TRUST BOARD - SUMMARY REPORT Date of Board meeting: 26 June 2007 Infection Control report to the Trust Board Name of Report: Dr Anne Uttley [Infection Control Doctor] and Karen Author(s): Taylor [Asst Director of Nursing – Infection Control]. Approved by (name of Dr David Roy Executive member): Presented by: Dr Anne Uttley & Karen Taylor Purpose of the report: To present the Infection Control programme for 2007 – 2008 To outline activity of the Trust Infection Control service 2006 – 2007 Action required: The Trust Board to ratify the Infection Control programme for 2007 – 2008 Recommendations to the Board: Relationship with the Assurance Framework (Risks, Controls, and Assurance): Summary of Financial and Legal Implications: Equality & Diversity and Public & Patient Involvement Implications: The Infection Control programme is developed to positively support diversity issues INFECTION CONTROL REPORT TO THE TRUST BOARD 1 June 2006 to 31 May 2007 1. INTRODUCTION The Infection Control Team (ICT) includes: Dr Anne Uttley, Infection Control Doctor and Karen Taylor, Asst. Director of Nursing. Dr David Roy is the Director of Infection Prevention and Control for the Trust. There is representation from Occupational Health [Kathy Baker], Catering [Paul Winter] and Health & Safety Risk Management [Ron Moody] at the six weekly ICT operational meetings. The programme was developed from the Infection Control Strategy [2006 – 2009] that outlines specific targets. It ensures that that the ICT offers a high quality service to reduce the risk of infection to patients, staff and visitors. The programme has also been developed to ensure compliance with: The Health Act 2006 [incorporating: Standards for Better Health; Winning Ways; Saving Lives: A delivery programme to reduce HAI including MRSA] The programme will be altered to reflect new Government Statutory Regulations or any other infection control issue deemed to be a priority by the ICT that may occur within the Trust in 2007/2008. The ICT aims to embed good infection control prevention throughout the Trust and make Infection Control Everybody‟s business. 2. PROGRAMME PERSONS TARGET RESPONSIBLE DATE 2.1 Policies and Infection Control [IC] policies will be reviewed to ICT 31/03/08 Procedures reflect published professional guidance and relevant legislation. The Influenza and C.difficile policies will be ICT 1/10/07 reviewed annually. The IC web site will be updated on a regular ICT Ongoing basis to provide: policies, product information, educational material and appropriate links. 2.2 Education and The IC education programme has been ICT Ongoing training developed and will be used in: Education & The marketplace induction for new Training Nursing, Support and Contract staff Department Ongoing education for existing staff and development of Knowledge & Skills Framework indicators for IC for all staff The National IC „e‟ learning programme Ongoing will continue to be introduced throughout the Trust. The Trust will comply with the National „‟Clean ICT Ongoing Your Hands‟‟ campaign to reinforce correct use of alcohol hand gels in all inpatient units. The „‟Squirt and Go‟‟ posters will be circulated. The ICT will support the introduction of the new ICT and Head of Ongoing hand wash solutions in all areas. Hotel Services Educational leaflets, posters and the quarterly ICT newsletter will continue to be developed. Circulation of the IC booklet to all Clinical staff ICT and inclusion in induction packs will continue. Road shows as part of National Infection Control ICT 10/07 week will be held in key areas of the Trust and will include the Health Act. 2.3 Audit A proposed strategy and programme have been ICT 31/03/08 developed [Appendix 1]. These will include audits on: Antibiotic prevalence Ward kitchens throughout the Trust, in collaboration with the Catering Manager All inpatient areas with feedback to the Trust Nurse Advisors & Modern Matrons Capital Planning and Estates & Facilities schemes. Additional standards when critical issues have been identified All audit tools reviewed and developed for ICT Ongoing specific areas, will link in with existing Trust risk management and assessment tools. 2.4 Surveillance A targeted surveillance programme of alert ICT Ongoing organisms with a feedback loop to relevant clinicians will be developed with external Pathology Laboratories. Work will continue to ensure that results are received by the ICT in a timely manner, e.g alert organisms: MRSA. C. difficile. 2.5 Capital Planning Advice from the ICT will be given, as part of the Capital Planning Ongoing & service Buildings and Engineering Services policy for Department/ development Capital Planning and Estates & Facilities [E &F] E & F Managers with reference to the following: When preparing service specifications for engineering and building services When preparing tender processes for building and commissioning. The ICT will monitor Cleaning programmes and ICT Ongoing protocols in patient care areas to ensure high standards of cleanliness. As part of the Matrons Charter, the ICT will continue to work with the Modern Matrons The ICT will attend the Client Environment Board and Patient Environmental Operational Group meetings and give activity updates. 2.6 Hotel Services The ICT will continue to be involved in all stages ICT and Hotel 31/03/08 & Contracting of the contracting process for hotel services and Services processes other services that have implications for infection Managers control: Hotel services Porter services Laundry services Clinical waste disposal. 2.7 Medical The ICT will continue to attend the Medical ICT Ongoing Devices and Devices Group meetings. Advice will be given Equipment on infection control risks associated with the Management purchase, lease or loan of medical devices and other equipment used within the Trust. The introduction of new safety devices e.g butterflies will be monitored and staff training will ICT be sought from Product Representatives Progress so far [programme April 2007 – March 2008]: 1. POLICIES & PROCEDURES 1.1 The following policies were developed to comply with the Health Act: Aseptic technique Clostridium difficile Enteral feeding Antibiotic prescribing 1.2 The IC web site is updated on a regular basis to provide: policies, product information and educational material. 1.3 A new Clostridium difficile leaflet has been developed and circulated to all MHOA wards. 2. EDUCATION & TRAINING 2.1 The ICT continues to attend the Market-place in the more interactive induction for all new staff. 2.2 The ICT has launched the National Infection Control „e‟ learning programme in the MHOA wards in the Trust. Funding will be identified to enable the package will be launched to other inpatient areas. 2.3 The March edition of the IC newsletter featured information on the new National Patient Safety Agency‟s colour coding of hospital cleaning materials and equipment. This is contained on the IC website. 2.4 Ad hoc teaching sessions will be carried out throughout the Trust. 3. AUDIT 3.1 The ICT has commenced the audit strategy for 2007/2008: Infection Control environmental audits As part of the „‟Cleaner Hospitals and Lower Infection rates‟‟ document from the Department of Health, the programme of audits on inpatient units continue. Ward Kitchen audits, Maudsley A programme of audits will continue, in collaboration with the Trust Catering Manager, on ward kitchens throughout the Trust. OT Kitchens will also be visited. Progress on programme April 2006 – March 2007 1. EDUCATION & TRAINING 1.1 Infection Control stands featuring the topics of hand hygiene and sharps disposal were set up at the Ward Managers & Team Leaders day throughout 2006. They were well attended. 1.2 The ICT attended the market- place on all induction days for new staff (nursing, PAMS and ancillary staff). 1.3 Hand wash products from Ecolab were introduced throughout the Trust. Site surveys were carried out by the ICT and a representative from Ecolab to review individual areas‟ needs. The new back plates housing the soap dispensers contain hand hygiene educational material. 1.4 Members of the Project team, involved with the „‟Clean Your Hands‟‟ campaign [for non acute Trusts] at the National Patient Safety Agency, have visited wards at York Clinic. 1.5 As part of the Health Act and the „‟Clean your Hands‟‟ campaign, information on the alcohol hand gel “Spirigel” and the importance of hand hygiene to prevent cross-infection was circulated to all community staff. 1.6 Road shows were held on the Maudsley and Bethlem sites at the beginning of November as part of National Infection Control week. The theme was hand hygiene. They were well attended. 1.7 The infection control newsletter has been distributed quarterly via the Intranet. Topics featured include: Keeping the patient environment clean and tidy and National Infection Control week theme: „‟It‟s in Your Hands‟‟. 2. AUDIT The ICT audit strategy for 2006/2007 was completed: Infection Control environmental audits As part of the „‟Cleaner Hospitals and Lower Infection rates‟‟ document from the Department of Health, the programme of audits on inpatient units commenced in September 2006: Maudsley – 2 wards Bethlem Royal Hospital – 7 wards Guys Hospital – 4 wards St Thomas Hospital – 1 ward Ladywell Unit, Lewisham – 6 wards Lambeth Hospital – 9 wards The tool used includes standards on: waste management, sharps disposal and cleanliness of clinical equipment e.g. catheter stands. A report for each area with recommendations was prepared and forwarded to the relevant Modern Matron and Nurse Advisor. The results indicate poor to good compliance with the set standards. The critical issues identified were: Poor cleaning practices [particularly at high level]; Poor waste management and untidy areas. Ward Kitchen audits A number of audits were carried out, in collaboration with the Trust Catering Manager, on ward kitchens throughout the Trust. Issues relating to hand hygiene, temperature documentation & chilled storage were been identified. Antibiotic prevalence study This audit was not carried out during 2006/2007 owing to staff shortages within the ICT. A site survey of all ward kitchens at the Ladywell unit was carried out to check compliance with food hygiene requirements for the environment. The findings were fedback prior to the programme of refurbishment programme. 3 SURVEILLANCE June 2006 – May 2007 [See Appendix 2] 4. NEEDLE STICK INJURIES There have been no identified infections after reported injuries. Members of the ICT were involved in advising staff on the use of safety devices e.g. blood lancets and continuing with retractable needles. 5. INFLUENZA An order has been placed for the Influenza vaccine for both staff and patients. The delivery date will be in September 2007. Anti viral drugs [Tamiflu] are in stock in the Trust Pharmacy Department , to be used in the event of an outbreak of Influenza. 6. CAPITAL PLANNING & SERVICE DEVELOPMENT Members of the ICT meet regularly with a senior Project manager in Capital Planning for an exchange of information on building schemes. Mandate forms on all projects have been forwarded to the ICT. 7. FOOD & CATERING The ICNs have attended the Client Environment Board [and the newly formed monthly sub committee: Patient Environment Operational Group] meetings to ensure compliance with Food Hygiene legislation and resolve cleanliness issues. The ICT meet regularly with the Trust Catering Manager. 8. DRINKING WATER TESTING The ICNs continue to carry out testing of the drinking water supply during the commissioning of new buildings or in areas where there are concerns. 9. SWIMMING POOL The ICT is involved in overseeing the monitoring of the quality and treatment of the swimming pool at the Bethlem Hospital. Testing of the pool is carried out on a monthly basis. The team carry out inspections in collaboration with the Trust Health & Safety Risk Manager. 10. INFECTION CONTROL IN JOB DESCRIPTIONS As part of the Health Act, statements regarding adherence to all IC policies and procedures and the prevention of infection have been included in all new job descriptions. 11. PROFESSIONAL DEVELOPMENT The ICT has attended the annual Infection Control Nurses‟ Association conference in Brighton. This included the themes of governance, anti-microbial resistance and innovations. The ICNs have attended conferences and study days relating to Infection Control issues Report prepared by Karen Taylor & Aileen Jack – Infection Control Nurses. 5 June 2007 Surveillance - 1 June 2006 to 31 May 2007 Appendix 1 MRSA: For the months of June 2006 – May 2007, there have been 21 clients colonised with MRSA (Maudsley Hospital - 5, St Thomas - 2, Ladywell Unit - 3, Guys - 1, Bethlem - 5, and Community units - 4]. No secondary cases. Hep C: For the months of June 2006 – May 2007, 15% [22 out of 150] of those screened at Bethlem & Maudsley for Hepatitis C antibody were positive. The ICT liaised with Clinicians to ensure appropriate follow-up Hep B: For the months of June 2006 – May 2007, 156 patients were tested at Bethlem & Maudsley for HepBsAg. Following further tests, none were found to be HepBeAg positive. HIV For the months of June 2006 – May 2007, 33 patients were tested at Bethlem & Maudsley for HIV, two were found to be positive. No action was required by the ICT. C. difficile For the months of June 2006 – May 2007 – Nil cases Antibiotic resistant October 2006 infections e.g. One case of an ESBL in a urine specimen from a patient on an Older Adults ward at Maudsley. The decision was taken not to *ESBL, VRE, etc treat as the patient was asymptomatic. December 2006 One case of an ESBL in a urine specimen from a patient on a ward at the Lady well Unit. The decision was taken not to treat as the patient was asymptomatic. Pulmonary November 2006 tuberculosis A patient attending a community unit was found to have Pulmonary TB. The ICT liaised with the Consultant in Communicable in Lambeth for the follow-up of staff contacts. Other infections: Headlice August 2006 There have been two cases on two different wards on the Bethlem site. Advice was given on appropriate treatment and preventing spread. Scabies June 2006 There has been one case of scabies at the Bethlem Hospital which was successfully treated. February 2007 There has been a case of scabies on a ward at the Ladywell Unit. This was successfully treated. In both cases, advice was given to prevent the spread of infection. Chickenpox December 2006 There were seven cases in the Day Nursery on the Maudsley site. They were all excluded and advice was given regarding transmission. Shingles June 2006 There has been a case in a patient on a ward at St Thomas‟ Hospital. All contacts were identified. March 2007 There has been one case of shingles on a ward at the Bethlem Hospital. All staff and patient contacts were identified. In both cases, advice was given to care staff on the likelihood of spread. OUTBREAKS Diarrhoea and July 2006 Vomiting Elderly Care Unit – Maudsley Hospital Affected 4 patients over a 5 day period - commenced 14/7/06 October 2006 Addictions Detox Unit, BRH Affected 6 patients and 5 staff over a 21 day period - commenced 2/10/06 Addictions Detox Unit, BRH Affected 7 patients and 3 staff over a 14 day period - commenced 16/10/06 Staff Day Nursery, BRH Affected 4 patients over a 5 day period - commenced 14/7/06 Three stool specimens were taken. March 2007 Acute Psychiatric ward, Maudsley Hospital Affected 6 patients and 4 staff over a 12 day period – commenced 25 March 2007 April 2007 Acute Psychiatric ward, Maudsley Hospital Affected 10 patients and 1 member of staff over a 22 day period – commenced 4 April 2007 Elderly Care Unit – Guys Hospital Affected 6 patients over a 19 day period – commenced 21 April 2007 In all cases, following investigation, food was not implicated. *Extended spectrum beta-lactamases. Vancomycin resistant enterococcus 5 4 3 MRSA TOTAL 2 1 0 ov 6 n- 6 O 06 7 Ju 06 ar 7 p- 6 ug 6 ay 7 ec 6 p 7 7 M b- 0 N t-0 Ja -0 Fe 0 D -0 A -0 Se -0 A l-0 M r-0 -0 n- c Ju NB MRSA was identified in clients, the majority of whom were transferred into the Trust. There were no cases of infection and no secondary spread.