Cheshire Review district nurse vaccination training programme, Work with emergency planning team to improve pandemic flu planning and business continuity during outbreaks in the community setting Reduce the number of urinary catheter related infections in health economy Reduce the number of antibiotic treatments prescribed; hospital, dental and community Improve IV to oral antibiotic switch Continue supporting clinical staff to produce more community based SOP for clinical skills Reduce the number of inoculation injuries relating to Diabetic procedures and venepuncture Roll out sepsis bundle in community teams Produce a water Safety Plan in conjunction with the Authorising Engineer Review the assurance programme for cleaning standards Review Care homes training programme Review Care homes audit programme 22

Appendix 1 Infection Prevention and Control Committee Membership Director of Nursing and Quality, Director of Infection Prevention & Control (DIPC) Associate Director of Professional Leadership Associate Director of Quality Lead Infection Prevention and Control Nurses Infection Control Doctor/ Microbiologists Medical Director Staffordshire County Council representative Health Protection Agency, Consultant in Communicable Disease Control Non-Executive Director Director of Finance Resource and Estates Representative Chief Operations Officer/s representative Hospital Manager Decontamination Lead/s Head of Infection Prevention and Control Clinical Commissioning Groups Public Health representative Occupational Health Health and Safety 23