WRIGHTINGTON, WIGAN AND LEIGH HEALTH SERVICES NHS TRUST DIRECTOR OF INFECTION PREVENTION AND CONTROL ANNUAL REPORT 2006-2007 Author(s) Gill Harris, Director of Infection Prevention and Control
EXECUTIVE SUMMARY This is the third Director of Infection Prevention and Control s report for covering the time period April 2006 to March 2007. The DIPC Report is produced on an annual basis and runs alongside the annual Infection Control Programme and Report. The DIPC Report consists of an updated overview and progress of the Infection Control management arrangements (including budgetary control), together with other Infection Control activities which enhance the primary Infection Control Team. This document provides summarative reports on the following:- Description of Infection Control Team Arrangements Infection Control Budgetary allocation Healthcare Associated Infection statistics Cleanyourhands Campaign Saving Lives Decontamination Cleaning Services Audit Targets and Outcomes DESCRIPTION OF INFECTION CONTROL TEAM ARRANGEMENTS See Annex A, Wrightington, Wigan and Leigh NHS Trust: Infection Control Policy and Infection Control Committee Terms of Reference. DIPC SUMMARY OF REPORTS TO THE TRUST BOARD - Summary. The Director of Infection Prevention and Control has presented the Trust Board with the following agenda items on Infection Control within the last 12 months. Infection Control Committee Annual Report endorsed Infection Control Committee Annual Programme endorsed Quarterly Infection Control minutes highlighting outbreaks and areas of concern and progress. The Trust MRSA Bacteraemia trajectory target progress and areas of concern. The Director of Infection Prevention and Control acts as the liaison between the Trust Board and Infection Control Committee and Infection Control Team. BUDGET ALLOCATION TO INFECTION CONTROL ACTIVITIES The Infection Control budget for 2006 2007 is 203,514 (non-pay = 4,175). The Microbiology budget for 2006 2007 is 1,960,281(non-pay = 253,453). Infection Control staff: = 4.5 WTE (4.5 2.5 WTE in post during the period of the report). Secretarial support = 0.7 WTE. Infection Control Doctor 0.5 WTE. Consultant Microbiologist 1.5 WTE. Infection Control Annual Report 06 07 Page 2 of 11
HEALTH CARE ASSOCIATED INFECTION STATISTICS Results of Mandatory Reporting See Table One. Trends in Health Care Associated Infection Statistics MRSA bacteraemia See Graph One. Clostridium difficile diarrhoea See Graph Two. Untoward Incidents (Including Outbreaks) U2006 - Second Quarter A new strain of MRSA was isolated from a number of babies on the Neonatal Unit. Typing of these isolates suggested that the babies all shared a related strain. However, this organism differed markedly from the MRSA strain found in adult patients within the Trust. Screening of staff members did not reveal any carriage of this new strain. One baby suffered an episode of skin sepsis, all other babies were asymptomatic. A terminal clean of the Unit and associated equipment was performed after discharge of the final colonised baby. Regular weekly screens of all babies on the Unit failed to reveal any further episodes of colonisation. There was a significant increase in the number of scabies patients being admitted from the community. There was no evidence of spread amongst in-patients or staff. A close working relationship with the PCT Infection Control Department ensured that effective control was rapidly implemented. A sibling of a baby on the Neonatal Unit developed chickenpox. Immunity checking on at risk patients and staff members was performed. No high-risk contacts were identified and immunoglobulin administration was not required. No patients or staff developed chickenpox. U2006 Third Quarter Sporadic episodes of diarrhoea and vomiting amongst inpatients were recorded. There were no significant outbreaks. Whelley Hospital recorded a significant rise in MRSA colonised patients. Many had been transferred in already colonised with MRSA and maximum limits for each ward were set to prevent recurrence. U2006 Fourth Quarter A patient known to be colonised with a highly antibiotic resistant Acinetobacter organism was transferred from a hospital in the USA. The patient remained on the Intensive Care Unit for five weeks. Stringent implementation of infection control precautions prevented the spread of this organism to any other patients within the Unit. A patient with an unrelated highly antibiotic-resistant Acinetobacter was transferred from the ITU of a neighbouring Trust. The organism had originally been acquired in a hospital in Iraq. The patient was managed on a surgical ward with appropriate precautions and again there was no evidence of spread of this organism. Infection Control Annual Report 06 07 Page 3 of 11
One further baby on the Neonatal Unit was found to be colonised with MRSA. This differed from the previous strain within the Unit and was not related to the earlier problem. No other babies were colonised. A single ward was closed due to the onset of diarrhoea and vomiting. This was rapidly reopened without any evidence of spread to other areas. U2007 First Quarter A number of isolates of a new MRSA strain producing the PVL toxin were identified amongst patients within the Borough. None had had recent hospital contact and the samples were submitted from the community. This provided the first real evidence of the presence of community acquired MRSA within the Borough. Investigations by the PCT revealed some evidence of spread within families. However, the number of isolates dropped away sharply after a four week period. An action plan has been formulated following discussions with the PCT and Health Protection Unit, for the management of any future patients. There is no evidence of this strain being present within the acute Trust inpatients. Small numbers of cases of diarrhoea and vomiting amongst inpatients were detected during this period. No ward closures were required. Antimicrobial Resistance 38.5% of Staphylococcus aureus isolates were resistant to Methicillin in 2006/2007 (i.e. MRSA). Infection Control Initiative/Goals See Annex B Infection Control Annual Programme 2006/2007 CLEANYOURHANDS CAMPAIGN UImplementation of NPSA Cleanyourhands Campaign Following the Trust s annual involvement in the National Patient Safety Agency (NPSA), we are now in the position to publish our compliance percentage. Hand Hygiene Compliance - Trust Overall 100% 80% 60% 40% 20% 0% Jul 05 Baseline Jan-06 Jul-06 The percentage improvement has not been as great as the Trust Board envisaged. However, there are problems with the NPSA audit tool, which are being addressed nationally. In the meantime, the Trust Board has given divisional challenges to improve Infection Control Annual Report 06 07 Page 4 of 11
compliance percentage by a further 20% over the next 12 months. The Trust Board has also tasked that the divisions ensure that all clinical staff carry/use their personal tottles at point of care and that consumption will be monitored. The Trust Board has agreed the continuing involvement with the NPSA Cleanyourhands Programme and that the promotion using hand hygiene posters is continued and a second Cleanyourhands Trust audit is undertaken this coming year. SAVING LIVES Programme The Trust has commenced reviewing its Policies and Guidance pertaining to the Saving Lives High Impact Interventions, in order to ensure implementation of the Department of Health s Saving Lives Infection Control Programme. A Saving Lives Steering Group has been established and tasked working parties or Specialist Nurses to review Policies and Guidance, examples, the IV Group peripheral cannulation and central venous catheter insertion, urinary catheterisation, prevention of ventilation associated pneumonia. DECONTAMINATION The Trust s Decontamination Programme for instrumentation is still being pursued through the joint venture. The project is entering its final stages and it is envisaged that this will be forwarded to the preferred suppliers by the end of the year. The Trust has initiated an Endoscopic Working Party with the aim of standardising Guidance and Protocols in terms of validating decontamination of equipment and scopes across the Trust. This Working Party is a sub-group of the Infection Control Committee. CLEANING SERVICES The Management arrangements for the domestic provision is as follows General Manager Estates & Facilities Assistant Estates & Facilities Manager Facilities Manager Hotel Services Manager Deputy Hotel Services Manager Domestic Supervisors Domestic Assistants Infection Control Annual Report 06 07 Page 5 of 11
The domestic assistants/supervisors work to planned rotas that are site specific, but have the agreement to transfer to the Trust s other sites to undertake cleaning duties if required. The deputy hotel services manager has the management responsibility for designated sites and reports to the hotel services manager whom in turn manages the services operationally Trustwide. The facilities manager has the overall management responsibility for the services provided strategically implementing initiatives and guidelines, monitoring the National Cleaning standards promoting a proactive service meeting the needs of the Trust in turn reporting to the assistant estates & facilities manager. The Trust holds a cleaning services forum which is chaired by the deputy director of nursing and governance. It comprises of members from multi disciplinary backgrounds and a patient representative (formerly the chair of the patient forum.) This group s remit is to improve the domestic provision and associated services delivered to the Trust. It also Implements quality measures and innovations. Examples of this is include: it was highlighted in audits that additional training was required to standardise the role of the housekeeper. training sessions were designed and delivered to the staff group. Offering an expansion to the remit of the housekeeper s role to provide continuity across the divisions within the clinical environment. the domestic department has standardised its procedures, protocols and products across the sites. The forum recommended the adoption of the safer practice notice from which the Trust implemented the National colour coding scheme The Trust has adopted the National Cleaning Standards and monitors its standards using the Maximiser system. The domestic supervisors audit the clinical areas on a monthly basis. This is supported by the ward manager accompanying the domestic supervisor to assess the levels of hygiene and environmental standards. The matrons accompany the deputy hotel services manager on a quarterly basis ensuring that areas maintain a high standard. The Trust score for its clinical areas is 92.5% and its external verification was good to excellent. The PEAT submission was good for environment and excellent for the food element. The senior team who agree the score is once again a multi disciplinary team with a patient representative. The budget allocation 3,199,768 (pay) and 228,706 (non-pay) totalling 3,428,474. The Trust has taken the decision not to incur a cost improvement saving on the domestic services department. To improving the department s financial performance office cleans were reduced trustwide. The hours saved were transferred into the patient environment. The department undertakes satisfaction surveys. The supervisors regularly meet with the patients to discuss ways of improving the domestic services. The Domestic supervisors also undertake planned environmental audits Infection Control Annual Report 06 07 Page 6 of 11
The director of nursing provides the clinical responsibility for the domestic services provision, engaging in regular meetings with the general manager for estates and facilities. The facilities manager is provided clinical access through the matrons meetings and regular meetings with the infection control manager. AUDIT See Annex B Infection Control Annual Programme 2006/2007. See Annex C Infection Control Annual Report 2005/2006. See Annex D Antimicrobial Pharmacists Annual Report 2006/2007 TARGETS AND OUTCOMES UMRSA Bacteraemia Thirty-five episodes were recorded in 2006/2007. This was 2.5 times the MRSA reduction target of 14 episodes set by the Strategic Health Authority. Concerted efforts to identify specific causative reasons for the MRSA bacteraemias are being undertaken using a newly developed Route Cause Analysis tool. This will enable the Trust to identify trends in order to focus resources/education to prevent re-occurrence. UHealth Care Commission self assessment See Annex E Health Care Commission self assessment for 2006/2007. Infection Control Annual Report 06 07 Page 7 of 11
TRAINING ACTIVITIES UInduction All staff, including medical staff, have Infection Control training included within the induction session. This includes instruction on handwashing, use of Infection Control Guidance and accessing Infection Control advice. In addition, medical staff receive instruction on antimicrobial prescribing. UCPD for all Staff Annual mandatory training is available for all staff and includes an Infection Control component. UCPD for Clinical StaffU The annual mandatory update programme for senior medical staff includes an Infection Control component. Junior medical staff receive educational sessions on Infection Control and prudent antimicrobial prescribing as part of their educational programme. UTraining for Infection Control SpecialistsU Infection Control Doctor is fully up to date with CPD requirements. Infection Control Team members attend national and local courses and updates as required. UTraining for the DIPCU Attends Department of Health training courses as required. UTraining for Matrons and Ward Managers Matrons and Ward Managers attend the University of Central Lancashire s Principals of Infection Control Course. Infection Control Annual Report 06 07 Page 8 of 11
14 12 10 8 6 4 2 0 Graph 1 - Trends in MRSA Bacteraemia No.of Cases 2002-2 2002-4 2003-2 2003-4 2004-2 2004-4 2005-2 2005-4 2006-2 2006-4 2001-2 2001-4
TABLE 1 RESULTS OF MANDATORY REPORTING INDIVIDUAL CASES YEAR 2006 2007 Quarter 2 3 4 1 MRSA Bacteraemia (cases) Glycopeptide resistant Enterococci bacteraemia (cases) 11 8 11 5 0 1 1 0 Clostridium difficile (cases) 110 74 91 144 Orthopaedic surgical site infection Not performed Not performed Not performed # # = Results awaited from the Department of Health. Infection Control Annual Report 06 07 Page 10 of 11
Graph 2 - Trends in Clostridium difficile Diarrhoea Number of Cases 160 140 120 100 80 60 40 20 0 Total cases 2004-1 2004-3 2005-1 2005-3 2006-1 2006-3 2007-1 Infection Control Annual Report 06 07 Page 11 of 11