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ANNUAL REPORT Infection Prevention and Control (2011 to 2012)

SECTION / CONTENTS / PAGE
1 / Introduction / 3
2 / Infection Prevention and Control Strategy / 3
3 / Policies / 4
4 / Care Quality Commission Registration and Inspection / 4
5 / Audits / 5
6 / HCAI (Healthcare Associated Infections) / 9
7 / Flu Vaccination Programme / 10
8 / Incidents / 10
9 / Staff Training and Information / 11
10 / Aseptic Technique / 12
11 / Decontamination and Cleaning the Environment / 12
12 / Planning and Refurbishment / 13
13 / References / 13
1.Introduction

Pennine Care NHS Foundation Trust (PCFT)provides a wide range of Community and Mental Health Services in a variety of community and in-patient settings.

This infection Prevention & Control (IP&C)Annual Report relates to the period April 2014 to March 2015 and provides an overview of the work undertakenagainst the IP&C work plan 2014 to 2015.

The Board receives regular reports in relation to IP&C via the Medical Director and Director of Nursing and Allied HealthcareProfessionals/DIP&C (Director for IP&C). There is a Board Level Agreement signed by the Chairman and Chief Executive.

2.Infection Prevention and Control Strategy

The systems for the prevention and control ofHealthcare Associated Infections (HCAIs) address leadership, management arrangements, design and maintenance of the environment and medical devices. It is essential that effective prevention and control of infection strategies are embedded into everyday practice and applied consistently by everyone.

Assurance of sound patient safety practices and clinical effectiveness is sought on a weekly, monthly and bi-monthly basis through monitoring of infections, standards of cleanliness, IP&C audits and incident reporting. These in turn are monitored via the relevant Departments, Governance Forums and Committees.

2.1Aim

  • PCFT is committed to reducing the risk of infection. It embraces the National ‘Zero Tolerance’ approach to preventable infections.

2.2Scope

  • The IPC Strategy is concerned with the prevention of avoidable risks of infection and the control and management of all unavoidable risks of infection to patients, service users & staff.

2.3 Objectives

  • To ensure that IPC is an integral part ofservice delivery.
  • To ensure that avoidableHCAIs are reduced to a minimum.
  • To maintain compliance with all requirements of the Health and Social Care Act (2008).
  • To ensure PCFT have policies and procedures in place to fulfil the requirements and comply with the Code of Practice for the Prevention and Control of HCAIs as outlined in the Health and Social Care Act (2008). To ensure compliance with risk management standards as part of NHSLA.
  • To work with other stakeholders to improve surveillance and to strengthen prevention and control of infection and communicable disease processes.
  • To ensure information is available to patients and the public about the organisations general processes and arrangements for preventing and controlling HCAIs (Health & Social Care Act 2008, NICE Guidance, 2014).
  • To ensure decontamination across the Trust meets all the National mandatory requirements.
  • To provide education and training on prevention and control of infection to ensure staff understand their responsibilities.
  • To ensure prudent antimicrobial prescribing and reduce inappropriate prescribing of antimicrobials which can result in the spread of resistance.
  • To ensure appropriate information is communicated relating to infection risk and outbreaks to all relevant parties.
  • To work with Public Health England to ensure appropriate and effective IPC practices across the Whole Health Economy.

3.Policies

Robust policies and procedures are essential to ensure all staff have access to evidence-based information, aimed at ensuring high standards of IPC. The Health and Social Care Act (2008) sets out requirements for specific policies and procedures to be in place. During 2014/15 the IP&C team (IP&CT) updated and reviewed policies in line with best practice. PCFT staff can access IPC policies via the Trust Intranet and policy folders are retained at a number of sites across PCFT. Compliance with IPC policies is currently monitored in a variety of ways but predominantly via clinical audits. Findings from the audit reports are shared to inform lessons learnt and inform future practice and service delivery.

4.Care Quality Commission registration and inspection

PCFT was registered with the Care Quality Commission (CQC) in accordance with the guidance issued by the Health and Adult Social Care services regulator in April 2011. CQC updated NHS providers in April 2014 on Safe and appropriate care and treatment. All care and treatment provided to service users must be appropriate and safe. To comply with the guidance in paragraph (1) registered persons must include ‘establishing and operating effectively systems designed to assess the risk of, and to prevent, detect and control the spread of, infections, including those that are health care associated’.

5.Audits

PCFT takes an organisational approach towards reducing HCAIs by embracing the Department of Health’s documents and National Guidelines. IP&C audits are undertaken to:

  1. Identify areas of good practice and highlight areas where improvements are required.
  2. To assess compliance against the IP&C related Trust policies.
  3. To provide evidence to inform the Infection Prevention and Control Committee (IPCC) and other Governance Forums.
  4. To comply with The Health and Social Care Act’s (2008) Code of Practice for health and adult social care on the prevention and control of infections and related guidance .
  5. To comply with the IP&C audit requirements of the NHS Litigation Authority who are responsible for handling negligence claims made against NHS bodies in England.
  6. To assess the implementation of aspects of IP&C National Guidelines.

Compliance level

Clinical Environmental audit toolsidentify IP&C standards.On completion of the audit tool, each section of the audit is scored to provide an accurate measurement of compliance and as a benchmark and subsequently used for future audits. An overall compliance rating is then applied to the service area. Audit results are presented at the IP&CC and any actions identified are monitored through the local governance meeting.

5.1 Hand Hygiene Audits (Mental Health and Community Services in-patients areas)

Hand hygiene is one of the single most effective ways of preventing transmission of infection. Hand hygiene audits have been completed every three months in accordance with the World Health Organisation “5 moments for hand hygiene”.

Results: Hand hygiene compliance has been very good overall. Individual ward percentage scores are produced from the audits and are given to staff to display on notice boards. From April 2014 to March 2015the average hand hygiene compliance score was 98% Trust-wide. When hand hygiene compliance falls below 89% audits are repeated at weekly intervals and action plans are completed.

5.2Clinical Environmental Audits

To ensure that PCFT is complying with National standards and that safety and cleanliness is maintained the IPCT are involved in regular spot checks and a process of continuous audit throughout the year. In collaboration with Estates and Facilities the clinical environments are audited to ensure patient’s areas are clean and safe.

a)Inpatient areas

The IPC Environmental in-patient Audits are completed every 6 months(January & July).Overall a Trust wide compliance result of 94% was achieved in the July 2014 and93%for the January 2015 audit. All wards/areas are requested to complete an action plan if a score of less than 100% is achieved. Action plans are developed/completed by ward/area managers, monitored via local governance forums, and reported into the IP&CC for assurance.

b)Community Buildings

All clinical rooms, that were used by PCFT staff within community buildings and that fit the audit criteria (involving clinical procedures) were audited in Quarter 3 of 2014 to 2015. The environments within many community buildings pose unique and significant challenges in relation to IPC, for example many community buildings are not solely owned by PCFT therefore addressing failings warrants a combined approach from different services using the building. Although significant improvements have been made in the past 12 months, there is still work required to ensure safe, clean environments is further developed and maintained.

All responsible managers of community buildings are requested to complete an action plan if a score of less than 100% is achieved. Service managers monitor action plans. Overall a Trust wide compliance result of 93.68% was achieved in the Community Services Community Buildings and a Trust wide compliance result of 91.8% was achieved in the Mental Health Community Buildings. It should be noted that most Mental Health Community Buildings and Trafford CS had been previously untested with the current audit proforma. Recognition of this was highlighted in the scores.

5.3 Mattress Audits

The Medical Devices Agency (MDA) issued an alert in January 2010 (reference MDA/2010/002) relating to mattresses in use in health care settings. The alert stated that if mattress covers are damaged, body or other fluids could pass through and contaminate the inner core. Therefore, there is the potential for cross-infection if contaminated mattresses remain in use.

In response to the alert a mattress audit is undertaken by PCFT annually. All in-patient facilities were audited across 5 borough sites over a period of two weeks using visual checks in October 2014.

Results

Number of Mattresses Assessed 614

Number of Mattresses Checked 571

Number Unchecked 43

A recommendation was made for every mattress audited. A number of mattresses were classed as having a limited life due to a slight fatigue of the foam, it was difficult to estimate the life left in a mattress, however, a repeat test within 6 months was recommended.

Mattresses will be re- audited in October 2015

5.4 Sharps Management Audit

Under the Management of Health and Safety at Work Regulations (1999), Trust employees have a responsibility to be aware of and adhere to the safe systems of work. Sharps must be handled and disposed of safely to reduce the risk of exposure to blood borne viruses. Staff must comply with sharps management in order to minimise the likelihood of sharps injuries occurring. The audit was undertaken to:

a)Raise awareness of sharp’s management.

b)Assess practice

c)Discuss problems

d)Advise on compliance to current legislation

In May 2014 a Sharps Management Audit was undertaken by Daniels© Healthcare Ltd. The audit was conducted over a period of 2 weeks across 5 Boroughs. Mental Health and Community Service in-patient areas were included in the audit.

Thirty six Wards/Departments were visited during the audit and Ninety five sharps containers were sighted.

The results of the audit are very good with Trust-wide compliance at 96% compared to 90.26%in 2013.The audit scoring matrix seeks to highlight those standards observed in Figure 2.

All wards have been informed of the audit results and requested to address any practices that did not meet with policy. Sharps Management audit will be undertaken again in May 2015.

Needle Safety Devices

A European Directive became legally binding on 11 May 2013 requiring healthcare organisations to adopt safety measures that protect healthcare workers from needle stick injuries. Delaying implementation of safety measures means healthcare workers remain at risk.

In response to this directive PCFT established a Task and Finish group to identify and procure safe sharp devices for review and testing Trust-wide. Meetings took place to review and pilot safety needle devices on wards and in the community. The Trust introduced BD Eclipse for IM injections and BD Autoshield for subcutaneous injections as a means to prevent needle stick injuries.

5.5 Specimen Rejection data collecting

During 2014 to 2015 Microbiology departments were contacted and requested to provide the numbers of specimens sent from in-patient areas and the amount that had been rejected for not meeting specimen collecting policy standards. A total of 2919specimens were sent to the laboratories by PCFT by in-patient staff and 115 were rejected(3.9%).The data collecting identified Specimens for analysis are being sent:

  1. Unlabelled,
  2. With Illegible details,
  3. Request details not stated,
  4. Initials being used instead of full name
  5. Details on specimen conflict with request card
  6. Insufficient patient identifiers.
  7. A label used on sample container

The report and results were forwarded to all team/Ward managers/ and medical staff. Collecting specimen rejection data will continueevery quarter during 2015 to 2016.

5.8 Antimicrobial Prescribing Audits

As recommended by the Department of Health’s Antimicrobial Stewardship guidance, procedures have been put in place to ensure prudent prescribing. The Antimicrobial Prescribing Audit is undertaken every 3-6 months to monitor how well the policies and guidelines for antimicrobial prescribing are adhered to in areas across the Trust where antimicrobial prescribing occurs.

The audit standards are informed by the Medicines Policy (CL15 v. 6) and the Procedure for the Prescribing of Medication (MM041) are included in the table below:

Compliance Standards
2014 to 2015 / Target / Mental Health / Community Health Services / Non-Medical Prescribers / Dental
1 / Patients being treated with antimicrobials should receive the appropriate agent(s), at an appropriate dose, in line with the antibiotic formularies of the Acute Trust partners. / 100% / 87% / 53.5% / 97% / 100
2 / The Adverse Drug Reactions/Allergies section of the inpatient prescription chart should be completed. / 100% / 95.5% / 59.25% / 92.67% / 91%
3 / An indication for the antimicrobial treatment should be stated in the case notes or on the inpatient prescription chart. / 100% / 80.5% / 78.75% / 98.67% / 100%
4 / Duration of antimicrobial treatment should be specified in the case notes or on the inpatient prescription chart. / 100% / 85% / 87.25% / 100% / NA
Total Compliance for 2014 2015 / 100% / 87% / 69.69% / 97% / 97%
6.Healthcare Associated Infections (HCAIs)

6.1Surveillance and Data Reporting

Mandatory surveillance of infections allows national and local trends to be identified and the data can be used as a measure of progress and an indicator of standards. The infections reported are Methicillin-Resistant Staphylococcus
Aureus (MRSA) Bacteraemias, Clostridium Difficile (C.Diff.) - Toxin Positive, Methicillin Sensitive Staphylococcus Aureus (MSSA) Bacteraemias and Escherichia Coli (E.coli) Bacteraemias. Not all MSSA Bacteraemias are HCAIs but for both MSSA and E.coli, data is collected to identify the baseline numbers of infections. Other antibiotic resistant organisms such as Extended Spectrum Beta Lactamase (ESBL) producing bacteria are also becoming more common and these are monitored at a local level.

There is national concern regarding the increase in carbapenemase producing enterobacteriaceae (CPE), reflected in the publication of a control Tool kit by Public Health England (2013). Patients with this are risk assessed and closely monitored.

A Post Infection Review (PIR)isundertaken for all new MRSA bacteraemiaand a Root Cause Analysis (RCA) for ClostridiumDifficile - Toxin Positive infections. PCFT is actively engaged with this process as a partner organisation where appropriate.

6.2Sepsis

Following a Patient Safety Alert published in September 2014 Sepsis has been introduced into the IP&C training session to alert staff of the need to act quickly if a patient has any signs of infection. There was an extended article in the quarter 4 newsletter for 2014-2015 on sepsis awareness.

6.3Organism Results 2014 to 2015

PCFT assisted in the investigation of 4 MRSA Bacteremia in Community services, none were attributed to PCFT any lessons were highlighted at local governance meetings and reported to the IP&CC.

6.4 Ebola

Since March 2014 there has been a large widespread outbreak of Ebola virus affecting Guinea, Liberia and Sierra Leone.

As a small number of cases have occurred outside Africa the IP&CT alongside, communications and emergency planning set about ensuring the staff and managers had guidance to follow if a suspected case presented at one of our clinics/units or if seen in their own home. The guidance was distributed by the intranet and managers informed at local Governance meetings.

  • Full Personal Protective Equipment was also obtained to ensure it was available if required.
  • A member of the IP&CT has supported the outbreak in Sierra Leone as part of a Territorial Army medical team.

6.5Outbreaks and Periods of Increased Incidences (PII)

8 outbreaks (OB) and 3 Periods of Increased Incidence (PII) were reported in PCFT Mental Health and Community in-patient facilities in 2014 to 2015. All outbreaks and PIIs are recorded on monitoring forms and a report is produced retrospectively for the purpose of learning lessons and making improvements. The report is then presented at the BIGGs/DIGGs and IP&CC and disseminated locally.

7.Flu Vaccination Programme

Public Health England continues to encourage the vaccination of all front -line healthcare staff against seasonal influenza to help prevent transmission of the virus to the public and staff and to reduce staff sickness during the winter period. PCFT’s staff flu vaccination campaign concluded on 27 January 2015 and the total uptake was 55% - which equates to around 3,250 members of staff. PCFT uptake is higher than the current national total for this year’s campaign of 54.9%.

PCFT is also one of only 140 Trusts nationally that has vaccinated half of their staff – which is a real achievement. Achieving the national target of 75% is particularly challenging for a Trust as large and geographically diverse as PCFT. This is evidenced in the national results, which show the higher performing Trusts are generally those with smaller numbers of staff who are all based in one location.

8. Incidents

During the last 12 months the promotion of sharps awareness and training on the safe use of sharps has continued to be a high priority. The promotion of good sharps management has highlighted the need for safe practice. All incidents are discussed at the IP&CC. All grade 4 incidents undergo a Team Investigation Report in order to review practice and identify learning. Lessons learned are shared through established governance forums.

9.Staff Training and Information

9.1 Core & Essential Skills Training (CEST)

The Care Quality Commission places strong emphasis on the need for all health care staff to understand and discharge their roles and responsibilities in relation to IP&C within the clinical governance and risk management framework. Ensuring effective training schemes to support the objectives contained within the various policy documents is critical for achieving success.

In order to support the implementation of the Trust’s strategy and to comply with the Health & Social Care Act, IP&C training is aimed at developing IP&C expertise to all levels and groups of staff remains a key priority for the Trust. The focus of the programme will be to ensure responsibility for in-service training arrangements, record keeping, monitoring, and feedback to divisions of attendance is documented and acted upon, and this will include Aseptic Non-Touch Technique (ANTT) training for all medical and nursing staff who undertakes clinical procedures.