Infection Control at West Middlesex University Hospital Update for - - PowerPoint PPT Presentation

Infection Control at West Middlesex University Hospital

Update for the Adult Health & Social Care Scrutiny Panel 2nd April 2007

Dr May Kyi – Director of Infection Prevention & Control Yvonne Franks – Director of Nursing & Midwifery

Presentation outline

• MRSA – definitions
• Targets & results
• MRSA performance 2006/7 & actions
• Clostridium Difficile – definition
• Results & actions
• Hand hygiene
• Training & development

What is MRSA?

• MRSA stands for Methicillin resistant Staphylococcus
• aureus. Staphylococcus aureus (Staph. aureus) is a

common bacteria that is carried in lots of people’s noses and skin.

• MRSA is a type of Staph. aureus that has become

resistant to many types of antibiotics such as methicillin.

• Around 25% of the UK population harmlessly and

unknowingly carry Staph. aureus on their skin. This is called colonisation, and is very different from being infected with MRSA.

Colonisation v. infection

• Colonisation means that

the MRSA is carried in the nose, on the skin and possibly in wounds but is not causing harm or producing symptoms.

• Staph. aureus and MRSA

are not normally a risk to healthy people.

• I nfection with MRSA can
• ccur when the MRSA gets

into the body through a break in the skin.

• There is no evidence that

MRSA is more likely to cause an infection than common bacteria, Staphylococcus aureus.

The main difference is that when a patient is infected with MRSA different antibiotics are required

The MRSA target

• Dept of Health set a target of 60% reduction in MRSA

bacteraemia (MRSA in the bloodstream) by all acute Trusts, between 2004 and 2008

• For WMUH this required a reduction from 34 cases to

14 cases per year in 2008

• Year on year reduction was achieved in the last three

years from 34 to 30 to 27 cases in 2005/06

• 2006/07 has seen an increase

41 34 30 27 5 10 15 20 25 30 35 40 45 numbers 2002-03 2003-04 2004-05 2005-06

Total MRSA bacteraemia

Total

WMUH MRSA bacteraemia rate per 10,000 bed days (as published on HPA website)

2.97 2.57 2.35 2.12 0.5 1 1.5 2 2.5 3 3.5 2002-03 2003-04 2004-05 2005-06 rate

31 8 24 10 20 10 16 11 5 10 15 20 25 30 35 numbers 2002-03 2003-04 2004-05 2005-06

MRSA bacteraemia by location of blood culture taken

Inpatients A&E

MRSA Bacteraemia 2006/7

• A target was set for each financial year

– 19 for 2006/07

• From April to September 2006 - 19

MRSA bacteraemia cases were identified

• Full investigation – root cause analysis
• We sought advice from Prof Duerden at

Dept of Health

2 4 6 8 10 12 numbers Jan-Mar Apr-Jun Jul-Sep Oct-Dec

MRSA bacteraemia comparison by quarter

2003 2004 2005 2006

31 8 24 10 20 10 16 11 25 6

5 10 15 20 25 30 35 number 2002-03 2003-04 2004-05 2005-06 Apr06-Jan07

MRSA bacteraemia by location of blood culture taken

Inpatients A&E

MRSA in blood cultures - monthly data with target for the month

2 3 2 1 1 1 3 3 3 3 2 3 2 2 7 2 4 2 2 4 2 4 1 2 3 4 5 6 7 8 Apr- 05 May- 05 Jun- 05 Jul- 05 Aug- 05 Sep- 05 Oct- 05 Nov- 05 Dec- 05 Jan- 06 Feb- 06 Mar- 06 Apr- 06 May- 06 Jun- 06 Jul- 06 Aug- 06 Sep- 06 Oct- 06 Nov- 06 Dec- 06 Jan- 07 numbers Number Target

Results of root cause analysis

19 cases investigated;

• 5/19 (26%) were taken within 48 hours of

admission – (4 in A&E)

• 10/19 (53%) required antibiotic treatment
• 7/19 (37%) had IV lines - 2 central lines
• 7/19 (37%) were from care of the elderly

wards

• 6/19 (32%) – previous known MRSA positives

Only 53% needed treatment

10/ 19 needed antibiotics

• 9/10 were taken within 21

days of admission and 3 were within 48 hours

• 5/10 had intravenous lines, 4

had related sepsis

• All cases have associated

risk factors such as IV lines, pacemaker, chest drain, leg ulcers, previous hospital attendances, long LOS, nursing or residential home resident

9/ 19 did not need antibiotics (contaminated samples)

• 3/9 with previous known

MRSA, 2 taken on admission,

• ne within 7 days
• 6/9 were taken between 22 to

> 100 days

• 4/9 had multiple organisms in

the blood culture

• 6/9 had previous hospital

admissions; 2 had IV lines and

• ne with known MRSA positive

chronic leg ulcer

Lessons learnt

• Nearly half 9/19 (47% ) were considered to be

contaminated blood cultures

• Contamination could either be from the

patients’ skin flora or poor technique

• IV lines are the biggest risk factor
• A third of cases from the care of the elderly

wards

• Contamination is highly associated with

increased length of stay

Key actions

• Vacutainer blood culture collection system

introduction with training of medical staff

• Audit, feedback & enhanced training on

line care and management

• Set up a line team – revise procedures –

standardise practice.

• Weekly line inspections by the Infection

Control Team with immediate flagging of notes with reminder stickers

• Continuing emphasis on good infection

control practice, particularly hand hygiene

• monitoring and feedback
• Feedback at all Q&R meetings and also

to senior medical and nursing staff

• Give MRSA decolonisation treatment to

high risk trauma patients

• Work collaboratively with Integrated

Assessment Rehabilitation Discharge Service (IARDS) team and PCTs to reduce the length of stay

• Inform and seek further advice from the

Strategic Health Authority, Healthcare Commission and the DH

• Monitor and performance manage staff

adherence to dress codes

What is Clostridium difficile?

• Clostridium difficile is a bacteria that produces toxins

(poisons).

• Usually found in the gut where it is present in small

numbers in 3% of healthy adults and 66% of infants

• Clostridium difficile rarely causes problems in children or

healthy adults, as it is kept in check by the normal (good) bacterial population of the gut

• When certain antibiotics disturb the balance of bacteria

in the gut, Clostridium difficile can multiply rapidly and produce toxins which cause illness such as diarrhoea

• Local target for 2007/8 agreed between Trust and PCT to

reduce by 10%

WMUH number of C difficile reports for over 65 years as published on Health Protection Agency website

75 61 33 35 10 20 30 40 50 60 70 80 January to March 2006 April to June 2006 July to September 2006 October to December 2006 C difficile reports for over 65 years

Control measures for Clostridium difficile infection

• Prudent antimicrobial prescribing
• Isolation of infected patients
• Enhanced environmental cleaning
• Hand hygiene
• Personal protective equipment
• Staff education and training

Hand hygiene Compliance

20 19 39 72 67 75 50 66 57 60 72 83 82 92 85 77 77 80 83 10 20 30 40 50 60 70 80 90 100

Q 4 2 1 Q 1 2 2 Q 2 2 2 Q 3 2 2 Q 1 2 3 Q 2 2 3 Q 4 2 3 Q 1 2 4 Q 2 2 4 Q 3 2 4 Q 4 2 4 Q 1 2 5 Q 2 2 5 Q 3 2 5 Q 4 2 5 Q 1 2 6 Q 2 2 6 Q 3 2 6 Q 4 2 6 percentage Compliance %

Second ICN appointed Link nurse system introduced Move into new hospital Became integrated IC team

Cleanyour- hands campaign Second microbiologist appointed Senior ICN left Trust Mandatory annual IC training started Full complement

• f staff

Hand hygiene charts

10 20 30 40 50 60 70 80 90 100

2nd / 2004 3rd / 2004 4th / 2004 1st / 2005 2nd / 2005 3rd / 2005 4th / 2005 1st / 2006 2nd / 2006 3rd / 2006 4th / 2006 percentage hands decontaminated % full compliance

88 21 62 19 15 37 379 45 57 Mandatory 24 19 79 9 10 5 74 4 1 Induction

Hounslow PCT Others Medical/ Nursing students Non-clinical Pharmacy Radiology Nurses, Midwives & HCA Junior doctors Consultants

I nfection control training attendances March 2006 to February 2007

• Total for I nduction = 227
• Total for Mandatory training = 723 (appraisal compliance – all

clinical staff)

• The figures below do not include;
• M&S Training attendances
• Junior medical staff training at induction for August and February

intakes

• Ecovert staff training.

We need your help! Patients, public & staff

• Health Act 2006 – devolving responsibility to

front line staff

• Infection control team role
• Vigilance – EVERYONE
• Continual training
• Challenging practice
• Patient information centre
• Trust website

http:www.west-middlesex-hospital.nhs.uk/for-patients/general- information/control-of-infection/healthcare-associated-infections/