Section 5 - STH



Sheffield Teaching Hospitals NHS Foundation Trust

Annual Infection Prevention and Control Report

April 2009 – March 2010

Contents

Page

Section 1 Introduction & Executive Summary 3-13

Section 2 Overview of the Year 14-19

Section 3 Saving Lives – A Delivery Programme to Reduce Healthcare 20

Associated Infection including MRSA

Section 4 Care Quality Commission Hygiene Code Inspection 21

Section 5 Report on the Infection Prevention & Control Programme 23-32

Apr 09-Mar 10

Section 6 Key Indicators 33-37

Section 7 Meticillin resistant Staphylococcus aureus (MRSA) 38-46

Section 8 Clostridium difficile toxin associated diarrhoea (CDD) 47-53

Section 9 Complaints, Outbreaks and Major Incidents 54-56

Section 10 Antibiotic Resistance 57

Section 11 Pandemic Influenza – ‘Swine Flu’ 58-61

Section 12 Norovirus 62-65

Section 13 Conclusion and The Future 66-67

Appendix A Membership of the STHFT Infection Prevention and 68

Control Committee

Appendix B STHFT Infection Prevention & Control Team & Attendees 69

of the Trust-wide Infection Prevention & Control Team Meetings

Appendix C Membership of the STHFT Decontamination Group 70

Appendix D Structure of the STHFT Infection Prevention & Control Service 71

Appendix E List of Infection Prevention and Control Policies and Guidelines 72

Section 1

Introduction

Infection prevention and control has continued to be at the forefront of activities within the Sheffield Teaching Hospitals NHS Foundation Trust, being a key quality issue in all areas of care. In addition to the ‘normal’ everyday challenges that occur year on year, the appearance of ‘swine flu’ and the disruption caused by the major national outbreak of Norovirus were additional burdens that needed to be addressed during 2009/10. Despite these extra challenges, the ‘routine’ day-to-day operational activities have continued.

Throughout this document several abbreviations or shortenings are commonly used.

• Trust-wide annual Infection Prevention & Control Report - Report.

• Sheffield Teaching Hospitals NHS Foundation Trust – STHFT or the Trust

• Royal Hallamshire Hospital - RHH

• Northern General Hospital - NGH

• Methicillin resistant Staphylococcus aureus – MRSA

• Clostridium difficile – C.difficile

• Clostridium difficile toxin associated diarrhoea - CDD

• Infection Prevention & Control, relating to a team, group, programme etc. - IPC

• Infection Control, relating to the title of team members – IC

• Department of Health – DH

• Director of Infection Prevention and Control – DIPC

• Health Care Associated Infection – HCAI

• Sheffield primary care trust (PCT) also known as NHS Sheffield

Several Department of Health documents are referred to throughout this Report, the references for which are given here:

1. Saving Lives: A delivery programme to reduce Healthcare Associated Infection (HAI) including MRSA.



2. Standards for Better Health. Department of Health April 2006. ROCR reference gateway 6405.

3. NHSLA Risk Management Standards for Acute Trusts. NHS Litigation Authority

4. Health Act 2006: Code of Practice for the Prevention and Control of Health Care Associated Infection

5. Health and Social Care Act 2008: Code of Practice for Health and Adult Social Care on the Prevention and Control of Infections and Related Guidance



6. Clostridium difficile Infection: How to Deal with the Problem



This Report covers a wide range of topics including the STHFT performance against a variety of national standards. Progress in relation to the IPC Programme forms a large part of this Report and Key Indicator results are reported.

This Report pertains to the year 1st April 2009 to 31st March 2010. However where appropriate, data/information have been included from April 2010 onwards although the majority of this will be reported in the 2010/11 IPC Report. I would like to thank all my colleagues who have contributed to this Report, which like the IPC Service as a whole is a multi-disciplinary team effort.

Dr C J Bates

Director of Infection Prevention and Control

July 2010

Executive Summary

Section 2: Overview of the Year

Infection prevention and control continues to be a key health care priority for the Department of Health (DH), patients and the public. The documents that have been used to assess infection prevention and control services over the last few years are listed in this Section, including the Saving Lives Programme1 and the Health and Social Care Act5. The Trust has undertaken an in-house assessment of current compliance against the Health Act4 using the tool within the Saving Lives Delivery Programme1 - see Section 3 of this Report.

The Care Quality Commission visited all trusts during 2009/10, to assess compliance against the Health and Social Care Act 20085. The Trust was inspected in January 2010 – see Section 4 of this Report for details.

A summary of the key roles and responsibilities within the Trust Infection Prevention and Control (IPC) Service is included in Section 2 and a diagram showing the current structure can be found in Appendix D of this Report. For most of 2009/10 Richard Parker held the post of Deputy Chief Nurse, but as from the 1st March 2010 he has moved on to take up the role of Deputy Chief Operating Officer within the Trust. Richard’s hard work, enthusiasm, ‘cup half full’ attitude and visionary leadership will be missed by the IPC Service although infection prevention and control will continue to impinge on various aspects of his new role. Chris Morley has taken on the Deputy Chief Nurse role and the IPC Team look forward to working with him.

The Communications Team continue to play an important role in helping to raise awareness of infection prevention and control issues and communicating information appropriately to patients, the public and the media. The Trust Governors continue to contribute to the work of the IPC Service ensuring that the Service is in line with the wider Trust agenda and that the patient and public perspective is taken into account. Finally, the ongoing commitment of the Board of Directors has been key in ensuring that this element of healthcare remains a priority and that appropriate financial, material and moral support has been available to enable plans and initiatives to become a reality.

The overall responsibility for infection prevention and control within each Group lies with the Clinical Directors (CDs), although this is generally a delegated duty to the Nurse Directors (NDs). The NDs and CDs are encouraged to use the Healthcare Governance arrangements within their areas as conduits for communicating, implementing and reviewing infection prevention and control advice, guidance and information. Infection prevention and control continues to be increasingly embedded into the Trust Governance system via the IC Accreditation scheme, Clinical Assurance Toolkit and the Directorate Dashboard. During 2009/10 it was recognised that it would be beneficial to identify a senior medical lead (to be known as the Medical IPC Lead) within each Directorate. The role of these individuals is to specifically lead on the medical aspects of infection prevention and control and antimicrobial prescribing issues in their areas including close liaison with the CDs and the IPC and Microbiology Teams.

The annual IPC Programme was written in a similar format to previous years and the process for monitoring progress during the year also remained largely unchanged. Each Group or Department completes a quarterly assessment form and returns this to the DIPC for review. Results of these reviews are reported at the quarterly IPC Committee, see Section 5 of this Report.

In February 2009 the Trust was chosen to receive an award from the DH Healthcare Associated Infection (HCAI) Technology Innovation Programme. Awards were presented to one trust from each Strategic Health Authority; the STHFT was the Yorkshire and Humber SHA nominee. Trusts were chosen on the basis that they were considered to have made an outstanding contribution to fighting infection showing excellence in infection prevention performance over the past twelve months. The award of £150k was to be used to fund projects assessing the in use suitability and effectiveness of innovative technology in reducing HCAI. The IPC Service determined that the funding was to be used to assess a) ultrasonic cleaning tanks, b) ATP hygiene monitoring systems and their use in assessing cleaning technology and c) rapid technology for identification of organisms in blood cultures. During 2009/10 these three projects have commenced and preliminary reports have been made to the Technology Innovation Programme.

In June 2009 the World Health Authority declared that an influenza pandemic was underway. In response to the alert, the Trust Pandemic Influenza Operational Team began to manage the Trust’s response to this outbreak. Thankfully, the disease caused by this strain was relatively mild and overall most cases were managed in the community with only a relatively small number needing in-patient care. Although generally mild, the illness was more severe in some people with certain underlying medical problems and some pregnant women. A small number of cases within Sheffield required intensive care and sadly four individuals died. A more detailed report can be found in Section 11 of this Report.

Norovirus activity during 2009/10 was particularly severe both in the community and within the Trust. The IPC Team managed the situation as per national guidelines but the pressure from incoming emergency cases meant that a significant proportion of elective surgical activity had to cease for a number of weeks in December, January and February. A number of high level meetings occurred to review the management of the outbreak and concluded that, despite the disruption, following national recommendations was the correct strategy. A review of the outbreak and possible measures that can be taken for next winter to alleviate the disruption is taking place during 2010/11. A more extensive review of the Norovirus outbreak can be found in section 12 of this Report.

Section 3: Saving Lives: Delivery Programme to Reduce HCAI including MRSA1

The ‘Saving Lives’ Programme1 contains a self-assessment and action planning tool plus a list of eight high impact interventions (HIIs) that are deemed key to controlling healthcare associated infection. Implementation and audit of the HIIs are a key part of the Trust’s Infection Control Accreditation Scheme; see Sections 5.5 to 5.9 of this Report. The Trust undertook self-assessments in June 2007, 2008, 2009 and 2010. The overall coding for the Trust was 71%, 87%, 91% and 93% respectively. All Duties are coded as Yellow or Green. Actions required to further improve compliance form part of the Trust 2010/11 Infection Prevention and Control Programme.

Section 4: Care Quality Commission Hygiene Code Inspection

During 2009/10 the Care Quality Commission commenced a programme of inspections to check compliance against the Health and Social Care Act 20085, otherwise known as the ‘Hygiene Code’. The Code lists the actions that NHS trusts in England must take to ensure a clean environment for the care of patients, in which the risk of infection is kept as low as possible. For the 2009/10 round of inspections the Commission chose to assess fifteen standards within the Hygiene Code. The assessors made unannounced visits, to ensure that they saw the hospitals as a patient or visitor would see them.

The STHFT Care Quality Commission assessment took place in January 2010. The Care Quality Commission’s overall judgment was “On inspection, we found no evidence that the trust has breached the regulation to protect patients, workers and others from the risks of acquiring a healthcare associated infection”. This judgement is obviously extremely pleasing and reflects the ongoing efforts by Trust staff across the board to provide the best service possible for staff and patients

These visits are unannounced and therefore inevitably cause some disruption to the plans and normal working of those individuals and wards/departments involved. The Infection Prevention and Control Service would like to thank all those who participated in the visit which, by its very nature, resulted in some anxiety and stress and the need to re-arrange diaries, meetings, ward work etc.

Section 5: Report on the Infection Prevention & Control Programme 2009/10

The main focus this year has continued to be the Infection Control (IC) Accreditation Scheme. Most of the other activities in the Programme relate to this Scheme by either being an integral part of it or via audit, ownership etc. In addition, compliance with the Health and Social Care Act 20085, prevention and control of Clostridium difficile (C.difficile) infection and the development of the infection prevention and control e-learning programme were key issues. Progress in respect of the Programme is detailed in this Section of the Report.

The Programme is divided into the following sections: ‘IC Accreditation’, ‘Saving Lives Toolkit’, ‘Health and Social Care Act’, ‘Audit and Review’, ‘Ownership at Group, Directorate and Ward level’, ‘Decontamination of Medical Devices’, ‘Surveillance’, ‘MRSA’, ‘C.difficile’, ‘Pandemic Influenza’, ‘Hand Hygiene’, ‘Management of Peripheral & Central intravenous cannulae’, ‘Environmental & Cleaning Issues’ and ‘Education & Training’.

Progress in respect of the Programme was assessed quarterly by completion of Performance Assessment Forms. These assessments were reviewed by the DIPC and each area coded Red, Amber, Yellow, Green or Blue depending on progress made, Table 1 summarises the results.

In summary:

• Coding was as follows: Blue 95-100% of the IPC Programme completed, Green 90-94%, Yellow 80-89%, Amber 65-70% and Red ................
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