Infection Control Annual Report

Infection Control Annual Report

2007 - 2008

Vishal Sookhoo

Senior Infection Control Nurse May 2008

CONTENTS:

1. Introduction

2. Infection Control Team

3. Infection Control Committee

4. Education and Training

5. Infection Control Project Champion

6. Clinical Audit

7. Mandatory Surveillance

8. Alert Organisms

9. Cleanyourhands Campaign

10. Department of Health Initiatives

11. Infection Control Programme 2007-2008. (See appendix 1)

INTRODUCTION

This report outlines the activities of the Trust relating to infection control from April 2007 to March 2008. Control of infection has always been taken very seriously at the Royal National Orthopaedic Hospital. The Trust has a very low rate of infection and the aim is to continue implementing the National Initiatives Programmes such as the Saving Lives Programme and The Health Act 2006 launched by the Department of Health to reduce healthcare associated infections (HCAI). Building on evidence based good practice Saving Lives draws on comprehensive learning and best initiatives in reducing healthcare associated infections. The Trust puts infection control and basic hygiene at the heart of good management and clinical practice. It is committed to ensure that appropriate resources are allocated for effective protection of patients, their relatives, staff and visiting members of the public, however, not all hospital infection is preventable. In continuing to address the problems of healthcare associated infections the Trust sets itself targets to try and ensure a reduction in the levels of infection based on the previous year’s targets. This financial year the Trust reported zero MRSA bacteraemia cases and nine Clostridium difficile cases.

THE INFECTION CONTROL TEAM.

The role of the Infection Control Team is to ensure that an effective infection control programme has been planned to co-ordinate its implementation and evaluate the impact of such measures. The Team provides advice, education and training to all staff in relation to infection prevention and control on a day-to-day basis. It also produces an Annual Infection Control Programme with clearly defined objectives. The Team is as follows:

ACTING DIRECTOR OF NURSING/

DIRECTOR OF INFECTION PREVENTION AND CONTROL

(K. CORDER)

CONSULTANT MICROBIOLOGIST BASED AT BARNET

AND CHASE FARM NHS TRUST

SENIOR INFECTION CONTROL NURSE

(V. SOOKHOO)

INFECTION CONTROL ADMINISTRATOR

(A. PATEL)

INFECTION CONTROL COMMITTEE

The Trust Infection Control Committee (ICC) is the main forum for discussion concerning changes to policy or practice relating to infection, prevention and control. The membership of the Committee is multidisciplinary and is chaired by a Consultant Orthopaedic Surgeon and meets bimonthly. The ICC is a sub-committee of the Clinical Governance Board and reports formally to this Board. It discusses surveillance of nosocomial infections, investigation of infection outbreaks, and development of infection control procedures for all departments; staff and patient education; and clinical waste management. Through policies, procedures, and evaluation, the Committee acts as a body for infection control information and uses the information in a way that will create the safest healthcare environment. The Infection Control Committee membership is as follows:

·  Mr J. Skinner Consultant Surgeon and Chairman of the Committee

·  Consultant Microbiologist ( to be appointed )

·  Mrs K. Corder Acting Director of Nursing and Director of Infection

Prevention and Control

·  Mr V. Sookhoo Senior Infection Control Nurse

·  Mrs H. Landers-Flynn Modern Matron (Adult)

·  Mrs S. Lalor-McTague Modern Matron ( Paediatrics)

·  Cathy Beaton Modern Matron PPU

·  Jackie Humphreys (JH) Theatre Manager

·  Mrs R. Taggart Theatre Sterile Supplies Unit Manager

·  Mrs J. Markham Occupational Health Nurse

·  Mrs L. Wilson Facilities Manager

·  Mrs S. Shah Antibiotic Pharmacist

·  Mrs Z. Ncube Theatre Sterile Supplies Unit Deputy Manager

·  Angela O’Hallaran Member of the Patient Forum

EDUCATION AND TRAINING

Education and training continues to be an essential aspect of the Infection Control Team. Mandatory training and education is carried out regularly for new and existing members of staff. From January 2008 two training sessions have been carried out every month, infection control annual update for clinical staff and infection control induction training for new members of the staff.

Infection control training for Specialist Registrars and Junior Doctors takes place at induction. The Infection Control Team also provides training sessions on wards and departments at the request of managers.

The mandatory teaching package has been designed to encompass the following Infection Control issues:

·  Hand hygiene

·  Healthcare Associated Infections (HCAIs) and the cost implication

·  MRSA

·  Clostridium difficile

·  Saving Lives

·  The Use of Personal Protective Clothing

·  Sharps Management

·  Waste Management

·  The Health Act 2006

·  Isolation Practice

·  Pandemic Flu

A total of 350 clinical and non-clinical staff attended the infection control mandatory training for the period April 2007- March 2008.

Key targets 2008-2009:

·  Increase the number of Infection Control training sessions

·  To provide Infection Control Training for Medirest staff

·  Increase awareness of Infection Control throughout the Trust

·  Infection Control training for doctors to be undertaken by the Consultant Microbiologist

Infection Control Project Champion

In October 2007, the Royal National Orthopaedic Hospital Trust was successful in securing government funding from the Strategic Health Authority for a Band 6 Trust-wide Infection Control Project Champion. This role was for a fixed term of six months to work alongside the infection control team and Modern Matrons undertaking infection control and prevention programmes within the Trust.

The following projects were undertaken by the Infection Control Project Champion:

·  Policy of the month

·  Hand washing sink posters

·  Alcohol gel usage audit

·  Teaching hand washing technique

·  Information leaflets

·  Infection Control for doctors induction

·  Bed side checklists

·  Clinical waste audit

The purpose of this challenging role was to heighten awareness about infection prevention and control.

The objectives for this included providing targeted staff, patient and visitor training to achieve high levels of compliance in clinical practice. This also involved challenging the current infection control behaviours and attitudes and taking part in the audit process. The aim of the programme was to maintain the current low infection rates within the RNOH and to ensure government targets are met.

CLINICAL AUDITS

Clinical Audits are on-going programmes carried out by the Infection Control Team on a regular basis. Wards and departments are audited under the categories listed below:

·  Environmental audit

·  Safe handling and disposal of Sharps

·  Hand hygiene

·  Management of patient equipment

·  Waste management

·  Handling and disposal of linen

·  Personal Protective Equipment

The following table illustrates examples of the audits carried out by the Infection Control Department and the compliance scores.

Audits / Wards / Compliance level %
Environmental audit / Phillip Newman
Ward 4
Jackson Burrows / 70%
88%
85%
Safe handling and disposal of sharps / Margaret Harte
Duke of Gloucester
Ian Munroe
Jackson Burrows
Ward 4
Phillip Newman / 87%
91%
94%
90%
96%
95%

Level of compliance:

Compliant 85% or above

Partial compliance 76% to 84%

Minimal compliance 75% or below

The wards which scored below 85% will draw-up action plans and will be re-audited in four months. The audit tools are used to focus on specific policies, procedures and practice. These tools can also be used to measure the implementation of policies and procedures relating to infection control.

Key targets 2008-2009:

·  To continue undertaking audits

·  To consider combining audits with the Trust wide Nursing Audit.

SURGICAL SITE INFECTION SURVEILLANCE

Surgical site infection is a mandatory programme from the Department of Health. This is a continuous programme which is undertaken by the Infection Control Department and the surveillance document is sent to the Health Protection Agency on a quarterly basis. Results are fed back to the Clinical Governance Board, the Infection Control Committee, clinical staff and Ward Managers. The mandatory surveillance programme for surgical site infections is a useful tool to identify potential cases of transmissible infections. It is essential that the surgical site infection surveillance results are fed back to front-line clinical staff in order to help them take preventive measures to reduce the rates of infections. The surveillance also acts as a key indicator to identify areas with infection control issues and help to implement necessary measures to minimise the risk of infection.

SURGICAL SITE INFECTION FOR TOTAL HIP REPLACEMENT YEAR 2007-2008

The table below illustrates the total number of hip replacements performed by RNOH on a quarterly basis and the number of infections for the particular period.

Apr-Jun 07 / Jul-Sep 07 / Oct-Dec 07 / Jan-March 08
No operations / 120 / 102 / 99 / 92
No SSI / 0 / 0 / 0 / 0
% operations infected / 0.0 / 0.0 / 0.0 / 0.0

SURGICAL SITE INFECTION FOR TOTAL KNEE REPLACEMENT YEAR 2007-2007

The table below illustrates the total number of knee replacements performed by RNOH on a quarterly basis and the number of infections for the particular period.

Apr-Jun 07 / Jul-Sep 07 / Oct-Dec 07 / Jan- March 08
No operations / 145 / 116 / 89 / 101
No SSI / 0 / 0 / 0 / 0
% operations infected / 0.0 / 0.0 / 0.0 / 0.0

The above tables illustrate that the Trust has low infection rates regarding the surgical site infection for total knee and hip replacements.

Key targets 2008-2009:

·  To participate in surgical site infection for spinal surgeries surveillance from August 2008

·  To continue to undertake surgical site infection for hips and knees

ALERT ORGANISMS

The alert organisms reported to the Infection Control Department from April 2004-March 2008 are as follows:

Type of Organism/Infection / No of cases
Apr 04-Mar 05 / No of cases
Apr 05-Mar 06 / No of cases
Apr 06-Mar 07 / No of cases
Apr 07-Mar 08
MRSA / 35 / 40 / 35 / 19
MRSA Bacteraemia / 4 / 4 / 2 / 0
Clostridium difficile / 23 / 2 / 5 / 9
VRE / 0 / 1 / 1
Acinetobacter / 1 / 3 / 6

Cases of MRSA Bacteraemia and Clostriduim difficile are sent on a monthly basis to the Health Protection Agency (HPA). The Trust key targets are to reduce the number of MRSA Bacteraemia and Clostridium difficile within the Trust. No cases of MRSA Bacteraemia have been reported for this financial year. However, nine cases of Clostidium difficile were reported for the whole financial year. Root Cause Analysis investigations have been undertaken for all cases and six of the cases were presented to the Clinical Governance Board.

Key Targets 2008-2009:

To continue to implement Saving Lives:

·  Isolating patients with healthcare-associated infection

·  Care bundle to reduce the risk from Clostridium difficile

CLEANYOURHANDS CAMPAIGN:

The Trust became part of this campaign in April 2005. The Campaign supports efforts to improve hygiene generally within hospitals in a bid to reduce Healthcare Associated Infections (HAIs). It is based on national and international evidence. Patients are encouraged to challenge staff regarding hand hygiene.

The campaigns aim:

·  To make it as easy as possible for staff in hospital to clean their hands at the right time and for the right task

·  To improve the quality of clinical care delivered through improving compliance with national and local hand hygiene guidelines

·  To increase the behaviour and personal responsibility of healthcare workers in observing hand hygiene standards

·  To share learning and best practice to enhance patient safety and confidence in healthcare

·  To display posters and highly visible promotional material to inform staff, patients and visitors of the importance of hand hygiene

The Trust receives new hand hygiene posters and patient’s leaflets on a regular basis from the National Patient Safety Agency (NPSA). The Infection Control department distributed these posters to most of the wards and departments. The patient leaflets highlight the importance of hand hygiene in healthcare organisations. Patients are asked to challenge health care workers who do not comply with hand hygiene. The aim is for hand hygiene to be everybody’s business and to increase compliance levels throughout the Trust.

The impact of the Campaign is measured through observing staff’s hand hygiene behaviour and monitoring usage of alcohol gel along with routine surveillance of infection rates.

The Infection Control Nurse encourages hand hygiene compliance through education and training and to emphasising the importance of hand decontamination.

Key Targets 2008-2009:

·  To continue to carry out wards and departments training for hand hygiene.

·  To ensure the Link Persons for infection control continue to undertake hand hygiene audits.

INFECTION CONTROL PROGRAMME

The Infection Control Programme (Appendix 1) aims to continuously review and build on existing activities driven by local needs, while complying with the latest Department of Health strategies and regulations documents. The following have been considered in the programme.

·  The Health Act 2006: Code of Practice for Prevention and Control of Health Care Associated Infections.

·  Health Care Commission: Standards for Better Health,C4a Infection Control

·  NHSLA: National Health Service Litigation Authority.

·  Consultation document on Action on Healthcare Associated Infections in England a proposal for legislation to support the prevention and control of Health Care Acquired Infection - HACI (July 05)

·  DOH “Saving Lives”: a delivery programme to reduce Healthcare Associated Infection including MRSA (2005)

·  DOH “Winning Ways” - Working together to reduce Healthcare Associated

Infections in England (2003)

·  DOH National Standards, Local Action for 2005/06 - 2007/08 (2004)

·  A Matron’s Charter: An Action Plan for Cleaner Hospitals (2004)

·  Towards Cleaner Hospitals and Lower Rates of Infection (2004)

·  The NHS Healthcare Cleaning Manual (2004)

·  The National Patient Safety Agency Hand Hygiene Campaign

The Infection Control Programme is discussed and reviewed at the Infection Control Committee meetings. The Hygiene Code is part of the programme focusing on the environmental audits and infection control policies in place according to the recommendations made in the Act. Education and training is a main topic of the infection control programme and from January 2008 the infection control team is carried out two training sessions each month one for existing staff and another for new staff.