HCAIs-Prevention & Control Nurses as Champions Karen Egan Associate Director of Infection Prevention...
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Transcript of HCAIs-Prevention & Control Nurses as Champions Karen Egan Associate Director of Infection Prevention...
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