Staffordshire and Stoke on Trent Partnership Trust ... Control... · supporting me in my role as...
Transcript of Staffordshire and Stoke on Trent Partnership Trust ... Control... · supporting me in my role as...
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Staffordshire and Stoke on Trent Partnership Trust Infection Prevention and Control team
Director of Infection Prevention and Control
Annual Report
April 2012 to March 2013
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Executive Summary
Throughout the year a vast number of clinical audits and quality inspections have taken
place. This has helped to maintain and raise standards and awareness of good infection
control practices. Educational infection control sessions have been embraced by staff
ensuring that at all times our mandatory training compliance target of 80% has been
met monthly throughout the year. Significant developments in services have taken
place to ensure treatment areas are safe and comfortable areas for patient treatments,
which have all contributed in the reduction of HCAI.
The highlights to the year include:
No concerns and agreement by the Care Quality Commission that the criteria
were met to register The Partnership Trust as a newly authorised Trust
The rate of Clostridium difficile in the community hospitals was on trajectory, 11
cases isolated for the year against a trajectory set by the Commissioners of 11
A successful MRSA screening programme for elective and emergency admissions,
with high compliance rates, with an average of 99.5% compliance to the
screening protocol per month
The successful introduction of Director led panels, to review MRSA bacteraemia
and Clostridium difficile root cause analysis. This has reinforced ownership of the
action plans within clinical teams and enabled ward managers and medics to
talk directly to Senior Executives within the Trust on operational issues relating
to HCAI
An extensive Capital Programme incorporating a comprehensive refurbishment
programme of Leek Hospital inpatient and outpatient wards and departments
The achievements and hard work that all Partnership Trust staff has shown over the last
year has been tremendous. Staff as individuals and team members have shown their
dedication in embracing zero tolerance towards HCAI. I would personally like to thank
all staff for their hard work and dedication during 2012-2013 and thank them for
supporting me in my role as the Director of Infection Prevention and Control (DIPC)
Thank you
Siobhan Heafield
Director of Nursing and Quality/ Director of Infection Prevention and Control
The prevention and control of health care
associated infections (HCAI) in
Staffordshire and Stoke on Trent
Partnership Trust (SSOTP) continues to be
a key priority. This year represents another
year in which the National Health Service
has continued to make significant
progress in the control and prevention of
HCAI. This report outlines the progress
made in prevention and control of HCAI
by The Partnership Trust for the period
April 2012-March 2013 and sets out the
annual programme of work for 2013-2014
to ensure continued improvement in the
prevention and control of infection.
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Introduction
The strategic and operational aim of the Infection Prevention and Control Services is to
increase organisational focus and collaborative working to effectively maintain
standards to ensure the Staffordshire and Stoke on Trent Partnership Trust (The
Partnership Trust) meet the ten criteria presented in The Health and Social Care Act
2008 (amended in 2010) Code of Practice on the Prevention and Control of Infections
and Related Guidance. The objective is to engage staff at all levels, through effective
leadership, in order to develop and embed a culture that supports infection, prevention
and control within the trust.
The purpose of this annual report is to outline the progress made in prevention and
control of HCAI by Staffordshire and Stoke on Trent Partnership Trust for the period
April 2012-March 2013.
The DIPC and the Infection Prevention and Control Team have worked in collaboration
throughout the year with Operational Leads and members of the Nursing and Quality
team to maintain an effective service that has delivered a broad infection control
programme of work.
The programme of work has been supported and monitored by the Infection
Prevention and Control Committee. The Committee is accountable to the Quality
Governance Committee and provides assurance to the Board via the DIPC. A designated
Non Executive Director joined the membership of the Infection Prevention and Control
Committee from September 2012 and has been a very active member since joining.
The following section of the report describes The Partnership Trust annual programme
of work in terms of delivering and maintaining compliance with the ten criteria of the
‘Code of Practice’, in which all providers of healthcare and adult social care are required
to demonstrate in order to register with the Care Quality Commission.
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Code of Practice for the Prevention and Control of Healthcare Associated Infections
Compliance
Criteria
What a service provider will need to demonstrate
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Systems to manage and monitor the prevention and control of
infection. These systems use risk assessments and consider how
susceptible service users are and any risks that their environment and
other users may pose to them
2
Provide and maintain a clean and appropriate environment in managed
premises that facilitates the prevention and control of infections
3
Provide suitable accurate information to service users and their visitors
4
Provide suitable accurate information on infections to any person
concerned with providing further support or nursing/medical care in a
timely fashion
5
Ensure that people who have or develop an infection are identified
promptly and receive the appropriate treatment and care to reduce the
risk of passing on the infection to other people
6
Ensure that all staff and those employed to provide care in all settings
are fully involved in the process of preventing and controlling infection
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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 Ensure, so far as is reasonably practical, that care workers are free of
infection and are protected from exposure to infections that can be
caught at work and that staff are suitably educated in the prevention
and control of infection associated with the provision of health and
social care.
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Criteria 1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any
risks that their environment and other users may pose to them.
It is the responsibility of all healthcare providers to ensure that organisations have in
place appropriate arrangements for Infection Prevention and Control, to protect
patients from the risk of acquiring Health Care Associated Infection (HCAI) and to
ensure compliance with the Health and Social Care Act 2008 (2010). The Trust board
members are committed to their responsibilities for minimising the risk of preventable
infection. An annually updated Strategy and Programme of work was agreed by the
Board in April 2012 outlining responsibilities of all staff within the organisation in
reducing avoidable HCAI’s.
The Infection Prevention and Control Team (IPCT)
During 2011 a considerable amount of work was completed looking at the most
effective way for the Infection Prevention and Control team to work on a daily basis.
The Infection Prevention and Control team has been restructured to reflect the
operational structure. The teams were re organised in to a North and a South division
location to mirror the Operational team’s structure. This structure was decided on, as it
would be more practical and aid response time to queries and actions which required
follow up as the teams were more centrally based within the two divisions. This
structure has proven to be the most effective and therefore agreed as the permanent
structure during April 2012-2013. The two main offices utilised are ST Chad’s Health
Centre in the South division and Longton Cottage Hospital in the North division,
however due to the nature of the role, the team members use the hot desks available,
throughout the Trust on a daily basis to allow them to be with front line staff.
The Infection prevention and Control Team sit within the Nursing and Quality
Directorate, together with the DIPC. The Associate Director for Professional Leadership
has a large input with the team and directly line manages the Head of Infection
Prevention and Control.
The team structure consists of a
Head of infection Prevention and Control
One Team leader, who covers both North and South division
1.00 WTE Band 7 covering The Partnership Trust services
1.60 WTE Band 3 covering The Partnership Trust services (0.6 post currently on
Maternity Leave)
1.80 WTE Band 6 covering The Partnership Trust services
3.00 WTE Band 5 covering The Partnership trust services
2.40 WTE Band 6 covering Independent Services as part of the block contract
1.0 WTE Band 5 covering Independent Services as part of the block contract
The new structure was agreed in July 2012 by the Infection Prevention and Control
Committee following the retirement of two Senior Infection Prevention and Control
nurses.
There are two Service Level Agreements (SLA) in place for Infection Control Doctor
(ICD) advice. A Consultant Microbiologist from Burton Hospitals Foundation Trust
provides ICD 24 hour advice for the south geographical area Dr Paton and a Consultant
Microbiologist at University Hospital North Staffs (UHNS) Dr Banavathi provides a
24hour service for the north geographical area.
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Advice on individual patient specimens continues to be sought from the laboratory in
which the specimens are sent to for processing. Due to the organisations geographical
area this refers to a number of acute trust hospital laboratories. The main hospitals are
Mid Staffordshire NHS Foundation Trust, Burton Hospitals Foundation Trust, University
Hospital North Staffordshire and all the hospitals on the boundaries including The
Royal Wolverhampton hospitals, Heart of England Foundation Trust and Dudley Group
NHS foundation Trust.
The work undertaken by the IPCT requires a flexible and responsive approach to
spontaneous requests for infection control advice and support, whilst ensuring
planned projects and deadlines are also met in a timely manner.
Over the last year the service has successfully provided reliable infection prevention and
control advice during normal office hours (Monday to Friday) with extra cover during
the weekend in the winter period when outbreaks occurred, to support the on call
microbiologist and clinical teams. The Infection Prevention and Control committee
agreed that the service should be extended in 2013 on a permanent basis, so that
clinical teams can receive advice from the infection control nurses seven days a week.
The Infection Prevention and Control nurses have continued to maintain skills and keep
up to date with current research by being active participants in the Infection Prevention
Society West Midlands regional group. The current Head of Infection Control is the
group secretary. Other members of the team have assisted in the preparation and
running of the West Midlands annual study day and contributed to writing Infection
Prevention Society documents.
All band 6 nurses within the infection Prevention and control team and above are
encouraged and supported to attend and complete a degree level module in infection
control at The University of Birmingham to enable them to become an infection control
specialist nurse. Within the current staffing there is one remaining Band 6 who is
currently completing this course and will finish June 2013.
All members of the team have developed their knowledge and skills further
throughout the year. They regularly deliver training sessions, within the Trust training
programme and externally, as invited speakers on Degree level courses at Staffordshire,
Keele and Wolverhampton Universities, Infection Prevention and Control courses and
The Masters in Public Health course delivered at the University of Birmingham.
As in previous years the IPCT extensive infection prevention and control annual
programme of work, relied on collaborative working with Facilities and Estates leads,
Hospital Matrons, Continence team, Tissue Viability, Dental managers, Podiatry
managers and the Professional Leads for District Nursing and Allied Health
Professionals.
During 2012 an extensive piece of work was carried out with the Facilities team and
Operational Directorate at Leek Moorlands hospital. A refurbishment programme has
taken place to improve the environment for patients as well as increase the amount of
space between beds to meet Health and safety, infection control and dignity and
privacy needs of the patients. Bathrooms, sluice rooms and clinical rooms have been
updated with new fixtures and fittings a dedicated waste room has been created to
improve the separation of waste. Similar work has been agreed and tendered at
Longton Cottage and Bradwell Hospitals, work commenced in April 2013.
Quality compliance audits based on the Saving Lives Programme have continued in
community hospital departments, dental services, podiatry teams, prison healthcare
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teams and district nursing services. The audits involve self and peer audit, which are fed
back within teams and reported as part of either the Hospital Matron Dashboard or
individual reports to the Safety and Effectiveness north and south groups chaired by
the Chief Operating Officers. Exceptions are fedback at the Infection Prevention and
Control Committee. Results of audits have been displayed within the individual
departments for patients and members of the public to view.
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Assurance framework
The Partnership Trust has an active IPCT with an agreed annual programme of work,
which is agreed by the Infection Prevention and Control Committee (IPCC). Members of
the Committee include the Medical Director, Non Executive Director, Consultant in
Communicable Disease Control West Midlands North Health Protection Unit (HPU),
Pubic Health Consultant, DIPC, Head of Infection Prevention and Control
Commissioning, Head of Infection Prevention and Control The Partnership Trust and
senior operational leads. (Full membership listed in appendix 2)
The IPCC provides The Partnership Trust Board of Directors and Commissioners with
assurance that the Trust is compliant with the ‘Code of Practice’ element of the Health
and Social Care Act 2008 (updated 2010) by providing evidence and assurance in the
form of
Infection Prevention and control surveillance data trends and analysis reports
Compliance with audit programmes
Matrons Dashboard
Quarterly Cleanliness scores
Annual Patient Environment Action Team scores
Serious Incident and Internal Safeguard reporting
Outbreak reports
Route Cause Analysis action plans
Criteria 2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections
Facilities and Estates services are provided via a combination of Service Level
Agreements and in house staff. The Partnership Trust Associate Director for Estates
works closely with the Infection Prevention and Control Team. This ensures
environments are fit for purpose. Sites are inspected using The National Standards of
Cleanliness 2007 audit tools and Infection Prevention Society national audit tools.
Action plans are monitored by the Infection Prevention and Control Committee.
Patient environment action team inspection
In addition to the monthly and quarterly cleanliness audits carried out by the
Operational team, each year a Patient Environment Action Team (PEAT) inspection has
been carried out by a multidisciplinary team, the team consisted of a patient
representative, an external inspector from a neighbouring Trust, and members of the
nursing, facilities and infection prevention and control teams.
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Table 1; Results of the National Peat inspection 2012
Site Name
Environment
Score
Food
Score
Privacy &
Dignity
Score
HAYWOOD HOSPITAL 5 Excellent
5
Excellent 5 Excellent
LONGTON HOSPITAL 5 Excellent
5
Excellent 5 Excellent
LEEK MOORLANDS HOSPITAL 5 Excellent
5
Excellent 5 Excellent
CHEADLE HOSPITAL 5 Excellent
5
Excellent 5 Excellent
BRADWELL HOSPITAL 5 Excellent
5
Excellent 5 Excellent
The Partnership Trust have extended the PEAT audits to include six of the prison
healthcare environments, following the successful introduction last year. The prison
healthcare audits are reported to the IPCC. From the audits an action plan has been
developed to ensure that the high standards are maintained throughout the year. For
2013-2014 the PEAT audits will be replaced by Patient Led Assessments of the Care
environment (PLACE) Therefore the Head of infection control, Facilities leads and
Patient Expereince Manager have been involved in the preparation workshops to move
over to this programme from April 2013.
A review of hospital cleaning services was undertaken during 2012. Cleaning schedules
and a new monitoring programme have been agreed. A considerable investment in
additional domestic cleaning hours has been supported by the Executive team,
Recruitment to all post will be complete May 2013. Criteria 3 Provide suitable accurate information to service users and their visitors
Performance against Local Health Economy Trajectories:
The Prevention and Control of HCAI’s continues to be a major priority for the
Partnership Trust as a provider of healthcare. We continue to ensure focused delivery
on improvements in both the rates of infection and in the overall quality of care.
The two key performance indicators that were set during 2010/2011 have continued
and remained the main performance indicators associated with alert organism
surveillance data. The performance indicators relate to the number of Meticillin
Resistant Staphylococcus Aureus (MRSA) bacteraemias (in the blood) and the number of
Clostridium difficile infections (CDI) cases in people over the age of two year old. In
addition the Local Commissioners requested that the Meticillin Sensitive Staphylococcus
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Aureus (MSSA) and Ecoli bacteraemias isolates were reported to ascertain the number
of positive specimens, within Staffordshire and Stoke on Trent. No reductions or
trajectories were set for MSSA or E.coli Bactereamias.
The Commissioners agreed the number of root cause analysis required as it was not
possible to carry out a detailed root cause analysis (RCA) on all data reported due to
the number in the large geographical area. The root cause analysis were completed in
conjunction with clinical teams and Acute Trust Infection Prevention and Control
Teams, to ascertain themes and trends.
In addition to mandatory reporting of MRSA bacteraemias the Partnership Trust is also
reporting on the number of MRSA clinical isolates within the community hospitals
inpatient beds.
A clinical isolate is a swab taken from an area which has signs and symptoms of a local
infection such as redness, heat, temperature, pain or a discharging wound. The
specimen maybe taken from a wound sputum or a urine specimen. A small number of
positive specimens were received from the community hospital wards the cases were
isolated cases, which received appropriate treatment and no further transmission took
place.
Effective surveillance is essential in reducing healthcare associated infection (HCAI)
rates and its associated harm and costs. Data routinely collected on HCAI’s are
monitored daily by the Infection Prevention and Control team (IPCT). The results are
disseminated to clinical teams on a daily basis and to the management team and
commissioners on a monthly basis.
Wider team engagement has taken place. Tools such as the Trust weekly newsletter
“The Word” and team brief have been used to distribute information, as well as
presentations at professional district nurse forums and team leader meetings.
A pre 48 hour MRSA bacteraemia is defined as a blood culture specimen taken within
the first 48hrs of the patient’s admission to an acute Trust or a sample taken by GP in
their practice. These bacteraemia figures are not recorded against The Partnership
Trust. The Partnership Trust IPCT start the RCA, if the RCA findings highlight that the
patient has received care by a healthcare provider a joint RCA is completed.
Between April 2012 and March 2013 a total of 11 Pre 48 hour MRSA bacteraemias
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were isolated across the health economy and reported to the Infection Prevention and
Control Team.
Table 2 The table represents the number of Pre 48hr MRSA Bactereamias reported from The Partnership Trusts geographical area. Apr
il May June July Aug Sep Oct Nov Dec Jan Fe Mar Total
North
0 1 1 0 0 0 0 0 1 0 0 0 3
South 0 0 1 1 0 1 0 0 3 1 0 1 8
Source of Bacteraemia
N/A
Su
rgic
al w
ou
nd
Fem
ora
l lin
e/
Ch
ron
ic w
ou
nd
Skin
co
lon
isati
on
N/A
Ch
ron
ic W
ou
nd
N/A N/A
Uri
ne
Skin
Skin
Sp
utu
m
Hic
km
an
lin
e
N/A
Ch
ron
ic W
ou
nd
Running Total
0 1 3 4 4 5 5 5 9 10 10 11 11
The pre 48hr MRSA Bacteraemias are segregated in to North and South geographical
areas headings as requested by the Head of Infection Prevention and Control for the
Staffordshire Primary Care Trust. The Partnership Trust IPCT investigated all 11 MRSA
bacteraemias and completed a RCA with the relevant clinical teams as part of the
infection control Service Level Agreement (SLA) with the commissioners. The probable
source of the bacteraemia was identified for each case.
The RCA’s have enabled lessons to be learnt across the Health Economy. During 2011
RCA themes highlighted that urinary catheters were one of the main risks associated
with MRSA bacteraemias. A considerable amount of work was carried out with district
nursing teams, care homes and Acute hospitals improving documentation and
communication and reviewing the need for the continued use for the catheter. For the
coming year, work has commenced focusing on chronic wounds and indwelling devices
such as peripheral cannulae management in the community.
The Partnership Trusts Community Hospital inpatient wards infection data was
collected weekly. A local trajectory of One MRSA bacteraemia case was set by the
commissioners. There was one of MRSA bacteraemias isolated during the time period. A
full review was held with the Chief Executive, Director of Nursing and Quality, Medical
Director, Director of Operations, clinical staff involved and the Infection Prevention and
Control team. The review highlighted that further training was required on the
management of peripheral lines, which has been completed.
Clostridium difficile infection The Partnership Trust Community Hospitals inpatients
Between April 2012- March 2013, the Clostridium difficle toxin rates within the
hospitals
remained on trajectory. There were a total of eleven cases isolated against a trajectory
of 11. A Period of Increase incidence (PII)of CDI was reported in April 2012 as a Serious
Incident (SI) at Leek hospital. The PII was managed by members of the Infection
Prevention and Control Committee.
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To maintain low Clostridium difficile infection rates remains of high importance. The
key achievements to meeting this trajectory, have been due to the review of the
antibiotic prescribing guidelines which has incorporated the three original documents
in to one standardised document. Appropriate antimicrobial prescribing is a vital
element in the prevention and control of Clostridium difficile infection. Improving the
ward environments by replacing fixtures and fittings and re decoration has aided the
cleaning of the environment. In addition increasing the amount of space between beds
and creating separate waste rooms to improve segregation has all contributed to
meeting the trajectory.
Table 3 The table represents the number of Clostridium difficile cases isolated
between April 2012 and March 2013 in The Partnership Trust Community Hospital
inpatient wards.
A trajectory of 11 cases was set by the commissioners for the year.
Community hospitals Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total
Day of admission plus four
(Admission date is day one) 4 1 2 1 1 0 0 0 0 0 2 0
11
Toxin+
Running Total SSOTP
4
5
7 8 9 9 9 9 9 9 11 11 11
Trajectory 1 2 3 4 5 6 7 8 9 10 11 11 11
Clostridium difficle in Care Homes As part of the Service Level Agreement with local Commissioners, the Infection Prevention and Control Team provide educational and audit support to care homes. Between April 2012 and March 2013 two care homes were identified as having a period of increased incidence (PII) of Clostridium difficile. The homes isolated two cases of Clostridium difficile over a short period of time. The care homes were audited and supported by the Infection Prevention Control Team. The support actions included providing training sessions, RCA with GP input, educational posters and sharing of the Partnership Trust Clostridium difficile policy. The Health Protection Unit West Midlands North was informed of all cases and lead on the PII investigations. Outbreaks in The Partnership Trust Community hospitals Outbreaks of diarrhoea and/or vomiting can occur at any time during the year, but are particularly prevalent during the winter months. They are often referred to as ’winter vomiting illness’. All outbreaks of infection are reported through The Partnership Trust Risk team and reported to the NHS England as a Serious Incident (SI.) SI’s are subject to a root cause analysis investigation. Actions are then monitored through the Infection Prevention and Control Committee. During December –March the number of norovirus cases within the community was very high, compared to the same time period the previous year. This was the case across the whole country. Of the 20 outbreaks that occurred, the index cases of 15 of the outbreaks were thought to have been patients admitted with symptoms. Table 4 The number of outbreaks reported as an SI during April 2012- March 2013 in the Community Hospital inpatient wards.
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Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total
Number 1 1 1 0 2 0 0 0 5 1 4 5 20
Cause
No
roviru
s
No
roviru
s
No
roviru
s
0
No
roviru
s
0 0
No
roviru
s
No
roviru
s
No
roviru
s
No
roviru
s
No of affected Patients
/Staff
18/3 5/4 10 0 10 0 0 0
55/
32 11/1 21/4
37/1
4
157/
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Criteria 4 Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion
The criteria for the movement and transfer of patients who are known or suspected to
have an infection was reviewed in May 2012 following the Period of Increased
Incidence (PII) of Clostridium difficile cases. The newly designed documentation
contains details of infections and the treatment that the patient has been prescribed.
The documentation aids communication between different wards and teams and
allows the receiving team to provide for any continuing needs/ treatment and ensure
that quality of care is not compromised during the transfer due to lack of information.
Throughout the year the Medicines Management team has provided educational
support to the non- medical prescribers such as nurses and therapists. This has
supported in the reduction of high risk antibiotic prescribing and inappropriate
prescribing. The team has continued to issue a letter to prescribers if high risk
antibiotics were prescribed educating them of the risks. Following the establishment of
the Partnership Trust the Pharmacists in the community hospitals have increased their
engagement with the Infection Prevention and Control team, inputting into RCA
process, maintaining antibiotic audits and following up of any inappropriate
prescribing. The Medicines Management team and the Infection Prevention and
Control team have prioritised the plan of work for April 2013 onwards, to concentrate
on Medical staff prescribing within The Partnership Trust, This will take place once the
new structure of the Medical staff cover for the Community hospitals has been fully
implemented and will involve a training program led by the Medical Director.
The Infection Prevention and Control Team have worked closely during the year with
the Pharmacy teams in the Clinical Commissioning Groups (CCG), data from RCA’s has
been shared which has enabled the pharmacists to follow up inappropriate antibiotic
prescribing for care home patients and General Practitioner (GP) samples.
To support healthcare staff in providing patients with the appropriate information
concerning treatment and management of specific infections. The IPCT has a catalogue
of Infection Prevention and Control related leaflets. During 2012 the team reviewed
the patient and carer leaflets available with The Partnership Trust Communications
team. All leaflets are available electronically for staff to access.
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Criteria 5 Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people
All patients admitted to the Partnership Trust Community hospitals are assessed for the
risk of infection. Using a locally designed assessment tool on admission. The tool will
demonstrate if the patient requires to be nursed in an isolation room or whether they
can be nursed in a communal bay.
All patients are screened on admission to Community Hospitals for MRSA . Elective
patient admission screening figures is reported monthly to the ward Matron, the
Infection Prevention and Control Committee, Management team. This information is
also provided to our Commissioners each month at a Clinical Quality Review (CQR)
meeting. A target has been set by the commissioners of 100% compliance. SSOTP
compliance rates have been recorded as between 99-100% over the whole year.
Table 5 demonstrates the number of MRSA elective screening swabs sent in the last six
months, during march one specimen form was inappropriately labelled therefore the
swab was not processed and a repeat swab required sending.
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Table 5 The Bar chart represents the MRSA screening compliance data for Quarter 3
and Quarter 4 2012.
Criteria 6 Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection
All Partnership Trust employees are required to act as a role model and take steps to
prevent and control infection. This includes adopting bare below the elbow and
standard infection control/ hygiene precautions.
If staff are not compliant with following policies, initially this would be followed up by
local team leaders and supported by Senior managers, matrons and heads of services.
Performance is monitored via the appraisal route.
The Link Worker Programme remains a strong forum, meeting on a quarterly basis. The
meetings update staff on new policies and guidance issued by the Department of
Health or the Health Protection Agency, which staff are asked to take back to their
individual teams. This year has seen the group split into six dedicated groups
General group ( North and South division)
Care home staff group (North and South division)
Prison Healthcare
Dental team
This split has enabled the meetings to focus on more areas pertinent to the individual
services.
MRSA Elective Screening Compliance
Community Hospital Admissions 2012-
2013
100 100 100 100 100 99.7
0
20
40
60
80
100
Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13
Month
Perce
ntage
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The Annual Infection Prevention and Control study day took place in October 2012 with
90 staff taking part. The study day brought together infection control link workers
from all areas, this enabled staff to share ideas and innovations from all specialities
relating to infection control. The day was opened by the Director of Nursing and
Quality who gave a key speech to delegates on The Partnership Trusts vision relating to
Healthcare infections and how each individual staff member can make a difference to
the quality of care each patient/ client receives.
Training continues to play a large role in bringing about change, ensuring staff are
motivated and reminded of factors that can prevent or minimise risks of infection. All
staff receive a basic training session when they commence working in the Trust as part
of the Induction Programme.
The training needs analysis template was updated in 2012 in agreement with the
Training Department. In addition to induction, all clinical staff are required to attend
an annual update. The training is available to staff in several forms, face to face session,
handbook or e learning. Non-attendance is followed up by the Training Department
and the individual managers.
Attendance figures are reported to Infection Prevention and Control Committee,
Quality Governance and Trust Board, at frequent intervals throughout the year.
Attendance has consistently remained at 80% or over throughout 2012-2013. Currently
there is not a set target for attendance.
The 2012-2013 mandatory training package emphasises standard infection control
precautions required to work safely and has concentrated particularly on aseptic non
touch technique (ANTT). ANTT has remained in the programme to help standardise
practices across the new Trust. In conjunction with the tissue viability team, clinical
practice educators (CPE) team and the continence team, ANTT has been strongly re
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enforced as a standardised approach for dressings, cannualtions or any procedure
requiring an aseptic technique procedure.
During 2012 in addition to the mandatory training programme the Infection Prevention
and Control nurses continued to support the Integrated Support Workers (ISW) and the
band 5 Registered Nurses development programmes. The IPCT continued to accept
student nurse placements within the team, the allocations last for one week per
student and throughout the team on average there are three student nurses attending
per week. Criteria 7 Provide or secure adequate isolation facilities
Isolation of patients was monitored very closely by the clinical team and reported as
part of the matron’s dashboard. Patients requiring isolation were reviewed daily by
ward staff and weekly during the Infection Control Nurse ward round. The Trust has
105 single rooms which can be used for patient isolation within the Community
Hospital. Criteria 8 Secure adequate access to laboratory support as appropriate
Due to the large geography of the Trust several laboratories’ services are used across
Staffordshire and Stoke on Trent for processing microbiology samples. The main
laboratories are University Hospital North Staffordshire, Mid Staffordshire Foundation
Trust, Burton Hospitals Foundation Trust , Heart of England Foundation Trust, Russell’s
Hall and New Cross Hospital Microbiology Laboratory. All of the laboratories used are
nationally CPA accredited. Details of the accreditation can be found on the website
www.cpa-uk.co.uk . Microbiology advice concerning the specimen results is obtained
from the laboratory which processed the specimen.
Criteria 9 Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections
The Infection Prevention and Control team have continued to ensure that the
Partnership Trust staff and patients have access to robust, evidence based up to date
policies. During the year the Infection Prevention and Control Team has reviewed all of
the infection control policies from the three previous predecessor organisations to
standardise the contents of the policies.
During 2012 Norovirus Toolkits and folders were reviewed in the Community hospitals.
The folders comprise of posters, leaflets, cleaning schedules and data collection tools to
be used during an outbreak.
.
Audit has driven the service forward to provide a systematic approach to infection
control and ensures compliance with Trust policies and the ten criteria of The Health
Act 2008 Code of Practice for the Prevention and Control of Health Care Associated
Infections (Revised 2010) and National Health Service Litigation authority (NHSLA).
The audits support the identification of areas for improvement.
A rolling programme of infection control audits based on the Infection Control Nurses
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Association tool (2011) have been completed in the Community hospital, departments,
Community dental services, Prison Healthcare departments, Health Centres and a small
number of GP buildings. Clinical audit can be used as a training aid as well as to
monitor clinical effectiveness. It has shown to be an effective tool in monitoring
standards and influencing change.
Prison healthcare services
Infection control practices were reviewed in the six prison healthcare departments
covered by the Partnership Trust. The Infection Prevention Society audit tool was used
to conduct the audit. All areas scored over 85% this would RAG rate as green.
Sharps safe working practice audit
The management of sharps was audited
across, wards, health centres and prison
healthcare departments. The audit
demonstrated that the standardisation of the
boxes that was carried out in the previous
year had been successfully completed.
Community staff carry sharps around in their
cars on a daily basis, the audit identified that
further work was required on the safe
transport.
As not all staff were securing boxes during
transport.
Observational practices were excellent with staff scoring highly on sharps management and wearing of personal protective equipment. A small number of rooms required refurbishments; Healthcare managers are working with the Prison estates departments and Prison Governors to coordinate the refurbishments.
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Annual Infection Prevention and Control audits
The audits are carried out on a rolling programme by the IPCT. Once completed audits
are shared with the service leads and action plans are developed and monitored
through the Infection Prevention and Control Committee.
Ward
Gen
Management Practices Equipment Linen
Waste
Management PPE Sharps
Sycamore 90% 82% 96% 90% 57% 100% 53%
Oak 90% 97% 96% 90% 57% 100% 67%
Bennion 100% 86% 90% 100% 57% 100% 66%
Ward 1 100% 94% 100% 100% 85% 100% 100%
Ward 2 100% 95% 100% 100% 85% 100% 100%
Saddler 100% 95% 96% 100% 57% 100% 92%
Cottage 100% 89% 100% 90% 57% 100% 92%
81%
86% 85%
97% 97%
91% 89%
86%
90%
97% 97%
91%
97% 96%
92%
70%
75%
80%
85%
90%
95%
100%
Overal Scores. SSOTP Community Hospital Wards. 2012 IPC audits
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Aynsly 90% 79% 89% 100% 71% 100% 76%
Smithchild 95% 91% 84% 85% 71% 100% 75%
Jackfield 100% 99% 100% 92% 100% 100% 92%
Scotia IP 95% 97% 96% 100% 100% 100% 92%
Sneyd 86% 93% 90% 85% 100% 100% 84%
Broadfield 100% 95% 96% 100% 100% 100% 92%
Grange 100% 88% 90% 100% 100% 100% 92%
Chatterly 95% 92% 93% 69% 100% 100% 100%
Areas of good practice highlighted within the environment standard:
Individual teams are using cleaning schedules to demonstrate that cleaning
has been completed
All healthcare teams have access to detergent cleaning wipes to clean the
work environments and medical devices after use
Personal protective equipment was widely available for staff to use
Posters demonstrating an effective hand hygiene technique and what first
aid to carry out if an inoculation incident occurs were displayed in the
majority of healthcare environments
Areas highlighted as requiring further work were include
Bradwell and Leek hospitals did not have separate waste rooms, therefore
clinical waste and clean items were being stored in close proximity, new
waste rooms have now been built in both hospitals
Sluice room fixtures and fittings out dated and worn at Leek and Longton
hospitals, sluice rooms have now been refurbished
Flooring worn at Leek hospital, now replaced
Bathrooms refurbished at Leek hospital
Urinary catheters
Throughout the year work has continued on the reduction of inappropriate insertion of
urinary catheters. The work entailed collecting data on the number of catheters and
ensuring that catheter life charts or diaries were in use, which act as an aid memoire to
review catheter use and remove if not required any longer. As the programme
progressed throughout the year, the number of catheter diaries in use has increased to
98% consistently resulting in more appropriate catheters in use and less inappropriate
catheters. Improved documentation has also helped with the communication
concerning the catheter when patients were visiting other healthcare providers.
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Criteria 10 Ensure, so far as is reasonably practical, that care workers are free of infection and are protected from exposure to infections that can be caught at work and that staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.
During 2012-2013 the Occupational Health service was provided by three individual
contracts. One team based at Mid Staffordshire General Hospital Foundation Trust, the
second team at Burton Hospitals Foundation Trust and a third team that covered the
North division.
The services could be accessed by all Trust staff. A range of services were available
which included advice and information for staff when suffering from infections,
vaccinations, occupational health screening and risk assessments following inoculation
injuries. Data relating to inoculation injuries reported to occupational health was
presented at the Infection Prevention Control Committee.
From April 2013 a new Occupational Health service Team Prevent will be providing the
Occupational Health service to The Partnership Trust.
To support staff in the prevention and control of infection the IPCT in The Partnership
Trust have an agreed Mandatory training programme. During April 2012-March 2013
4460 staff members attended an infection control training session.
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The Partnership Trust IPCT work with independent contractors and Social Care Sector Care homes to provide advice and support on compliance with infection control standards as part of a service level agreement with the local commissioners. General Dental Practices Engagement
Between April 2012 and March 2013, Independent Dental practices received a follow up
visit by the Dental Officer and a member of the IPCT. The Director for Dental services
decided on which practices should be audited depending on the results of the self-audit
completed and the number of complaints received concerning the individual business.
All actions were followed up by the commissioners as part of the contract reviews
The IPCT have reviewed twenty decontamination rooms, building plans with
independent practices to ensure the building works met HTM 01-05 guidance.
General Medical Practice Engagement
The IPCT have continued to strengthen relationships with general practice teams.
Training sessions for practice nurses and practice staff have been arranged on request.
General Practitioners (GP’s) have been encouraged to actively take part in the RCA of
alert organisms which are reported through the national surveillance programme.
Regular newsletters and updates to policies have been circulated to practice teams.
Infection control policies are available on the external web site and Practice teams are
advised to adapt these for use in their own teams.
There were 135 Practice Nurses attended a number of Infection control training sessions
held throughout the patch, concentrating on Standard Precautions and carrying out a
Infection Prevention Society audit and were asked to disseminated the information
with their own teams.
Care homes, hospices and care agencies
Work in this area has continued to increase during 2012 the SLA with commissioners
was reviewed to include increased support to care homes, no further resources were
available therefore annual General Practice audits were discontinued unless a specific
concern had been raised, from a incident, complaint or positive microbiology sample.
A large number of training sessions were held throughout the Health Economy for care
home staff to attend. There were 560 staff in total who attended and took part in the
sessions throughout the year. Staff were asked to cascade the information within their
own care setting.
The care home link worker programme has continued to go from strength to strength,
with new link nurses form residential and nursing homes being added to the group on
a weekly basis. Educational meetings are held on a quarterly basis.
A Care Home Tool to aid compliance with CQC registration was re circulated by the
IPCT to all homes across Staffordshire and Stoke on Trent geographical area. The IPCT
continued to follow up diarrhoea and vomiting outbreaks in care homes, in conjunction
with the Health Protection Unit. The outbreaks continue to be managed by the HPU
with the IPCT visiting the home within the first 48hrs after the outbreak commences, to
check advice is being followed and that specimens and relevant data are being
collected appropriately and to facilitate the management of the outbreak. The visits
often encompass an educational session and an audit.
Between April 2012 and March 2013 76 infection control audits were completed in
nursing homes and residential homes. The audits provided homes with up to date
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information on working safely reducing the risk of infection for both patients and staff.
The commissioners and Care Quality Commission have used the evidence to support
performance issues and concerns highlighted for a small number of homes under
scrutiny. There were three main audits carried out. An IPS audit was carried out, this is a
general tool developed by the Infection Prevention Society, the tool covers all areas of
the environment and includes observing practices, the second audit is a tool used
during a Diarrhoea and vomiting outbreak, the tool asses if the home is compliant in
managing an outbreak and has implemented control measures to reduce the spread
and the third audit is only carried out when a care home is treating a patient who has
Clostridium difficile. The aim of the tool is to ensure that the patient is receiving the
most appropriate treatment and that precautions have been instigated to reduce the
risk of cross infection.
Audits completed in the South Staffordshire Care homes
Quarter IPS Outbreak CDI
Quarter 1 8 10 2
Quarter 2 1 2 0
Quarter 3 2 3 0
Quarter 4 2 1 2
Total for 2012/2013 13 16 4
Audits completed in North Staffordshire and Stoke on Trent Care homes
Quarter IPS Outbreak CDI
Quarter 1 11 3 1
Quarter 2 14 0 0
Quarter 3 5 2 0
Quarter 4 2 5 0
Total for 2012/2013 32 10 1
Data collection related to organisms isolated in care homes has continued as previous
years. This includes all Clostridium difficile cases, MRSA bacteraemias, MSSA
bacteraemias and E coli bacteraemias. Due to the amount of time a RCA takes to
complete effectively only a small number are completed by the IPCT the data is used to
ascertain trends, however care homes are encouraged to follow up on all of their own
individual cases internally.
Summary
The strategic and operational aim of the Infection Prevention and Control services is to
increase organisational focus and collaborative working to effectively implement and
maintain The Health and Social Care Act 2008 amended in 2010, Code of Practice for
the Prevention and Control of Infections. The year 2012 -2013 has been a very
productive year for the Trust. It is recognised that an increased engagement with
different staff groups at all levels has taken place, collaborative working within the
Trust with the Continence team, Tissue Viability team and the District Nurse
Professional lead has enabled the trust to continue to develop and embed a culture
further that supports and promotes infection, prevention and control within the Trust.
One of the main focuses has to improve The Partnership Trusts owned estates, ensuring
that the buildings, fixtures and fittings are maintained and fit for purpose.
The Infection Prevention Control team look forward to another productive year, which
will see further work on
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increase collaboration with Social care teams and Community teams
following the development of integrated teams. The IPCT will develop a
programme
of work with the Chief Operating Officers to encompass social care services to
ensure all elements of ‘The Hygiene Code’ are met.
improving health centre clinical environments
working with Podiatry teams to launch a Diabetic Foot Ulcer pathway which
incorporates a antimicrobial treatment advice section
work on the improving the safety of sharps related procedures
working to succeed in meeting the new local Clostridium difficile trajectory 8
cases set by the Commissioners
improving MRSA screening compliance to meet 100% consistently
working with medicines management and pharmacy team to standardise
improve Antibiotic prescribing compliance
Working with neighbouring Trusts and organisations to reduce the number of
inappropriate admissions and successfully manage outbreaks in the Community,
preventing further spread
Examples of newsletters and articles presented in the Staff Newsletter throughout
2012.
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Appendix 1- Attached as a separate document
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Appendix 2
Infection Prevention and Control Committee Membership
Director of Nursing and Quality, Director of Infection Prevention & Control (DIPC)
Associate Director of Professional Leadership
Associate Director of Quality
Lead Infection Prevention and Control Nurses
Infection Control Doctor/ Microbiologists
Medical Director
Staffordshire County Council representative
Health Protection Agency, Consultant in Communicable Disease Control
Non-Executive Director
Director of Finance Resource and Estates Representative
Chief Operations Officer/s
Hospital Manager
Decontamination Lead/s
Head of Infection Prevention and Control Commissioning Support Unit
Public Health representative