Attachment Y Trust Board Meeting 27th January 2010 Title of document Paper No: Attachment Y DIPC Update on Infection Prevention and Control Submitted on behalf of Mr Rob Evans Aims / summary Present compliance with Code of Practice, Health and Social Care Act, for prevention and control of infection. Update progress against IP&C projects Action required from the meeting Document owners to ensure updated. Clinical Units to prioritise activity for IP&C, especially audit Contribution to the delivery of NHS / Trust strategies and plans Contribution towards zero harm Financial implications Legal issues Legal requirement to be registered with CQC and comply with Code. Who needs to be / has been consulted about the proposals in the paper (staff, commissioners, children and families) and what consultation is planned/has taken place? Who needs to be told about any decision Who is responsible for implementing the proposals / project and anticipated timescales All staff, especially CUs Who is accountable for the implementation of the proposal / project DIPC, CUs, Medical Director, Other units Author and date J C Hartley 20/1/2010 Attachment Y Update Report on Infection Prevention and Control at GOSH Jan 2009 Author: Dr John Hartley, Director of Infection Prevention and Control Thank you for the opportunity to give this regular update, my first since taking up the role of DIPC from Ms Susan Macqueen, Lead CNS Infection Prevention and Control, following her official retirement at the end of July 2009. Susan is currently working 3 days a week with us as the Lead CNS, pending the commencement of her replacement, Ms Enfys Mercieca, in March In this report I will focus on the three areas, compliance with the Code of Practice and some areas of process and outcome audit. 1. Health and Social Care Act 2008 Code of Practice for health and adult social care on the prevention and control of infections and related guidelines Update version published 16 Dec 2009 Registration with the Care Quality Commission is a legal requirement. Compliance with the Code of Practice is a necessary requirement to maintain registration. There are 10 Compliance Criteria Compliance What a service provider will need to demonstrate 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. 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 on infections 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. 7 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 practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care. Detailed analysis of the compliance guidance has been performed and documentation is available, or in preparation, to demonstrate compliance. A huge amount, of often unseen, activity underpins this. However, some policies have not been completed or updated at expected time and this is a priority. Not all required reporting to Board occurs. Attachment Y Action: a.All document owners to ensure regular review and update of policies. b. Need to address compliance point 1.5 on IP&C activity, requiring quarterly reporting to Board by clinical directors and modern matrons. Endoscope decontamination was an area of focus at the previous Health Care Commission visit. This has been addressed. Investment of space and money is likely to be necessary to maintain Decontamination Services en site and respond to the concerns regarding vCJD control. Action: Decontamination Strategy options, being developed, will need to consider this. 2. Infection Prevention and Control Process Audit – Link Practioners A large range of audit is performed in relation to the policies and procedures highlighted through compliance with the Code of Practice. In this report I would like to comment on the schedule of Infection Prevention and Control process audits that are required (these include areas such as hand hygiene and central venous line care bundle compliance). Feed back of data has been facilitated by development of Dashboards, through the work of the Transformation team. As demonstrated previously in November Zero Harm Report. Completion of audit cycles: The audits are performed by the team of Link Practioners. Completion of audits is not 100% and this must be addressed. Discussion with staff suggest that performance of routine clinical care does not leave adequate time to complete the audits. Action: All clinical units need to ensure adequate time and staff are available to ensure timely performance of Infection Prevention and Control Audit. 3. Infection Prevention and Control Outcome Data A. KPI mandatory data i. MRSA Bacteraemia Data Financial year 06/07 07/08 08/09 09/10 to Jan Episodes 5 2 8 1 New ‘MRSA Objective’ for 10/11 is 2 or less (previously 4 or less). See ‘Risk’ below. ii. Trust assigned C. difficile infection Financial year 06/07 07/08 08/09 09/10 to Jan Episodes 11 10 8 Risk of non-compliance: Small numbers of cases and new criteria raise risk GOSH will not meet MRSA and C. difficile targets simply through ‘statistical’ variation. Action: Meeting with Lead Commissioning PCT arranged. Attachment Y B. Transformation supported Infection Projects The Transformation Infection Projects Elimination of avoidable • Central venous line associated infection • Ventilator associated pneumonia • Surgical site infection Combination of - implementation of best practice through care bundles - with surveillance to detect a problem and demonstrate improvement. CVL infections CVL infections – unavoidable base line or stuck? - Modify hand 2% Chlorhexidine/70% Alcohol Practical Annual Hub Disinfection IV competency Update hygiene and Introduction of annual line care IC audit programme bundle audit Re-launch CVL Care Bundle -Increase analysis -Target areas 2%Chlorhexidine/ 70% Alcohol Skin Disinfection Ventilator associated pneumonia Pilot surveillance (accepted for publication JHI) PICU One year surveillance shows Establishing Nurse-Led 1. VAP is rare – one case in Ventilator-Associated Sept 2009. To change to Pneumonia Surveillance - ‘Days since last case’ In Paediatric Intensive Care M Richardson (1), S Hines (1), G Dixon (2), 2. Care bundle compliance L Highe (1), J Brierley (1) (1) Paediatric and Neonatal Intensive Care Unit rose from 6.5% to 91%. (2) Microbiology Department Routine care. Reduce frequency necessary. 3 cases over 4 months Introduction of Care Bundle and surveillance - Modified over coming year July 2007 Oct 2008 Dec 2009 Jan 2010 NICU – pilot underway Attachment Y Surgical site infections GOSH Surgical site infection Clinical speciality surveillance: surveillance team (Special Trustee Spinal – Oct 08 – Jun 09. funded) Local team, with support and Mr Garner (tissue viability CNS) encouragement, working to HPA would lead the group, based standard with post discharge within IP&C component (but not sustained). 4 new staff for 3 years: - Data manager (Started Nov 09) Urology – May 08 - integrated a - 2 clinical support workers (first system within newly developed local started Nov 09) audit data base. Working in parallel with Neurosurgery – continuous audit data A new practice educator base (but not continuous output) to work on care bundle side (Starting today) Nov 09 Jan 10 Action: Reinforce audit and compliance with care bundles and root cause analysis. Look forward to working with surgical specialities on overall IP&C action plans, with assistance on surveillance and implementation of care bundles. Additional data - C. MRSA acquisition in GOSH Year - 06 07 08 09 First detection 127 128 158 162 Possible acquisition 19 5 11 11 Action: Continue extensive screening (remaining compliant with national screening requirement) and implement isolation policy. D. All S. aureus bacteraemia GOSH S.aureus bacteraemia – patient episodes 30 S. aureus 25 MRSA 20 15 10 5 0 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2001 2002 2003 2005 2006 2007 2008 Action: Achieving steady decline but not eliminated avoidable. All CUs asked to support staff in RCA process. Consider decolonisation for MRSA or sensitive strains.