TRUST BOARD
/ Tuesday 2nd September 2008PAPER / Infection Control Report
PURPOSE / To update the Board on the position in relation to Infection Prevention and Control
FORMAT / Monthly Report
THE BOARD IS ASKED TO: / Receive the report and comment on any issues of concern
All data referred to is in the appendix data file
1. Executive Summary
The month of August has seen the entire trust focused on achieving the required reductions in Clostridium difficile cases. The Medical Director, Chief Nurse and Director of Infection Control and Prevention have spent much of their time this month in clinical areas reviewing practice, cases and problems. The twice weekly meeting to oversee activity is being chaired by the Medical Director or the Chief Nurse.
We are able to report that we have witnessed an overwhelming commitment from staff in all disciplines and professions, to reducing the number of cases. Problems that have been identified for resolution have been invariably the result of organisational or system / process deficits and not ones related to individuals. The clinical and facilities staff are to be commended for their hard work and commitment.
2. Clostridium difficile
2.1 – Clostridium difficile performance against target April 2008 to March 2009 (Graph 1 / Page 3)
The Trust Board will be aware that the position in July had not improved as expected, hence the focus on action at the last Board meeting and in the month of August. The position at the time of writing the report is that in August we have seen the impact of the measures we have made. A verbal report on the position will be made to the Board at its meeting. In addition, many measures implemented in the month will not yet be impacting.
2.2 Divisional Performance
(Graphs 3 – 6 / Pages 5-8)
The position of the divisions is in the data sheets.
2.3 Clostridium difficile Action Plan
Many actions have been completed and, more significantly many added in in the month. The headlines therefore are:
- Bi-weekly Clostridium difficile management meetings led by the Chief Nurse or Medical Director.
- Significantly improved management of the symptomatic patient in terms of identification, management and speedy isolation.
- A wide range of practical Standard Operating Procedures available in clinical practice for staff.
- An expanding Deep Cleaning Team.
- The Clostridium difficile dashboard – which will be ready to report w/c 25th August.
3. MRSA
3a. Performance
Graph 7 / Page 9 shows that the trust is achieving the target for post-48 cases, with three being reported in quarter one, one per month.
3b. MRSA Action Plan
The plan is on target by the deadlines set.
There are meetings taking place with the Primary Care Trust about the screening target to be monitored from October.
We have asked the Department of Health to visit to do a Challenge session with us following the recovery plan and their visit last year. Whilst they do not insist on this we believe that some rigour is needed to ensure that we are still focused on MRSA appropriately.
4. Hand Hygiene Audits
Graphs 9 –11 on pages 12-14 , show that in July the divisions of Medicine, and Diagnostics and Therapies did not have audits done in all the required areas. Technical difficulties have meant that performance by division can not be reported but will be available at the Board meeting for tabling.
The Trust has reviewed the possible reasons for the discrepancies between the results of the Department of Health Observation Audits and the monthly trust ones. The trust ones are conducted by the Link Nurses who do their 25 observations over the period of a month as opposed the ‘snap shot’ by the Department of Health. It is clear that there is a possibility of the Hawthorne effect in that staff know who the Link Nurses are and can see that they are auditing. There is also some discrepancy between interpretation of what is compliance or not. For example, if a nurse goes to the bedside and gels hands as she / he approaches the bedside, but picks up the folder to look at before going to the patient, one person may see that as compliant and another not, unless hands are gelled again after touching the folder. We are clarifying the exact requirements for the process.
Whatever the reasons for the discrepancies it has been agreed that more assurance is needed on the compliance of staff. The weekly 15minute checks have been introduced and will be reported verbally to the Board, the results are being collated as we speak.
5. Other Issues
5a. Universal Action Plan
The action plan is on target.
5b. Cleanliness
The cleanliness results for May are in Graph 12 / page 14.
Prepared and presented by:
Lindsey Scott
Chief Nurse and Director of Governance
Christine Perry
Assistant Chief Nurse and Director of Infection Prevention and Control
22n August 2008
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