Infection Control Annual Report Templates Commissioning Infection by pce42101

VIEWS: 334 PAGES: 37

More Info
									          Commissioning
  Infection Prevention & Control
          Annual Report
              2009/10


              September
                2010


                 AUTHORS:

                  Sue Jeffers
Director of Infection, Prevention and Control
                       &
        Linda Woodward-Stammers
         Lead Community Infection
   Prevention & Control Nurse Specialist
                NHS Hounslow

                  Page 1 of 37
Acknowledgments:

Dr Stella Barnass, Consultant Microbiologist, Flu Resilience Director, West Middlesex
University Hospital
Carlolyn Calvert, Emergency Planning Officer NHS Hounslow
Colin Holloway, Hounslow and Richmond Community Healthcare
Jyoti Khambhaita, Interface Pharmacist NHS Hounslow
Dr May Kyi Consultant Microbiologist, West Middlesex University Hospital
Wing Liu, Epidemiologist North West London Health Protection Unit
Archibong, Mfon, Contract Manager (Primary Care) Feltham Young Offenders
Institute
Yuen Marusic, Facilities Manager West London Health Estates
Anna Marie Mitchell, Occupational Health Manager West Middlesex University
Hospital
Yasmin Quereshi Senior Commissioning Manager
Nicola Sirin, Assistant Director for IPC and Decontamination Hounslow and
Richmond Community Healthcare
Elaine Smith Lead Infection Prevention and Control Nurse West London Mental
Health Trust




                                   Page 2 of 37
                                                                      Page
      Table of Contents                                               No.
      Part One: Executive summary and corporate overview of IPC
      responsibilities and arrangements

1.0   Introduction                                                     5

2.0   Executive Summary                                                5

3.0   Statutory Responsibilities                                       7

4.0   Infection Prevention and Control Nurses report                   8

4.1   Raising Awareness                                                8

4.2   Freedom of Information requests                                  8

4.3   Complaints                                                       8

4.4   Policy Development                                               9

4.5   Support and Advice                                               9

4.6   Training                                                         9

4.7   Publication and Guidance                                         9

5.0   Antibiotic Stewardship                                           10

6.0   Outbreaks, Adverse Incidents and Serious Unto Wards Incidents    10

6.1   Inoculation Incidents                                            10

6.2   Community Acquired MRSA Bacteraemia and Clostridium difficile    10
      related deaths

6.3   Outbreaks                                                        11

7.0   Facilities Report                                                12

7.1   Waste Management                                                 12

7.2   Cleaning                                                         13

8.0   Pandemic Influenza                                               14

9.0   Surveillance                                                     15

9.1   Tuberculosis                                                     15

10.0 Immunisation                                                      16




                                   Page 3 of 37
10.1 Influenza Campaign                                              16

10.2 BCG Immunisation                                                16

10.3 School Leavers Vaccination Programme                            16

10.4 Primary Immunisation Programme and MMR Vaccination Programme    16

10.5 HPV Immunisation Programme                                      17

11.0 Occupational Health                                             17

      Part Two: Independent Contractors and Provider Organisations


1.0   Introduction                                                   19

2.0   General Practitioners                                          19

3.0   General Dental Practitioners                                   20

4.0   Pharmacist and Ophthalmologists                                20

5.0   Nursing and Residential Homes                                  20

6.0   West Middlesex University Hospital                             20

7.0   Hounslow and Richmond Community Healthcare                     23

8.0   West London Mental Health Trust                                24

9.0   Feltham Young Offenders Institute                              26

10.0 Conclusion                                                      27

      Appendix A                                                     28




                                     Page 4 of 37
       1.0 Introduction

NHS Hounslow has a general responsibility as a commissioning body to satisfy itself
that commissioned services from providers and independent contractors have the
appropriate systems in place to keep patients, staff and visitors‟ safe from acquiring a
health care associated infection as far as is reasonably practicable.
The Board has collective responsibility for minimising the risk of infection and to
ensure that arrangements are in place in order to provide the required assurance that
the above responsibility is being effectively discharged. This report identifies the
general means by which the Board secures that assurance and is duly requested to
note the content of this report.

Prior to the Provider/Commissioning separation in October 2009 the PCT had a joint
infection prevention and control (IPC) plan which included the work plan to be
undertaken by both PCT Provider Services and Commissioning. From April 2009
NHS Hounslow and Richmond Community Healthcare had separate IPC action
plans. This report summarises the progress made with the continued implementation
of IPC practices across services commissioned by NHS Hounslow. It provides an
overview of developments and incidents related to IPC and how the organisation is
monitoring the performance of the services in relation to compliance with the Hygiene
Code (The Health and Social Care Act 2008: Code of Practice for the health and
social care on the prevention and control of infections and related guidance) together
with an assessment of performance against national targets during 2009/10.

       2.0 Executive Summary

 This year has been challenging for the integrated IPC team as the team has
undergone a number of changes both within the current structure of the team and the
organisation.
Following the separation of provider services from NHS Hounslow and to ensure the
continuity of the IPC service for both arms of the organisations it was agreed by all
parties concerned that one WTE IPC nurse post would be allocated to the provider
and one WTE IPC nurse post to commissioning. This restructuring was effective from
1st September 2009. However due to the long term sickness of the provider IPC
nurse there were limitations to the service provided to the alliance provider
organisation.

Despite the additional pressures of the pandemic flu and long term sickness within
the community team the IPC team has maintained an effective service and has
delivered the majority of the objectives set out IPC annual plan. This has resulted in
an improved level of awareness for commissioning staff and the independent
contractors and the effective monitoring of the provider organisations.

The objectives that have not been met in this financial year will be transferred to the
2010/11 plan. These include a further audit on the use of the inter health care
transfer form, self assessment audits of IPC practices in primary dental and general
practice and monitoring of new staff for pre employment screening and
immunisations.

One of the key concerns highlighted in this report is compliance with annual IPC
training for both provider organisations and the independent contractors. This will be
closely monitored by the IPCC in 2010/11 with a recommendation that training
records are reviewed during contract monitoring meetings for the provider


                                    Page 5 of 37
organisations and incorporated as part of the monitoring and verification process for
relevant local enhanced services within primary care.

In October 2009 Hounslow and Richmond Community Healthcare registered with the
Care Quality Commission (CQC) in April 09 and was awarded unconditional
registration with the requirements of the Health and Social Care Act 2008 Code of
Practice for health and adult social care on the prevention and control of infections
and related guidance.

West Middlesex University Hospital (WMUH) also successfully registered with the
CQC in April 2009. In addition the CQC made an unannounced inspection on the 3rd
September. It was reported by the inspectors that the Trust had breached the
regulation to protect patients, workers and others from acquiring a healthcare
associated infection. From the 16 measures inspected two were found to be in
breach of the code. The trust addressed the issues identified and on a subsequent
visit on the 3rd November 2009 the Trust provided assurance to the inspectors and no
further breaches were reported.

For the second year in succession NHS Hounslow and WMUH has achieved a
significant reduction in the number of Clostridium difficile infections within the local
health economy the total number being 77 positive samples being identified, the
upper limit being set at 210. The total number of post 48 hour positive samples
identified at WMUH was 36 cases the upper limit being set at 145.

In addition WMUH has achieved the MRSA bacteraemia target for the first time since
the targets were set in 2004. In total 16 cases were identified out of an upper limit of
17. It should be noted that 9 of the cases were classed as community infections as
they were identified within 48 hours of admission. Five of the nine cases were
apportioned to NHS Richmond and four to NHS Hounslow, three out of the four
cases were admitted from nursing/residential homes. Improving communication and
monitoring IPC practices will be key in reducing the reservoirs of infection within the
local community settings and forms part of the annual IPC plan for 2010/11.

In September 2009 the new cleaning contract was awarded to Lakethorne Group.
Cleaning standards continue to be monitored by West London Health Estates.
Overall the audit results have remained consistently high. However, due to the delay
in awarding the contract the deep clean programme was not implemented. This will
be addressed during 2010/11 financial year.

In conjunction with the IPC nurse from West London Mental Health Trust (WLMHT)
the commissioning IPC nurse has continued to monitor the IPC practices at FYOI.
IPC audits have been undertaken and the majority of the actions identified have been
addressed by the Associate Clinical Director for healthcare at FYOI. One area of
concern is the low uptake of infection control training, to date only 58% of FYOI staff
have attended IPC training.

In addition poor attendance at training for WLMH trust staff is of equal concern with
the trust reporting only 75% of staff attending. As highlighted by the CQC during an
inspection in November 2009 further development is required to ensure that there is
a robust audit plan in place to monitor compliance with IPC including regular hand
hygiene audits. Attendance at infection control training will now be a focus for FYOI
with the new provider in place.




                                    Page 6 of 37
Further progress on ensuring IPC is implemented into general practice has been
achieved this year by incorporating IPC standards in the local enhanced services;
these include the MRSA screening LES and the minor surgery LES.
A rolling programme of minor surgery audits has been carried out by the quality
standards nurse and the lead IPC nurse. This work will continue as part of the
2010/11 annual plan. To date all practices audited who are undertaking minor
surgery are compliant with the standards.
Poor attendance of GPs and practice staff at IPC training remains an issue of
concern that the team is seeking to address by providing the contact details of IPC e-
learning courses to practice managers.

IPC visits have not been carried out routinely to General Dental Practices but when
invited by the practice or requested by the dental commissioning manager. Eight
practice visits were undertaken by the lead IPC nurse as part of the Department of
Health‟s national dental survey. The purpose of this survey was to gain good quality
information to help the Department of Health Dental and Estates teams to further
develop well constructed, supportive policies and guidance on decontamination in
primary care. The intention is that compliance with these structures will be an
effective way for practitioners to ensure that they are using dental instruments which
meet modern standards in terms of cleanliness and sterilisation. This will increasingly
be one of the recognised key requirements within the Health and Social Care Act
2008 Code of Practice for health and adult social care on the prevention and control
of infection.

Following a review of the work programme required for 2010/11 and the expanding
remit of the IPC service which now includes providing advice to the nursing and
residential homes a business case has been approved for a second part time IPC
nurse for commissioning. Fully implementing the measures in the 2010/11 annual
plan will be dependent on the successful recruitment of a trained professional.

During the last year both IPC nurses have continued to update their professional
development by attending key seminars and study days provided by outside
agencies such as the Department of Health, the National Patient Safety Agency and
the Royal College of Nursing.



       3.0   Statutory Responsibilities

The Health and Social Care Act 2008 – Code of Practice for the NHS on the
prevention and control of healthcare associated infections and related guidance.
This Act published by the Department of Health in January 2009 was revised and
republished in 2009, changing the title slightly to include health and social care in
stead of NHS and to cover the prevention and control of infections instead of
healthcare associated infections only. This is to ensure that people who use health
and social care services receive safe and effective care. This document sets out
what registered providers of health and social care services should do to ensure
compliance with the Care Quality Commission (CQC) registration requirement for
cleanliness and infection prevention and control.
It also sets out the 10 criterion against which a registered provider will be judged on
how it complies with this registration requirement.
The main purposes of the code of practice are:
To make the registration requirement for cleanliness and infection prevention and
control clear to providers of health and social care services so that they know what
they need to do to comply;


                                    Page 7 of 37
For the CQC‟s staff who will be judging compliance with the Code;
For people who use the services of a registered provider
For commissioners of services (primary care trusts and councils); and
for the general public.
From April 2010 prison healthcare services will be required to comply with the full set
of requirements. Independent healthcare and adult social care providers will be
bought into the system from October 2010 with Primary dental care joining in April
2011 and General Practitioners joining in April 2012.
Monitoring the provider organisations compliance with this Code will be documented
under part B of this report.


4.0 Infection Prevention and Control Nurse Progress Report

       4.1 Raising Awareness

The implementation of the National Patient Safety Agency (NPSA) Cleanyourhands
campaign continues to be embedded across the whole health economy. Promotional
campaign materials have been distributed quarterly to all PCT sites, General Practice
and the residential homes in Hounslow to continue to promote the importance of
hand hygiene. IPC road shows have been held at Brentford Health centre, WMUH,
Feltham Centre for Health and Heart of Hounslow Polyclinic. The focus of these has
been hand hygiene and sharps management and provides an opportunity for both
staff and the public to discuss infection prevention and control initiatives.
In conjunction with the World Health Organisation the NPSA launched the “Five
Moments for Hand Hygiene”. This approach to hand hygiene was developed to
reduce unnecessary hand hygiene, stresses the importance of the correct location
and time for hand hygiene thus ensuring that the chain of transmission is broken to
avoid preventable infections. This new programme for hand hygiene is now included
as part of the mandatory IPC training. Leaflets and credit cards were attached to all
employees wage slips as part of the launch.

IPC newsletters have been circulated to the independent contractors, commissioning
staff and provider staff. Topics covered include results of audits, information on the
flu pandemic, “The Five Moments for Hand Hygiene”, sharps management and
training dates.

       4.2 Freedom of Information Requests

During 2009/10 there were four requests relating to infection prevention and control
received under the freedom of information act 2000 section 10. All received the
appropriate response within the specified time frame.

       4.3 Complaints

NHS Hounslow received one complaint relating to an infection prevention and control
incident which involved an independent practitioner. The team worked closely with
the patient experience team and the other healthcare professional cited in the
incident to ensure that the complainant issues received a satisfactory response.
Lessons learnt from the investigation are being disseminated within general practice
and will be included as part of the IPC newsletters and presented at one of the GP
forums.




                                    Page 8 of 37
       4.4 Policy Development

The integrated infection prevention and control policies are available on the PCT
intranet.
In view of the provider and commissioning split it has been agreed by the IPCC that
the relevant IPC polices required by the commissioning staff will be reviewed by the
IPC team. These will also be available for the independent contractors and the
nursing and residential care homes as guidance. Polices will be evidence based and
reflect current legislation.
In 2009/10 an MRSA screening policy was introduced to support the implementation
of the MRSA screening programme.

       4.5 Support and Advice

To comply with The Code of Practice (2006) and Infection Control in the Built
Environment (2004) it is imperative that the IPC team are involved prior to any
refurbishment or building works to ensure that the plans meet IPC standards.
In 2009/10 the IPC team provided advice and support to a number of refurbishments
and building projects within NHS Hounslow‟s premises; these include the new sexual
health clinic, radiology suite and changing places at Heart of Hounslow polyclinic and
refurbishments of some of the clinical rooms at Chiswick Health Centre.
Disappointingly the team was not consulted at the onset of all of these projects;
hence there are some concerns with the finished projects.

        5.6    Training
During the first three quarters of the year local IPC training was carried out by the
integrated team across various PCT sites for provider and commissioning staff.
Training has also been provided at the bi-monthly corporate induction to acquaint
new staff with IPC procedures. For the last quarter the training was delivered by the
Hounslow and Richmond Community Healthcare IPC team. Low attendance at these
sessions from primary care remains a concern for the IPCC. To encourage
attendance and to ensure that IPC standards are maintained mandatory IPC training
is now a pre-requisite for performing any clinical local enhanced service in 2010/11.
In addition evening training sessions for Lakethorne cleaning staff were arranged but
poorly attended. Attendance at training is an issue for all providers and is something
that will be closely monitored by the commissioners supported by the IPC
commissioning nurse during 2010/11.

As part of the flu pandemic preparedness Filtering Face Particle 3 (FFP3) mask train
the trainer sessions were organised. This training is required to comply with health
and safety legislation for all staff undertaking aerosol generating procedures while
caring for patients who have pandemic influenza to ensure that the mask is fitted
correctly.
Representatives from community nursing, physiotherapy, community dentistry,
community children services and general dental practices attended the training.
In addition two IPC sessions were held for frontline staff who volunteered to work at
the ACP at the Therapy Centre at WMUH and Montague Hall.

       4.7 Publications and Guidance

All new publications and statutory legislation are reviewed by the IPCC.
Any relevant issues are disseminated throughout the organisation and the local
health economy.




                                   Page 9 of 37
       5.0 Antibiotic Stewardship

The Health Act 2006 (revised 2008) states that procedures should be in place to
ensure prudent antibiotic prescribing, while the Department of Health states that
prescribing polices should be compliance audited.
During 2009-2010 NHS Hounslow Management of Infection Guidelines has been
updated and a Quick Reference Guide produced for prescribers to use alongside the
full document. An audit of antibiotic prescribing was not undertaken during 2009-
2010. However, antibiotic prescribing is one of a number of target areas that GPs
have been requested to focus on. The aim of monitoring antibiotic prescribing is to
encourage prescribers to reduce the overall number of prescriptions written for
antibiotics and also to use agents from the PCT Preferred Top 10 list. Monitoring of
antibiotic prescribing will be a priority for the medicines management team in 2010-
2011. In addition the importance of appropriate antibiotic prescribing will be
emphasised again at the annual QOF Med6 indicator meeting between GP practice
and the Prescribing Advisor.

6.0 Outbreaks, Adverse Incidents and Serious untoward Incidents

        6.1 Inoculation Incidents
Since the last report seven staff from the independent contractors have sought
treatment and advice from the occupational health department for inoculation injuries.
In comparison to 08/09 this relates to a 57% increase. Although this data shows that
there has been more staff sustaining an injury, in the past under reporting of
incidents has been a concern and therefore this figure is probably a more realistic
interpretation of the incidents that have occurred. The increase may also be
attributed to the sharps awareness audit which was completed in 2009/10.
Only one member of staff completed an IR1 form. However, it should be noted that
independent contractors have their own in house reporting mechanisms in place and
are therefore not obliged to report these incidents to the PCT.


       6.2 Community Acquired MRSA Bacteraemia and Clostridium difficile
        Related Deaths

The definition of a community acquired MRSA bacteraemia is an infection identified
from a blood culture taken within 48 hours of admission.
In total nine cases of community acquired MRSA bacteraemia were detected during
2009/10. Four of the cases were identified at WMUH, one at Hillingdon hospital, one
at Kingston and three from Imperial College Healthcare NHS.

The WMUH integrated IPC team have reviewed the four community cases identified
from samples sent to the Quest laboratory. An action plan has been developed
based on the relevant findings in order to eliminate preventable cases in the future.
Of the four cases identified three of the patients were admitted from a
nursing/residential home. Working with the nursing/residential homes has been
identified as a key priority in the annual plan for 2010/11, implementing this will be
subject to the successful recruitment of an additional IPC nurse.

One serious unto wards incident relating to Clostridium difficile associated diarrhoea
related death was reported to the Strategic Health authority and fully investigated
through a RCA by the integrated team at WMUH. This SUI was classified as a
community acquired infection as a positive stool sample was identified in the
laboratory within 48 hours of admission.



                                   Page 10 of 37
For 2010/11 the National Quality Board has introduced a new objective for MRSA
bloodstream infections. Primary Care organisations will, for the first time be directly
accountable for improving rates of MRSA bacteraemia in their local populations.
In addition, in 2010/11 PCTs also need to achieve the national target for Clostridium
difficile infections which is at least a 30% reduction in the number of infections
compared to the 2007/8 baseline.
Reductions in healthcare associated infections are a tier 1 priority for the NHS and
will be monitored as VSA01 and VSA03.

       6.3 Outbreaks

Information prepared by Wing Liu Epidemiologist from the North West London Health
Protection Unit.
In 2009/10 there were twenty outbreaks reported to the North West London Health
Protection Unit. Please see below table.
One of the key outbreaks that attracted both public and media interest was the E coli
0157 outbreak in a primary school. This investigation identified 13 confirmed cases
and involved screening 300 pupils before the school was re-opened.

Cause of          Date of        Number of            Location         Control Measures
Outbreak          Incident       people involved
Gastroenteritis   11/5/09        10                   Primary School   Exclusion period
                                                                       Enhanced cleaning
                                                                       Emphasis on hand
                                                                       washing
Norovirus         25/06/09       37                   School           Exclusion period
                                                                       Enhanced cleaning
                                                                       Emphasis on hand
                                                                       washing
Food poisoning    10/08/09       16                   Wedding          Cleaning of
                                                                       premises
Swine flu         28/09/09       8                    Special Needs    Advised vaccination
                                                      School           of staff and children
Norovirus         28/9/09        31                   Infants School   Exclusion period
                                                                       Enhanced cleaning
                                                                       Emphasis on hand
                                                                       washing
Gastroenteritis   29/09/09       2                    Nursery School   Exclusion period
                                                                       Enhanced cleaning
                                                                       Emphasis on hand
                                                                       washing
Norovirus         1/10/09        21                   Infants school   Exclusion period
                                                                       Enhanced cleaning
                                                                       Emphasis on hand
                                                                       washing
Gastroenteritis   14/10/09       12                   Primary school   Exclusion period
                                                                       Enhanced cleaning
                                                                       Emphasis on hand
                                                                       washing
Norovirus         20/10/09       3                    Primary school   Emphasis on hand
                                                                       washing Exclusion
                                                                       period




                                      Page 11 of 37
Norovirus         26/11/09      58                   Middle school    Exclusion period
                                                                      Enhanced cleaning
                                                                      Emphasis on hand
                                                                      washing
Norovirus         13/01/10      7                    Nursing home
Norovirus         11/01/10      14                   Primary school   Enhanced cleaning
Norovirus         28/01/10      15                   Nursing home     Hand washing
                                                                      Isolation of
                                                                      symptomatic cases
Ecoli 0157        30/1/10       13 confirmed         School           Hand washing,
                                                                      exclusion period,
                                                                      clearance samples
Gastroenteritis   25/01/10      10                   Nursery          Enhanced cleaning
Norovirus         4/2/10        6                    Nursery          Enhanced cleaning
Norovirus         8/3/10        15                   Primary school   Exclusion period
                                                                      Enhanced cleaning
                                                                      Emphasis on hand
                                                                      washing
Norovirus         4/2/10        25                                    Hand washing,
                                                                      Clearance samples,
                                                                      Exclusion period
                  19/3/10       8                    Care Home        Enhanced cleaning,
Norovirus                                                             hand washing,
                                                                      isolation of
                                                                      symptomatic cases
Norovirus         2/2/10        10                   Hospital         Ward closed,
                                                                      reopened after
                                                                      patients
                                                                      asymptomatic for
                                                                      48 hours



7.0 Facilities

        7.1 Waste Management
The waste steering group chaired by the Assistant Director for Quality Standards
continued to meet throughout 09/10. The main function of this group was to monitor
the implementation of Health Technical Memorandum 07-01 Safe Management of
Healthcare Waste. The group reports to the IPCC. The PCT‟s appointed waste
advisor (Independent Safety Services (ISS) Ltd) carried out an audit in June 2009 at
three of the PCT sites. This was to determine NHS Hounslow‟s current compliance
with waste management and dangerous goods safety. The majority of the main
findings of the audit have been rectified. The table below shows the outstanding
issues to be addressed;

Recommendation                          Action to be Implemented
Implementation of an offensive waste Partly addressed, awaiting confirmation
stream.                                 from the waste contractor for operational
                                        arrangements for collection of offensive
                                        waste.
Issue clear signage on bins and support Posters now in place, labels for bins to
posters to aid segregation of waste.    be ordered.
Pre acceptance audits to be undertaken Finances to be agreed.


                                     Page 12 of 37
to provide assurance to the waste
contractor of what type of waste is
generated and that services are
segregating waste correctly.


In addition the waste advisor delivered waste training to both staff from Provider
Services and the independent contractors.

NHS Hounslow‟s waste management policy was ratified and approved by the Board
in year.

       7.2 Cleaning

Cleaning Tender

West London Health Estates Facilities Management (WLHEFM) tendered out the
cleaning services on behalf of the five PCTs. This was done under a joint Official
Journal for European Union process to achieve best pricing under economies of
scale.

The tender programme commenced in the middle of February 2009 and of the 44
contractors that expressed an interest in the contract, 19 submitted Pre Qualification
Questionnaires, 6 companies were short listed and 4 submitted full tender
documentation by the deadline on Friday, 19th June 2009. Two companies withdrew
their tender prior to the deadline.

The contract is estimated to be in excess of £1.5 million and the specification is
designed to be in line with the latest National Standards of Cleanliness with the ability
to adapt to future requirements. Bidders have included in their tenders, related
services that each PCT can purchase if they wish to depending on costs. The
additional services were:

Window Cleaning
Annual Deep Cleaning programme (NHS “From Deep Clean to Keep Clean”
program)
Weekly clinical equipment wash down
IT and Phone Cleaning service
Curtains and Blinds

Bids were opened, analysed and Lakethorne were unanimously voted by the
Cleaning Tender Steering Group on the 24th July 2009 to be the preferred contractor
for the new cleaning contract.

The new contract commenced on 1st December 2009 with a 3 years (and 1 year + 1
year) term by Sue Jeffers and it was confirmed that the PCT would fund the
additional services of curtain changes and annual deep clean.

Cleaning Audit Scores

The table below highlights the average monthly cleaning audit scores for the
community sites within NHS Hounslow from 1 April 2009 to 31 March 2010. The
National Standards of Cleanliness 2007 recommends each NHS organisation sets
out its own pass rate, taking into account of the clinical activities being carried out
and the level of infection/risk these carry. A complicated formula is proposed to


                                    Page 13 of 37
establish this for each area so a general pass mark of 85% was the adopted
standard in the current cleaning contract and the approved contractor Lakethorne is
expected to maintain the standards and achieve this pass mark.

Results of Quarterly Cleaning Audits - April 2009 to March 2010

Site                                    Average Score Per Annum
Bedfont Clinic                          93
Brentford Health Centre                 91
Brookwood Centre for Health             92
Chinchilla Centre for Health            93
Chiswick Health Centre                  90
Feltham Health Centre                   91
Heart of Hounslow                       94
Heston Health Centre                    94
NHS Hounslow Headquarters               93
Isleworth Centre Practice               91
Maswell Park Health Centre              91
Spur Road                               91
Thornbury Road Centre for Health        92


All sites achieved and exceeded the pass mark.

Regular feedback from Support Services Managers and Health Centre Co-ordinators
have been positive and overall all sites are satisfied with the services of Lakethorne.

Cleaning Auditing Process

WLHEFM have provided Cleaning Audit Training to site staff previously and have
provided weekly and monthly/quarterly excel auditing templates for staff to use and
complete.

Regular weekly audits from Chiswick HC, Feltham HC and Bedfont Clinic have been
received by WLHEFM. Joint monthly audits between site staff with Lakethorne‟s
Auditor are carried out and joint quarterly audits are undertaken by the Facilities
Team, Lakethorne, IPC team and site staff when dates are made available.

8.0 Pandemic Influenza
The first cases of swine influenza were reported in Scotland on 27th April 2009; the
virus challenged all those involved in delivering healthcare nationally. The World
Health Organisation (WHO), declared escalating phases of pandemic alert over the
course of the following weeks. Fortunately, Hounslow was reasonably well prepared
locally due to excellent partnership working during the years prior to pandemic via the
„Flu Pandemic Planning Group. Flu plans were in place and revised accordingly, to
meet the challenging needs of this escalating situation. On June 11th, the WHO
declared the first influenza pandemic of the century.

NHS Hounslow responded to the initial outbreak of Swine „Flu and ensured all
protocols were followed in accordance with the HPA, NHS London and Department
of Health guidance. The first confirmed cases were identified locally on 26th June
(one patient seen in A&E at West Middlesex University Hospital and one a GP
patient).




                                   Page 14 of 37
Personal protective equipment was ordered based on the original Hounslow
stockpiling tool document to ensure enough equipment would be in place for the PCT
and partners including West London Mental Health Trust and GP practices.
 Arrangements were made for storage within the Heart of Hounslow Centre for Health
and space was rented at the Big Yellow Storage Facility locally.

Herbert and Herbert Pharmacy were identified as the initial Antiviral Collection Point
(ACP) locally. A decision was made soon afterwards, to open the planned primary
site at O Block, West Middlesex University Hospital, to increase capacity. Training
took place to ensure staff had the necessary skills and capabilities to man the ACP.
As the pandemic progressed, a decision was made to relocate the ACP to Montague
Hall (1 of 5 identified ACP sites included in the Hounslow Pandemic Influenza Plan),
which was more centrally located and positioned close to the Metropolitan Police
Station, in preparation of a surge situation.

Over the course of the pandemic a total of 214 patients (131 adults and 83 children)
were admitted with suspected Swine „Flu at West Middlesex university Hospital,
although these figures may be underestimated. 47 cases were confirmed and six
patients required intensive care.

The antiviral drugs Tamiflu & Relenza arrived at the end of May 2009 and were
stored within the pharmacy at West Middlesex University Hospital. Vaccine stocks
arrived for local use on 26th October 2009 and the NHS Hounslow Vaccination Sub-
Group was set up to organise delivery of the programme in conjunction with
Occupational Health at WMUH.

The ACP was scaled down back to Herbert & Herbert Pharmacy at the end of
January 2010. The final meeting of the „Flu Pandemic Operational Group was held
on 29th January 2010 and a Hounslow Health Economy debrief workshop was held,
hosted by NHS Hounslow on 19th February 2010.


9.0    Surveillance

       9.1 Tuberculosis
The prevalence of tuberculosis within Hounslow remains high with a rate of
approximately 79.9 cases per 100,000 population.

A targeting TB Steering Group is in operation which is a partnership across three
„agencies‟ including the West Middlesex University Hospital the London Borough of
Hounslow (LBH) and the PCT. The partnership was formed in 2006 as part of the first
LAA (Local Area Agreement). The partnership was created due to increasing rates of
TB in Hounslow which at the time had the third highest rate in North West London.
The overarching outcome indicator for the LAA was “To improve the control of
Tuberculosis and reduce transmission rates in Hounslow”. The focus of the
partnership has been threefold: (a) increasing the percentage of people who
complete their treatment for TB and (b) increasing the percentage of people who
complete the contact tracing follow-up process. Both of these indicators are seen as
being of high priority in the National TB Action Plan and (c) to raise awareness within
the local population – in particular amongst high risk groups); health professionals
and key workers in the LBH.

Since March 2010 Dr Shaaz Mahboob, Associate Director of Public Health Business
and Programmes has taken over as the Lead for TB from Dr Latha Hapugoda. The
TB Steering Group has been meeting regularly with participation from NHS


                                   Page 15 of 37
Hounslow, WMUH, London Borough of Hounslow and HPA. The TB Standards
agreed by the Steering Group have been monitored regularly. The major issue
affecting TB rates and uptake of TB treatment remains the mobile population within
Hounslow. This has a direct impact on Did Not Attend (DNA) rates and is being
addressed at the Steering Group.

The WMUH in conjunction with the North West London Health Protection Unit has
provided training for primary care teams including GPs.

The West Middlesex University Hospital continues to provide screening, treatment
and follow up of contacts for NHS Hounslow. In addition the outreach worker has
acted as an advocate for local TB patients.


10.0 Immunisations

The aim of immunisation is two fold:
To achieve herd immunity against those diseases that are transmitted from person to
person e.g. measles, mumps and rubella.
To protect the population from diseases transmitted by other sources e.g. tetanus.


       10.1 Influenza Campaign

NHS Hounslow achieved an uptake rate of 70.8% for the influenza vaccine for the
over 65 age group up to 31st January 2010. This rate is within the government target
of 70%.

       10.2 BCG Immunisation

Currently parents are offered the BCG vaccination for babies born at WMUH. They
can also request vaccination up to one year after the birth at the PCT led community
clinics. Out of the 3943 identified as requiring the BCG vaccination 3141 received the
vaccine.

       10.3 School Leavers Vaccination Programme

The school nursing team has an ongoing school leaver‟s booster vaccination
programme. During the academic year 2009-2010, 1166 pupils received school
leaver‟s booster for Diphtheria, Tetanus and Poliomyelitis and 177 pupils received
the 2nd dose of Measles, Mumps and Rubella.
At the time of writing this the data for five of the schools had not been collated and
therefore not included in this report.

       10.4 Primary Immunisation and MMR Vaccination Programme

The total number of children for whom the PCT is responsible on the 31st March 2010
whose 1st birthday fell between 1st April 2009 and 31st March 2010 = 4448 children.

Total number and percentage vaccinated completing a course at any time up to their
1st birthday for each of the following:




                                   Page 16 of 37
DTaP/IPV/Hib         Men C Infant            PCV Infant          BCG
3958                 3888                    3927                3698
88.98%               87.41%                  88.29%              83.14%

The total number of children for whom the PCT is responsible on the 31st March 2010
whose 2nd t birthday fell between 1st April 2009 and 31st March 2010 = 4522 children.

The total number and percentage vaccinated completing a course at any time up to
their 2nd birthday for each of the following:
DTaP/IPV/Hib           MMR           MenC Infant    Hib/MenC       PCV
                                                    Booster        Booster
4127                   3634          3909           3517           3578
91.26%                 80.36%        86.44%         77.78%         79.12%

The total number of children for whom the PCT is responsible on the 31st March 2010
whose 5th birthday fell between 1st April 2009 and 31st March 2010 = 3967children.

The total number and percentage vaccinated completing a course at any time up to
their 5th birthday for each of the following:
DTaP/IPV/Hib            MMR 1st Dose          MenC Infant    PCV
                                                             Infant
3462                    3433                  3113           47
87.27%                  86.54%                78.47%         1.18%

DTaP/IPV Booster     Hib/MenC                MMR 2nd dose        PCV
                                                                 Booster
2736                 628                     2699                1197
68.97%               15.83%                  68.04%              30.17%

       10.5 Human Papillomavirus (HPV) Immunisation Programme

NHS Hounslow introduced a HPV immunisation programme for 12-13 year olds and
17-18 year olds in September 2008.
In addition to the 12-13 and 17-18 year olds programme introduced in September
2008, NHS Hounslow commissioned GP practices to carry out the accelerated
programme which commenced in July 2009. NHS Hounslow is amongst one of the
few PCTs in the country to commission this work from general practice. In the
majority of other organisations this work is organised through the schools
programme. For the year 8 routine programme for 2009/10, the PCT commissioned
this work from its provider arm – Hounslow and Richmond Community Healthcare.
The data for 2009/10 is not currently available due to a problem with the data
collection tool the final figures will be available in August 2010.

11.0   Occupational Health

The Infection Prevention & Control Team has a collaborative working partnership
with the occupational health staff at WMUH. Both teams meet on a bimonthly basis to
address IPC issues relating to occupational health.

During the flu pandemic the occupational health team organised immunisation
training for designated PCT staff to undertake the staff immunisation programme for
both social care staff and PCT staff across the Borough.
The team actively promoted for all PCT staff to be immunised against both swine flu
vaccination and seasonal influenza vaccination. Clinics have taken place at various


                                    Page 17 of 37
local PCT premises to ensure they are accessible to all staff. Despite the active
campaign the uptake still remained poor with only 244 staff immunised for swine flu
and 68 for seasonal flu.




                              Part Two
                      Independent Contractors
                                 &
                       Provider Organisations




                                  Page 18 of 37
1.0 Introduction

It is within the role of the Infection Prevention and Control Specialist nurse to monitor
the performance of all commissioned services with regard to IPC and how they
implement local and national guidance and legislation within their practices and
protocols.
The IPC specialist nurse also provides advice and support to all non-acute
commissioned services with regards to improving and maintaining good IPC
practices therefore ensuring quality and safety of all the services that are provided by
the PCT to the wider community.

2.0 General Practitioners

Further progress on ensuring IPC is implemented into general practice has been
achieved this year by incorporating IPC standards in the local enhanced services
(LES); these include the MRSA screening LES and the minor surgery LES.
A rolling programme of minor surgery audits has been carried out by the quality
standards nurse and the lead IPC nurse. This work will continue as part of the
2010/11 annual plan. To date all practices audited who are undertaking minor
surgery are compliant with the standards.

 In addition a decontamination audit was undertaken to ascertain the
decontamination practices with regards to the sterilisation of instruments. The
response rate was good with 75% of practices completing the questionnaire.
Practices that did not complete the questionnaire or who have been identified as non-
compliant with the EU Medical Devices Directive 92/42/EEC will be inspected by the
IPC team during 2010/11.

 A further audit was carried out within practices located on PCT sites, an audit of the
sharps containers was undertaken to observe equipment, practice and awareness.
The audit reported very positive results. However, some areas needed further review
to improve practice. The IPC team has initiated measures for training and
awareness. It is necessary to audit sharps management routinely to have an
accurate assessment of current practice and prevent occupational exposure to blood-
borne pathogens

Poor attendance of GPs and practice staff at IPC training remains an issue of
concern that the team is seeking to address by investigating the possibility of IPC e-
learning packages.

Appropriate prescribing of antibiotics is an important quality issue. Over prescribing
and inappropriate selection of antibiotics results in an increase in antibiotic resistance
with potentially serious public health consequences The PCT has in place an agreed
management of infection policy which has been reviewed and updated and re-
circulated to the GP practices. The medicines management team is responsible for
monitoring the prescribing practice of practitioners. In 2010/11 prescribing patterns
will be monitored by the IPCC and inappropriate prescribing will be challenged by the
Director of Infection and Control.




                                     Page 19 of 37
3.0 General Dental Practitioners

IPC visits have not been carried out routinely to General Dental Practices but when
invited by the practice or requested by the dental commissioning manager. Eight
practice visits were undertaken by the lead IPC nurse as part of the Department of
Health‟s national dental survey. The purpose of this survey was to gain good quality
information to help the Department of Health Dental and Estates teams to further
develop well constructed, supportive policies and guidance on decontamination in
primary care. The intention is that compliance with these structures will be an
effective way for practitioners to ensure that they are using dental instruments which
meet modern standards in terms of cleanliness and sterilisation. This will increasingly
be one of the recognised key requirements within the Health and Social Care Act
2008 Code of Practice for health and adult social care on the prevention and control
of infection. It is expected that the Department of Health dental survey team will be
writing to individual PCTs with an outline of key findings from the practices audited as
part of the survey.


4.0 Pharmacist and Ophthalmologists

The IPC team are available to provide advice and support to the contracted
pharmacists and ophthalmologists within Hounslow if required.
In 2010/11 subject to the successful recruitment of an additional IPC nurse the
monitoring of IPC practice will be extended to these services by means of a self
assessment audit.

5.0 Nursing and Residential Homes

The lead IPC nurse attends regular care home manager meetings to highlight key
IPC issues and to feedback data and key findings from RCAs. The meetings also
provide an opportunity to improve communication and promote partnership working
across the local health economy.
As outlined in The Health and Social Care Act 2008 Code of Practice for the
prevention and control of infections and related guidance all independent healthcare
providers and adult social care providers will be expected to register with the Care
Quality Commission in October 2010. From the revised document published in
January 2010 it is now expected that IPC advice and support for care homes will be
provided by the Community IPC team. A business case has been approved to
provide extra resources to facilitate this extra service delivery.


6.0 West Middlesex University Hospital

       6.1 Surveillance
       National mandatory MRSA bacteraemia surveillance.

All MRSA positive blood cultures detected in the laboratory, whether acquired in the
hospital or community are reported monthly on the Health Protection Agency website
(MESS). The Department of Health has set targets for each Trust based on the 2003-
04 data. As the Trust went above the upper limit of 17 in 2008-09, the same number
was set for 2009-10.



                                    Page 20 of 37
In year WMUH has achieved the MRSA bacteraemia target. In total 16 cases were
identified out of an upper limit of 17. This equated to a 61% reduction in the number
of cases (18 to 7) compared to 2008-09. It should be noted that 9 out of the 16
cases were classed as community infections as they were identified within 48 hours
of admission. Chart C shows the distribution of cases whether from in-patients or
from the community. It should be noted that out of the 9 community cases in 2009/10
4 were apportioned to NHS Hounslow.
Chart
                                                                                   MRSA bacteraemia by location of blood culture taken

                                                                                                                                                 Inpatients                   <48 hours

              35
                                    33
                                                                                                                                                                                               31
              30


              25                                                           24


                                                                                                                  20
              20
    numbers




                                                                                                                                                                                                                                                                           18
                                                                                                                                                           16
                                                                                                                                                                                                                                   15
              15

                                                                                                                                                                    11
                                                                                       10                                      10
              10                                                                                                                                                                                                                                                                                                              9
                                                 8
                                                                                                                                                                                                          7                                                                                                          7
                                                                                                                                                                                                                                                 6
                  5                                                                                                                                                                                                                                                                       4


                  0
                              2002-03                                   2003-04                              2004-05                              2005-06                              2006-07                               2007-08                                   2008-09                              2009-10
C

National mandatory Clostridium difficile surveillance

Since 2008-09, the Trust has apportioned cases to include patients who are (i) in-
patients, day-patients, emergency assessment patients; AND (ii) have had a
specimen taken at an acute trust; AND (iii) specimen is 3 or more days after date of
admission (admission date is considered day „0‟). In January 2008 a DH letter
(Gateway No. 9397) was published to set a national target to reduce Clostridium
difficile infections: SHA envelopes. In year there were 36 cases apportioned to
WMUH, 109 below the trajectory.
It is to note that no new cases of C. difficile were detected in January 2010; the very
first month with a nil return on the data capture system since reporting began. Chart
D shows the distribution of all the cases detected since 2007.


Chart D
                                                                                                                  Distribution of new C. difficile cases
                                                                                                                WMUH (I/Pts)                                        AE                   GP                      OPD                        <48hours

         35

                             0        1
                             3        0
         30                           2
                      4
                      0               4

         25

                                               4

         20                                    0                                                                                                                      4
                                               2                           2                                                     2                                                                                 3
                                                                           0                                   0                 0
                                                                                                                                 1
                                               2                           2        2                          2                 0                                    2                                            0
                                                                                                                                                                                                                   1
                                                                                                               0
                                                                                                               1                                    5                 1                                            0
         15                29                                              3        3                                   1                                                                        4
                      27                                                            0                                   1
                                                                                                                        0                 3         0
                                    25                                              2        2                          1                 0         2        1
                                                                                                                                                             0        5                 4        1
                                                        0        1
                                                                 0                                    0                                   1         0                                            1                                   1
                                                                                                                                                                                                                                     0
                                                                 1                           1                                                               3                          0        2                          5
         10                                                                                                                                                                    5        1                 3
                                                        4                                    2                                  17                           1
                                             16                                              1               15                                                                                           0      16         0
                                                        0                13                                                                                                    0                                                              1        0
                                                                                                                                                                                                                                                       1
                                                                                  11                11                12                11 11                                  2                                                   11         0
                                                                                                                                                                                                                                              1                           3                                                              1
              5                                                10                                                                                                   10                  9        9                                            0                                                               0
                                                                                                                                                                                                                                                                                                              1          0
                                                                                                                                                                                                                                                                                                                         1               1        1
                                                        7                                    7                                                               8                                            8                 8                                             0                                              0               0        0
                                                                                                                                                                               5                                                              5        6        1                  1          1      1
                                                                                                                                                                                                                                                                0
                                                                                                                                                                                                                                                                1         4        0          0
                                                                                                                                                                                                                                                                                              1      0
                                                                                                                                                                                                                                                                                                     1        4          4               4        4
                                                                                                                                                                                                                                                                1                  2          1      0
                                                                                                                                                                                                                                                                                                     1                          1
              0                                                                                                                                                                                                                                                                                                                 0
                           May-07




                                                                                                                                        May-08




                                                                                                                                                                                                                                                     May-09
                                                                                  Nov-07




                                                                                                                                                                                               Nov-08




                                                                                                                                                                                                                                                                                                            Nov-09
                  Apr-07


                                    Jun-07
                                             Jul-07
                                                      Aug-07
                                                               Sep-07




                                                                                                                               Apr-08




                                                                                                                                                                    Aug-08
                                                                                                                                                                             Sep-08




                                                                                                                                                                                                                                            Apr-09




                                                                                                                                                                                                                                                                                 Aug-09
                                                                                                                                                                                                                                                                                          Sep-09
                                                                         Oct-07


                                                                                           Dec-07
                                                                                                    Jan-08
                                                                                                             Feb-08
                                                                                                                      Mar-08




                                                                                                                                                  Jun-08
                                                                                                                                                           Jul-08




                                                                                                                                                                                      Oct-08


                                                                                                                                                                                                        Dec-08
                                                                                                                                                                                                                 Jan-09
                                                                                                                                                                                                                          Feb-09
                                                                                                                                                                                                                                   Mar-09




                                                                                                                                                                                                                                                              Jun-09
                                                                                                                                                                                                                                                                        Jul-09




                                                                                                                                                                                                                                                                                                   Oct-09


                                                                                                                                                                                                                                                                                                                     Dec-09
                                                                                                                                                                                                                                                                                                                              Jan-10
                                                                                                                                                                                                                                                                                                                                       Feb-10
                                                                                                                                                                                                                                                                                                                                                Mar-10




                                                                                                                                        Page 21 of 37
6.2 Audits

       6.2.1 Hand Hygiene
WMUH has continued to promote the national “CleanYourHands” campaign
launched by the national patient safety agency. In addition “Your 5 Moments for hand
hygiene” at the point of care and 8 steps hand hygiene technique were both
introduced during the year. Hand hygiene audits are carried out weekly by the IPC
advocates with verification audits completed quarterly by the IPC team. The Trust
reports a variation in compliance across the organisation with the ultimate aim of
achieving 95%.

       6.2.2 Saving Lives: High Impact Interventions (HII) – using care bundles
       to reduce healthcare associated infection by increasing reliability and
       safety.

These audits have been completed monthly by the link practitioner with the IPC team
carrying out periodic verification audits. The results of the audits are monitored by the
IPC management chaired by the WMUH DIPC.
To improve compliance on documentation and monitoring, an Infection Prevention
and Control Care Plan booklet containing the care bundles has been introduced
during the year.

NHS Hounslow‟s IPCC will continue to monitor the above audits on a quarterly basis
throughout 2010/11.

6.3 Training

By the end of March 2010 77% of all patient facing staff have attended IPC training.
A further improvement is required to achieve the Trusts target of 80% compliance.
However this years figure does show a 16% improvement in 2009/10. Again training
figures will be closely monitored by NHS Hounslow‟s IPCC.


6.4 Compliance and Registration with the Care Quality Commission (CQC)

The Trust successfully registered with the CQC in relation to healthcare associated
infection which came into force on 1 April 2009.
Two members of the CQC made an unannounced visit to the Trust on 3rd September
and a further re-visit on 3rd November 2009.
On initial inspection, it was reported that they found evidence that the Trust had
breached the regulation to protect patients, workers and others from the risks of
acquiring a healthcare-associated infection.
Of the 16 measures that were inspected, they had no areas for concern about 14 and
found areas for improvement in the remaining two.
The two for improvement were:
Using effective arrangements for the appropriate decontamination of instruments and
other equipment, which are detailed in appropriate policies (Code of Practice criterion
2 and guidance 2h)
Following appropriate policies and protocols on the control of outbreaks and
infections associated with specific alert organisms (those that may give rise to
outbreaks) (Code of Practice criterion 8 and guidance 8m)

After the follow-up unannounced visit on the 3rd November 2009 it was reported on
the CQC website as follows:



                                    Page 22 of 37
“When we followed up, we found no evidence that the trust has breached the
regulation to protect patients, workers and others from the risks of acquiring a
healthcare-associated infection.”

The trust provided assurance that it had addressed both areas for improvement.

7.0 Hounslow and Richmond Community Healthcare (HRCH)

       7.1 National mandatory MRSA bacteraemia surveillance

The HRCH IPC team has contributed to the investigation for the root cause analysis
for the pre 48 hour bacteraemia identified at the acute trusts. From the 4 cases
apportioned to NHS Hounslow none had required any community services from the
provider organisation.


       7.2 Audits

       7.2.1 Hand Hygiene Audits
During the first three quarters of 09/10 hand hygiene audits were completed in the
community nurse led leg ulcer clinics and the therapy centre at O block.
Overall the hand hygiene rate is good. The last audit showed a compliance rate of
100% for community nurses and 89% for the therapists.
However, full compliance with the “Bare Below the Elbow” policy still remains a
concern with the overall compliance within both clinical areas being 83%. Over the
next year it is aimed that these audits will be carried out by the IPC link advocates.

       7.2.3 Observational Sharps Audit

This audit was undertaken in March 2010 by the NHS Hounslow commissioning IPC
Lead, the IPC nurse from HRCH and the company representative from the
organisation‟s sharps container manufacturer. Twelve sites were visited. Some areas
of the audit have shown an improvement in comparison to last year‟s results.
However, some areas such as using the temporary closure and using the correct
colour coded lid and container need to be improved and will be addressed in the IPC
training updates in 2010/11.

       7.3 IPC Training

       7.3.1 Mandatory and Induction Training

Mandatory IPC training is provided for all staff on induction and clinical staff must
attend an update annually. In addition during the first three quarters of 09/10
lunchtime sessions were provided by the integrated IPC team to encourage
attendance. Despite these extra sessions being arranged only 50% of staff attended
the training. This is an area that is a priority for improvement by HRCH over the next
year and will be closely monitored by the IPCC.

        7.3.2 Link Advocates Training
During the first three quarters of the year bimonthly IPC link practitioner meetings
were held in conjunction with the integrated IPC team. A variety of topics were
covered these included; “Your 5 Moments for Hand Hygiene”, urinary catheter care,
flu pandemic and the use of antibiotics. In December 2009 the president of the
Infection Prevention Society gave a dynamic presentation at WMUH on „Working
together to reduce infections‟.


                                   Page 23 of 37
A link scheme has now been established as part of the HRCH.



       7.4 Compliance and Registration with the Care Quality Commission
       (CQC)

In January 2010 HRCH successfully registered with the CQC unconditionally.

       7.5 Community provider metric for infection control: self-assessment of
       provider compliance with infection control standards

Community providers assess their own performance for NHS London against the
following standards and return a number of 0-5 corresponding to the number of
standards achieved:
The community provider fully complies with the NHS Code of Practice on the
Prevention and Control of HCAIs (2008);
The community provider has implemented the Essential Steps to clean, safe care
and monitors progress;
90% of clinical staff have undertaken their mandatory infection control training (and
this remains valid);
The community provider follows the WHO Five Moments for Hand Hygiene and has a
schedule of hand hygiene audits that is based on a risk assessment. As a minimum
hand hygiene audits should be undertaken in each clinic/service on an annual basis;
The community provider undertakes regular infection control audits (e.g.
decontamination policy) with a programme of audits to be undertaken each year.

 Hounslow Provider returned at year end that it has met three of the five standards
set out within this metric. Standard two and three have not been met. The
organisation does not currently meet the target for 90% of clinical staff to have
attended infection control training within the past year and the Department of Health‟s
„Essential Steps‟ has not yet been fully implemented. Despite staff attendance at
training sessions on how to implement Essential Steps, the audits have not been
completed by the clinicians. This initiative will require the full commitment of clinical
staff with the support of managers to self-audit practise and the IPC Team is planning
to work with the Clinical Audit and Risk Team to roll this out across the organisation
in 2010/11.
The Provider IPC Team is aiming to be in a position to return a compliance score of
five by the end of 2011.


8.0 West London Mental Health Trust

       8.1 Surveillance

One positive MRSA sample was identified from a wound swab from an inpatient in
2009/10. There were no cases of Clostridium difficile identified within WLMHT
inpatient facilities during 09/10.

       8.2 Audits

       8.2.1 Hand Hygiene Audits




                                    Page 24 of 37
Hand hygiene audits were commenced in February 2009. At the time of writing this
report the overall data was not available. However, it is estimated that the
compliance rate is 85%.

        8.2.2 Patient Environment Action Team (PEAT) Audit
PEAT is an annual assessment of inpatient healthcare sites in England with more
than ten beds.
PEAT is self assessed and inspects standards across a range of services including
food, cleanliness, infection control and patient environment.
The assessment was established in 2000 (managed by the NPSA since 2006) and is
a benchmarking tool to ensure improvements are made in the non-clinical aspects of
a patient‟s healthcare experience. PEAT highlights areas for improvement and
shares best practice across the NHS.
NHS organisations are each given scores from 1 (unacceptable) to 5 (excellent) for
standards of privacy and dignity, environment and food within their buildings. The
NPSA publish these results every year to all NHS organisations, as well as
stakeholders, the media and the general public.

The PEAT inspection at Lakeside WLMH was carried out on the 19th March 2010.
Overall The Environmental Score was rated as acceptable; this included the level of
cleanliness and the infection prevention and control measures:
Does the Trust/Organisation‟s hand hygiene policy promote hand hygiene at the
point of care? The point of care refers to the patient‟s immediate environment in
which healthcare staff to patient contact or treatment is taking place.
Does the placement of hand hygiene consumables (products) focus on the point of
patient care?
Is there a Trust/Organisation-wide risk management strategy in place to effectively
manage the risks associated with alcohol hand rub?
Does the organisation‟s hand hygiene policy explain when alcohol hand rub is
sufficient for hand hygiene and when soap and water hand washing must be
performed?
Does the organisation‟s “about us” or “information for patients” material explain the
organisation‟s approach to staffs‟ hand hygiene?
Does the organisation have a structured hand hygiene audit program?
Does the organisation‟s hand hygiene policy promote/reference the World Health
Organization‟s Five Moments approach to hand hygiene?
Does the hand hygiene audit tool specifically audit against the World Health
organization‟s Five Moments approach to hand hygiene?

       8.3 Training

Attendance at mandatory infection prevention and control training remains poor with
only 75% of staff attending. Extra training session has been organised. The IPCC will
continue to monitor the training data and will expect a significant improvement
throughout 2010/11.

       8.4 Compliance with the Care Quality Commission (CQC)

In November 2009 WLMHT were inspected by the CQC. Out of the 15 measures that
were inspected there were no concerns about ten. For two measures, a breach of the
regulations was identified and recommendations were made to address these issues.
For the other three measures areas for improvement were observed and
recommendations were made by the inspectors.
The two breaches and three areas for improvement were;



                                  Page 25 of 37
Performing a programme of audit to ensure that policies and practices are being
followed
Ensuring that the environment for providing healthcare is suitable, clean and well
maintained
Providing suitable hand-washing facilities and antibacterial hand rub
The trust must ensure it uses effective arrangements for the decontamination of
instruments and other equipment and these should be detailed in appropriate
policies.
Ensuring that staff are protected from exposure to infections during their work and
that all staff are suitably educated on how to prevent and control infections

A follow up inspection on the 16th February 2010 found that the trust had provided
assurance to the inspectors that it had addressed all five areas for improvements and
the following statement was documented;

“When we followed up, we found no evidence that the trust has breached the
regulation to protect patients, workers and others from the risks of acquiring a
healthcare-associated infection”.


9.0 Feltham Young Offenders Institute (FYOI)

Throughout 09/10 the Associate Clinical Director for Healthcare chaired the quarterly
infection control and cleanliness in prisons committee, which is a sub committee of
the Health Board, which reports to the Prison Health Partnership Board. It has
delegated responsibility to promote prevention and control of infection in HMP YOI
healthcare settings, and the wider establishment including all residential units for
young people and adults and departments. The Lead IPC nurse specialist is a
member of this committee.


       9.1 Surveillance

In December 2009 there was one case of Pulmonary Tuberculosis identified from a
patient discharged from hospital to FYOI. The Health Protection Unit carried out a
risk assessment in conjunction with the consultant physician from the acute hospital.
The risk of transmission was deemed low and therefore contact tracing was not
initiated.

       9.2 Audits

       9.2.1 Infection Prevention and Control Audits

The lead IPC nurse for commissioning has carried out IPC audits across the primary
care facilities within the prison. An action plan identifying the key findings was
developed and the action points were completed within the target date. In 2010/11 it
is expected that quarterly audits including hand hygiene will be completed quarterly
by the new provider. The results will be presented to the IPCC on a quarterly basis.

       9.3 Training

Attendance at IPC training remains poor with only 58% of primary healthcare staff
attending. The IPCC will monitor the progress throughout 2010/11 and expect a
significant improvement in compliance.



                                  Page 26 of 37
10.0 Conclusion

This comprehensive report provides the Board with an overview of the vast
improvements and developments in infection prevention and control throughout
2009/10. Despite the many challenges following the reconfiguration of the
organisation and the shortage of staff within the team an effective IPC service has
been maintained.
For 2010/11 the continuing priorities for the management of IPC have been outline
the IPC action plan which has previously been approved by the Board.

Infections have no boundaries and it is imperative that both provider organisations
and independent contractors have effective systems in place to protect patients from
acquiring an infection. NHS Hounslow is committed to ensuring that optimum IPC
practices are provided from the services they commission and will continue to
monitor the progress of these services throughout 2010/11.




                                  Page 27 of 37
Appendix A




Page 28 of 37
Page 29 of 37
               NHS Hounslow Infection Prevention & Control – Annual Plan 2009/10

This annual plan is based upon the need for compliance with the following objectives:
   1. The recommendations set out in the documents;
    “Winning Ways – Working together to reduce Healthcare Associated Infection in England” 2003
    Saving Lives: reducing infection, delivering clean safe care
    “The Essential Steps to Safe Clean Care” 2006
    National Cleaning Standards 2007

   2. The requirements for:
    Standards For Better Health

  3. The national statutory requirements:
   The Health and Social Care Act 2008 Code of Practice for the NHS on the prevention and control of healthcare associated infections
      and related guidance
 Key Areas                               Action Required                                     Outcomes               Lead        Compliance
                                                                                                                                Target Date
Management Board level responsibility/accountability clearly defined through the
Activities  DIPC.
                Infection Prevention & Control annual report and revised                                     DIPC             09/09
Cross             action plan for the Health and Social Care Act 2008 to be
referenced        ratified by the Executive Board.
against The
Health &        Continued bi-monthly meetings of the Infection Prevention &                                  ICC/APO and      Completed
Social Care       Control Committee which includes representation from the                                    WMUH             03/10
Act 2008          APO and WMUH.                                                                               representative
C1.
                Production of annual report to be submitted through the IGC                                  DIPC/Lead        Completed
                  to the Board.                                                                               IPC Nurse        09/09

                     Production of annual infection prevention and control                                   Lead IPC         Completed
                      programme with clearly defined objectives.                                              nurse            04/09

                     Circulation of infection control committee minutes to all senior                        Lead IPC         Ongoing
                      managers and relevant committees for dissemination of                                   nurse/AD for
                      information                                                                             clinical
                   DIPC to report regularly to Public and Patient Information                                Governance
                      forum                                                              Update PCT website   DIPC             Not completed
                   DIPC to report to the trust board                                                         DIPC             Ongoing
               Monitoring of Hounslow Community Healthcare (HCH)and West
               Middlesex University Hospital WMUH)
                   To monitor the infection prevention and control standards in
                                                                                         Data monitored by    ICC              Ongoing
                      both the acute trust and HCH including the setting of targets
                                                                                         ICC
                      for reducing healthcare associated infections and the
                      monitoring of both the quantitative and qualitative measures
                      for ensuring infection prevention and control. This includes
                      ensuring that WMUH are compiling with the pre-screening of
                      elective admissions where applicable.
                                                                                         All pre 48 hour      Lead ICN for     Ongoing
                   To continue work collaboratively with WMUH and HCH
                                                                                         bacteraemias         NHS
                      especially with regards to the investigation of community
                                                                                         investigated         Hounslow and
                      acquired infections and review of MRSA bacteraemias
                                                                                         throughout 09/10     ICN for HCH

                                                                       31
NHS Hounslow Annual Plan 2009-2010
March 2010
 Key Areas                              Action Required                                    Outcomes                  Lead        Compliance
                                                                                                                                 Target Date
Policies         Review and update infection prevention & control policies in line   IPC Team to              IPC Team
Cross             with national guidance and ensure that they are available on the    monitor review           Communicatio     April 09
referenced        internet and intranet and available for independent contractors.    dates.                   ns/Lead IPC
against The                                                                           Communication to         nurse
Health &                                                                              ensure that polices      ICC
Social Care                                                                           are on the
Act 2008                                                                              internet/intranet. All
C.8                                                                                   polices now
                                                                                      available on the
                                                                                      intranet/internet


                  Ensure national policies are disseminated and acted upon and       All new publications                      Ongoing
                  ratified by IGC and Board e.g. The Health and Social Care Act       reviewed by the ICC      ICC
                  2008.

                 Ensure infection prevention and control issues are considered in
                  the review of all clinical, estate and health & safety                                       WLHE             Ongoing
                  policies/procedures & guidelines.




                 Waste Management policy to be reviewed at April 09 ICC then         To ensure policy is
                  presented to IGC.                                                   ratified and             WLHE             June 09
                                                                                      disseminated and         AD for Quality   Completed
                                                                                      available on the         Standards
                                                                                      NHS Hounslow
                                                                                      intranet and internet
                                                                                      sites.




                                                                     32
NHS Hounslow Annual Plan 2009-2010
March 2010
 Key Areas                               Action Required                                    Outcomes                Lead        Compliance
                                                                                                                                Target Date
Surveillance      Monitor alert organism and condition surveillance e.g. TB cases      New MRSA cases        Specialist       Ongoing
                   in Hounslow and new MRSA cases taken from GP wound                   reported to ICC       Nurse for
Cross              samples.                                                                                   TB/ICC/HPA
referenced
against The       Monitor outbreaks reported as a SUI at WMUH
Health &                                                                                Reports to be         WMUH IPC         Ongoing –
Social Care       Monitoring and reporting of communicable disease in conjunction      provided to ICC       Team             monitored by
Act 2008           with the Public Health Directorate, Communicable disease unit,       Bimonthly reports                      ICC as a
C.1                and the Health Protection Agency to include surveillance of          presented to the      HPA              standing item
                   Independent Contractors e.g. GPs, Dentistry, Community               ICC by the HPA                         on agenda
                   Pharmacy, Feltham Young Offenders, care homes provision,
                   social services and voluntary agencies and the Initial
                   Assessment Centre.

                  Monitor immunisation/vaccination uptake e.g. TB, & MMR               Staff uptake          Public Health,   March 10
                   PCT to achieve 95% uptake for staff and client groups in line with   monitored by Occ      Occupational
                   SHA target                                                           health                Health

                  Monitor the surveillance of post surgery infections, WMUH and        Monitored quarterly   HCH ICP          March 10
                   HCH to continue with the joint audit of post discharge SSI‟s                               Nurse and
                                                                                                              WMUH IPC
                                                                                                              Nurse

                  Monitor WMUH C diff and MRSA bacteraemia rates at ICC.               Monitored monthly     ICC              March 10

                                                                                        Unable to apportion
                  Monitor C diff and MRSA data for HRCH                                data                  ICC              Not completed

                                                                                        WMUH data             WMUH HCH         Ongoing
                  WMUH and HCH data to be presented at ICC bimonthly
                                                                                        presented             IPC Nurse

                                                                                        Uploaded monthly      Lead IPC         March 10
                  MRSA and Clostridium difficile data for 09/10 to be reported on
                                                                                                              Nurse NHS
                   PAT monthly.
                                                                                                              Hounslow


                                                                      33
NHS Hounslow Annual Plan 2009-2010
March 2010
 Key Areas                               Action Required                                   Outcomes               Lead          Compliance
                                                                                                                                Target Date
Audits                                                                                                       Lead IPC          Completed
Cross            Annual sharps audit for general practices located in PCT sites                             Nurse NHS         02/10
referenced                                                                                                   Hounslow
against The
Health &         Waste disposal incl. audit of the clinical waste bins               Two audits             WLHE              March 10
Social Care                                                                           completed
Act 2008
C.1              Minor Surgery audit for surgeries carrying out outreach minor       Assurance required     Lead for minor    March 10
                  surgery.                                                            by Minor surgery       surgery
                                                                                      lead

                 Rolling programme of minor surgery audits                           To date 5 audits       Lead IPC          Ongoing
                                                                                      completed              Nurse NHS
                                                                                                             Hounslow,
                                                                                                             Quality
                                                                                                             Standards
                                                                                                             Nurse, audit
                                                                                                             facilitator

                 Audit of decontamination of surgical instruments in general                                Lead IPC          March 10
                  practice.                                                                                  Nurse NHS
                                                                                                             Hounslow/audi
                                                                                                             t facilitator

                 Infection Prevention and Control self assessment audit of primary   DH survey              Lead IPC          March 10
                  care dental Services.                                               completed. Self        Nurse NHS         Not completed
                                                                                      assessment to be       Hounslow &
                                                                                      completed as part of   Commissionin
                                                                                      the CQC registration   g manager for
                                                                                      process in 2010/11     dental
                                                                                                             services, audit
                                                                                                             facilitator

                 Encourage General practice to undertake self assessment audits      To be carried          Lead IPC          Not completed
                  using the Essential Steps audit tool.                               forward in 2010/11     Nurse NHS
                                                                                      annual plan            Hounslow,
                                                                          34
NHS Hounslow Annual Plan 2009-2010
March 2010
 Key Areas                               Action Required                               Outcomes        Lead            Compliance
                                                                                                                       Target Date
                                                                                                  audit facilitator
                  Quarterly IPC audits at FYOI.
                                                                                                  Lead IPC
                                                                                                  Nurse NHS
                                                                                                  Hounslow,

Education         To co-ordinate an infection prevention & control educational                   Lead IPC            Ongoing
Cross              programme for independent contractors through;                                 nurse
referenced                 1. Refresher training
against The                2. Practice cleaners training
Health &                   3. Residential and Care Home staff training                            Lead IPC
Social Care                4. Contracted Cleaners                                                 nurse
Act 2008          Distribution of the Cleanyourhands material to general practice
C.1                and residential homes                                                          Lead IPC
                  Production of educational posters on PCT sites for the ICP notice              nurse
                   boards
                  Quarterly Infection prevention and control awareness road shows                Lead IPC
                   promoting the Cleanyourhands campaign                                          nurse
                  Distribution of quarterly ICP Newsletters to general practice and
                   general dental practice.                                                       Lead IPC
                  Encourage participation in the ICP link advocate programme for                 nurse
                   practices nurses from general practice
                                                                                                  Lead IPC
                                                                                                  nurse
Provision of These may include;
support and   Procurement of medical devices/equipment
advice        Setting contracts for cleaning services
Cross         Various committees and groups for the Clinical Governance
referenced      Agenda
against The   Produce patient information leaflets as required and ensure that
Health &        they are available on the PCT website and intranet
Social Care   Respond as appropriate to incidents and outbreaks associated
Act 2008        with infection prevention & control
C.1           Ensure infection control and prevention are included at all levels
                of PCT building planning and refurbishment (e.g. LIFT schemes)
              Provide advice and support for Independent Contractors in
                                                                   35
NHS Hounslow Annual Plan 2009-2010
March 2010
 Key Areas                               Action Required                              Outcomes       Lead         Compliance
                                                                                                                  Target Date
                  primary care, dentistry, and community pharmacy and FYOI.
                 Ensure close liaison with local acute trusts and all other health
                  and social care providers – statutory and voluntary.
                 Promote consideration of infection prevention and control in the
                  commissioning of services for NHS Hounslow.
                 Liaison with primary care health care Independent contractors.
                 Specific work with Care Homes within London Borough of
                  Hounslow for ongoing support and to reduce the levels of HCAIs
                 Liaison with LBH social care partners, LINKS and Overview and
                  Scrutiny
Occupation       Ensure that there is a immunisation programme for staff                        Occupational    March 2010
al Health                                                                                        Health/ HR
Cross            Monitor problems with hand skin conditions                                     IPC Team/       Completed
referenced                                                                                       Occupational    03/10
against The                                                                                      Health
Health &         Monitor and report incidence of inoculation injuries to ICC                    Occupational    Completed
Social Care                                                                                      Health          03/10
Act 2008         Occupational health and IPC Team to attend integrated sharps                   IPC/Occupatio
C.9               meeting.                                                                       nal Health      Completed
                                                                                                 Teams           03/10

                 Ensure that all new staff have their pre employment screening                  Occupational
                  and immunisations                                                              Health          Not completed


Clean
Environmen       Cleaning contractors training in place                                         Lead IPC        Completed
t                                                                                                Nurse NHS       03/10
Cross                                                                                            Hounslow
referenced       Cleaning contract to be reviewed and renegotiated against NHS                                  Completed
against The       cleaning standards.                                                            WLHE            09/10
Health &
Social Care      Monthly audit of sites and cleaning equipment                                  WLHE
Act 2008                                                                                                         Ongoing
C.2              Weekly audits by clinic co-ordinators                                                          monitoring

                                                                      36
NHS Hounslow Annual Plan 2009-2010
March 2010
 Key Areas                            Action Required                          Outcomes       Lead         Compliance
                                                                                                           Target Date
                                                                                          HRCH clinic
                Introduction the waste management policy and the new colour              co-ordinators
                 coded waste containers and sharps containers                             Waste           Completed
                                                                                          Steering        03/10
                                                                                          Group




                                                                 37
NHS Hounslow Annual Plan 2009-2010
March 2010

								
To top