Infection Control Annual Report
2006 - 2007
Vishal Sookhoo
Senior Infection Control Nurse
August 2007
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CONTENTS:
Pages
1. Introduction
3
2. Infection Control Team
3
3. Infection Control Committee
4
4. Education and Training
5
5. Clinical Audit
5
6. Mandatory Surveillance
6
7. Alert Organisms
7
8. Cleanyourhands Campaign
7
9. Department of Health Initiatives
8
10. Infection Control Programme 2007-2008. (See appendix 1)
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INTRODUCTION
This report outlines the activities of the Trust relating to infection control from April 2006 to
March 2007. Control of infection has always been taken very seriously at the Royal
National Orthopaedic Hospital. The Trust has a very low rate of infection and the aim is to
continue implementing the National Initiatives Programmes such as the Saving Lives
programme launched by the Department of Health to reduce healthcare associated
infections (HCAI) by 50% by March 2008. Building on evidence based good practice
Saving Lives draws on comprehensive learning and best initiatives in reducing healthcare
associated infections. The Trust puts infection control and basic hygiene at the heart of
good management and clinical practice. It is committed to ensure that appropriate
resources are allocated for effective protection of patients, their relatives, staff and visiting
members of the public, however, not all hospital infection is preventable. In continuing to
address the problems of healthcare associated infections the Trust sets itself targets to try
and ensure a reduction in the levels of infection based on the previous year’s targets. This
financial year the Trust reported two MRSA bacteraemia cases and five Clostridium
difficile cases.
THE INFECTION CONTROL TEAM.
The role of the Infection Control Team is to ensure that an effective infection control
programme has been planned to co-ordinate its implementation, and evaluate the impact
of such measures. The Team provides advice, education and training to all staff in relation
to infection prevention and control on a day-to-day basis. It also produces an Annual
Infection Control Programme with clearly defined objectives. The Team is as follows:
DIRECTOR OF INFECTION PREVENTION AND CONTROL
(A. PALMER)
CONSULTANT MICROBIOLOGIST BASED AT BARNET
AND CHASE FARM NHS TRUST
(to be appointed)
SENIOR INFECTION CONTROL NURSE
(V. SOOKHOO)
INFECTION CONTORL NURSE
(M. MUKAHAL)
INFECTION CONTROL ADMINISTRATOR
(D. MCAREE)
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INFECTION CONTROL COMMITTEE:
The Trust Infection Control Committee (ICC) is the main forum for discussion concerning
changes to policy or practice relating to infection, prevention and control. The membership
of the Committee is multidisciplinary and is chaired by a Consultant Orthopaedic Surgeon
and meets bimonthly. The ICC is a sub-committee of the Clinical Governance Board and
reports formally to this Board. It discusses surveillance of nosocomial infections,
investigation of infection outbreaks, and development of infection control procedures for all
departments; staff and patient education; and clinical waste management. Through
policies, procedures, and evaluation the Committee acts as a body for infection control
information and uses the information in a way that will create the safest healthcare
environment. The Infection Control Committee membership is as follows:

Mr J. Skinner
Consultant Surgeon and Chairman of the Committee

Consultant Microbiologist
( to be appointed )

Mr A. Palmer
Director of Nursing and Infection Prevention & Control

Mrs K. Corder
Deputy Director of Nursing and Clinical Governance

Mr V. Sookhoo
Senior Infection Control Nurse

Mr M. Mukahal
Infection Control Nurse

Mrs H. Landers-Flynn
Modern Matron (Adult)

Mrs S. Lalor-McTague
Modern Matron (Paediatrics)

Mrs R. Taggart
Theatre Sterile Supplies Unit Manager

Mrs J. Markham
Occupational Health Nurse

Mrs L. Wilson
Facilities Manager

Mrs S. Shah
Antibiotic Pharmacist

Mrs Z. Ncube
Theatre Sterile Supplies Unit Deputy Manager
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EDUCATION AND TRAINING:
Education and training continues to be an essential aspect of the Infection Control Team.
Mandatory training and education is carried out regularly for new and existing members of
staff. Infection control training for Specialist Registrars and Junior Doctors takes place at
induction. The Infection Control Team also provides training sessions on wards and
departments at the request of managers.
The mandatory teaching package has been designed to encompass the following Infection
Control issues:
 Hospital environment
 Hand hygiene
 Chain of infection
 Healthcare Associated Infections (HCAIs) and the cost implication
 Saving Lives
 The use of personal protective clothing
 Sharps management
 Waste management
A total of 220 clinical and non-clinical staff attended the infection control mandatory
training for the period April 2006- March 2007. 15 training sessions were undertaken in
that period.
Key targets 2007-2008
 Increase the number of Infection Control training sessions
 Increase awareness of Infection Control throughout the Trust
CLINICAL AUDITS:
Clinical Audits are on-going programmes carried out by the Infection Control Team on a
regular basis. Wards and departments are audited under the categories listed below:







Environmental audit
Safe handling and disposal of Sharps
Hand hygiene
Management of patient equipment
Waste management
Handling and disposal of linen
Personal protective equipment
The following table illustrates examples of the audits carried out by the Infection Control
Department and the compliance scores.
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Audits
Wards
Compliance level %
Environmental audit
Margaret Harte
Plaster Theatre
81%
87%
Waste management
Margaret Harte
Plaster Theatre
88%
100%
Personal Protective
Equipment
Margaret Harte
Alan Bray Unit
Jackson Burrows
100%
89%
80%
Verbal and written feedback is given to the managers.
Key targets 2007-2008
 To continue undertaking audits
 To consider combining audits with the Trust wide Nursing Audit.
SURGICAL SITE INFECTION SURVEILLANCE.
Surgical site infection is a mandatory programme from the Department of Health. The
Infection Control Team commenced surgical site infection surveillance in October 2005 for
hip and knee replacements. This is a continuous programme which is undertaken by the
Infection Control Department and a surveillance document is sent to the Health Protection
Agency on a quarterly basis. Results are fed back to the Clinical Governance Board, the
Infection Control Committee, clinical staff and Ward Managers. The mandatory
surveillance programme for surgical site infections is a useful tool to identify potential
cases of transmissible infections. It is essential that the surgical site infection surveillance
results are fed back to front-line clinical staff in order to help them take preventative
measures to reduce the rates of infections. The surveillance also acts as a key indicator to
identify areas with infection control issues and help to implement necessary measures to
minimise the risk of infection.
SURGICAL SITE INFECTION FOR TOTAL HIP REPLACEMENT YEAR 2006-2007
The table below illustrates the total number of hip replacements performed by RNOH on a
quarterly basis and the number of infections for the particular period.
No operations
No SSI
% operations
infected
Apr-Jun 06
109
1
0.9
Jul-Sep 06
85
0
0.0
6
Oct-Dec 06
116
1
0.9
Jan-Mar 07
129
0
0.0
SURGICAL SITE INFECTION FOR TOTAL KNEE REPLACEMENT YEAR 2006-2007
The table below illustrates the total number of knee replacements performed by RNOH on
a quarterly basis and the number of infections for the particular period.
No operations
No SSI
% operations
infected
Apr-Jun 06
109
3
2.8
Jul-Sep 06
111
1
0.9
Oct-Dec 06
107
0
0.0
Jan-Mar 07
126
0
0.0
The above tables illustrate that the Trust has low infection rates regarding the surgical site
infection for total knee and hip replacements.
Key targets 2007-2008
 To participate in surgical site infection for spinal surgeries surveillance once in
place
 To continue to undertake surgical site infection for hips and knees
ALERT ORGANISMS.
The alert organisms reported to the Infection Control Department from April 2006-March
2007 are as follows:
Type of
Organism/Infection
MRSA
MRSA Bacteraemia
Clostridium difficile
VRE
Acinetobacter
Staph aureus
E.Coli
Campylobacter
Number of cases
Number of cases
Apr 2004-Mar 2005 Apr 2005-Mar 2006
35
40
4
4
23
2
0
1
5
17
19
0
0
Number of cases
Apr 2006-Mar 2007
35
2
5
1
3
5
17
0
Cases of MRSA bacteraemia and Clostridium difficile are sent quarterly to the Health
Protection Agency. The Trust key targets are to reduce the number of MRSA Bacteraemia
cases and to undertake Root Cause Analysis for each case within the Trust. Root Cause
Analysis for the two cases of MRSA bacteraemia will be presented to the Clinical
Governance Board and the Trust Board. This shows that the Trust is undertaking MRSA
bacteraemia very seriously.
Key Targets 2007-2008
 To continue to implement Saving Lives
CLEANYOURHANDS CAMPAIGN:
The Trust became part of this campaign in April 2005. In order to take part the Trust
changed its supplier of alcohol gel. This enabled the Trust to involve areas that had never
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used alcohol hand gel before and encourage patients to challenge healthcare
professionals regarding hand hygiene.
The campaign supports efforts to improve hygiene generally within hospitals in a bid to
reduce Healthcare Associated Infections (HAIs). It is based on national and international
evidence. The campaigns aim.





To make it as easy as possible for staff in hospital to clean their hands at the right
time and for the right task
To improve the quality of clinical care delivered through improving compliance with
national and local hand hygiene guidelines
To increase the behaviour and personal responsibility of healthcare workers in
observing hand hygiene standards
To share learning and best practice to enhance patient safety and confidence in
healthcare
To display posters and highly visible promotional material to inform staff, patients
and visitors of the importance of hand hygiene
The impact of the campaign is measured through observing staffs hand hygiene behaviour
and monitoring usage of alcohol gel along with routine surveillance of infection rates.
The Infection Control Nurses are encouraging hand hygiene compliance through
education and training and to emphasise the importance of hand decontamination.
Key Targets 2007-2008
 To continue to carry out wards and departments training for hand hygiene.
 To ensure the Link Persons for infection control continue to undertake hand
hygiene audits.
INFECTION CONTROL PROGRAMME
The Infection Control Programme (Appendix 1) aims to continuously review and build on
existing activities, driven by local needs, while complying with the latest Department of
Health strategies and regulations documents. The following have been considered in the
programme:





The Health Act 2006: Code of Practice for Prevention and Control of Health Care
Associated Infections
Health Care Commission: Standards for Better Health, C4a Infection Control
NHSLA: National Health Service Litigation Authority
Consultation document on Action on Healthcare Associated Infections in England a
proposal for legislation to support the prevention and control of Health Care
Acquired Infection - HACI (July 05)
DOH “Saving Lives”: a delivery programme to reduce Healthcare Associated
Infection including MRSA (2005)
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





DOH “Winning Ways” - Working together to reduce Healthcare Associated
Infections in England (2003)
DOH National Standards, Local Action for 2005/06 - 2007/08 (2004)
A Matron’s Charter: An Action Plan for Cleaner Hospitals (2004)
Towards Cleaner Hospitals and Lower Rates of Infection (2004)
The NHS Healthcare Cleaning Manual (2004)
The National Patient Safety Agency Hand Hygiene Campaign
SAVING LIVES
The Saving Lives programme aims to reduce healthcare associated infections. Reducing
HCAI requires the commitment and involvement of every member of the hospital team.
The self assessment and action plan tool allows the wards and departments to plan and
measure continuous improvement for regular review. It helps to identify areas for
improvement.
CONCLUSION
The Trust continues to record very low rates of infections which are a credit to the clinical,
non clinical and support staff working at the RNOH. This reduced rate has been achieved
despite the poor state of the environment in many areas.
RECOMMENDATIONS
The following recommendations have been made for 2007/2008.





To develop a robust mandatory training programme for all doctors
To continue to raise the profile of Infection Control via the Trust Board and Clinical
Directorates
To fully participate in Clinical Audit
To update policies as required
To continue reporting agreed key indicators on a monthly basis to the Trust Board
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