Meeting
Subject
Nature of item
Decision required (if any)
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
Date Board of Directors
Infection Prevention and Control (IP&C)
Quarterly Report
Enclosure
27 April 2011
O

For information
For approval
For decision
The Board is asked to receive and note this report.
General
Information
Received or approved by
Report Author
Lead Director
Meeting
Date
Christine Georgeu
– Matron of IP&C
Helen Walton
– Director of Nursing
Helen Walton – Director of Nursing/Director of
IP&C
Resource
Implications
Freedom of
Information
Revenue
Capital
Workforce
Use of Estate
Funding Source
No Confidential (Y/N)
(if yes, give reasons)
Final/draft format
Ownership
Intended for release to the public
Final
Trust
Yes

South Warwickshire NHS Foundation Trust
Report to Board of Directors – 27 April 2011
Infection Prevention and Control Quarterly Report
Executive Summary
This report details the progress made over the year in reducing MRSA and CDiff infection.
The Trusts annual target for MRSA Bacteraemia was 3, and 3 cases of MRSA
Bacteraemia were reported in year therefore not exceeding the target.
There has been a significant reduction in the numbers of CDiff infections with only 27 cases being reported during the year. New surveillance is required for Methicillin Sensitive
Staphylococcus Aureus (MSSA) and Escherichia coli bacteraemia. No formal target for reduction has been set.
Considerable work has been undertaken in ITU and across the Trust to reduce Central venous catheter related bacteraemias, embedding Matching Michigan Interventions and developing a monitoring tool across the Trust. Hand hygiene compliance across the Trust is 97.8% and the Saving Lives initiative is now fully embedded.
Helen Walton
Director of Nursing/Director of Infection Prevention and Control
2

Infection Prevention and Control
During the last year the Trust has continued to focus on the importance of improving patient safety and reducing healthcare associated infections by maintaining an emphasis on infection control as one of the Trust’s Key Objectives 2010/11. MRSA bacteraemia and
Clostridium difficile associated disease (CDAD) cases have reduced significantly over the last 3 years. Of particular note, the Trust has achieved approximately an 84% reduction in hospital attributed cases of CDAD since March 2008.
The Root Cause Analysis (RCA) process has continued to be rigorously applied by the
Infection Prevention Team for the investigation of cases of MRSA bacteraemia, CDAD and deaths where CDAD has been certified as a leading cause of death. This has enabled the
Trust to understand how these infections have occurred, if we could have prevented them, which leads us to understand what measures must be implemented to prevent further patients developing these infections or being seriously effected by the complications of such infections. The benefit of RCA can never be underestimated as it has meant a targeted approach to reducing infections can be implemented within the Trust. These
RCA findings are shared with the Trust as a whole and form specific elements of our action plans to reduce infections.
The Infection Prevention Board, chaired by the Chief Executive, continues to meet monthly. Departmental managers and clinicians are required to attend this board and present their Infection Prevention audit results, rates of infection and findings of RCA associated with their areas. This has helped ensure managerial responsibility for infection acquisition and these managers and clinicians have assisted greatly in the RCA process.
The Trust managed to achieve its MRSA bacteraemia target in 2010/11 by identifying only
3 cases of hospital attributed MRSA bacteraemia. A focus on reducing infections associated with invasive devices, which are a key cause of MRSA bacteraemias has been emphasised and the Trust has developed an improved Central Line monitoring form to ensure that any minor infection is identified early so as to prevent more significant infections occurring.
Another key activity in preventing MRSA bacteraemias has been the daily identification, isolation and decolonisation of known MRSA carriers, which has been embedded in the organisation over the last 3 years. This has been instrumental in not only reducing the risk of severe infection to those already known to carry MRSA on their skin but by isolating and treating these patients, this has helped reduce any risk of transmission to other patients.
In respect of CDAD reduction the Trust is delighted but not complacent about our performance this year. 27 hospital attributed cases were identified, which is significantly below the target set for us by the Department of Health. Strict and prompt isolation of patients with diarrhoea, adherence with the Tru st’s antibiotic policy, strict hand hygiene and a robust cleaning service have had a combined effect on reducing the incidence of
CDAD. In addition, a weekly ward round comprising of key experts in the management of patients with CDAD has been conducted resulting in improved outcomes for those patients suffering from CDAD.
3

In March 2008, the Department of Health’s “Bare below the elbows” directive was introduced Trust-wide. This is now a behaviour expected of all staff involved in hands on care in clinical settings within the Trust and compliance with this is monitored monthly in the form of ward and departmental Hand Hygiene audits. Results of these audits are fed back to all ward and departmental managers, Infection Prevention Board and the Trust’s
Governance groups on a monthly basis. Hand Hygiene compliance has increased with an average compliance figure of 97.8% achieved trust-wide during the year.
Trust Hand Hygiene Totals April 2010 - March 2011
100
90
80
70
60
50
40
30
20
10
0
Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
Months
The Department of Health’s “Saving Lives” initiative is now a fully-embedded audit process within t he Trust. Wards and departments audit a series of “high impact interventions” specific to procedures performed in their area. These interventions relate to those key clinical procedures which can increase the risk of infection if not performed appropriately.
Trust Saving Lives Total April 2010 - March 2011
100
90
80
70
60
50
40
30
20
10
0
Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
Months
During the last quarter 2 further bacteraemias have been identified for surveillance.
Formal surveillance of Methicillin Sensitive Staphylococcus Aureus (MSSA) commenced in January 2011. All MSSA positive bacteraemia results are relayed from the laboratory to the Infection Prevention Team (IPT) via the Consultant Microbiologist .On receipt of the result an Infection Prevention Nurse (IPN) visits the clinical area and completes a data collection form regarding the bacteraemia case. Data is entered and submitted on the HPA HCAI Data capture System (MESS) and IPT database. Any areas of non compliance are addressed by the IPT. Currently there is no requirement to initiate a formal Root Cause Analysis process however one is undertaken. Figures from January-
4

March 2011 = 9 cases of MSSA bacteraemia (3 Hospital acquired, 6 Community acquired)
No formal target for reduction has been agreed
Bench marking surveillance for Escherichia coli bacteraemia commenced January 2011.
Data is entered on IPT database only. Currently there is no facility to submit on the HPA
HCAI Data capture System (MESS) and no requirement to initiate a formal Root Cause
Analysis process. To date the majority of cases have been community acquired Figures
January- March 2011 = 20 cases of E.coli bacteraemia (2 Hospital acquired, 18
Community acquired) No formal target for reduction has been agreed
Central line associated / related bacteraemia in ITU
Warwick ICU has not had a catheter related blood stream infection for 7 months. This has been achieved by managing to maintain the high profile of the Matching Michigan interventions. It is now second nature to all ICU staff to use “Aseptic Non-Touch
Technique” when handling a central line. Lines are taken out far earlier than ever before and the Matching Michigan insertion checklist is now fully implemented. We have also gone beyond the interventions and started using chlorhexidine impregnated dressings for all our Central venous catheters (CVC's) that stay in longer than 48 hours.
Central venous catheter monitoring across the Trust
The Root Cause Analysis meetings held in response to 2 MRSA bacteraemia reported during 2010 – 2011 identified that a standardised dedicated form was required for Central
Venous Catheters (CVCs) and other types of long catheters. The aim of the form was to have something similar to the PIVA form used for peripheral cannulae. It was discussed that the form must have the capacity to record the insertion details, the daily VIP score and also space to document the date of removal of the line (which is all encompassed on the
PIVA form).The final format is now being to be trialled across Castle, Willoughby and
Farries wards
Since January 2011 the Infection Prevention and Control Team have effectively managed a number of outbreaks and infection:

Influenza

Norovirus

Meningitis

TB

Chickenpox/shingles

Scabies

Measles
5