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Ring Fenced Beds in Orthopaedics- Aintree experience

Aintree University Hospitals NHS Foundation Trust May 2015

Aintree University Hospitals NHS Foundation Trust May 2015

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CRG Specialised Orthopaedics

• Provider – service RequirementsA defined ward for specialist orthopaedic patients ie. ‘ring fenced orthopaedic beds’

< 10% loan kitsDefined theatre suiteExpertise and volumesCCU/HDUMDTTertiary referral centres

Aintree University Hospitals NHS Foundation Trust May 2015

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Why Ring Fenced Beds?

• Traditional (any evidence?)-MRSA screening-Decrease Infection risk

• Quality of Service-Specialist nurses / physio-appropriate environment

Aintree University Hospitals NHS Foundation Trust May 2015

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BODS SURVEY RESULT DEFINITION

MRSA screened elective orthopaedic admissions

+/- screened semi-elective trauma+/- other screened clean elective surgery

Breach = stop elective surgery until deep clean

Aintree University Hospitals NHS Foundation Trust May 2015

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BODS Survey ResultsDo you have ring fenced beds?

27 replies

Yes

19(70%)

3 separate elective facilities

No

8(30%)

Aintree University Hospitals NHS Foundation Trust May 2015

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Aintree JRU

Aintree University Hospitals NHS Foundation Trust May 2015

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JRU Development

• 2000 – Audit of infection

• At Best – 6.5%• At worst – 15%

• Independent enquiry

Aintree University Hospitals NHS Foundation Trust May 2015

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JRU Development

• Isolated Infection Controlled JRU– Cost benefit analysis– 2005!

‘Space’ suitsTheatre disciplineDedicated theatresMDT input – microbiology support

Aintree University Hospitals NHS Foundation Trust May 2015

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JRU Development

• No evidence any one intervention works either locally or in the literature

• BUT

• TKR audit post changes – 0.4% infection rate• Been robustly defended since

Aintree University Hospitals NHS Foundation Trust May 2015

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Aintree JRU SOP

• 16A – 12 Beds• 16B – 8 Beds & 10 daycase trolleys

• Restricted access– Screened patients– Visiting 6.30 – 8PM

• Admission Control– Ward Manager/ Orthopaedic lead/ Microbiology Lead

Aintree University Hospitals NHS Foundation Trust May 2015

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Aintree JRU SOP

Aintree University Hospitals NHS Foundation Trust May 2015

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Aintree JRU Admissions

MRSA screened elective orthopaedic admissions

+/- screened semi-elective trauma

+/- other screened clean elective surgery

Breach = stop elective surgery until deep clean

• But…. We can ½ the ward…. Detrimental?

Aintree University Hospitals NHS Foundation Trust May 2015

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Aintree JRU Admission Criteria

• MRSA Screened patients• No Antibiotics• No evidence infection• Patient zero tolerance to ward discipline• No open wounds / Ex-Fix• Inpatients from other wards

• Revision patients? Separate discussion / exception

Aintree University Hospitals NHS Foundation Trust May 2015

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Aintree JRU SOP

• MRSA SCREENING– Just moved from 4 to 8 weeks pre-surgery– Previous MRSA = 3 negative swabs 1 week apart

• WOUND DRESSINGS– Designated treatment room– Staff yearly aseptic technique assessment

Aintree University Hospitals NHS Foundation Trust May 2015

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‘Times of high bed pressures’

• FULL JRU– Full ward under rules

• HALF JRU– 16A isolated behind ‘locked’ doors

• NO JRU– Joint Replacement surgery shut down

DEEP CLEAN BEFORE RE-OPENING

Aintree University Hospitals NHS Foundation Trust May 2015

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Cleaning specifications

• Daily clean• Enhanced clean– Area gets special attention each day of the week

• Uniform– Nurses have 5 pairs of uniform for JRU only– Blue aprons, hands, BBTE’s etc.

Aintree University Hospitals NHS Foundation Trust May 2015

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JRU Conclusions

• Does it reduce infection rates?– Probably, but we lack conclusive evidence

• Do the patients like it?– Yes, looks professional with specialist staff

• Do the staff like it?– Yes, it is now an essential part of our care

Aintree University Hospitals NHS Foundation Trust May 2015

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Questions?