HCAIs-Prevention & ControlNurses as Champions

Karen Egan

Associate Director of Infection Prevention & Control

Mid Cheshire Hospitals NHS Trust, UK

Increasing Profile of Infection Prevention and Control

Infection Control Hospital Acquired Infections Informal Systems Infection Prevention and Control

Healthcare Associated Infections (HCAIs) Formal Systems/Services Integral Part of Governance

Increasing Profile of Infection Prevention and Control

5,000 deaths per year and 15,000 associated deaths per year

Over one billion pounds pa for all HCAIs MRSA bacteraemia costing £4-10,000 per case

Clostridium difficile; £4,000 Dept of Health targets, directives, guidance Change in delivery and monitoring of NHS

healthcare in the UK

Current Climate

Public Concern Media Politics Staff Concern Quality Issues Published data Commissioning Monitoring Patient Choice

Greater Emphasis on IP&C

Winning Ways- 2003 NICE guidance- 2003 (primary care) Towards Cleaner Hospitals- 2004 National Audit Office Reports- 2004/04 NPSA Alert- 2004 (Cleanyourhands) Matrons Charter- 2004 MRSA targets- 2004 Healthcare Commission Standards- 2005 Saving Lives- 2005

Greater Emphasis on IP&C

Going Further Faster- 2006 3rd National Prevalence Study- 2006 (8.2% of hospitalised patients with an HCAI, previously 9.2%)

Revised NHSLA Standards- 2006 Stoke Mandeville Report- 2006 (334 patients affected,38 deaths)

Hygiene Code of Practice- 2006 Continuation of PEAT Assessments-2006-07 Kent & Tunbridge Wells Report- 2007 1,170 patients affected April 04-Sept 06 345 C.diff pos deaths; 90 def.or probably, 255 contributed

Greater Emphasis on IP&C C.difficile Targets (30%)- 2007/08-2011 Saving Lives &Code of Practice Tool- 07 DH guides for best practice;1. Blood Cultures- Aug 072. Antibiotic Prescribing- Aug 073. Isolating Patients with HCAI- Sept 074. Chronic wound related BSIs- Nov 07 DH evidence base for uniforms and work

wear- Sept 07 Deep clean, Matrons, Cleanliness &

Reporting-07 Clean, Safe Care- Jan 07

Key DevelopmentsCode of Practice (OCT 06)

Forms part of the Health Bill (Oct 06) Monitored by HC and results in Improvement

Notices or Special Measures Three sections;

1) Management, Organisation and

Environment

2) Clinical Care Protocols

3) Healthcare Workers All Healthcare providers by 2008

Key DevelopmentsMRSA Targets (Nov 2004)

To reduce MRSA bacteraemia by 50% by 2008 Perform detailed surveillance and Root Cause

Analysis on each case Reduction in the UK for the 3rd year 2001/02 ( 7,291) 2002/03 (7,426) 2003/04 (7,700) 2004/05 (7,2330 2005/06 (7,096 2006/07 (6,378) Continuation of reduction target for further 3

years MRSA screening strategies; electives 2009,

emergencies 2011

Key DevelopmentsSaving Lives Programme (05 onwards)

Assessment of Infection Prevention & Control practice in clinical areas through the review of High Impact Interventions

1) Central Venous Catheters2) Peripheral Lines3) Renal Dialysis Care4) Surgical Site Infection5) Care of the Ventilated Patient 6) Urinary Catheters7) Clostridium difficile

Key DevelopmentsHealthcare Commission Standards

Annual review of corporate Infection Prevention & Control arrangements

HC Report July 20071) An organisational culture2) Management systems3) Performance review systems4) Integrated risk management 5) Dialogue with patients and the public

www.healthcarecommission.org.ukwww.clean-safe-care.nhs.uk

www.nric.org.uk

Key Developments Clostridium difficile 2 significant reports with organisational

recommendations HPA Care Bundle- Jan 07 Local targets with PCT- 07 National target (Public Service Agreement) NPSA; National Spec for Cleanliness (07) SLA for cleaning (07)

www.patientexperience.nhsestates.gov.uk Cleanyourhands (phase 3) Additional support (tariff uplift 2.3%) for IP&C

Practitioners and Antibiotic Pharmacists

Strategic Aspects of IP&CNurses as Champions

Approach required from the whole health economy IP&C from Board to Ward LOCAL ACTION…

Policies, Education, Audit, Accountability, Divisional Targets, Personal Objectives, Personal Development Plans, Management Plans, Patient Involvement

Every clinical member of staff must practise effective Infection Prevention & Control…. AND….evidence must demonstrate this

Clinical Aspects of IP&CNurses as Champions

Implement National Directives

(CYH, SL Programme, Code of Practice)

Implement National Guidance

(EPIC 2, MRSA Guidance & Screening Strategy)

MRSA & Clostridium difficile targets/action RCA for MRSA bacteraemia and C.diff Environmental hygiene & measurement of

Cleaning Standards Critical Care Bundles, Surviving Sepsis

Campaign (17%bacteraemia in Critical Care)

Key Aspects of Patient CareNurses as Champions

Effective Infection Prevention & Control consists of many factors and not just one single action

Many Healthcare workers are involved in patient care, patients are cared for in many different environments and they come into contact with a great deal of equipment

Evidence must demonstrate that an organisation has an effective culture embedded, is aware of the potential risks to patients and puts measures in place to reduce risk and provide safe healthcare

How to Prioritise…..?

Patients Patients Patients Staff Visitors Relatives

Environmental Factors…

Staphylococcal Abscess

IM Premed Normal Staph

aureus In the absence of

a foreign body, Staph. aureus rarely causes infection deep IM bolus

Patient Bedside…

Staphylococcal Infection

Pacing wire site Normal Staph

aureus Presence of foreign

body enhances the ability of the organism to become established

Invasive Devices…

The Role of Medical Devices

80% of UTI’s are due to indwelling catheters

Over 60% of blood infections are introduced by feeding lines, catheters or similar devices

Pneumonia occurs frequently in ventilated patients

PPE and Decontamination…

Hand Hygiene…

Infection Occurs When…..

There is a source or reservoir of the bacteria, virus or other organism

There is a means of transmission; equipment, hands, cough, sneeze

There is a host; patient, visitor, staffThere is an entry route; mouth,

eyes, skin, lungs, innoculation

Basic Control Measures

Aim to eliminate the source or reservoir

Boost the host response to infection

Break the chain of transmission

Overall responsibility lies with the Trust Board, but everyone involved in the patient journey has a responsibility to ensure safe, reliable healthcare

Strategic/Clinical approaches required Many factors involved in HCAIs Interpreting how they were most likely

transmitted (and responding) is key in relation to reducing rates of HCAIs

Infection Prevention and Control is a given and not an option