The challenge for today - best practice, better outcomes and safer healthcare

The challenge for today - best practice, better outcomes and safer healthcare A practical guide to improving practice & monitoring compliance against the National Quality Standard for Healthcare associated Infection Prevention and Management Wednesday 20 th April 2016 ICO Conference Centre, London Dr Bharat Patel Consultant Medical Microbiologist & AMR & HCAI Lead for PHE Public Health Laboratory London Infection Control Doctor Community Services Brent Public Health England National Infection Service 3 rd Floor Pharmacy and Pathology Building Barts Health NHS Trust Whitechapel, London

Effective management & prevention The views portrayed are my personal views and NOT PHE or DH policy Disclosure: I have been on advisory panel for pharmaceutical companies and have been invited to chair and lecture at meetings Patient safety Quality in healthcare delivery Zero tolerance

Background Development of infection prevention and control HCAI epidemics and their control NICE Quality Statements NICE IPC & HCAI guidance NICE Quality Standards Where do we go from here? 3 Presentation title - edit in Header and Footer

A hospital outbreak - diarrhoea and vomiting Residents ate Saturday evening Sunday morning 7am 1 st case 9.15am 36 Residents 355/788 ill Staff 106/980 ill 19 deaths 1.30pm 45 4.30pm 50 6.45pm 70 9.15pm 94 11.35pm 1 st death 4 Presentation title - edit in Header and Footer

A hospital outbreak 26 th August 1984 diarrhoea and vomiting Stanley Royd Baroness Trumpington "Stanley Royd is a large hospital in Wakefield for mentally ill and psychogeriatric patients. Major outbreak of salmonella food poisoning Began on 26th August 1984, 355 patients and 106 members of staff were affected. Food poisoning caused, or contributed to, the deaths of 19 patients. At the time of the outbreak and subsequently a number of allegations were made of errors in the control of infection, of poor standards of hygiene in the hospital kitchen and of other shortcomings. 5 Presentation title - edit in Header and Footer

Outbreak of Legionnaires' disease Date? 6 Presentation title - edit in Header and Footer

The Stafford outbreak of Legionnaires' disease Epidemiology and Infection 1990 140 361-80 A large outbreak of Legionnaires' disease was associated with Stafford District General Hospital. April 1985 A total of 68 confirmed cases was treated in hospital and 22 of these patients died. A further 35 patients, 14 of whom were treated at home, were suspected cases of Legionnaires' disease. All these patients had visited the hospital during April 1985. Epidemiological investigations demonstrated that there had been a high risk of acquiring the disease in the out patient department (OPD), but no risk in other parts of the hospital. The epidemic strain of Legionella pneumophila, serogroup 1, subgroup Pontiac 1a was isolated from the cooling water system of one of the air conditioning plants. This plant served several departments of the hospital including the OPD. The water in the cooling tower and a chiller unit which cooled the air entering the OPD were contaminated with legionellae.

The Stafford outbreak of Legionnaires' disease Epidemiology and Infection 1990 140 361-80 The water in the cooling tower and a chiller unit which cooled the air entering the OPD were contaminated with legionellae. April 1985 Bacteriological and engineering investigations showed how the chiller unit could have been contaminated and how an aerosol containing legionellae could have been generated in the U-trap below the chiller unit. These results, together with the epidemiological evidence, suggest that the chiller unit was most likely to have been the major source of the outbreak. Nearly one third of hospital staff had legionella antibodies. These staff were likely to have worked in areas of the hospital ventilated by the contaminated air conditioning plant, but not necessarily the OPD. There was evidence that a small proportion of these staff had a mild legionellosis and that these 'influenza-like' illnesses had been spread over a 5-month period. A possible explanation of this finding is that small amounts of aerosol from cooling tower sources could have entered the air-intake and been distributed throughout the areas of the hospital served by this ventilation system. Legionellae, subsequently found to be of the epidemic strain, had been found in the cooling tower pond in November 1984 and thus it is possible that staff were exposed to low doses of contaminated aerosol over several months. Control measures are described, but it was later apparent that the outbreak had ended before these interventions were introduced. The investigations revealed faults in the design of the ventilation system.

The efficacy of infection surveillance and control programs in preventing nosocomial infection in US hospitals. Haley R W, Culver DH, White JW, et al. Am J Epidemiology 1985; 121: 182-205 1985 SENIC Study of the Efficacy of Nosocomial Infection Control - validated the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented. 9 Presentation title - edit in Header and Footer

1988 Joint Department of Health and Social Security and Public Health Laboratory Service Hospital Infection Working Group. Hospital infection control guidance on the control of Infection in hospitals. London DHSS 1988. Cooke Report HC(88)33 10 Presentation title - edit in Header and Footer

1995 Hospital Infection Working Group of the Department of Health and Public Health Laboratory Service About 30% of hospital acquired infections could be avoided by better application of existing knowledge and realistic infection control practice 11 Presentation title - edit in Header and Footer

recommends that purchasers of health care include enhanced surveillance, prevention and control in their contractual requirements recommends routine surveillance of hospital acquired infection, including non outbreak associated infection recommends arrangements for the control of outbreaks if infection in hospitals recommends the action which should be taken by the hospital in response to major outbreaks of infection in the community 12 Presentation title - edit in Header and Footer

The Management and Control of Hospital Infection - 11 February 2000 Action for the NHS for the Management and Control of Infection in Hospitals in England This Health Service Circular sets out a programme of action for the NHS to: strengthen prevention and control of infection in hospital; secure appropriate health care services for patients with infection; improve surveillance of hospital infection; and monitor and optimise antimicrobial prescribing Action Health Authorities (HAs), Primary Care Groups (PCGs) and NHS Trusts should work together to implement the attached action programme, using the infection control standards in the Controls Assurance framework; NHS Trust Boards should formally review arrangements for the control of infection within hospitals for which they are responsible at least annually; Regional Directors of Public Health, working with Regional Directors of Performance Management, will ensure that the NHS has robust infection control arrangements (including the implementation of clinical governance arrangements and achievement of the Controls Assurance Standards) in accordance with the timetable set out in this Circular. http://www.dh.gov.uk/en/publicationsandstatistics/lettersandcirculars/healthservicecirculars/dh_4004217 14 Presentation title - edit in Header and Footer

First description of MRSA M Patricia Jevons Staphylococcus Reference Laboratory No direct connexion between the strain isolated from the eczematous patient in July and the two strains isolated in October could be demonstrated. Nurse B was not on duty in the out-patient department or the ward to which the patient was admitted in July, and she was not a nasal carrier at the end of October when her lesion had healed. It seems, however, very likely that the strain isolated from patient C in July was in fact the same as that isolated from patient A and nurse B in October, especially as the original patient with the infected eczema is a regular hospital attender, and this strain has been isolated from her nose three times over a three-month period and from her skin on the only occasion this was swabbed. 15 Presentation title - edit in Header and Footer

Epidemic MRSAs in England & Wales Geographical distribution of hospital incidence of EMRSA 3, 15 & 16 CRD weekly (1998) 16 Presentation title - edit in Header and Footer

Staphylococcus aureus bacteraemia laboratory (Voluntary) reports England, Wales and Northern Ireland 1993-2003 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 UK SA MRSA 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Labbase 2 data 17 Presentation title - edit in Header and Footer

MRSA deaths Office of National Statistics Age specific death rate highest in aged 85 and over 18 Presentation title - edit in Header and Footer

Media headlines left very little to imagination OUR SQUALID HOSPITAL The deadly superbug that puts Britain s hospitals to shame THE PLAGUE 2004 Filthy NHS wards kills 5000 a year MRSA.THE FORGOTTON MASSACRE 19 Presentation title - edit in Header and Footer

The DH National approach Patient safety Quality in healthcare delivery Zero tolerance Individual ownership, individual responsibility, individual accountability Leadership Leadership Leadership 20 Presentation title - edit in Header and Footer

High impact interventions Consistent & reliable practice Central venous catheters CVC Peripheral Venous Catheters PVC Ventilator Associated Pneumonias VAP Urinary catheters Antimicrobial prescribing Many others now 21 Presentation title - edit in Header and Footer

Cost to the NHS Trust apportioned - Apr 2008 Apr 2013-57679 Cases 230,716,000 @ 4000 a case LOS - 57679 Cases 1,211,259 additional bed days @ 21 beds days a case Complaints, Litigation Loss of Reputation Loss of patient confidence CCG Quality premium Healthcare commission inquiries Trust breaches & penalties 22 Healthcare Commission Reports (now CQC)

Setting of targets and objectives Patient safety Quality in healthcare delivery Zero tolerance Individual ownership, individual responsibility, individual accountability 23 Presentation title - edit in Header and Footer

Performance management DH Department of Health Strategic Health Authorities Patient safety Quality in healthcare delivery Zero tolerance Individual ownership, individual responsibility, individual accountability 24 Presentation title - edit in Header and Footer

Support systems Peer support teams Peer review visits Meetings and workshops Some doing well Case studies Information Letters Information - Guidance 25 Presentation title - edit in Header and Footer

Incentives and penalties Stretch targets Over trajectory Monitoring Comparisons Regular data publications Phone calls Commissioning systems CQUIN (Quality thro commissioning) 26 Quality and improvements (QUIP) Presentation title - edit in Header and Footer

Penalties Variable penalties 20,000-100,000 for every case above trajectory A proportion of budget 0.25% - 0.5% Incentives Stretch targets ¼m - 1/2m 27 Presentation title - edit in Header and Footer

Control strategies and initiatives Multiple strategies High impact interventions Saving lives Matrons Charter Going further faster Clean safe care Hand Hygiene Deep clean Bare below the elbows 28 Presentation title - edit in Header and Footer

Code of Practice 2015 Compliance criteria 1-10 6. Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection. 7. Provide or secure adequate isolation facilities. 8. Secure adequate access to laboratory support as appropriate. 9. Have and adhere to policies, designed for the individual s care and provider organisations that will help to prevent and control infections. 10. Providers have a system in place to manage the occupational health needs and obligations of staff in relation to infection. for all providers of healthcare and adult social care on the prevention of infections under The Health and Social Care Act 2008. This sets out the 10 criteria against which a registered provider will be judged on how it complies with the registration requirements related to infection prevention. Not all criteria will apply to every regulated activity. 29 The CQC is responsible for judging compliance with the registration requirements set out in regulations.

What should good Trust look like? What do patients expect? 1. Health & Social Care Act 2008 - compliance criteria 2. Board Assurance Board to Ward 3. NICE/HPA 11 Quality Statements - criteria can what can be evidenced 4. Board s role in improving patient safety 5. Cleaning contracts 6. Estate Department 7. Mandatory training 30 Presentation title - edit in Header and Footer

NICE Quality Statements 11 Aspirations PH 36 QS 113 Healthcare associated Infections QS 61 Infection Prevention and Control 31 Presentation title - edit in Header and Footer

NICE/HPA Quality Improvement Statements 1: Board level leadership to prevent HCAIs Trust boards to demonstrate leadership in infection prevention and control to ensure a culture of continuous quality improvement and to minimise risk to patients 32 Presentation title - edit in Header and Footer

NICE/HPA Quality Improvement Statements 1: Board level leadership to prevent HCAIs What does this mean for people visiting, or receiving treatment in, hospitals? People visiting, or receiving treatment in, hospitals can expect all trust staff - from board to ward level - to take responsibility, and be accountable for, continuous quality improvement in relation to infection prevention and control. What does it mean for trust boards? Boards are proactive in ensuring continuous quality improvement by leading on, and regularly monitoring compliance with, all relevant infection prevention and control objectives, policies and procedures. 33

1: Board level leadership to prevent HCAIs Evidence of achievement 1. Evidence that the board is up-to-date with, and has a working knowledge and understanding of, infection prevention and control. 2. Evidence that the board has an agreed set of key performance indicators for infection prevention and control which includes compliance with antibiotic prescribing policy. 3. Evidence that the agreed key performance indicators are used by the board to monitor the trust's infection prevention and control performance. 4. Evidence that the trust's aims and objectives for infection prevention and control are included in the board's Balanced score card'. 5. Evidence that a board member has been assigned to lead on infection prevention and control. 6. Evidence of a board-approved infection prevention and control accountability framework. This includes evidence of specific responsibilities allocated to staff working in, or coming into contact with, clinical areas (reflected in their job descriptions and appraisals). 34 7. Evidence that a mechanism is in place to report regularly to board meetings on

Practical examples Annual improvement plans include comparative data on progress towards relevant quality improvement statement goals, as well as in areas covered by other relevant guidance. (An example is NICE's clinical guideline on prevention and treatment of surgical site infection) Regular audit of board infection prevention and control accountability framework. Infection prevention and control features in the planned board development programme. Audit of infection prevention and control objectives within annual work programme. Health and Social Care Act code of practice Criterion 1: Guidance for compliance 1.1, 1.5 Criterion 6: Guidance for compliance 6.2 1: Board level leadership to prevent HCAIs 35

Quality Improvement Statements 2: Be a learning organisation Trusts use information from a range of sources to inform and drive continuous quality improvement to minimise risk from infection 3: HCAI surveillance Trusts have a surveillance system in place to routinely gather data and to carry out mandatory monitoring of HCAIs and other infections of local relevance to inform the local response to HCAIs. 36 Presentation title - edit in Header and Footer

Quality Improvement Statements 4: Workforce capacity and capability Trusts prioritise the need for a skilled, knowledgeable and healthy workforce that delivers continuous quality improvement to minimise the risk from infections. This includes support staff, volunteers, agency/locum staff and those employed by contractors. 5: Environmental cleanliness Trusts ensure standards of environmental cleanliness are maintained and improved beyond current national guidance. 37 Presentation title - edit in Header and Footer

Quality Improvement Statements 6: Multi-agency working to reduce HCAIs Trusts work proactively in multi-agency collaborations with other local health and social care providers to reduce risk from infection. 7: Communication Trusts ensure there is clear communication with all staff, patients and carers throughout the care pathway about HCAIs, infection risks and how to prevent HCAIs, to reduce harm from infection. 38 Presentation title - edit in Header and Footer

Quality Improvement Statements 8: Admission, discharge and transfer Trusts have a multi-agency patient admission, discharge and transfer policy which gives clear, relevant guidance to local health and social care providers on the critical steps to take to minimise harm from infection. 9: Patient and public involvement Trusts use input from local patient and public experience for continuous quality improvement to minimise harm from HCAIs. 39 Presentation title - edit in Header and Footer

Quality Improvement Statements 10: Trust estate management Trusts consider infection prevention and control when procuring, commissioning, planning, designing and completing new and refurbished hospital services and facilities (and during subsequent routine maintenance). 11: New technology and innovation Trusts regularly review evidence-based assessments of new technology and other innovations to minimise harm from HCAIs and antimicrobial resistance (AMR). 40 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections 11 February 2016 Statement 1 Statement 2 Statement 3 Statement 4 Statement 5 https://www.nice.org.uk/guidance/qs113/resources/healthcareassociated-infections-75545296430533 41 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Statement1. Hospitals monitor healthcare-associated infections and other infections of local relevance to drive continuous quality improvement. Statement2. Hospitals work with local health and social care organisations to assess and manage the risk of infections in hospitals from community outbreaks and incidents. Statement3. Hospital staff have individual objectives and appraisals on infection prevention and control linked to board-level objectives and strategies. Statement4. Hospitals involve infection prevention and control teams in the building, refurbishment and maintenance of hospital facilities. Statement5. People admitted to, discharged from, or transferred between or within hospitals have information about any infections and associated treatments shared with health and social care staff to inform their care. 42

NICE Quality Standards QS113 Healthcare-associated infections Statement 1: Surveillance Trust boards to demonstrate leadership in infection prevention and control to ensure a culture of continuous quality improvement and to minimise risk to patients Quality Statement Rationale Quality Measures Structure 43 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 1: Surveillance Hospitals monitor healthcare-associated infections and other infections of local relevance to drive continuous quality improvement. Identification and monitoring of other infections of local relevance, including resistant organisms, contributes to a fuller understanding of the risk of infection to people in hospital. The results of monitoring can be used by staff across the organisation to help inform practice, review the effectiveness of responses, and review how well strategies to reduce healthcare-associated infections are working. 44 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 1: Surveillance Hospitals monitor healthcare-associated infections and other infections of local relevance to drive continuous quality improvement. a) Evidence of local arrangements for hospitals to monitor healthcare-associated infections and other infections of local relevance. b) Evidence of local arrangements for the results of monitoring healthcare-associated infections and other infections of local relevance to be used across the organisation to inform and review objectives for quality improvement. 45 Outcome Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 2: Collaborative action Hospitals work with local health and social care organizations to assess and manage the risk of infections in hospitals from community outbreaks and incidents 46 Healthcare-associated infections are a serious risk to hospital patients, staff and visitors. Infections contracted outside a hospital setting can be brought into the hospital by patients, visitors and staff, and transmitted to others. By identifying and assessing potential risks from community outbreaks and incidents, hospitals can take action in collaboration with other local health and social care Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 2: Collaborative action Hospitals work with local health and social care organizations to assess and manage the risk of infections in hospitals from community outbreaks and incidents a) Evidence of local arrangements for hospitals to monitor the risk of healthcare-associated infections from incidents and outbreaks in the community. b) Evidence of local arrangements for collaborative working between hospitals and other local health and social care organizations to investigate and manage the risks of healthcareassociated infection from incidents and outbreaks in the community. 47 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 3: Responsibilities of hospital staff Hospital staff have individual objectives and appraisals on infection prevention and control linked to boardlevel objectives and strategies Trust boards provide leadership in infection prevention and control, but all hospital staff have responsibility for, and are accountable for, infection prevention and control. Boards can help minimise the risk to patients and ensure continuous quality improvement by leading on and regularly reviewing all relevant infection prevention and control objectives, policies and procedures. 48 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 3: Responsibilities of hospital staff Hospital staff have individual objectives and appraisals on infection prevention and control linked to boardlevel objectives and strategies A clear governance structure and accountability framework will allocate specific responsibilities to all staff. All staff having these responsibilities as clear objectives that are reviewed in appraisals and reflected in development plans will help ensure that board-level objectives are achieved and that the risk of healthcareassociated infection is minimised. 49 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 3: Responsibilities of hospital staff Hospital staff have individual objectives and appraisals on infection prevention and control linked to boardlevel objectives and strategies a) Evidence of local arrangements to ensure all staff have clear objectives in relation to infection prevention and control that are linked to board-level objectives. b) Evidence of local arrangements to ensure all staff have an appraisal and development plan that cover infection prevention and control. 50 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 4: Planning, design and management of hospital facilities Hospitals involve infection prevention and control teams in the building, refurbishment and maintenance of hospital facilities. 51 The design of new buildings, as well as their refurbishment and on-going maintenance, should allow good infection prevention and control practices. Involving infection prevention and control teams in the planning, design and maintenance of hospital facilities can ensure that needs are anticipated, planned for and met, and that the risk of healthcare-associated infections is minimised.. Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 4: Planning, design and management of hospital facilities Hospitals involve infection prevention and control teams in the building, refurbishment and maintenance of hospital facilities. a)evidence of local arrangements for involving infection prevention and control teams in the building and refurbishment of facilities in the hospital. Examples of evidence may include protocols covering infection prevention and control in the built environment; estate department procedures to engage infection prevention and control teams in new build and refurbishment projects; building and refurbishment project plans and schedules of work that show the involvement of infection prevention and control teams; and records of completed building and refurbishment works that show whether infection prevention and control requirements have been met. 52 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 4: Planning, design and management of hospital facilities Hospitals involve infection prevention and control teams in the building, refurbishment and maintenance of hospital facilities. b) Evidence of local arrangements for involving infection prevention and control teams in the maintenance of facilities in the hospital. Examples of evidence may include protocols covering infection prevention and control in the built environment; estate department procedures to engage infection prevention and control teams in maintenance works; maintenance plans and schedules that show the involvement of infection prevention and control teams; and records of completed maintenance works that show whether infection prevention and control requirements have been met. 53 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 5: Admission, discharge and transfer People admitted to, discharged from, or transferred between or within hospitals, have information about any infections and associated treatments shared with health and social care staff to inform their care. Potentially avoidable healthcare-associated infections can occur when people are admitted to, discharged from or transferred between or within hospitals. Sharing information on current infections, treatment and colonising organisms can result in better care and outcomes for people with, or at risk of, infections and can help to reduce the risk of infections being spread between care settings. 54 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 5: Admission, discharge and transfer People admitted to, discharged from, or transferred between or within hospitals, have information about any infections and associated treatments shared with health and social care staff to inform their care. A consistent approach to sharing information between health and social care practitioners involved in a patient's care pathway should ensure appropriate on-going support, and minimise the risk of inappropriate management and transmission of infection. Information should be shared when arrangements are made for a person to move from the care of one organisation to another, or when arrangements are made to move a person within a hospital, while maintaining patient confidentiality and privacy. 55 Presentation title - edit in Header and Footer

NICE Quality Standards QS113 Healthcare-associated infections Quality Statement 5: Admission, discharge and transfer People admitted to, discharged from, or transferred between or within hospitals, have information about any infections and associated treatments shared with health and social care staff to inform their care. Evidence of local arrangements to ensure information about any infections and associated treatments for people admitted to, discharged from, or transferred between or within hospitals, is shared with the health and social care staff responsible for the on-going care. 56 Presentation title - edit in Header and Footer

Where are we now? More can be done Patient safety Quality in healthcare delivery Zero tolerance MRSA Better Outcomes Infections continue to happen non bacteraemia Sustained effort required Further progress can be made Clostridium difficile Better Outcomes Infections continue to happen - colonisation Sustained effort required Further progress can be made Individual ownership, individual responsibility, individual accountability

What is the challenge? The New NHS Framework Patient safety Quality in healthcare delivery Zero tolerance All Trusts face key challenges Having a strategy to fit the Trust Staffing Financial constraints 120b to 100b Changing NHS structures Further work through commissioning Maintaining the focus In these challenging times Tailored Annual plans further reductions internally driven Reduce infection at every stage of patient pathway Improving outcomes Better commissioning Burden of infection Individual ownership, individual responsibility, individual accountability

What is the challenge? The Key issues Patient safety Quality in healthcare delivery Zero tolerance Organisation key challenges Sustainability Culture of an organisation Device associated infections - Bacteraemias - Catheter associated - Post surgical infections Behaviour of staff Individual ownership, individual responsibility, individual accountability

Why is there variability? Patient safety Quality in healthcare delivery Zero tolerance Better Leadership Better Engagement Better teams Sharper focus Rapid response Preparedness Local surveillance/data Listen Changed perception Open honest dialogue Developed a better organisational culture Changed practice Changed behaviour Individual ownership, individual responsibility, individual accountability

Be prepared Optimise Communicate Use all the resources Get everyone involved Organisational approach Make practice reliable/consistent What do we need to do? Key aims and objectives Patient safety Quality in healthcare delivery Zero tolerance Sustain improvements Make sure its happening Are all the systems working to an optimal level Water management Bed management - Isolation Good things learnt disseminated widely Individual ownership, individual responsibility, individual accountability

What do we need to do? The arts of persuasion Patient safety Quality in healthcare delivery Zero tolerance Networks Neonatal networks Obstetrics networks Intensive care networks Professional bodies Constant reminders/development of good habits Leaders Champions Management Patient advocates Directors of Public Health Commissioners Individual ownership, individual responsibility, individual accountability

What do we need to do? If not on priority list Patient safety Quality in healthcare delivery Zero tolerance Constantly keep Infection prevention and control one of the top priorities in the organisation all the time When things go wrong it does affect the operational characteristics of an organisation/hospital/health system and takes up considerable time and diverts essential resources Poor patient experience Damages reputations Leads to poor patient experience Individual ownership, individual responsibility, individual accountability

The role of other organisations and agencies Care Quality Commission Public Health England National audit office Public Accounts Committee Parliamentary reports NHS Confederation NHS Improvement (Monitor /TDA) NHS England CCGs Royal Colleges (National Patient Safety Agency) 64 Presentation title - edit in Header and Footer

Support the campaign Make the pledge - please http://antibioticguardian.com/ 65 Start Smart then focus prudent antimicrobial prescribing

ICO Conference Centre - London - best practice, better outcomes and safer healthcare - Quality and Improvement Thank you for your listening A question of quality in healthcare delivery A question of patient safety Delivering quality in Healthcare Acknowledgements April 14, 2016 Wednesday 20 th April 2016 Dr Bharat Patel Consultant Medical Microbiologist Infection Control Doctor Brent Community Services Public Health Laboratory London National Infection Services Public Health England Barts Health NHS Trust Antimicrobial resistance & Stewardship & Healthcare associated infection lead for London