INFECTION CONTROL UPDATE

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INFECTION CONTROL UPDATE

• Donna Kinnair
• Director of Infection Prevention and Control

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Key Issues and Priorities for Southwark re HCAIs

• Monitoring of MRSA and C.difficile rates at KCHFT
• Dulwich Intermediate Care Unit
• Care Homes and Care Homes with Nursing
• Community Services

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Work In Progress or Completed

• Healthcare Act 2006 Code of Practice
• - Gap analysis
• Infection Control and Minimum Standards for
  Premises Audits of all PCT and GP Practice
  Premises - completion end Nov 07
• Mandatory Infection Control Training for all
  relevant staff on appointment and yearly
  thereafter
• All training required for Core Standards will be
  audited as part of 07/08 Core Standards Quality
  Assurance Plan
• Development of a Quick Reference Guide for Staff,
  Patients and Carers

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Planned Work Nov 07 April 08

• Targeted work around standards of care
• Review of guidelines for the management of high
  risk patients
• DIPC and Senior Nursing Staff to work with front
  line staff
• Joint work with KCHFT HPA to review the
  management of high risk patients transferring
  from acute to community setting
• Successful bids NHS London reduction in
  incidence of HCAIs
• - 31,050.00 awarded
• - Infection control audits Care Homes
• - Infection Control Conferences 5th/18th Feb
  2008

5
Healthcare Commission Investigation into
outbreaks of Clostridium difficile at Maidstone
and Tunbridge Wells NHS Trust October 2007

• April 2004 June 2006
• Healthcare Commission estimates deaths definitely
  or probably due to C.difficile were between 47
  and 127
• Implications for PCT as both a provider of
  in-patient care, community care and as a
  commissioner of acute services and services from
  independent contractors.

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Key Lessons Learnt

• Robust Governance systems
• Trust boards must be well informed
• Clear guidelines on the effective isolation of
  patients
• Guidance on risks of broad spectrum antibiotics
• High quality medical and nursing care

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5 National Recommendations

• 1. The diagnosis of C.difficile needs to be
  regarded as a diagnosis in its own right, with
  proper continuity of management. 
• 2. Further consideration needs to be given to the
  education and supervision of trainee doctors,
  with a view to improving the recording of C.
  difficile on death certificates. 
• 3. Antibiotics should be targeted, of the
  narrowest spectrum possible, and used for the
  shortest possible time. 
• 4. The NHS and HPA should agree clear and
  consistent arrangements for the monitoring of
  rates of C. difficile infection. 
• 5. The board of every NHS Trust must understand
  the roles and responsibilities of the Director of
  Infection Prevention and Control (DIPC), and
  receive regularly, information about incidence
  and trends.  

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Specific Recommendations For PCTs as
Commissioners

• Communications between the PCTs and Trust must
  focus on the quality of care and not soley on
  numbers of patients treated and associated costs.
• Service Level Agreements must include indicators
  related to healthcare acquired infections and be
  monitored both at performance meeting between the
  PCT and Trust and by PCT Boards

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PCT Governance Arrangements
PCT DIPCI
The PCT DIPC is also a member of Kings Strategic
Infection Control Committee, which is chaired by
the Kings DIPC and provides ward level data
regarding C.difficile and MRSA rates and reviews
action plans for addressing these issues. The
PCT DIPCs role in these meeting is to receive
this information, review processes in place
within Kings and challenge issues of concern
where appropriate. The DIPC reports back
directly to the PCT Senior Management Team and
the PCT Integrated Governance Committee. The
Southwark PCT Board will receive a report on a
quarterly basis.
ICCE
KSICC DIPC
Southwark PCTs contract with Kings College
Hospital Foundation Trust requires that all SUIs
be reported to the PCT via the Associate Director
- Governance to the DIPC and the PCT Medical
Director. SUIs are presented for review at the
Senior Management Team and the Board. The PCT
Medical Director is a member of Kings Governance
Committee where all SUIs are discussed and
progress against associated action plans is
discussed.
The Director of Nursing undertakes the role of
the DIPC for Southwark PCT. The Infection Control
Team leads on the work of the Infection Control
and Clinical Environment Committee, which is
chaired by the DIPCl. The Infection Control and
Clinical Environment Committee (ICCE) reports to
the Integrated Governance Committee and from
Integrated Governance to the Board six monthly
and via exception reporting when required. The
DIPC is a member of both the Integrated
Governance Committee and the Board. Minutes from
the ICCE are also made available to the Board.
PCT SMT
The PCT also has an identified Non Executive
Director who is briefed on matters of patient
safety, which will include infection
control. Southwark PCTs Serious Untoward Incident
Policy September 2007, identifies reportable
incidents associated with infections. NHS London
issued guidance on SUI reporting in Oct 2007 with
particular reference to C.diffcile and MRSA and
the PCT policy will be updated to reflect this.
PCT Integrated Governance
PCT BOARD
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Role of the Director of Infection Prevention and
Control

• 1. Oversee local control of infection policies
  and their implementation
• be responsible for the Infection Control Team
  within the healthcare organisation
• 2. Report directly to the Chief Executive and the
  Board and not through any other officer
• 3. Have the authority to challenge
  inappropriate clinical hygiene practice as well
  as antibiotic prescribing decisions
• 4. Assess the impact of all existing and new
  policies and plans on infection and make
  recommendations for change
• 5. Be an integral member of the organisation's
  clinical governance and patient safety teams and
  structures
• 6. Produce an annual report on the state of
  healthcare associated infection in the
  organisation(s) for which he/she is reponsible
  and release it publicly. 

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Dulwich Intermediate Care Unit

• One case of MRSA transfer from Acute
• Antibiotic prescribing reviewed and in line with
  guidance
• Clear guidelines in place management of patients
  with diarrhoea
• All staff receive yearly update on infection
  control
• Patient accommodation provided in single rooms
  if isolating patient required
• Infection Control Audit completed yearly action
  plan implemented
• Deep clean scheduled in line with DH
  recommendations

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Targets, Monitoring and Surveillance

• MRSA
• set by NHS London
• reduction of 50 against 02/03 baselines
• Kings target 4 cases per month/48 per annum
• Performance at Oct 07 22 cases equating to 3
  below trajectory
• C.difficile
• set by PCT
• 3 year period from April 2007 March 2010
• 10 reduction year on year
• Performance at Oct 07 228 cases against target
  of 178 equating to 50 above trajectory

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KHCFT C.difficle
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KCHFT MRSA
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Infection MRSA London and Local Data - MRSA
2007/08
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Infection MRSA London and Local Data - MRSA
2007/08
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Infection MRSA London and Local Data - MRSA
2007/08
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Infection MRSA London and Local Data - MRSA
2007/08
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Self-Assessment Action Plan
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Policy and Performance Indicators

• Tackling HCAIs prioritised in NHS Operating
  Framework
• PCT performance against all Core Standards for
  Infections Control 06/07 scored as compliant
• In view of national priorities the Core Standards
  for Infection Control, Clinical Waste and Well
  Designed and Maintained Environment for a more
  comprehensive review