Summary for Submission of
Paper to the Trust Board
Paper No: NHST(13)023
Subject: Annual report Infection Control 2012
Purpose:
The control of healthcare associated infections is of major public concern and is
a key issue for trusts. The Department of Health requires Directors of Infection
Prevention and Control to ensure that infection control is a key function of the
organisation and to produce an annual report on the state of healthcareassociated infection.
Summary: This report summarises the situation within the Trust for the
calendar year 2012. It describes recent policy initiatives and concerns and the
Trust’s response to them. It also includes the forward plan for 2013.
Financial Implications:
Over £300,000 was spent on infection control initiatives. However it is expected
that reduction of healthcare associated infections will have a positive financial
impact, ensure patient safety and improve patient experience. Failure to deliver
HCAI targets will also place the Trust at risk of financial penalties and risk
Foundation Trust application status.
Stakeholders: Patients, the public, staff and commissioners.
Recommendation(s): It is recommended that the Council note this report.
Review Date: 1st January 2014
Authors : Infection Prevention & Control Team, Andy Lewis, Dyan Clegg, Sue
Dickinson, Sandra Corlett & Matrons
Presenting Manager: Karen D Allen
Board date: 27 March 2013
St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
ANNUAL REPORT
INFECTION PREVENTION & CONTROL 2012
1st FEBRUARY, 2013
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
INDEX
Executive summary
Description of infection control arrangements
Infection Prevention & Control Team
Hospital Infection Prevention Committee
Budget
Page
3
6
6
7
7
2.
Responsibilities of Infection Prevention & Control Team
7
3.
Policies and guidelines 2012
8
4
Staff education
9
5.
Research and publications
10
6.
Audit
11
7.
9.
Hospital outbreaks
Outbreaks 2012
Number of outbreaks p.a. 1989-2012
Nature of outbreaks: changes over 18 years
Mandatory reporting
MRSA
C difficile
MSSA
E coli
VRE
Surgical site infection (orthopaedics)
Infectious disease 2012
10.
Surveillance
28
11.
Committee representation
29
12.
Involvement in Hospital services
30
13.
Additional activities
30
14
Antimicrobial prescribing
30
15.
Decontamination
33
16.
Cleaning Services
34
17.
Infection Control Programme for 2013
35
1.
8.
13
15
15
15
23
25
25
26
26
26
Appendix A: Surgical care group
Appendix B: Medical care group
Appendix C: Paediatric Care Group
Appendix D: Emergency Department
Appendix E: Critical Care Unit
40
43
44
45
46
Glossary of abbreviations
47
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
ANNUAL REPORT, INFECTION PREVENTION AND CONTROL, 2012
Executive summary
1. Mandatory surveillance
1.1 CDT diarrhoea
The Trust is within the Department of Health target of 37 cases, having had 25 cases in the first 9
months of the financial year.
1.2 MRSA bacteraemia
The Trust has failed the Department of Health target for 2012-2013 (3 cases), having had 7 cases of
MRSA bacteraemia in the first 9 months of the financial year. A Task and Finish Group was set up to
review the root cause analysis (RCA) and address the required actions.
1.3 Surgical site infection surveillance in orthopaedics
January-September 2012
Whiston
rate National rate
(Infected/Total)
Hip replacement
1/213 (0.5%)
1.2%
Knee replacement 4/249 (1.6%)
1.6%
Regular multi-disciplinary meetings have been held throughout 2012 to tackle all aspects of the
patient pathway.
1.4 Mandatory reporting of MSSA and E coli bacteraemia has continued in 2012. No objectives
for these have yet been set by the Health Protection Agency (HPA). However, there was a 36%
reduction in the number of MSSA blood stream infections compared with the same time period last
year. The E coli bacteraemia numbers were around the same as last year.
Comparison of calendar year figures:
C difficile
VRE
MSSA
infection
acquisition
bacteraemia
2011
46
14
28
2012
41
3
18
MRSA
bacteraemia
4
10
2. Hand decontamination and ANTT
Hand hygiene continues to be strongly promoted throughout the Trust. Monthly audits of hand hygiene were
undertaken on all wards throughout the year. Covert hand hygiene surveillance has also been undertaken.
ANTT (aseptic non-touch technique) training has been promoted throughout the Trust. A senior nurse was
seconded to the post of ANTT specialist nurse. All relevant clinical staff are expected to have demonstrated
ANTT competency by the end of January 2013. IV packs were introduced throughout the Trust to promote
ANTT and safe handling of sharps. Blood culture packs were also introduced in order to facilitate ANTT and
prevent blood culture contamination.
3. Policies
Seventeen chapters of the Infection Control Manual were updated in 2012. The pre-op MRSA screening
pathway was revised with the focus on colonisation suppression. The Trust Antibiotic Policy was also revised.
4. Training
Infection control induction and mandatory training sessions were provided for all clinical staff. Infection
Control Link Nurse training continued on a 2-monthly basis. Additional training sessions were also provided
for consultants, other medical staff and nursing staff. The intranet and internet (patient) websites have been
updated throughout the year.
5. Audit
36 wards/departments and 7 theatre areas were audited in 2012. Wards achieved scores of 86-97% (average
92%). Targeted audits on sharps, hand hygiene, commodes, mattresses and MRSA screening were also
undertaken. Executive Team ward rounds commenced.
The unannounced CQC inspection on 5 October 2012 found that the Trust met the standard for cleanliness
and infection control. An external review (Duerden Consulting Ltd) was undertaken.
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
6. Outbreaks
There were 13 outbreaks of infection: MRSA (8) diarrhoea (4) other (1). The increased number of MRSA
outbreaks compared with last year is due to the new policy of screening all staff if there is a single case of
ward-acquired MRSA.
7. Surveillance
In addition to alert organism surveillance, the Trust participated in the Department of Health mandatory
surveillance of health care associated infection, including MRSA, MSSA, E coli and VRE bacteraemia rates,
CDT diarrhoea and surgical site surveillance (orthopaedics).
Urinary catheter associated infection surveillance: A single day prevalence study done in June 2011
showed an infection rate of 4% (2 out of 50 patients). After UCAM initiatives, the repeat audit in January 2012
showed an infection rate of 1.2% (1 out of 84 patients).
Large bowel surgical site infection surveillance: 1 September 2011- 30 November 2011. The results for
38 eligible patients were analysed and fed back to the surgical team in 2012. The national rate of infection
reported by the HPA is 10.1%. This audit identified an infection rate of 8%.
8. Antibiotic prescribing
The Trust Antibiotic Policy was updated and adapted for an interactive antibiotic website due to be launched
in early 2013. The Trust has actively participated in the Advancing Quality program for North West Trusts and
also the NW antibiotics pharmacists group, providing benchmarking data on antibiotics management. Audits
continued across the Trust, including regular Antimicrobial Management Team ward rounds. The OPAT
service was expanded. Feedback on antibiotic prescribing has been provided to directorates.
9. Communications
Infection prevention and control messages were reinforced with the use of many different means of
communication including global emails, intranet messages, Team Brief, meetings, posters, additional training
sessions, payslip messages, lift mirror messages and personal communication. The Infection Prevention and
Control Team visited other Trusts in order to adopt good infection control ideas.
10. Information technology
The infection control dashboard was heavily publicised and used in the Executive Team RCA reviews.
Patient & Telepath (laboratory) systems were linked to obtain automated MRSA screening compliance
figures. Epidemiological data fields were added to Telepath to enable analysis of results for cases of
bacteraemia.
11. Engagement at ward level.
Twenty one consultants from all specialities volunteered to be Consultant Leads in Infection Prevention and
control for their own areas. An infection control register was produced for nursing staff to sign off completed
infection control training. Infection Prevention and Control Nurses and ward pharmacists reviewed the
management of all new and readmitted MRSA patients. Root cause analyses of infections were presented by
consultants to the Executive Team.
12. Infection Control Programme for 2013
Surveillance:

To continue with national surveillance projects. To continue providing monthly feedback
reports on hospital-acquired infection to clinical staff.
 The peripheral & central line infection rate surveillance will be repeated by the ANTT specialist nurse.
Objectives
 To achieve DOH objectives for healthcare associated infection (MRSA bacteraemia & CDT
diarrhoea).
 To continue to demonstrate compliance with the Code of Practice.
 To achieve NHSLA level 3 compliance with criteria for hand hygiene (Learning and Development)
and inoculation incidents (Health Work & Wellbeing).
Policies
 To update 5 chapters of the Infection Control Manual.
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
Antibiotic Prescribing
 To launch the interactive Antibiotic Policy.
 To audit prescribing of antibiotics (especially high risk antibiotics), PPIs, outpatient parenteral
antimicrobial therapy (OPAT) services) and provide feedback to prescribers and educate staff.
 To continue liaison between pharmacy and IP&CT including input into CDT diarrhoea root cause
analysis.
 To continue the weekly antimicrobial management team ward rounds introduced in 2011.
 To continue liaison with community pharmacists.
 To actively participate in the development of benchmarking data on antimicrobial prescribing with NW
antibiotics pharmacist group.
Hand decontamination
 The Trust will promote further hand hygiene initiatives. All wards will continue monthly hand hygiene
audits, but more covert audits will be undertaken.
Audits
 To continue the rolling programme for all ward audits.
 To repeat the sharps, commode, sluice room, mattress, hand decontamination, isolation and patient
screening audits.
Education & training
 To continue induction and mandatory training programmes and to provide additional study days for
infection control link nurses and other hospital staff.
New build
 To continue to provide infection control advice with regard to new build.
IT initiatives
 To continue to promote the use of the infection control dashboard throughout the Trust. This will
enable continued performance monitoring of wards so that problems can be identified before they
cause high rates of MRSA/CDT.
 Qlikview: To investigate the possibility of automatic triggers to alert IPCT and Executive Team when
staffing levels/indicators fall so that action can be taken before there is a risk of patients acquiring
infection.
To produce an app for the interactive Antibiotic Policy.
Ownership at ward level
 To continue to encourage ownership of infection control at ward level.
 To ensure that there are clear responsibilities for housekeeping duties in the absence of the
housekeeper.
Medical staff engagement
 To continue Executive Team RCA reviews with RCAs presented by the consultant with the ward
manager and Matron in attendance.
 Medical staff appraisals to include infection control.
 Consultant Infection Control Lead meetings to continue with champions taking responsibility for
greater ownership of infection control issues at ward level.
Infection predictor tool
To evaluate the results of pilot studies and determine whether to adopt this tool Trust-wide.
External Review Action Plan
To complete the action plan.
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
1. Description of infection control arrangements
1.1
The Infection Prevention & Control Team
Dr K. D. Allen
Dr K Mortimer
Dr M. S. Vardhan
Mrs G White
Ms J Grimes
Ms M Kendrick
Ms T Kelly
Ms A Cruz
Director of Infection Prevention & Control (DIPC) Consultant Microbiologist
Consultant Microbiologist
Consultant Microbiologist
Service Manager, Infection Prevention & Control
Clinical Nurse Specialist, Infection Prevention & Control
Clinical Nurse Specialist, Infection Prevention & Control
Surveillance Assistant
Surveillance Assistant
Ms C Cooke, Director of Nursing, is the Executive Lead for Infection Control.
Consultant Infection Control Leads
Consultant champion
Emergency & Critical Care
Francis Andrews
Medicine
Upendram Srinivas
Chakri Molugu
Vinay Shanker
Maged Gharib
Mark Fox
Krishna Murthy
Julie Dawson
Sunanda Mavinamane
Katherine McBeth
Surgery
Ravi Gudena/Nick Emms
Mike Scott
Anil Kaul
David Assheton
Paul McArthur
Paul Atherton
Ed Whelan
Tennyson Idama
Amer Daud
Hosea Gana
Azi Samsudin
Paediatrics
Abubaker El Badri
Department
Wards
Emergency & Critical Care
Medicine (Div. Lead)
Acute Medicine
Respiratory
Haematology
Gastroenterology
Cardiology
Rheumatology
Stroke & Care of the Elderly
Dermatology
1B, 1C
2B, 2C
2A
2D, 3D
CCU 1D
1A, 5A, 5B, 5C
T&O
General Surgery
General Surgery
Ophthalmology
Burns & Plastics & Anaesthesia
Anaethesia
Anaesthesia
O&G
ENT
Urology
Urology
Paediatrics
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
The following also have considerable input into Infection Prevention in the Trust:

Andrew Lewis, works closely with the ICT with regard to antibiotic stewardship including audit,
education, patient management, ward rounds and root cause analysis.
 The Infection Prevention & Control Team also works closely with the Matrons, Infection Control Link
Nurses and Facilities Management.
1.2
Hospital Infection Prevention Committee
The Hospital Infection Prevention Committee met in January, April, October and December 2012.
The reporting line to the Trust Board is shown below. The DIPC reported to the Trust Board in February, July,
September and November 2011. Reports included the annual report, mandatory surveillance results, and
infection control initiatives. Reports were also given to the Clinical Performance Council, Clinical Directors
Forum and Clinical Senate.
Trust Board
Trust Governance Board
DIPC reports directly as
required by Code of Practice
Clinical Performance Council
Hospital Infection Prevention Committee
HIPC receives annual reports from Clinical Directorates
Dr Mortimer is also a member of the Drugs & Therapeutics Committee.
1.3 Budget
1.3.1 Budget for Infection Control Team – Cost Centre 355821. Report by Sandra Corlett
The current year budget for 2012/2013 is £213,314 (known at Month 9). This value includes funding
for salary costs and some non-pay costs associated with the IV Access Team. Large non pay items
associated with the IV Access Team do not appear within this department, as the costs are incurred
at ward level, hence the budgets for such items appear within the appreciate ward rather than this
cost centre (e.g. silver coated catheters, etc).
Pay: £206,992 (4.76wte)
1WTE Service Manager (Band 8a), 2.00WTE Clinical Nurse Specialists Infection Control (Band 7),
1.00WTE IV Access Team Nurse (Band 3), 0.76 WTE A&C band 4. (Total: 4.76WTE)
Non pay: £6,322
The non-pay budget of £6,322 includes budgets for the following: dressings, medical and surgical
equipment, sterile products, staff uniforms, printing costs, stationery, travel and subsistence and
course fees.
Summary
Overall, Infection Control is reporting an under-spend position of £7,615 at Month 9.
2.
Responsibilities of the Infection Prevention & Control Team (IPCT)
2. 1
Education & training
The work of the team involves close liaison with every grade and discipline of staff
throughout the hospitals, not purely the clinical areas. Education of staff plays a major role in
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St Helens & Knowsley Teaching Hospitals Trust
2.2.
2.3
2.4
2.5
2.6
2.7
2.8
Annual report, Infection Control 2012
the establishment of good practices. All staff are provided with mandatory induction training
in infection control, followed by annual or biennial training sessions, according to clinical
area. The IPCT also act as a reference source on infection control matters for health care
personnel. Numerous patient information leaflets have been produced and the Infection
Control Nurses are always willing to discuss infection control issues with patients or their
relatives.
Surveillance of infection in the hospital with prompt investigation of increases in the
infection levels. This includes alert organism/condition surveillance, monthly laboratory
reports (including non-alert organisms) mandatory surveillance and targeted surveillance.
Action is taken to ensure that the Trust achieves its targets with regard to healthcare
associated infection.
Isolation of patients and outbreak management
The Infection Prevention and Control Nurse Specialists ensure that infected patients are
isolated appropriately. The IPCT is also responsible for investigation and prompt control of
outbreaks of infection.
Infection Control Policies
Development & updating of a comprehensive range of infection control policies to ensure that
the Trust is compliant with national standards.
Audit
The IPCT audits infection control policies to ensure that standards are maintained. This
includes ward audits and also targeted audits e.g. sharps disposal, hand decontamination,
isolation practices, commodes, mattresses etc.
The IPCT advises on
 New procedures for control of infection.
 Contracts e.g. cleaning, laundry, clinical waste
 Purchasing of medical devices or equipment
 Assessment of new engineering or building works
 Performance management of infection control
Production of an annual report and infection control programme
Out of hours service
3. Policies and guidelines introduced/revised in 2012
3.1
Revision of policies
Seventeen Infection Control Manual chapters were updated in 2012:
Chapter
Title
1
10
11E
15
20A
21A
23
24
28C
32
33
34
35
36
40
42
43
Infection Control Guidelines
Patients & visitors information
Policy for HCW’s exposed to HIV
Waste disposal policy
Laundry policy
Glove policy
Influenza pandemic plan
Clostridium difficile
Infection Control Strategy
Transport of biohazards in personal vehicles
Viral gastroenteritis
Meningococcal infection
Hepatitis C
Smallpox
Pest control Policy
MARO
Plague
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St Helens & Knowsley Teaching Hospitals Trust
4.
Annual report, Infection Control 2012
Staff education
Introduction & aims
All staff, including those employed by support services, must receive training in prevention and
control of infection. Infection control is included in induction programmes for new staff, including
support services. There is also a programme of ongoing education for existing staff, including update
of policies, feedback of audit results with examples of good practice and action required to correct
deficiencies. Records should be kept of attendance of all staff who attend infection control
programmes. (NHSLA, Standards for better health & Trust requirements).
4. 1
Training Sessions/Courses
Trust Induction
The Infection Control induction lecture is 20 minutes for clinical staff and is held 2-3 times
each month. The induction session is mandatory for all new Trust staff.
Bank staff and student nurses receive an infection control lecture as part of their initial
induction which includes use of disinfectants and commode cleaning.
Trainee medical staff and medical students also receive infection control induction tailored to
their needs.
Infection Control Mandatory Update Sessions: provided by the IP&C Team – All clinical
staff must attend every year and non clinical staff every two yesrs. Clinical staff and nonclinical staff receive 30 minutes training. Booking and attendance is carried out by Learning
and Development, who follow up any failures to attend.
Infection Control Mandatory Training can also be accessed via the Infection Control intranet
website. This is available to all grades of staff as an alternative/additional means of receiving
Infection Control training.
The Infection Prevention and Control Nurse Specialists also provide training sessions on the
band five and HCA rolling education programme, topics including MRSA and CDT. The
Team also provide training for Student, Cadet and Bank Nurses.
The Team have also started putting additional hour long education sessions four each month
held in seminar rooms in main hospital building. These sessions address current HCAI
problems identified within the Trust. Topics have included MRSA and CDT. Staff book places
via the Team Secretary.
An E-learning package was produced by Dr Mortimer.
Mandatory infection control sessions (10 sessions in 2012) are provided for Consultant staff.
4.2
Link Nurse Programme
Link nurse meetings were held every other month. An education session, usually from a
guest speaker is incorporated into the meeting. Numerous topics were covered and included
hand hygiene, CDT, MRSA, ANTT etc.
In addition the link nurses have been encouraged to continue to undertake their own ward
audits.
4.3
Hand Hygiene
4.5.1 Clean Your Hands campaign.
The National Clean Your Hands Campaign has now been disbanded but hand hygiene
continues to be strongly promoted throughout the Trust, including covert surveillance of hand
hygiene. Wards are encouraged to audit each other.
4.5.2 Bare below Elbows
Compliance with “bare below the elbows" dress code is continually monitored by the IP&C
Team, Matrons and Senior Management.
4.5.3 Audits
The matrons are undertaking at least monthly observational audits of hand-washing to
determine compliance with the Infection Control Manual Hand Decontamination Policy
(Chapter 21). Infection control compliance and Trust uniform policy (hand jewellery etc.) is
audited on every ward monthly using infection control indicators. Convert hand hygiene
audits have also been carried out.
4.5.4 Information leaflets
A patient booklet on handwashing is available. Ward managers can purchase their own
supply in batches of 50 booklets. There is a visitor information booklet on all aspects of
reducing risks of infection.
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
4.5.5 Training
Glow germ machines enable further reinforcement of hand hygiene messages and technique
to staff. Matrons and link nurses continue to use these at ward level for hand hygiene
training.
4.5
IV lines & Urinary catheters. Report by Julie Grimes
4.5.1 IV lines.
 Peripheral line surveillance is planned for January 2013
 Cannulation packs were introduced Trust wide in November 2012
 Chloraprep for the insertion site continues to be used Trust wide.
 Safety cannulae: the business case was successful and devices are now in use throughout
the Trust.
 Responsibility for ANTT (Aseptic non-touch technique) training has been devolved to
Matrons. Each ward has a key trainer who is responsible for cascading training to staff in
their areas.
 Patient information leaflets are available for staff to disseminate to patients.
 Teaching sessions are implemented by education and training.
 PICC line insertions are now undertaken by the MET (Medical Emergency Team).
4.5.2 Urinary catheterisation.
 The Trust has continued with the objective of reducing urinary infections associated with
indwelling catheters, which is also part of the CQUINN monitoring for 2012/2013.
 NHS Safety Thermometer has now been implemented Trust wide. The safety thermometer is
a measurement instrument that has been developed by the Safe Care work-stream. It aims to
measure and monitor “harm free” care and thereby reduce harm from 4 conditions including
urinary tract infection (in patients with catheters).
 The use of the UCAM (Urinary Catheter Assessment and Monitoring Form) continues it was
introduced to minimise the risk of catheter-related infections by the prevention of
unnecessary catheterisation and by ensuring the best quality of care (both at insertion and
ongoing care). Prompts are used to encourage early removal of the catheter. The UCAM
form, for patients discharged with catheters, is faxed to district nursing teams to improve
communications and continuity of care for the patient. The use of UCAM forms has been
included in the monthly ward indicators.
 The BARD urinary catheter pack has been introduced Trust-wide. It uses a pre-connected
system which has been shown to reduce catheter infections by up to 41%.
 A patient information leaflet has been introduced.
 Promotion of bladder scanning has included further staff training in the use of scanners to
assess the need for catheterisation. The bladder scanner also provides evidence for the
patient notes to support why the catheter was inserted.
 Catheter training is accessed via Education and Training.
4.6
Training activities for infection prevention & control specialists:
The Clinical Nurse Specialists in Infection Prevention and Control and DIPC attended
national meetings e.g. Infection Prevention Society (IPS) and various meetings/study days
throughout the year, including meetings of North West Infection Control Group (NORWIC).
5.
Research, publications and website – infection prevention and control
5.1
The intranet website for infection control has been continually updated throughout 2012. All
Infection Control Manual policies are readily available. The minutes of the Hospital Infection
Prevention Committee and link nurse meetings are added to site. All patient and visitor
information leaflets are also available from this website.
5.2.
The infection control section of the patient-accessible section of the Trust website has been
kept updated. This includes the team profile and functions, information on MRSA & CDT,
leaflets and advice for patients & visitors.
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St Helens & Knowsley Teaching Hospitals Trust
6.
Annual report, Infection Control 2012
Audit
6.1
Sharps audit of Sharps policy (Chapter 22, Infection Control Manual)
A comparison with the last 6 years’ audits is shown below.
Unsuitable
positioning
Protruding
sharps
Incorrect
assembly
Overfilling
Incorrect
labelling
Significant
non-sharps
contents
2006
2007
2008
Sep
2008
March
2009
2010
2011
2012
7%
5.7%
2.9%
51%
4.2%
6.4%
1.4%
0.5%
0.2%
0%
0%
19%
0.4%
0%
0%
0%
1.2%
2.6%
1.9%
18%
0.7%
2%
0%
0.4%
0.4%
16%
0.2%
14%
0.4%
0%
9%
47%
1.6%
7%
0.6%
15.8%
0.2%
5%
0.3%
0%
3.5%
4%
3.2%
Action
Education & advice on correct assembly, bracketing and labelling was given where appropriate. The
full report has been widely disseminated. To be re-audited in 2013.
6.2
Ward & theatre audits
The programme of ward audits has continued. These entail detailed inspection of the ward
concerned to ensure that infection control is of a high standard. Feedback, both verbal and in the
form of a detailed written report is also produced. A retrospective evaluation is made post audit to
ensure that all problems are rectified. Scores of 36 wards/departments audited since January 2012
are shown in the table below. Average score was 92% (average score 2011: 92%, average score
2010: 90%).
Ward
5B
1E
4D
B&P Dressings/Holbrook
3A
SCBU
Delivery suite
Sanderson
Endoscopy
1C
4B
2E
3D
1B
3E
2F (OPD)
2B
5A
4F
Score
97%
97%
97%
97%
96%
96%
95%
95%
94%
94%
93%
93%
93%
93%
93%
92%
92%
92%
92%
Ward type
Medicine for Elder Persons
CCU
Burns Unit
OPD Clinic
Plastics
Paediatrics
Womens
Endoscopy
Medical
Surgery
Womens
Medical
Medical
Gynaecology
Paediatric OPD
Respiratory
Medicine for Elder Persons
Paediatrics
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St Helens & Knowsley Teaching Hospitals Trust
Endoscopy St Helens
5C
Seddon
4A
Duffy
2C
ED Zone 3 Children's triage
1A
3F
Observation ward
St Helens OPD
2A
1B
1D
ED Resus Zones 1&2
Lilac centre
Annual report, Infection Control 2012
91%
91%
91%
91%
90%
90%
90%
90%
89%
89%
89%
88%
88%
88%
88%
86%
Endoscopy
Elderly
Elderly
Surgery
Temporary
Respiratory
Ambulance triage children's
Medical (stroke)
Paediatrics
Observation
OPD
Medical
GPAU
Cardiology
ED
Haematology
All areas with scores under 90% were re-audited soon afterwards until scores were over 90%.
The operating theatres were also audited:
Theatre type
Score
Recovery
94%
Obs & Gynae
94%
B&P
93%
Maternity
92%
ENT
91%
Urology & General
87%
Orthopaedic
87%
St Helens theatres
80%
Theatre area
Recovery
12
2,3,4 &5
Maternity
1
9,10,11
6,7,8
Theatre
All areas with scores under 90% were re-audited soon afterwards until scores were over 90%.
6.3
6.4.
6.5
6.6
6.7
Hand hygiene audits (compliance with Chapter 21, Infection Control Manual)
Observational audits were conducted by infection control link nurses, Infection Prevention
and Control Nurse Specialists, Matrons (fortnightly/monthly) and Secret Shoppers.
Commode audit (Compliance with Chapter 24 (C difficile) & Chapter 33 (Viral
gastroenteritis) Infection Control Manual)
The surveillance assistant completed monthly commode audits throughout the Trust.
Commodes are inspected for damage, cleanliness and correct use of tape. Results are fed
back to Assistant Director of Nursing and Matrons. Comparative data for all wards had been
circulated.
Compliance with MRSA screening policy (Chapter 41 Bed Management Policy)
In order to determine compliance with MRSA screening policy, monthly audits were
undertaken. In addition daily checks on all patients with MRSA were commenced with the
focus on isolation, use of the MRSA care plan (IPCT) and appropriate antibiotic prescribing
(ward pharmacists).
Antibiotic prescribing audits see 14.2
Mattress audit
Wards check mattresses on a weekly basis. In addition there are monthly audits of
documentation and checks on 10% of mattresses by the IP&CT. Mattresses with defects in
the cover were replaced.
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St Helens & Knowsley Teaching Hospitals Trust
6.8
6.9
6.10
6.11
6.12
6.13
7.
Annual report, Infection Control 2012
Linen audit
This audit was undertaken in May & June 2012. Fifteen out of 27 wards achieved 100%.
Criteria not achieved had been addressed e.g. storage of inappropriate items like pulp
products in the same cupboard as linen.
Peripheral line audit
Data was collected for 147 patients in a 3 month period (Sep-Nov 2011). Documentation was
addressed. Only 27% patients were given patient information leaflets. Infection rate was
2.4% in 2010 & 2.7% in 2011. Matrons have provided these results to clinical staff and have
taken action within their own areas. The temporary ANNT nurse has also achieved great
improvements in promotion of ANTT, line care and VIP scores. Medical staff have all
received ANTT training at induction. The patient information leaflet has been updated. Reaudit planned in 2013.
Isolation audit
23 wards were audited over a 3 day period in June 2012. Five other wards had no isolated
patients at the time of the audit. Most wards had good compliance with most criteria.
However only 43% were compliant with doors being kept closed, with no documented
evidence as to the reason why. Some wards did not have MRSA or CDT care plans for all
their isolated patients. Action has been taken.
Kitchen audit
28 ward kitchens were audited (Feb-Mar 2012). 4C achieved 100% but only 6 wards scored
over 90%. Medirest have taken action.
Sluice audit
The results of the annual audit were mostly excellent. They had been circulated to all
Matrons for action. Four wards, 1E, 3C, 1C and 5D have since improved their hopper
cleaning.
CQC unannounced inspection 5 October 2012
The CQC found the Trust met the standard for Cleanliness and infection control.
Hospital outbreaks 2012
7.1
4E – MRSA – February 2012
7 patients (4 different strains)
3 staff (not epidemiologically linked to patient strains)
7.2
Orthopaedics – C difficile infection- March 2012
7 patients (3 out of 4 patients on 3 alpha had same strain, two patients on 3B with another
strain)
0 staff
7.3
5C– MRSA – March 2012
5 patients
2 staff
3 patients with same strain. Staff strains were unrelated.
7.4
5B– MRSA – March 2012
2 patients
3 staff
4 distinct strains on typing. One patient and one staff had the same strain.
7.5
1D- Diarrhoea and/or vomiting- April 2012
14 patients
3 staff
This was a possible outbreak although several cases were explained by non-infective causes
e.g. laxative use etc.
7.6
4E – Chickenpox– May 2012
0 patients
3 staff
Index patient with shingles had been nursed in side room. All staff and patients had been
checked for history for chickenpox/shingles. Five patients required immunity testing. All were
immune.
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St Helens & Knowsley Teaching Hospitals Trust
7.7
7.8
7.9
7.10
7.11
7.12
7.13
Annual report, Infection Control 2012
5C– Norovirus – May 2012
15 patients (5 confirmed)
5 staff
2B– MRSA – May 2012
3 patients
3 staff
Two patients and one staff with the same strain.
5D– MRSA – June 2012
1 patient
5 staff
One patient and 3 staff with the same strain.
1A– MRSA – June 2012
1 patient
2 staff
All isolates were the same strain
5B– MRSA – August 2012
2 patients
2 staff
Both patients had the same strain. The 2 staff had 2 different strains
2C– MRSA – September 2012
3 patients
6 staff
Five different strains implicated:
One patient and 1 staff with t032 strain
One patient and 2 staff with t025 strain
3C- Diarrhoea- October 2012
11 patients
0 staff
• Presumed viral aetiology.
• One patient CDT positive
• 2 patients CDT negative (GDH & PCR positive i.e. potential toxin producers)
• One patient developed CDT on another ward 4 weeks later.
• All four patients had different ribotypes ( 014, 023, 002 & unassigned)
The total number of outbreaks in 2012 was increased compared with 2011. This was due to the new policy of
screening all ward staff if there is a single case of ward-acquired MRSA.
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St Helens & Knowsley Teaching Hospitals Trust
8.
Annual report, Infection Control 2012
Mandatory reporting
8.1 Meticillin-resistant Staphylococcus aureus (MRSA)
MRSA can cause substantial morbidity e.g. wound infections, line infections, bacteraemia, chest
infections, urinary tract infections, osteomyelitis etc
Since 2004, the Department of Health has set objectives for all Hospital Trusts to reduce their MRSA
bloodstream infection rates e.g. by 60% by 2007/2008 against the 2003/4 baseline. The objectives
for this Trust are shown below:
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
Year
2001/2002
2002/2003
2003/2004
2004/2005
2005/2006
2006/2007
2007/2008
2008/2009
2009/2010
Actual MRSA bacteraemias
Objective
28
24
21 (Target based on this figure)
31
16
17
30
13
25
12
8
12
12 (7 of which were community12 (community and hospital)
acquired)
The following objectives apply to hospital-acquired cases only.
2010/2011
8
5
2011/2012
5
5
2012/2013
7 (9 months into financial year)
3
MRSA bacteraemia against trajectory
The 2012/2013 objective (3 cases or fewer) was not achieved (7 cases):
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
Key findings from root cause analysis of the 7 hospital-acquired cases
Sex
Age
Ward
Source
1
2
3
4
m
f
f
f
85
61
81
91
5B
1D
4C
5A
Chronic wound
IV line infection
Post op chest infection
IV line infection
5
6
7
f
f
f
39
84
76
1B
3D
1B
Infected skin lesions
?Deep seated infection
Cellulitis
RCA
Failure to screen chronic wound on
admission. Staffing levels.
Line care issues. Staffing levels.
No pre-op MRSA suppression
Line care issues. Staffing levels.
Failure to swab infected dermatitis on
admission
Under appeal
Inappropriate empirical Rx
Prior
MRSA
No
Yes
Yes
Yes
No
Yes
Yes
5
4
3
2
Medical staff not aware of MRSA status
Failure to give decolonisation
Inappropriate patient placement
Staffing issues
Incomplete screening
Line care issues
Incomplete ANTT training
0
Delay in starting appropriate abx/delay
in appropriate clinical assessment
1
Inappropriate empirical treatment
Number of RCAs in which factor
was identified
Analysis of all issues:
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
Contributory factors:
Analysis of the factors which had contributed to increased infection rates in the Trust, which had previously
been achieving targets, highlighted the following issues:
• Increased activity
• 20% increase in Emergency Department attendances
• 10.5% increase in non-elective admissions
• Bed capacity remained static
• Staffing levels/skill mix inadequate
• Two wards were planned for closure in 2012 but winter pressures continued so these wards
remained open and further escalation areas were also opened. This resulted in staff being
spread more thinly. More bank & agency nurses were utilised. Redistribution of staff resulted
in ward teams being split up and working less effectively. In some areas the skill mix was
suboptimal
• IV Access Team merged into Medical Emergency Team (MET)
• While the team continue to insert PICC (peripherally inserted central catheter) lines,
responsibilities such as audit, training, VIP scores, care bundles, ANTT (aseptic non touch
technique), high impact interventions etc. were devolved to ward level. These functions were
undertaken at ward level with variable quality. Medical staff were no longer included in
training. Surveillance data was no longer gathered. IV line policies had lapsed.
• Suboptimal ANTT.
• Ownership of infection prevention and control at ward level was variable.
• Medical engagement was variable e.g. contribution to RCA (root cause analysis) & suboptimal
prescribing for patients with a past history of colonisation with MRSA.
• The pre-op MRSA clinic pathway was focussed more on screening than decolonisation.
In order to address these and other issues, action was taken in the following areas:
1. Staffing levels
– Rapid workforce review was undertaken.
– The recruitment process was speeded up.
– Staffing levels were improved.
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St Helens & Knowsley Teaching Hospitals Trust
–
–
Annual report, Infection Control 2012
A more detailed workforce review is to be reported to Trust Board imminently.
Root cause analysis of all MRSA & MSSA (Meticillin-sensitive Staphylococcus aureus)
bacteraemias for the past 12 months were repeated by Head of Quality and Patient Safety
Manager. Highlighted issues were fed into the action plan. A Task & Finish Group was set up
to address the required actions.
2. ANTT
– A senior nurse was immediately seconded to focus initially on the admission units, later
Trust-wide. Her remit included promotion of ANTT, audit, line care, VIP scores, HIIs etc.
– A business case for the permanent post of ANTT specialist nurse was approved
– ANTT training was addressed at training sessions. In addition, the Clinical Skills Laboratory
produced training videos uploaded onto the intranet for access by all staff.
– All junior doctors were trained in ANTT at induction in August 2012
– Amalgamation and updating of all intravenous line insertion & care policies was undertaken
by the Nurse Consultant in charge of the Medical Emergency Team (MET).
– All lines inserted by ambulance staff and those inserted in emergency situations within the
Trust labelled with red dots (for removal within 24 hours).
– ANTT posters were produced for a wide range of procedures.
3. IV line care
– IV packs were in place on all wards by November 2012 (the earliest date possible as the
company required a minimum 3 month turn around). The IV packs include: sterile drape,
Chloraprep, single patient use tourniquet, Bionector, waste bag, VIP score chart, Tegaderm
dressing
– Training on the use of the packs (with ANTT) was provided to all clinical staff. A clinical skills
video on cannulation was uploaded onto intranet.
– The cost pressure was in excess of £200,000.
4. MRSA screening & management
– Revision of the pre-op MRSA screening pathway with the focus on colonisation suppression
rather than repeat screening. The MRSA policy, patient group directives and patient
information leaflets were all updated to take account of changes in the decolonisation
pathway.
– Increased screening of staff for MRSA. If there is a single hospital-acquired MRSA on ward,
the IPCT will recommend on staff screening.
– Reinforcement of key messages to clinical staff.
– Empirical prescribing information for patients known to be colonised with MRSA has been
circulated to all wards (posters) and GPs (email).
5. Communications
Infection prevention and control messages were reinforced with the use of many different means of
communication including:
– Global emails.
– Intranet messages.
– Screensaver (Clean your hands campaign).
– Home page ticker tape message.
– Feature of the month.
– Team Brief.
– Meetings & presentations: Clinical Directors, Consultants, Matrons, Link Nurses,
Directorates, wards, ward managers.
– Posters on management of patients with MRSA.
– Additional junior doctor infection control training given on Wednesday and Thursday teaching
sessions (also walk in messages).
– Payslip messages (Spread good practice, not infection).
– Lift mirror messages .
– Personal communication on wards.
6. Visits to other Trusts by IPCT
– 2011: Leighton Hospital, Aintree University Hospital
– 2012: Stepping Hill Hospital, Stockport, Lancashire Teaching Hospitals, Preston
– A report was produced and an action plan completed for each visit.
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
7. Information technology
– Infection control dashboard was already in place. This was heavily publicised and used in the
Executive Team RCA reviews. The dashboard is accessible to all Trust staff. It can be used
to look at Trust-wide reports (mandatory data & comparative ward data). It can also produce
individual ward 3-page reports on key performance indicators e.g. infections, results of audits
(ward audits, hand hygiene, BBE (bare below the elbows) compliance, commodes,
mattresses, RCA returns, link nurse attendance at infection prevention and control
meetings).
– Patient & Telepath (laboratory) systems were linked to obtain automated MRSA screening
compliance figures, in place of time-consuming ward visits & audits.
– An interactive Trust Antibiotic Policy is being created. There are plans to produce an app for
the Antibiotic Policy in 2013.
– A business case for assistance with management of dashboard, data entry systems,
provision of statistics is in progress.
8. Executive Team engagement
– Executive Team ward rounds
– Executive Team reviews of RCAs:
• Chaired by Medical Director. Attended by Director of Nursing, CE, IPCT
• RCA presented by Consultant (non-negotiable)
• Matron & Ward Manager in attendance
• Review of ward dashboard (key performance indicators)
• Any non-compliance reported for escalation
– Disciplinary measures were utilised as required for refractory non-compliance with Trust
infection prevention and control policies.
– External review was commissioned (Duerden Consulting Ltd)- see next page for summary.
9. Engagement at ward level.
– Medical staff engagement:
• Reinforcement of messages on appropriate empirical prescribing for patients known
to be colonised with MRSA
• Annual mandatory training lectures for consultants included guidance on RCAs,
alerts, ANTT.
• Consultant RCA presentations at Executive Team RCA reviews.
• 21 consultants from all specialities volunteered to be Consultant Leads in infection
prevention and control for their own areas. A job description was produced and
guidance was provided at the first meeting
• Additional junior medical staff teaching sessions were provided.
– Infection control registers were produced for all nursing staff to sign off when they had
completed training for ANTT, Ayliffe hand hygiene, commode cleaning, VIP scoring, UCAM,
MRSA swabbing, dress code and isolation requirements.
– Supervision at ward level:
• IPCNs (Infection Prevention and Control Nurses) review all new/readmitted patients
with MRSA and check that isolation precautions are correct, correct PPE (personal
protective equipment) is used, MRSA care plan is in notes, full MRSA screen has
been done and that empirical prescribing is appropriate, with escalation to
Microbiology Medical staff if not. They also check that appropriate colonisation
suppression treatment has been started. They revisit if any problems are identified at
the first visit(s).
• A 3 month secondment of band 5 Staff Nurse to IPCT commenced November 2012
to assist with the additional workload.
• Ward Pharmacists now also have access to ADT alert searches and review
prescribing for all patients with a history of MRSA colonisation in the past.
10. Prevention of blood culture contamination
– Blood culture packs were provided initially to the Emergency Department and acute
admissions wards, later extending to other wards. Contents include: blood culture bottles,
disposable tourniquet, Chloraprep, alcohol wipes, ANNT mini-poster, waste bag (with
surviving sepsis information printed on the side).
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
11. Other
– Operating theatre issues were addressed.
– The infection predictor tool is currently being trialled on 5 wards.
– Epidemiological data is monitored for blood cultures on telepath (hospital/community/device
related)
– Sustainability
External Review
The external review was undertaken by Duerden Consulting Ltd on 23 rd November 2012. It included
interviews with key staff and also ward inspections. The report was circulated to all consultants, matrons,
ward managers and infection control link nurses. Key actions included:
1. Competency assessments for ANTT for all staff by the end of January 2013.
2. Improved MRSA decolonisation.
3. Interactive antibiotic policy.
4. Cleaning processes in absence of housekeeper. Communications on what cleaning provision is
available.
5. Medical engagement and ownership, with inclusion of infection prevention and control in appraisals.
6. Governance and assurance processes.
7. Hand hygiene audits when staff are unaware.
8. Share practice with other Trusts
9. To promote judicious antibiotic & PPI prescribing in the community.
A detailed action plan has been produced and reviewed by the Hospital Infection Prevention Committee and
the issues are being tackled.
Rates for the previous financial year were published in July 2011:
MRSA bacteraemia (Trust apportioned)
MRSA bacteraemia rate per 100,000 bed days (April 2011-March 2012) was 2.2
Previous year’s rate was 3.5 per 100,000 bed days (April 2010-March 2011).
The average for all Trusts was 1.3 (excluding Specialist Trusts). (April 2011-Mar 2012)
We rank 7th of 9 Trusts in Merseyside and the 123rd out of 149 Trusts nationally (excluding Specialist Trusts).
MRSA rates per 100,000 bed days Mersey Trusts 2011-2012
3.5
3.0
Rate per 100,000 bed days
2.5
2.0
1.5
1.0
0.5
0.0
Series1
Southport &
Ormskirk
Warrington &
Halton
St Helens &
Knowsley
East Cheshire
Aintree
Royal Liverpool
& Broadgreen
Chester
Mid Cheshire
Wirral
3.3
2.6
2.2
1.7
1.6
1.4
1.2
0.6
0.4
Trust
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
MRSA screening of elective patients
All elective patients have been screened for MRSA since March 2009. Screening of all emergency patients
for MRSA was phased in during the last 4 months of 2010. Compliance rates can now be monitored on a
daily basis, utilising the link between PAS and Telepath IT systems.
Staff screening
Staff screening/specimens revealed 36 carriers, all of whom have received decolonisation treatment. This
increase is due to the new policy of screening all staff if there is a single case of ward-acquired MRSA.
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St Helens & Knowsley Teaching Hospitals Trust
8.2.
Clostridium difficile toxin infection (CDI)
Targets for CDI were introduced in 2008/2009:
Baseline data
334
Targets
2008-2009
302
2009/2010
235
2010/2011
169 (DOH target) 71 (PCT target)
2011/2012
65
2012/2013
37
Annual report, Infection Control 2012
Actual
170
75
74
52
25 (in first 9 months)
The following chart shows ALL cases of CDT diarrhoea (community-acquired and hospital-acquired)
since 2007. The figures relate to calendar years, not financial years.
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
The chart below shows the progress with the current year’s target of 37 cases. So far, there have been 25
cases in the first 9 months of the financial year.
There was a peak in the number of cases in November 2012. The RCAs for all 7 cases were been reviewed
by the Executive RCA Review Team on 10th December. The cases had all been on different wards. No
common links between cases had been identified. Only 2 patients were found to have the same ribotype
(020). The other patients had 5 different strains. These 2 patients were never on the same
wards/departments. Ribotype 020 is not the most common strain in the UK (see below) but it is amongst the
top 10 most common ribotypes, so this was probably just coincidence. Five patients were on antibiotics (all
were prescribed appropriately). Five patients were on PPIs. This area is a national outlier for high prescribing
rates for PPIs, therefore an audit will look into whether prescribing is initiated in the hospital or community
and whether it is in line with NICE guidelines. The cases on 2A in November & December were unrelated
ribotypes.
Rates for the previous financial year were published in July 2012:
CDT diarrhoea (Trust apportioned)
CDT rate was 22.8 per 100,000 bed days for patients ≥ 2 years (April 2011-Mar 2012).
Previous year’s rate was 32.4 per 100,000 bed days (April 2010-March 2011).
The average for all Trusts nationally was 21.8 per 100,000 bed days for patients ≥ 2y (April 2011-Mar 2012)
(average includes Specialist Trusts).
We ranked 5th out of 9 Trusts in Merseyside (see chart below) and 94th out of 149 Trusts nationally
(excluding Specialist Trusts) for patients over 2 years.
Page 24/48
St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
CDI rates Mersey Region (Trust apportioned cases) patients >2y 2011-2012
CDI rate per 1000 bed days
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Series1
8.3
Chester
Wirral
Aintree
East Cheshire
St Helens &
Knowsley
Royal Liverpool &
Broadgreen
Southport &
Ormskirk
Warrington &
Halton
Mid Cheshire
30.9
25.2
24.6
24.4
22.8
22.5
22.5
21.0
16.8
Meticillin-sensitive Staphylococcus aureus (MSSA)
MSSA bacteraemia mandatory surveillance commenced in January 2011, but objectives have not yet
been set by HPA. The number of hospital-acquired cases in 2012 (18) was reduced (36%) compared
with 2011 (28). Sources were skin & soft tissue (5), line (4), chest infection (4), surgical site infection
(3), urinary tract (1) and unknown (1). Root cause analysis was undertaken on each case and
appropriate action was taken.
Year
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
Total
8.4
Month
January
February
March
April
May
June
July
August
September
October
November
December
Total
Acute
5
3
5
3
6
6
3
6
0
5
2
3
47
2
1
4
1
2
1
1
4
0
1
0
1
18
Community
3
2
1
2
4
5
2
2
0
4
2
2
29
Escherichia coli
E coli bacteraemia mandatory surveillance commenced in April 2011. Objectives have not yet been
set by HPA. The number of hospital-acquired cases in April-December 2012 (42) was around the
same as the same period in 2011 (44).
The majority (80%) of cases are community-acquired. Of those that occur in hospital, most are
unavoidable e.g. biliary tract infection, urinary tract infection in non-catheterised patient. Only 3% are
potentially avoidable e.g. urinary tract infection in catheterised patient.
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St Helens & Knowsley Teaching Hospitals Trust
UCAM
urinary
aim of:


Annual report, Infection Control 2012
(Urinary Catheter Assessment & Monitoring) was introduced in 2011 in order to reduce
catheter associated urinary tract infection. All urinary catheter care is documented with the
Preventing unnecessary catheterisation.
Prompting daily review of patients with catheter to encourage the earliest possible removal of
catheter.
 Providing evidence of quality of patient care (insertion & ongoing care) as per High Impact
Intervention No.6 catheter care bundle (Saving Lives).
UCAM compliance is monitored monthly and included as a key performance indicator in the infection
control dashboard.
2012
Jan
Feb
Mar
April
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
TOTAL
8.5
Hospitalacquired
5
4
6
5
4
2
8
3
4
6
6
4
57
Communityacquired
17
16
20
18
17
16
18
21
19
23
14
31
230
Total
22
20
26
23
21
18
26
24
23
29
20
35
287
Percentage
hospitalacquired
23
20
23
22
19
11
31
13
17
21
30
11
20
Vancomycin-resistant enterococcus (VRE)
VRE is multi drug-resistant enterococcus (usually Enterococcus faecalis or Enterococcus faecium).
Patients found to be colonised with these organisms are isolated to avoid transmission of infection.
In 2012 there were 9 patients colonised or infected with VRE. Six were community-acquired
(including one blood stream infection), 3 were hospital-acquired (all from catheter specimens of
urine). The hospital-acquired strains were on 3 different wards.
8.6 Orthopaedic surgical site infection: mandatory surveillance
January-September 2012
Whiston
National
(Infected/Total)
Hip replacement
1/213 (0.5%)
1.2%
Knee replacement 4/249 (1.6%)
1.6%
Regular multi-disciplinary meetings have continued throughout 2012 to tackle all aspects of the
patient pathway.
9.
Infectious disease 2012
The Medical Microbiologists notifies the following infectious diseases to the Consultant in
Communicable Disease control.
These figures are for infections diagnosed in the Whiston Microbiology Laboratories and therefore
include patients from other districts. Patients with gastro-intestinal infections do not usually require
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St Helens & Knowsley Teaching Hospitals Trust
Annual report, Infection Control 2012
hospital admission unless they have a severe case, in which case they will be isolated on
admission. These are not hospital-acquired organisms.
9.1
Salmonella infection
31 patients developed Salmonella food poisoning. This is decreased compared with last year
(54 patients).
9.2
Campylobacter food poisoning
267 patients developed Campylobacter food poisoning. This is decreased compared with
last year (356 patients).
9.3
Cryptosporidium diarrhoea
17 patients (mainly children) developed Cryptosporidium diarrhoea. This is increased
compared with last year (5 patients).
9.4
Summary of gastro-intestinal infections for past 7 years
2006
2007
2008
2009
2010
2011
2012
Salmonella
82
60
39
50
42
54
31
Campylobacter
311
307
262
296
273
356
267
Shigella dysentery
1
3
2
0
7
5
2
Cryptosporidium diarrhoea
11
9
7
17
10
5
17
Giardia
3
1
4
3
4
6
3
E.coli 0.157
6
4
3
3
3
2
6
Vibrio cholerae (non O1)
0
0
0
0
0
1
0
9.5
Tuberculosis
Mycobacterium spp. were isolated from 31 patients.
Nine isolates were identified as
M. tuberculosis.
Twenty two isolates were identified as atypical Mycobacterium species (Mycobacterium
avium intracellulare, chelonae, malmoense, gordonae & fortuitum).
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St Helens & Knowsley Teaching Hospitals Trust
9.6
Annual report, Infection Control 2012
Meningitis
The number of patients admitted with community-acquired meningitis was increased
compared with last year, mainly due to an increase in viral meningitis cases.
Organism
Meningococcal/
presumed
meningococcal
Pneumococcal
Treated
bacterial
Viral
Staphylococcus
aureus
Group B strep
TB
Listeria
E coli
TOTAL
2007
11
(10
GpB)
6
3
2008
6
(6
GpB)
4
6
2009
16
(16
GpB)
1
3
2010
5
(5
GpB)
9
6
2011
6
(5
GpB)
3
3
2012
3
(2
GpB)
5
2
15
0
24
0
24
0
19
1
25
0
43
1
0
0
0
1
36
1
0
1
0
42
1
0
1
3
49
1
0
1
0
42
1
0
1
0
39
4
0
0
1
59
9.7 Other infections
2007
2008
2009
2010
2011
2012
Infection
Hepatitis A
5
2
4
3
1
1
Hepatitis B
15
17
12
4
7
6
Legionella
3
1
2
0
1
4
HIV
3
2
3
5
9
6
Typhoid/paratyphoid
0
1
0
0
0
0
Listeria
0
1
1
2
1
0
Malaria
2
2
0
2
0
2
Non-toxigenic diphtheria 2
2
2
1
0
0
Pneumocystis
4
0
4
1
3
2
Leptospira
1
0
0
0
0
0
Lyme disease
0
0
0
0
0
1
The largest measles outbreak on Merseyside since the MMR vaccine was introduced (1988) commenced in
February, affected over 400 people in the North West and started to slow in August. Patients in the St Helens
and Knowsley area were also affected, a small number requiring admission to hospital. The Microbiology,
Infection Control and Health Work and Wellbeing Departments were involved in ensuring that all staff
contacts were vaccinated.
10.
10.1
10.2
10.3
10.4
10.5
Surveillance
Alert organism surveillance (MRSA, C difficile, VRE, gastrointestinal pathogens etc) is undertaken on
a daily basis utilising infection control boards. Appropriate infection control action is taken.
Mandatory surveillance of MRSA and S aureus bacteraemia rates. This Trust submits a detailed
electronic proforma on each case of MRSA bacteraemia to the Health Protection Agency. Root cause
analysis is also undertaken on every case of hospital-acquired MSSA/MRSA bacteraemia.
Mandatory surveillance of CDT diarrhoea. Enhanced reporting of CDT diarrhoea commenced 1st April
2007. This Trust submits a detailed electronic proforma on each case of CDT diarrhoea to the Health
Protection Agency. Root cause analysis is also undertaken on every case of CDT diarrhoea
Mandatory surveillance of MSSA bacteraemia commenced 1st January 2011.
Mandatory surveillance of Escherichia coli bacteraemia commenced in June 2011.
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10.6
10.7
10.8
10.9
10.10
10.11
10.12
10.13
11.
Annual report, Infection Control 2012
Mandatory surveillance of GRE (Glycopeptide-resistant enterococcus) bacteraemia.
Mandatory surveillance of surgical site infection for orthopaedics.
CoSurv reporting of blood culture isolates, gastrointestinal pathogens, meningitis isolates etc. to
CCDC via the regional Epidemiologists is automated via the CoSurv system.
Monthly feedback reports have been provided to Matrons and Consultants on the number of cases of
C difficile diarrhoea, MSSA, VRE and MRSA within their areas.
HCAI (healthcare associated infections) performance monitoring framework
Since 1st October 2009, monthly reporting to the PCT via the performance monitoring framework has
continued.
Urinary catheter audit
A single day prevalence study done in June 2011 showed an infection rate of 4% (2 out of 50
patients). After UCAM initiatives, the repeat audit in January 2012 showed an infection rate of 1.2%
(1 out of 84 patients). In September, UCAM forms were in use for all catheterised patients and there
were no infections.
Large bowel surgical site infection surveillance 1 September 2011- 30 November 2011. The
results for 38 eligible patients were analysed and fed back to the surgical team in 2012. The national
rate of infection reported by the HPA is 10.1%. This audit identified an infection rate of 8%. However,
there were additional patients with insufficient documented evidence to classify as infected or noninfected e.g. infection reported by patient after discharge home.
Cumulative hospital-acquired infection counts per ward
Committee representation
11.1
Hospital Infection Prevention Committee
11.2
Health Economy Healthcare Associated Infection Group (Knowsley)
11.3
Health and Safety Committee
11.4
Sharps Safety Group
11.5
Patient Safety Executive Committee
11.6
Drugs & Therapeutics Committee
11.7
Decontamination Joint Management Board
11.8
Decontamination User group
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St Helens & Knowsley Teaching Hospitals Trust
11.9
11.10
11.11
11.12
11.13
11.14
11.15
11.16
11.17
11.18
11.19
11.20
Annual report, Infection Control 2012
Matrons’ Infection Prevention & Control meetings
Monthly Division (Medical/Surgical) Infection Control meeting
Clinical Performance Council
Catheter focus group.
Integrated Systems Project Board.
Infection control/facilities management meeting
Major incident planning committee
St Helens & Knowsley NHS Trust Major Incident Planning Group
Clinical Directors Forum
Augmented care water supply meeting.
Medical Governance Council
Surgical Governance Council
12.
Involvement in Hospital Services
12.1
Building plans
New Hospital Build
The Infection Prevention & Control Team has continued to assist in advising on the infection
control aspects of the new build.
12.2
Best practice technical guidance: Water sources and potential Pseudomonas
aeruginosa contamination of taps and water systems.
This guidance was published by the Department of Health 31 March 2012. It applies to
augmented care units i.e. Critical Care, Burns, SCBU, 2A. Water testing of 100 outlets in
April revealed Pseudomonas (>10cfu/100mls) at 7 outlets. A multi-disciplinary group has met
throughout the year to address a water safety plan, further testing as indicated, remedial
action, replacement taps, point of use filters and possible use of chemical agents (halogen
based biocide). Affected wards have been issued with guidance on avoidance of
contamination of the taps, daily flushing of taps and provision of sterile water where indicated
by risk assessment. Advice has also been sought from other Trusts and experts throughout
the country. However this is proving to be a difficult issue nationwide. Revised guidance is
expected in 2013.
13.
Additional activities
13.1
Annual General Meeting September 2012
A stand was manned by the Infection Prevention & Control Team.
13.3
IT initiatives
Performance management
The executive dashboard tailored to infection control went live in February 2012. It is updated
monthly. The dashboard is accessible to all staff in the Trust and features mandatory
surveillance results. It also allows wards to compare their performance with that of other
wards. They can also produce a 3 page summary of their key performance indicators. The
dashboard is used for quality ward reports and also for the Executive Team RCA review
meetings.
14. Antimicrobial prescribing (Report by A Lewis Medicines Management Pharmacist (Antimicrobials)
14.1
Trust Antibiotic Policy
The Trust Antibiotic Policy from 2010 is currently being updated and adapted for an
interactive antibiotic website due to be launched in early 2013.
14.2
Audits
 The Trust entered into the Advancing Quality (AQ) program for northwest NHS
Trusts in Oct 2008. The Trust was the top performing trust for 2012 for the
management of community acquired pneumonia (CAP). An independent review of
the first eighteen months of the Advancing Quality Programme has now been
published in the New England Journal of Medicine in November 2012. This review
shows that the Advancing Quality Programme has saved lives and increased
productivity and exemplifies the great work being undertaken at the St Helens and
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Annual report, Infection Control 2012
Knowsley Trust and the continual striving forward to provide an exceptional standard
of care. Areas for improvement still include time to first dose for antibiotics and
antibiotic selection, with strategies being discussed and implemented accordingly.
Following entry into the AQ program there have been a number of audits throughout
2011-12 regarding time to first antibiotic dose (TTFD). The focus has been using stat
dose antibiotic prescribing for first doses to speed rate of drug administration to the
patients in both acute and non acute ward settings. Audits in 2011 have shown an
average time from writing the prescription to drug administration for stat doses was
39 mins vs 2 hrs 50 mins for acute wards (AMU and A&E). On non-acute surgical
wards the mean TTFD for stat doses and non-stat doses was 28 mins and 5 hrs 14
mins respectively and for the other non-acute wards 50 mins and 5 hrs 18 mins
respectively. In 2012, there has been investigation into the effect of reduced TTFD
and outcome and how increased education has increased greater prioritisation of
patients and need for prompt treatment by staff at the Trust. Initial data shows that
reduced TTFD leads to a reduced length of stay in all CAP disease severities. All
initiatives have been presented at DTC, HIPC meeting and junior, senior doctor and
nurse teaching. A full report on effects of TTFD is to follow in early 2013.
The trust-wide antibiotics point prevalence audits continued in 2012 with the
commencement of the Antibiotic Management Team (AMT) ward rounds. Audits
continue to include pharmacist intervention and effect on course length review date
endorsement, allergy status, and documentation of antibiotic indication, route of drug
administration. All data was analysed trust wide and subdivided into medical and
surgical directorates. Audits in 2012 showed similar performance on previous 2011
audits with review stop dates being endorsed greater than 80% for antibiotic
prescriptions (throughout all audits). High pharmacist intervention was needed to
achieve this and as initially only approximately 55-65% of antibiotics prescribed had
course lengths or review dates documented by prescribers. It must be noted that
while certain areas continue to improve other areas are not complying with the Trust
policies and areas that prescribe IV antibiotic consistently do not have review dates
or course lengths on them which needs to be addressed to promote a quick IV to PO
switch campaign. Any poor performing wards/areas and those with increased
incidence of healthcare-associated infections will be targeted by the regular AMT
ward rounds. Other findings in the audits showed that allergy status, indication
documentation, and adherence to trust antibiotic policy continued to be greater than
90% for the trust. All results and findings were presented at Drug and Therapeutic
Committee (DTC) and Hospital Infection Prevention Committee (HIPC) meetings
throughout 2012 while reports were produced for the directorate leads to disseminate
the information throughout their directorates. All audit information is incorporated into
the junior and senior doctor teaching. This will be re-audited quarterly to monitor
compliance to implementation of policy.
In 2012 quarterly antibiotic prescribing audit information was continued to be
incorporated into a northwest antibiotics group audit. The aim was to try and
determine antibiotic prescribing trends for different trusts and any direct correlation
with C difficile infection rates.
Audits looking at the percentage of missed antibiotic doses for 2012 continued
across the trust. Audits in January and June showed that between 5-9% of all
prescribed antibiotic doses were missed. The most common reasons for drug
omission was were drug kardex not signed by nursing staff, patients refusing
treatment and where patients had no IV access. Recommendations will be made and
implemented though the HIPC and DTC which include matrons, doctors and
pharmacy staff. Further audit is planned for early 2013.
OPAT (outpatient parenteral antibiotic therapy) services for Halton and St. Helens
were re-evaluated for in 2012. Utilising the OPAT service saved the Trust 1817 bed
days in 2011-12 increased on the 2010-11 figures of 1400 bed days saved and
saved approximately £545k (up from (£420k). Successful completion rates of therapy
to the desired outcome over 2 year’s audits were greater than 86%. Greater than
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14.3
14.4
Annual report, Infection Control 2012
84% of levels are within the therapeutic range of 10-20 mg/l under OPAT and
continues to be more accurate than in the inpatient setting. Reasons for levels being
outside of this range included samples being incorrectly taken (wrong time, taken
incorrectly from PICC line, changes in clinical condition, or where inappropriate level
was taken in clinic follow up).
 A poster presentation was presented back at the second northwest antibiotics
conference held at Whiston Hospital in Nightingale House in October 2012. In 2013
the OPAT service will continue to be re-audited and potentially expanded to areas
allowing either early discharge or admission avoidance. There is continued work with
the CCGs to provide a uniformed service provision across different areas in primary
care for this locality. All audit data for the success of the interface between primary
and secondary care was presented to the CCGs for information for GPs interested in
the service. The aim is the develop confidence in the OPAT service and potentially
prevent hospital admissions.
 The success of the St. Helens and Knowsley Trust and the OPAT program for Halton
and St. Helens was presented at the first OPAT conference held at Whiston hospital.
A poster was present in conjunction with the community teams.
 OPAT missed doses were audited in 2012 and compared to secondary care. In
secondary care between 5-9% of the prescribed antibiotic doses being missed
compared to patients under OPAT this fell to 3% (less than 2% if poor patient
compliance is removed from the data analysis). This will be monitored in 2013.
 The Halton and St. Helens OPAT team had no line-related infections again for 2012.
Liaison with Infection Prevention & Control Team
 The weekly joint C difficile ward rounds by the IPCT and Antimicrobial Pharmacist
commenced in 2008 continued throughout 2012.
 All pharmacists covering wards working with IPCT staff now check all MRSA patients
for appropriateness of antibiotic therapy.
 In the event of high rates of infection on a ward, Pharmacy staff were involved in the
multidisciplinary meetings between the IPCT and clinical staff to discuss action.
 The Antimicrobial Pharmacist contributed to the multi-disciplinary root cause analysis
of healthcare-associated association infection e.g. C difficile infection (CDI), MRSA
bacteraemia as required.
 The Consultant Microbiologists have continued to be integral to the Antimicrobial
Management Team (AMT) and interactive antibiotics policy and guideline
development. AMT ward rounds commenced in August 2011 focussing on areas of
high use antibiotics, increased rates of healthcare associated infection or areas that
were performing poorly in point prevalence audits.
 New MRSA screening pathways and PGDs commenced in 2012 at St. Helens
hospital pre-op screening clinics.
Feedback on antibiotic prescribing
 Pharmacy staff continued to develop the production of auto-generated reports of
DDDs in order to provide directorate feedback. The overall aim is to upload all
prescribing information on to the interactive antibiotics policy on the intranet for ease
of disseminating information to all members of staff.
 In addition to the auto-generated DDD report, we have developed a database/query
engine which allows very detailed analysis of antibiotic usage by DDD. This
database is being developed further by incorporation of hospital activity statistics and
expanding the numbers of drugs analysed on the data base. This will facilitate better
benchmarking of antibiotics usage with other Trusts able to generate these data.
Individualised directorate antibiotic usage information was available using this
database on request.
 Antibiotic prescribing is a standing item on the DTC and HIPC agendas.
 Issues surrounding antibiotic prescribing including cost performance improvement
programs and patient safety are discussed at HIPC.
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Annual report, Infection Control 2012
Antibiotic pharmacist and consultant microbiologists undertake Root Cause Analysis
(with regard to antibiotic prescribing) for all cases of CDT diarrhoea. The findings are
fed back to both hospital and community infection control teams. Every month all
report cases of hospital acquired CDI are review at executive level by a review team.
Quarterly audits regarding antibiotic prescribing issues will continue as before.
Results circulated through directorate heads and clinical leads.
Time to first antibiotic dose audits have been presented at HIPC, DTC meeting and
incorporated into the educational session for A&E, MAU, and junior doctor sessions.
Surgical increased rates of infection group continued to meet every 3 months in
2012.
All RCAs for MRSA bacteraemias and CDI antibiotic prescribing is fedback to the
teams caring for the patient to review appropriateness. For MRSA management
additional MRSA treatment summary sheets were circulated throughout the wards
and clinical staff to inform all members of staff regarding appropriate treatment
pathways for covering potential MRSA infections.
Findings from AMT ward rounds are discussed with ward medical staff at the time of
the ward rounds (if immediate action required) and also fed back to all relevant
medical and nursing clinicians after the ward round.
Other
 The Pharmacy Aseptic Dispensing Unit continues to work under its manufacturing
license for production of certain aseptically prepared products. This allows wards to
stock certain pre-made up IV antibiotics to aid rapid administration. They are also
continuing to look to increase the number of aseptically prepared products in the
near future as per NPSA advice.
 Three monthly meetings between critical care areas and Antimicrobial Pharmacist to
review drug use and expenditure continued in 2012.
 Throughout 2012 we were actively involved with the NW antibiotics pharmacist
group. We have been supporting work to produce useful benchmarking information
on antibiotics management allowing comparison of trusts.
15. Decontamination. Report by Sue Dickinson
15.1 Cold Decontamination
The Cold Decontamination Units at both sites have extended their working hours to accommodate
the increase in demand from the user departments (mainly Endoscopy). A review of further expected
increase in demand and decontamination capacity issues is being undertaken as Government health
promotions are likely to increase endoscope procedure referrals in the near future.
Decontamination equipment continues to be covered by a service contract which includes validation
of the process; weekly testing of the final rinse water quality takes place and the results are closely
monitored. Any washer disinfector which has results falling below the stipulated levels for rinse water
quality is taken out of use and re tested following any remedial action before being put back into use.
Thus ensuring decontamination equipment is fit for patient use.
Decontamination Technicians receive regular update training on use of decontamination equipment
and care of endoscopes and undertake competency assessments.
An on call service has been provided since April 2012 to cover the decontamination of emergency
use endoscopes outside of normal working hours ensuring only trained and competent staff
undertake decontamination procedures.
The Decontamination units have recently purchased a Vac-a-scope system which vacuum pack
decontaminated endoscopes. Once vacuum packed the endoscope remains decontaminated for 30
days and this has allowed the trust to offer a decontamination service to a neighbouring Trust under
an SLA, generating income.
15.2 Trust wide decontamination.
An audit of decontamination practices undertaken throughout the Trust is ongoing; issues highlighted
so far have included decontamination of ophthalmic equipment used in the Eye Clinic and ultrasound
probes (including transoesophageal echocardiography probes). Action plans have been developed
and implemented to resolve these issues. The audit and action plans benefit from close working
between Decontamination and Infection Control. In addition, as a result of an MHRA medical device
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alert, the Trust reviewed the decontamination process for re-usable laryngoscope handles. As a
result of this review, the Trust changed to single use laryngoscope handles in all clinical areas except
in those areas which have sufficient numbers of laryngoscope handles to be able to sterilise them by
autoclaving between patients.
15.3 Synergy – off site private provider of decontamination services
The service continues to work well with good working relationships between the two parties
15.4 Choice Framework for local Policy and Procedures (CFPP)
These are a set of Department of Health Guidelines which have been recently published relating to
decontamination. The requirements of the CFPP are to undertake risk assessments of
decontamination practice, develop and implement action plans thus ensuring that the Trust achieves
all essential practice requirements and have a clear plan to meet the best practice as determined by
local choice. The Trust has a working group (which includes representation from Infection Prevention
and Control) to oversee the achievement of CFPP requirements.
16. Cleaning services (Report by Dyan Clegg)
16.1
Management arrangements
Cleaning is a top priority for the Trust and the team goal is to provide the cleanest and safest
environment possible for patient’s staff and visitors. For the past six years the Trusts cleaning
services have been provided as part of the PFI (Private Finance Initiative) partnership arrangement
with New Hospitals by their service provider Medirest. Medirest manage the cleaning of all wards and
departments within the Trust. The strong partnership between the Contracts Monitoring Team, The
Infection Prevention & Control Team, New Hospitals and Medirest ensures service developments
and improvements are implemented, maintaining a focus on patient services.
The teams at St Helens and Whiston Hospitals have spent time reviewing cleaning standards and
training staff in working methods and techniques keeping up to date in line with the clinical service
requirements. The team continues to be involved in the care group infection control meetings to
ensure the cleaning team is working in harmony with clinical staff to improve infection prevention and
control.
Various equipment trials and projects have been completed in the past twelve months, ranging from
new high tech chemical dispensing systems, computerized monitoring tools to revised processes for
cleaning areas upon patient discharge.
16.2
Monitoring and user satisfaction measures
The monitoring systems implemented at St Helens and Whiston Hospitals relate to the NHS
standards for cleanliness and link in with the PEAT initiative. Within the PFI partnership all parties
jointly monitor the services provided against the agreed performance standards. This information is
collated and reported monthly at the main contract meetings.User satisfaction links in with all
monitoring systems in the form of various customer questionnaires, response to complaints, and
patient feedback from PEAT inspections. Feedback from patients, staff and visitors is used to
determine areas of service improvement and development. The link between Domestic Supervisors,
Managers and Matrons provides regular feedback on the ward environment and is essential in
providing excellent standards of cleanliness.
16.3
Budget allocation
The Trust currently spends just under £3,000,000 per annum on cleaning services across all sites.
16.4
PEAT scores for cleanliness
All NHS hospitals are annually inspected and externally rated against published PEAT standards
including cleanliness, catering, infection control, privacy and dignity and environment. Both St
Helens and Whiston Hospitals were rated as having an ‘Excellent’ overall PEAT score at the
inspection in 2012. This was an excellent achievement for all staff involved in maintaining cleanliness
and maintenance within the Hospital environment. Next year the Trust faces a big challenge as the
PEAT assessment process ends and the PLACE (Patient Led assessments of the care environment)
process is implemented. The process involves the recruitment of volunteers who will undertake
training in the assessment process and work with the Trusts Contracts and facilities tem to conduct
formal assessments of the hospital environment.
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16.5
Training and Development
The Domestic services cleaning has gone from strength meeting staff appraisal and training
development targets set by the Trust. The team have developed specialised training booklets and
resources for staff to complete training programmes. Some of the innovative training schemes
include a cleaning quiz in the format of the “who wants to be a millionaire” game.
17.
Infection Control programme for 2013
17.1
Surveillance projects
17.1.1 To continue mandatory reporting for the Department of Health:
a. MRSA bacteraemia
b. C difficile diarrhoea
c. VRE bacteraemia
d. Surgical site surveillance for orthopaedics
e. MSSA bacteraemia
f. E coli bacteraemia
17.1.2 To continue monthly feedback reports to Modern Matrons and Consultants on the
number of cases of C difficile diarrhoea, MRSA and hospital-acquired blood stream
infections within their areas.
17.1.3 To continue monthly reports to Assistant Director of Nursing, Director of Operations
and Performance, Medical Director and Directorate Managers.
17.1.4 The peripheral & central line infection rate surveillance will be repeated by the
Infection Prevention & Control Team & the ANTT specialist nurse respectively.
17.2
Written policies, procedures and guidelines
17.2.1 Three of the 59 Infection Control Manual policies are due to be updated in 2013:
Chapter
16
28E
14
Title
Guidelines for care and removal of infected bodies
Major Outbreak Plan
MRSA policy
17.2.2
The Infection Prevention and Control Team has also taken over some Nursing Policy Group
policies which will be updated in 2013:
Chapter
44
45
Title
Policy for the Collection of Blood Cultures
Policy for aseptic non touch technique (ANTT)
17.2.3
The MRSA decolonisation treatment pathway will be simplified in order to ensure that all
MRSA patients receive appropriate suppression, promptly and without exception, on first
diagnosis or re-admission.
17.3
Antibiotic prescribing initiatives (Report by A Lewis)
17.3.1 Liaison with Infection Prevention and Control Team
 To continue the weekly meetings introduced in 2008.
 To continue input into CDI root cause analysis.
 To continue to be informed of areas with high CDI rates by the IPCT and to target
these hot spots.
 To continue to be involved with multidisciplinary meetings between the IPCT and
clinical staff (to discuss high rates of infection and issues surrounding patient
treatment).
 To continue to review current practice and guidelines to provide efficacious and cost
effective patient treatment.
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 To continue weekly AMT (antimicrobial management team) ward rounds.
17.3.2 Feedback on antibiotic prescribing
 Pharmacy have introduced and circulated (via clinical directors and directorate
managers) auto-generated reports of antibiotic use by DDDs in order to provide
prescriber feedback every three months. Service continuing to be developed. We are
hoping to try and incorporate this DDD information into the new interactive antibiotics
policy so information on antibiotic usage is readily available to all members of staff.
 This DDD database is being developed further by incorporation of hospital activity
statistics per 1000 bed days.
 Prompt reminders on patient kardexes via pharmacist endorsement for early IV to
oral switch and reminders to review duration will continue in 2013. Compliance
audited every 3 months with findings being presented to directorate/speciality heads.
 Formal education sessions for junior doctors on antibiotic prescribing are continuing
to be led by Pharmacy and Consultant Microbiologists, as part of the F1/F2 training
curriculum. Education sessions have been expanded to include medical students
and band 5 & 6 nursing staff. Emergency Department and MAU sessions undertaken
to provide education advice for the AQ program and improve our current
performance. Overall aim is to promote culture of safety and reduce delay in patient
treatment.
17.3.3 Audit
The programme of antibiotic audits by Pharmacy will continue and will include:
 Audits of areas identified by monthly analysis of antibiotic prescribing and infection
trends.
 Three monthly point prevalence survey to assess whether the duration or review
date for antibiotic treatment is endorsed on the inpatient drug kardex, adherence to
antibiotics policy, documentations of both patient allergy status and indication for
antibiotic treatment.
 Focus on high risk antibiotics implicated in CDI such as quinolones, co-amoxiclav
and third generation cephalosporins.
 Therapeutic drug monitoring audits will continue in 2013 to monitor response to
increase pharmacy teaching and new intranet antibiotic website.
 Time to first antibiotic dosing will continue to be audited to determine why patients
are not receiving antibiotics promptly. This will expand to include both acute and nonacute areas. Poor performing areas practices and process will be reviewed
accordingly dependant on the findings.
 Point prevalence audits in 2013 will not just be focused on adherence to trust policy
and endorsement of review stop dates for antibiotics but will also consider the
relevance of course lengths specified and whether they are appropriate, number of
missed doses and why.
 OPAT services will be re-audited in 2013 for number of bed days saved, missed
doses, therapeutic drug and patient monitoring in 2013 for benchmarking against the
acute Trust. Patient outcomes will also be re-evaluated.
 Proton pump inhibitor (PPI) prescribing will be audited in 2013 following the high
incidence in PPI prescribing in patients that develop CDI throughout the Trusts. The
audit will aim to focus on PPI initiation and documentation and further review
following discharge.
These antibiotic prescribing audits will be reported as a standing agenda item on the
DTC, HIPC, Medical and surgical audits.
17.3.4 Treatment & prevention of CDI
 In 2013, the role of probiotic therapy will be reviewed to try and reduce modifiable
risk factors for patients receiving antibiotic therapy while an inpatient and developing
CDI.
 Community prescribing of antibiotics and PPIs
o NW Region has high prescribing rates compared with the rest of the country
and within the NW, our PCTs are amongst the highest prescribers.
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Community Pharmacists are to target prescribing of both antibiotics and
PPIs in the community in 2013.
17.3.5 Antimicrobial stewardship
Antibiotic Policy
 To ensure that the updating of the Trust Antibiotic Policy is completed in early
2013 as well as completing the development of the online interactive antibiotic
website.
 To ensure relevant staff are aware of the updated policy and new website.
17.3.6 Other
 We will continue to be actively involved with the NW antibiotics pharmacist group in
the support and development work to produce useful benchmarking information on
antibiotics management allowing comparison of trusts.
 There is considerable trust involvement in the organisation and active participation in
the Northwest antibiotics conference due to be held 2013.
17.4 Hand decontamination
17.4.1 Hand decontamination
To continue promotion of hand hygiene initiatives throughout the Trust.
To continue the use of covert hand hygiene audits when staff are not aware that their
practice is being observed, to give a true reflection of practice.
17.5
Audit
17.5.1 Ward audits
To continue the rolling programme of audits of all wards/departments, with additional
audits where indicated.
17.5.2 Infection Control Manual audits 2012:
Sharps policy
(Chapter 13A & 22, Infection Control Manual)
Daniels Healthcare and Infection Prevention & Control Team to repeat the annual
sharps audit throughout the Trust and provide written and verbal feedback. Matrons
to provide evidence that all the recommendations have been actioned.
Viral gastroenteritis policy/ C difficile diarrhoea policy
(Chapters 33 & 24 Infection Control Manual)
Vernacare to complete commode audit and sluice audit throughout the Trust in 2013
and provide written and verbal feedback. Matrons to provide evidence that all the
recommendations have been actioned. Infection Prevention and Control Nurse
Specialists to provide monthly statistics on CDT diarrhoea to Matrons, targeting any
specific problems. To continue commode audits monthly by the IP&CT.
Hand decontamination policy
(Chapter 21, Infection Control Manual)
To continue the monthly hand hygiene observation tool (HHOT) audits. Matrons and
link nurses to regularly audit their own areas using Glow Germ machine. IPCNs to
monitor hand hygiene compliance with targeted use of Glow Germ machine. To
continue covert surveillance of hand hygiene compliance.
Isolation Policy
(Chapter 12, Infection Control Manual)
Surveillance assistant to conduct audits of compliance with isolation policies on
acute wards.
MRSA screening
(Chapter 14 MRSA policy & Chapter 41 Bed Management Policy)
To repeat monthly spot-check audits to determine compliance with MRSA screening
policies. Now that there is a link between the PAS and Telepath systems, it is
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planned to produce automated compliance data every month, with feedback of
results to all wards.
17.5.3 Urinary catheter assessment & monitoring (UCAM)
To continue monthly audits.
17.6
Education and Training
17.6.1 Induction training
To continue with the infection control induction programme.
17.6.2 Mandatory training
To continue to provide the infection control mandatory training programme.
17.6.3 Link nurses
To continue with link nurse programme. Topics planned so far include ANTT, blood
cultures, MRSA case studies, sharps audit findings, environmental cleaning, waste
disposal and current infection problems and planned solutions.
17.6.4 Intranet website
To continue with the infection control elearning package and the IP&C workbook
available on the Infection control intranet website as educational aids for those
wishing to undertake additional infection control training, or use as mandatory training
update.
Copies of Patient Information leaflets will continue to be included on the patient
accessible internet website.
17.6.5 Aseptic non-touch technique (ANTT)
There will continue to be focused training on IV line care, wound care, urinary
catheter care, with regard to the use of ANTT.
17.6.6 To encourage sharing of practice by different groups of staff with their
counterparts in Trusts with low infection rates
17.7 ANTT & Device related infection
17.7.1 ANTT
To record ANTT competency assessments for all relevant clinical staff by end of
January 2013.
ANTT nurse specialist appointed (job description & specification have been
produced) and undertaking audits, education and training.
17.7.2 IV access
 ANTT specialist nurse is to undertake audits, including VIP scores, and ensure that
all areas are achieving best practice.
 Central & peripheral line surveillance: The ANTT specialist nurse will audit central
& peripheral line infection rates.
17.7.3 Continence
 There will be further Trust-wide surveillance of catheter-associated urinary tract
infection rates.
 UCAM will continue to be monitored Trust-wide for all catheterised patients and
reported as a key performance indicator on the infection control dashboard.
17.8
New hospital build
To continue to provide infection control input for the new hospital build.
17.9
DOH Targets
To comply with DOH targets & local targets for healthcare-associated infections.
17.10
IT initiatives
Performance management
 To continue to promote the use of the infection control dashboard throughout the
Trust. This will enable continued performance monitoring of wards so that problems
can be identified before they cause high rates of MRSA/CDT.
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
Qlikview: To investigate the possibility of automatic triggers to alert IPCT and
Executive Team when staffing levels/indicators fall so that action can be taken before
there is a risk of patients acquiring infection.
To consider an APP for the interactive Antibiotic Policy.
17.11
17.12
17.13
17.14
17.15
Trust registration with Care Quality Commission
The Health Act 2006: Code of Practice for the Prevention and control of Health Care
Associated Infections
To ensure continuing compliance with the the Code of Practice. From April 2009 all trusts
have been legally required to register with the new Healthcare Commission (the Quality Care
Commission).
Ownership at ward level
 To continue to encourage ownership of infection control at ward level.
 To ensure that there are clear responsibilities for housekeeping duties in the
absence of the housekeeper.
Medical staff engagement
 To continue Executive Team RCA reviews with RCAs presented by the consultant
with the ward manager and Matron in attendance.
 Medical staff appraisals to include infection control.
 Consultant Infection Control Lead meetings to continue with champions taking
responsibility for greater ownership of infection control issues at ward level.
Infection predictor tool
To evaluate the results of pilot studies and determine whether to adopt this tool Trustwide.
External Review Action Plan
To complete the action plan. Progress is being monitored by the Hospital Infection
Prevention Committee.
To achieve NHSLA level 3 compliance with criteria for hand hygiene training (Learning and
Development) and inoculation incidents (Health Work & Wellbeing).
K. D. ALLEN
G. WHITE
K. MORTIMER
J ROBERTS
M KENDRICK
M. S. VARDHAN
A LEWIS
FEBRUARY 2013
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Appendix A
INFECTION CONTROL INITIATIVES
REPORTS FROM SURGICAL CARE GROUP
Initiatives from General Surgery, Urology, Orthopaedics & Burns & Plastics
1. Annual infection control ward audits with action plans generated formulated where performance is
poor.
2. Bi-weekly hand hygiene observations. Results are displayed on each ward area.
3. Monthly indicators for infection control.
4. Productive ward principles applied in terms of well organised ward to ensure a less cluttered
environment.
5. Housekeepers attend peer group meetings within SCG to ensure best practice across the
departments. The housekeepers are fully aware of the need to maintain a streamlined and
standardised approach to the management of ward stocks.
6. New Matron check list to ensure all infection control audits are up to date.
7. Gel compliance audits performed.
8. Mattress check weekly with new mattresses in place where required.
9. Protected time for infection control link nurses.
10. Strict visiting policy of two per bed.
11. Bare below the elbows culture firmly embedded across the care group.
12. MRSA swabbing of all elective and non-elective admissions, as per hospital guidance. Monthly
results analysed and non-compliance addressed.
13. Monthly Matron and Domestic walk around within each area, concerns resolved immediately or job
numbers for maintenance work provided.
14. Use of Chlorclean in clinical areas throughout the care group.
15. Clean-trace swabbing performed in many areas with actions for poor results.
16. Close links continue with Pharmacy to monitor antibiotic policy compliance.
17. RCA completed in all cases of CDT, MRSA and MSSA bacteraemia.
18. Anti-microbial cleansers routinely used pre-operatively for joint replacements
19. Quarterly steering group meetings to monitor and action hip and knee infections.
20. The use of disposable tourniquets continues.
21. Toilet/bathroom check lists are maintained.
22. Current and ongoing SSI audit of patients post colonic resections on 4C ward.
23. Weekly monitoring of antibiotic usage by Matron and Consultant.
24. SSI monitoring of hip and knee replacements.
25. MD Team Meeting/Presentation to board when a case of CDT is identified.
26. ANTT compliance monitored at ward level.
Alison Kennah, Gwen Pantak and Helena Mullin
Obstetrics & Gynaecology
1. Annual Infection control audit continues to be undertaken by Trust Infection Control Team in all
clinical areas and recommendations and actions taken. All areas achieve 90 +%
2. Matrons attend all clinical areas every morning (except weekends) and any issues identified on walk
about are addressed
3. Infection control remains a standing agenda item on the monthly managers meeting. (Head of
Midwifery, Matrons, Ward Managers and Specialist MW’s) feedback provided from the SCG Monthly
Infection Control Meetings.
4. Infection control has been included as a standing agenda item on Directorate Management Monthly
Meetings attended by Consultants and Management Team to ensure multidisciplinary involvement
and ownership across Maternity, Gynaecology, Anaesthetics and Maternity theatre.
5. Signs in all clinical areas encouraging staff, visitors and relatives to use alcohol gel as they enter and
leave wards and departments.
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6. “Bare below the elbows” culture embedded within the Directorate, fully supported by the Clinical
Director. Staff challenged on a daily basis
7. Work continues with the Director of Public Health to raise both professional and public awareness re
seasonal and swine flu. Active steps taken to promote the uptake of the flu vaccine by pregnant
women.
8. Further working with Director of Public Health in relation to the Whooping cough Campaign. Vaccine
programme is being actively promoted. Pregnant women are provided with information advising
them to have the vaccine after 28 weeks gestation.
9. Work undertaken to raise awareness of women and the public regarding the measles outbreak during
the early part of 2012
10. Daily environment checklists and Legionella checklists in all clinical areas.
11. Use of Chlorclean in clinical areas throughout the care group.
12. Matrons continue to meet with Domestic Supervisor, maintenance issues also addressed and an
action plan devised.
13. Fortnightly Hand hygiene observation audits and infection control audits continue by Matrons and
Infection control link nurses / midwives.
14. Mattress check weekly and action taken as appropriate.
15. Annual Infection control audit continues to be undertaken by Trust Infection Control Team in all
clinical areas and recommendations and actions taken.
16. Link midwives / nurses attend Trust infection control meetings.
17. RCA completed in all cases of CDT, MRSA and MSSA bacteraemia. Within Obstetrics &
Gynaecology only 1 case of MSSA in the previous 12 months.
18. Use of toilet cleanliness checklists throughout the unit.
19. Every effort made to provided protected time for link persons in clinical areas for infection control.
20. MRSA Screening continues for Elective Caesarean Sections and for all Gynaecology admissions.
21. UCAM forms and VIP Charts monitored daily by Ward Managers / Shift Leaders
22. All staff trained in ANTT are fully aware of requirement to use ANTT procedures. Ward Managers
undertake spot checks to ensure compliance
23. Monthly IC Indicators inclusive of dress code, UCAM, VIP Scores, Commodes and Isolation Infection
Control signage.
24. ‘Infection Control’ notice boards in ward areas, displaying audit results and Infection Control
information.
Tina Bogle and Val Blakemore
Maternity & Gynaecology
St Helens Patient Access Care Group – Sanderson Suite, Theatre, Pre op, Oral Surgery
1. Annual ward/dept. infection control audits undertaken. Action plans formulated and recommendations
addressed.
2. Audits undertaken by Infection Control Team i.e. commode audit are addressed, discussed and action
plans formulated and completed.
3. Mattress audit completed weekly by HK on Sanderson Suite.
4. Toilet and bathroom check lists being completed 3 times daily.
5. Vernacare green “cleaned” tape being used on all equipment.
6. All areas continue to implement the CYHC.
7. Monthly infection control audit and VIP Scoring implemented. Spiders displayed on ward and
discussed with staff at ward/departmental meetings.
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8. HHOT completed weekly.
9. IC Link nurses monitoring Bare below the Elbow compliance.
10. Regular sessions with the Glow Gem machine to raise hand hygiene awareness for staff and visitors.
11. Infection Control Manual updated monthly.
12. Infection Control Link Nurses attend Infection control meetings.
13. Isolation Policy followed when patients require barrier nursing and appropriate information displayed.
14. Disposable tourniquets are in use.
15. Single use surgical site marking pens in use.
16. MRSA and CDT surveillance by Infection Control Team.
17. All staff use personal gel dispensers and work ongoing to encourage all clinicians and medical staff to
carry gel. Infection control link nurses audit the use of gel when entering or leaving a ward/dept.
18. Gel dispensers available by each patient bedside.
19. Root Cause Analysis commenced by ward managers on patients with MRSA or CDT
20. Infection control issues and updates discussed at all monthly staff meetings.
21. All staff compliant with ANNT procedures.
Steph Wiswell, Matron, Patient Access Care Group, St Helens.
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Appendix B
INFECTION CONTROL INITIATIVES
REPORT FROM MEDICAL CARE GROUP
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Bi Monthly audits at ward level continue with action plans to address areas of concern
Continued monitoring of Bare below elbows and escalation as necessary
Weekly Matron/ Directorate manager walk rounds have commenced and action plans monitored
Weekly VIP audits completed and letters to address poor compliance sent to staff
UCAM monitoring
Commode cleaning training re commenced for all staff.
Daily Commode cleaning checklists re introduced.
Infection control staff agreement form commenced for all staff.
Inclusion of Infection control auditing through the NHS nursing indicator audits on some wards. This
will be rolled out across the Trust in 2013.
The first of the File holders to be placed outside cubicle to hold patient documents in infected rooms
have been put up on DMOP wards, the remaining holders will be installed on all wards over the next
4 weeks.
Monthly Protected time for link nurses continues.
Housekeeper checklist continued
Discharge cleaning teams commenced on all wards with a rapid team allocated to the high turnover
wards.
Infection control Clinical lead identified for the care group
Monthly MCG/SCG Joint meetings with Infection control continue
MDT involvement with RCA for MRSA, MSSA, CDT
Guidance for the treatment of suspected or confirmed MRSA has been put at every nurses station
Information regarding the use of alcohol gels before using computers has been put at every
workstation/ computer.
Infection control is a standard agenda item at departmental, ward and business meetings.
ANTT links on all wards training staff and monitoring compliance.
Participation in EXEC RCA reviews ensures lessons learned can be fed back at Departmental/ MCG
meetings.
Infection control information boards on all wards display current level of compliance
Information boards in Clinical rooms have been put up to hold vital information regarding ANTT
compliance etc.
All patients are now screened for MRSA on admission- compliance figures shared and addressed
with action plans
All patients re screened following 4 week stay in hospital.
Continued use of patient specific equipment i.e. Hoist slings, slide sheets, pulp bowls, tourniquets.
Peer audits between wards to monitor practices.
Matrons: Sue Noon, Mike Babbs, Debbie Stanway, Debbie Ball.
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Appendix C
INFECTION CONTROL INITIATIVES
REPORT FROM PAEDIATRIC DIRECTORATE
Earlier this year vacant Health Care Assistant hours were converted to a part time Housekeeper role for
Ward 3F. Ward 3F is one of the busiest wards in the Trust with approximately 5000 admissions through
the 25 Paediatric inpatient beds annually, therefore stringent infection control standards are essential.
This role was much needed as the Health Care Assistant role is very patient care focussed on the
Paediatric Wards. The Housekeeper is responsible for completing the following checks of Infection
Control (IC) standards:The ‘Daily IC Checklist’ and reports any issues to the Ward Manager or Shift Leader. This checklist
includes checking the cleanliness of milk kitchen, ward kitchen, beds, mattresses and checking hand
wash facilities at sinks.
The ‘Commode Checklist’ completed weekly.
The Housekeeper duties also include keeping the Parents lounge on Ward 3F clean and tidy and the
‘Clini’ cleaning of all the plastic intravenous drugs trays taken to the patient’s bedside, placing a ‘clini’
clean sticker on them once completed. All the ward staff have noticed the benefits of this role.
On Ward 3F, the ‘Shift Leader Ward Checklist’ continues to be completed every shift and includes
ensuring the Health Care Assistant IC Checklist has been completed.
Throughout the Department, fortnightly Staff Hand Hygiene Audits and monthly Ward IC Audits have
continued with excellent results. However in December an external, secret hand hygiene audit by
Infection Control staff was undertaken which audit highlighted missed opportunities for hand hygiene on
Ward 3F producing a score of 62%. The Paediatric team have now decided in future to undertake hand
hygiene audits a minimum of weekly without staff knowing they are being observed, using a different
auditor each time who keeps the audit completely confidential at the time to remove the possibility of the
‘observer affect’ on the results. Two further secret audits have been undertaken internally since this
external audit, the first raising a couple of issues addressed immediately on completion of the audit and
the second producing a 100% score. The findings are reported monthly at the Paediatric Nurses Meeting
and at the Paediatric Clinical Governance and Management Committee.
The Paediatric Directorate ‘Safety and Quality Standards’ audit tool was rolled out across the Neonatal
Unit, Wards 3F and 4F during 2012. This audit includes asking all staff on duty if they are aware of the
Infection Control Policies, where they locate them for use in clinical practice and how to access a
member of the Infection Control team. Work is being undertaken to incorporate these standards into a
Paediatric Safety Thermometer as the existing Safety thermometer for adult patients is not relevant for
use on the Paediatric Wards.
The Paediatric clinical areas have achieved over 85% attendance at Trust Mandatory training during
2012 where the staff receive their IC annual update and some staff including the Clinical Director and
Lead Nurse have attended MRSA updates in the last few months.
The annual unannounced Infection Control Ward Audit undertaken by the Trust Infection Control team
produced excellent results on the Neonatal Unit and ward 4F. Ward 3F’s results were an improvement on
last year, the issues raised have been addressed and the re-audit produced better results. The work from
previous years’ audits was finally undertaken in October including a sink in the Parents Lounge and
plinths built in two of the store rooms to ensure no storage on the floors.
The Ward Entrances now benefit from very informative Notice Boards for all visitors and patients about
the risk of infection and importance of hand hygiene.
Infection Control unannounced ‘Walkabouts’ commenced in December with the Lead Nurse and Ward
Managers in the clinical areas using the Trust template and action plans formulated to ensure issues
identified are addressed and will be followed up at the next ‘Walkabout’.
Sally Duce, Lead Nurse, Directorate Manager
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Appendix D
INFECTION CONTROL INITIATIVES
REPORT FROM THE EMERGENCY DEPT
1. Involvement with root cause analysis in MRSA bacteraemia and sharing lessons learned.
2. Continuation of fit testing for PPE.
3. Regular attendance at Link staff meeting
4. Continued appropriate use of Chlorclean.
5.
Trial conducted into the use of Chlorclean wipes to be used on pt trolleys/mattresses to assist the
cleansing between patient use. (wipes to be introduced following this trial)
6. Participation in commode audits and feedback of information.
7. Regular auditing and presentation of each areas “minimum standards” compliance with appropriate
actions taken.
8. 2 link ANTT trainers on the departement provided with protected teaching time and ANTT procedures
embedded into clinical practice.
9. New areas established in every clinical area for the ANTT procedures, i.e. resuscitation area, zone 1 and
paediatric ED. Zone 2 and EAU already have the clinical rooms.
10. Introduction and continued use of the cannulation packs and blood culture packs.
11. Regular liaison with microbiology staff regarding any contaminated blood culture sample investigated and
discussed with the staff involved. Further training and re-attendance at venepuncture and cannulation
sessions has been attended and staff have been ANTT reassessed.
12. Regular walkaround audits and action plans produced and monitored for outcomes.
13. Infection Control Manuals regularly updated and readily accessible.
14. All members of staff, irrespective of grade or role, encouraged to proactively promote “bare below
elbows” campaign.
15. Infection Prevention and Control is an agenda item at every Governance and staff meeting.
16. All patients identified as MRSA/CDT are isolated as soon as possible within the department and all
cubicles are deep cleaned after use.
17. The 2 cubicles on the Observation ward are now kept as much as possible to accommodate any infected
pts.
18.. a staffing review is being undertaken to identify the possibility of sourcing more housekeeper/HCA’s who
would be tasked with general duties including the maintenance of cleanliness standards on the department,
particularly at times of heightened escalation.
19. MRSA screening maintained for Observation Ward admitted patients .
20. Liaison with members of the Infection Prevention and Control team to seek advice and maintain
communications.
Donna Doyle (Emergency Care Manager)
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Appendix E
INFECTION CONTROL INITIATIVES
REPORT FROM CRITICAL CARE UNIT
1. Bi-annual Infection Control Audits performed – compliance with infection control practices,
November 2011 92%
2. MRSA screening on admission of all patients and weekly screening continued.
3. ‘Ventilator Care Bundle’ embedded into practice, checked daily via ‘Fast hug’
4. Daily house-keeping charts embedded into daily practice, now available on INNOVIAN (clinical
information system)
5. ‘Chlorclean’ used as standard for de-contamination of all clinical areas.
6. Legionella checks performed and recorded twice weekly basis.
7. Daily flushing of all water outlets continues
8. Named Infection Control Link Nurse – local infection control team, 1 x member allocated study day
per month to complete audits, raise awareness
9. Up to date infection control boards with information for staff – MRSA, CDT & VRE rates
10. Agenda item at monthly unit meeting & Directorate/Governance meeting
11. All staff use personal individual gel dispensers.
12. Line surveillance continued – despite ‘Matching Michigan’ programme suspension.
13. Bare below elbows enforced, non-compliant staff challenged
14. RCA for CDT, MRSA & MSSA bacteraemia undertaken
15. Housekeeper role established
Kim Sims, Critical Care Unit
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Glossary of abbreviations
AMT:
Antibiotic Management Team
ANTT:
Aseptic non-touch technique
AQ:
Advancing Quality
BBE:
Bare below the elbows
CAP:
Community-acquired pneumonia
CCG:
Clinical commissioning group
CDI:
Clostridium difficile infection
DDD:
Defined daily dose
DOH:
Department of Health
DTC:
Drugs & Therapeutics Committee
ED:
Emergency Department
HII:
High impact intervention
HIPC:
Hospital Infection Prevention Committee
IPCT:
Infection Prevention & Control Team
IV:
Intravenous
MRSA:
Meticillin-resistant Staphylococcus aureus
MSSA:
Meticillin-sensitive Staphylococcus aureus
MET:
Medical Emergency Team
NICE:
National Institute for Health & Clinical Excellence
OPAT:
Outpatient parenteral antibiotic therapy
PGD:
Patient Group Directive
PPE:
Personal protective equipment
PPI:
Proton pump inhibitor
RCA:
Root cause analysis
TTFD:
Time to first antibiotic dose
UCAM:
Urinary catheter assessment and monitoring
VIP:
Visual infusion phlebitis
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