Infection Prevention and Control
Annual Report 2015-16
Infection Prevention and Control Conference 2015
Nicola Lucey Director of Nursing and Quality/ Director of Infection Prevention and Control
Lisa White Head of Infection Prevention and Control
1.0 Executive Summary
Over the last year the Infection and Prevention team have supported the operational teams to deliver further improvements in infection prevention and control. This annual report provides a full account of this activity. In addition, new guidance and evidence has been reviewed and incorporated into policies, practice, education and guidance.
A summary of the main headlines in this annual report are outlined below:-
· Trajectory MRSA bacteraemia and Clostridium difficile infection targets were achieved
· MRSA screening targets were not fully met, achieving 99% compliance pertaining to 4 patients throughout the year not being screened as per policy
· Catheter associated urinary tract infections and Urinary tract infection reduction targets were achieved
· Compliance to Infection prevention and Control training exceeded target
· National guidance has been analysed and incorporated into annual workplans
· Policies have been reviewed and reflect national and best practice guidance.
· KCHFT continue to work collaboratively with the Kentwide HCAI reduction group
INDEX
Section / Page (s)Executive Summary / 2
Introduction / 4
DIPC assurance / 4
Healthcare Associated Infection
Surveillance / 5 - 8
Incidents and Outbreaks / 8-9
Flu campaign / 10
National Guidance / 10
Decontamination / 10
Cleaning / 11-13
Estates / 13
PLACE / 13 - 16
Audit / 16 - 17
Antimicrobial stewardship / 17-18
Waste / 18-19
Patient Experience / 19-21
Training and education (and link workers) / 22
Policy Reviews / 22
Staff Health / 23
Collaborative Working / 23
Conclusion / 23
Governance Structure / 24
Infection Prevention and Control Committee Terms of reference / 25-31
Hygiene Code compliance / 32
1.0 Introduction
Kent Community Health NHS Foundation Trusts’ vision is ‘to be the provider of choice by delivering excellent care and improving the health of our communities.’
Our values demonstrate the trust acts with integrity and professionalism by:
· caring with compassion
· listening, responding and empowering
· leading through partnerships
· learning, sharing and innovating
· striving for excellence
Infection Prevention and Control is a key priority for the Trust and the Trust values are integral to achieving ongoing improvement in avoidable healthcare associated infections.
This year has been challenging across the whole system of the NHS ‘family’ with increased demand for complex care from the population care and new ways of working requiring staff to innovate, adapt and change at significant pace. Therefore the Trust is very proud of the staff achievements, which have successfully managed to reduce healthcare associated infections and managed infection outbreaks to support patient safe care.
1.1 Director of Infection Prevention and Control assurance
The DIPC gives the following assurances:
· Kent Community Health NHS Foundation Trust is strategically compliant with the Hygiene Code.
· Kent Community Health NHS Foundation Trust has a zero tolerance approach to Healthcare Associated Infections (HCAI) as stated by the Department of Health
· 100% of patients presenting for elective surgery are MRSA screened at pre-assessment.
· Every case of Clostridium difficile infection is investigated and a Root Cause Analysis completed, with the clinical teams, to ensure lessons are learned and actions taken for non-compliances
· Kent Community Health NHS Foundation Trust take part in the Post Infection Review process for all MRSA bacteraemia as part of the whole systems approach to healthcare
· The Infection Prevention and Control Team carry out an annual programme of audit as required by the Hygiene Code
· Kent Community Health NHS Foundation Trust use National cleaning specifications to determine cleaning frequencies and methodology within the healthcare environment
· Kent Community Health NHS Foundation Trust carry out inspections of all in-patient areas in conjunction with the Patient Led Assessment of the Care Environment (PLACE)
· Kent Community Health NHS Foundation Trust undertake decontamination audits and report to the Medical Devices Decontamination Committee which reports to the Board.
· Kent Community Health NHS Foundation Trust has Occupational Health provision from an external provider. Screening is carried out on all staff at pre-employment checks and further surveillance and screening is carried out at agreed intervals and as necessary
· Kent Community Health NHS Foundation Trust has the required infection prevention and control arrangements in place. (See Appendix 1 for Infection Prevention and Control Team Reporting Structure and Appendix 2 for Terms of Reference of Infection Prevention and Control Committee).
1.2 DIPC Reports to the Trust Board
The Director of Infection Prevention and Control has presented the Quality Committee and Board with the following agenda items on Infection Prevention and Control during 2015/16.
· 2015/16 Annual Report
· Quality Account 2015/16
· Monthly Meticillin Resistant Staphylococcus aureus bacteraemia surveillance, progress and areas of concern
· Monthly Clostridium difficile surveillance, progress and areas of concern
· Monthly compliance with Statutory and Mandatory Training in infection control and hand hygiene
· Monthly CAUTI/UTI rates (community Hospitals only)
· Outbreak and incident reports
· Decontamination reports
· Carbapenemase Producing Enterobacteriacea (CPE) actions and updates
· Quarterly Infection Prevention and Control Updates
The DIPC acts as the liaison between the Quality Committee, Trust Board and the Infection Prevention and Control Committee.
1.3 Infection Prevention and Control Annual Programme – Review and Progress for 2015/16
Actions listed on the work plan for 2015/16 that have not been completed are: –
· Source IT system for surveillance of micro –organisms – this is due to the fact that the microbiology labs IG departments will not allow data to be stored centrally outside of their governed IT processes.
2.0 Healthcare Associated Infection Surveillance
2.1 Figure 1: Healthcare Associated Infection Surveillance
Indicator Description / Target / Apr 15 / May 15 / Jun 15 / Jul 15 / Aug 15 / Sept 15 / Oct 15 / Nov 15 / Dec 15 / Jan 16 / Feb 16 / Mar 16 / Year TotalMRSA bacteraemia / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
MRSA screens for podiatric surgery
% compliance / 100 / 100 / 100 / 100 / 100 / 100 / 100 / 100 / 100 / 100 / 100 / 100 / 100 / 100
MRSA screens in Community Hospitals
% compliance / 100 / 100 / 98 / 100 / 100 / 100 / 100 / 97 / 100 / 93 / 100 / 100 / 100 / 99
Clostridium difficile infections / ≤ 7 / 0 / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 0 / 1 / 1
Hospital acquired UTI’s / 10%less than 2014/15
<178 / 13 / 16 / 16 / 13 / 18 / 17 / 12 / 15 / 14 / 16 / 5 / 12 / 167
Hospital acquired CAUTI’s / 10%less than 2014/15
<35 / 5 / 2 / 3 / 1 / 1 / 2 / 5 / 1 / 3 / 1 / 2 / 5 / 31
2.2 Clostridium difficile 2015/16
Clostridium difficile is a bacterium that is found in peoples intestines. It can be found in health people and cause no symptoms (up to 3% adults, and 66% of babies). Disease occurs when normal bacteria in the gut are altered, usually by the administration of antibiotics. This allows the Clostridium difficile bacteria to increase to high levels with the ability to cause toxins, these toxins cause diarrhoea. This has potential to lead to more serious infections with severe inflammation of the bowel.
The Public Health England Epidemiological commentary on the mandatory reporting data produced in July 2015 identified that between 2013 and 2015 Clostridium difficile rates continued to rise, and identified that the largest increase was in ‘community acquired’ cases. KCHFT are not formally set trajectories by NHS England, however their cases are formally assigned to the CCG’s, therefore targets are set and agreed with CCG’s using the national formula for trajectory setting. In 2014/15 KCHFT did record an increase in reportable Clostridium difficile infections, and utilising learning from that year put in place measures to reduce cases in 2015/16.
A route cause analysis (RCA) is undertaken on every case of Clostridium difficile infection identified as associated or attributed to KCHFT, with staff from the Acute sector and CCG invited as required to assist in learning from cases. Within the RCA a discussion is held around ‘lapses of care’ and any of these identified result in action plans and lessons for the organisation. Level 3 lapses in care are measure by the CCG, and if the Trust exceeds it’s target, the CCG can impose contract query notices on any level 3 lapses. All antimicrobial prescribing issues are escalated through the antimicrobial stewardship group, and learning shared through quality meetings and the infection prevention and control committee.
The Trust over achieved on its target of no more than 7 cases of Clostridium difficile by reporting just 1 toxin positive attributable case, with no level 3 lapses in care. The one case was at Tonbridge Cottage hospital, and the investigating team agreed there were no lapses in care identified, and the infection was deemed unavoidable, and presumed to be due to the patients underlying medical condition, as the patients had received no antimicrobials, protein pump inhibitors or been exposed to other positive patients. However, there was an identified link to a second toxin negative, antigen positive case, suggesting environmental cross contamination, and lessons were learned from the incident.
2.3 Meticillin Resistant Staphylococcus aureus (MRSA)
In 2013/14 the government introduced a new method of investigating MRSA bacteraemias, and assigning them, this was referred to as the Post Infection Review (PIR) process. Previously Acute Trusts or the CCG were attributed cases dependent on length of time patients were cared for in a location, the PIR process allowed for a full review of care providers, enabling cases to be assigned more appropriately, and introduced a ‘third party’ assignment, for cases where the panel believed the bacteraemia to have been completely unavoidable. Nationally the cases of MRSA bacteraemias have continued to fall, highlighting that a healthcare economy wide focus appears to be working.
For the second year running, there were no MRSA blood stream infections attributed to the Trust in 2015/16, although 9 cases where KCHFT staff were providing care were investigated – all were reviewed by NHS England and deemed as either unavoidable and attributed as a ‘third party assignment’, or avoidable, but attributed to another NHS organisation. In one case the Trust received commendation on the level of care provided, however in once case the Trust were requested to provide evidence of changes in communication systems between primary, acute and community care. This evidence has been provided, and the actions closed.
3.1 MRSA Screening
Owing to the release of new national guidance on MRSA the Trust screening policy changed, from screening all patients admitted from home to our Community Hospitals or where the patient has not been screened within the Acute Hospital, to only screening those deemed to be ‘high risk’. The risks include history of MRSA infection / colonisation, open wounds, and invasive devices. The screening policy of ensuring all patients admitted for podiatric surgery are screened prior to their operation has remained unchanged. Compliance for podiatry has remained 100% for the previous year, however compliance in community hospitals averaged 99% in the year, with a total of 374 patients being admitted who fitted the criteria for screening, but only 370 patients being screened. All missed patients were subsequently screened and found to be negative.
3.2 Figure 2: MRSA screening compliance
4.0 Hospital Acquired Catheter Associated Urinary Tract infections (CAUTIs) and Urinary Tract Infections (UTIs)
The target for 2015/2016 was to reduce both Hospital acquired CAUTIs and UTIs by 10%, and to focus on catheter care in community teams.
For this year the Trust have achieved a 16% reduction in CAUTIs (31 reported attributable cases against a target of <35) and a 20% reduction in UTIs (167 reported against a target of < 178) compared to last year. Reporting within the community services has remained difficult to assure, but the IPC team continue to work with community teams through the Trust UTI/CAUTI reduction working group to ensure there is a continued focus on reduction.
Figure 3: Community Hospital acquired UTIs and CAUTI’s
This significant reduction was achieved through the following actions:
· A continued focus on education surrounding UTIs and CAUTIs during clinical visits
· Implementation of a care bundle for insertion and maintenance of urinary catheters
· The Catheter passport re-launching and refocusing efforts on single documentation sources
· An Algorithm to identify appropriate urine specimens being implemented
· The Catheter Management Policy being implemented.
· Leading on Kent wide collaborative campaign to reduce these infections
· Focussed CAUTI/UTI reduction working group
5.0 Incidents and Outbreaks
Outbreaks
In total in 2015 / 2016 there were 11 outbreaks of infection that lead to ward closures, 6 confirmed Norovirus, 2 Diarrhoea (no confirmation of pathogens) and 3 respiratory viral outbreaks with no Influenza A this year. This is a significant reduction in the number of outbreaks occurring last year (17). The IPC team continue to update and provide training on outbreaks management to staff and provide all resources required for this.
5.1 Figure 4:
Outbreak summary data 2015/2016 (11 total)
Hospital / Period / Outbreak / OutcomeFaversham Cottage / Ward closed 8/4/15 –12/4/15 / Viral respiratory infections / 2 patients paraflu, 1 RSV, 2 Influenza A
Edenbridge hospital / Ward closed 3/5/15. Opened 13/5/15 / Confirmed norovirus / 8 patients, 7 staff with symptoms
Hawkhurst Hospital / Ward closed 17/8/15 – 26/8/15 / Diarrhoea / 4 patients and 5 staff symptomatic
Edenbridge Hospital / Ward closed 10/09/15 to 15/09/15 / Confirmed norovirus / 7 patients and 10 staff affected
Sevenoaks Hospital / Ward Closed 16/10/15- 22/10/15 / Rhinovirus / 5 patients symptomatic – 2 tested positive
Deal Hospital / Ward
closed 28/11/2015 – 30/11/15 / Diarrhoea / 4 patients affected
Sevenoaks Hospital / 1 bay closed 10/12/15 ward closed 11/12/15- 15/12/15 / Confirmed norovirus / 3 patients affected
Queen Victoria Hospital Herne Bay / Ward Closed 28/1/16- 1/2/16 / Parainfluenza / 5 patients affected
Faversham Cottage Hospital / Ward closed 27/2/16 -10/3/16 / Confirmed norovirus / 16 patients and 10 staff affected
Deal Hospital / Ward closed 5/3/16 – 18/3/16. / Confirmed norovirus / 15 patients 17 staff affected
Livingstone Hospital / ward closed 7/3/16 – 16/03/16 / Confirmed norovirus / 8 patients and 2 staff affected
Incidents