Infection prevention and control

We take cleanliness and infection control very seriously at our hospitals. Infections such as meticillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile can prolong your stay, cause considerable distress to patients and their families and, in some cases, lead to death.

Many hospital infections can be avoided. To control hospital infections effectively we need the support and co-operation of patients and visitors as well as staff.

The infection prevention and control team is a key Trust-wide service which leads on developing innovative techniques and tools to beat infection on our wards. This multidisciplinary service works across our five hospitals and seven clinical practice groups. It provides expert clinical input as well as regular data feedback, monitoring and information to support continuous improvement and to target action. The service also drives and supports innovation, education and applied research.

Our targets
MRSA
During 2010/11 the Trust reported 19 cases of meticillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI). While this was just above the very challenging target set for us, the risk of acquiring MRSA In the Trust is very low, and our rates are similar to or better than most other comparable sized NHS Trusts in London.  

MSSA
We have now established a system for monitoring meticillin-sensitive Staphylococcus aureus (MSSA) blood stream infections in all patients admitted to the Trust. We will be reviewing underlying causes that may help us target those causes that may be preventable.

Escherichia coli (E. coli)
We have reviewed data on E. coli cases reported in the Trust and are using this analysis to inform the development of systems to capture this data and better understand the underlying causes of these infections.

Clostridium difficile (C. difficile) infections
The Trust was set a target of 309 cases for 2010/11 by the Department of Health. To drive down our rates further, we set our own target of 200 cases. We achieved our own internal target and reported 179 cases during last year. This represents a 30 per cent reduction compared to 2009/10.

What we are doing to prevent bloodstream infections
During 2010/11, the Trust implemented the following key strategies to prevent bloodstream infections:

  • Root cause analysis of each MRSA BSI to ensure learning is gained from each case
  • Updated guidance on taking blood cultures to minimise the risk of contaminating the specimen and associated training programme implemented

Preventing C. difficile
In 2010/2011, the Trust implemented an active review of patients on antibiotics, more accurate laboratory tests, treating patients carrying the bacteria more effectively. The design of a standardised assessment chart to assist clinical staff in recognising patients at high risk and developing systems that enable the prompt detection and analysis of the root causes of episodes of increased incidence of C. difficile to ensure we learn from past cases. 

Antibiotic stewardship
Careful management of antibiotics remains a high priority within our hospitals. The Trust-wide antibiotic policy launched two years ago has been updated and we continue to support an active multidisciplinary antibiotic prescribing, review and surveillance programme. Progress has been made towards meeting the target to ensure that at least 90 per cent of antibiotic prescriptions have an indication documented. Currently over 80 per cent are documented.

Showcase hospital programme
We continue to be one of only nine ‘showcase trusts’ throughout the country. The programmes continue to speed up the evaluation, adoption and diffusion of technologies to combat healthcare associated infections. Two wards at St Mary’s Hospital are currently trialing ‘Design Bugs Out’ products, designed to reduce the spread of infection, including: furniture equipment specially designed collaboratively with Imperial College NHS Trust frontline staff.

We are trialing a preoperative wash cloth, for use prior to a caesarean section to reduce the risk of postoperative infection to our mothers. The programme has supported the production of a film for effective cleaning of equipment to reduce the risk of C.difficile as well as a trial of a chlorehexidine-impregnated dressing for major vascular lines used on some of our patients. The completion of an environmental hygiene swabbing system trial will soon report on the effectiveness of using this technology.

Supporting and driving quality improvement in patient care and safety
The data and epidemiology team have continued to develop sophisticated surveillance systems which underpin our drive to continuously improve quality and safety for all our patients. When the Trust saw a significant rise in ‘flu cases during the winter months, the team set up collaborative processes which helped clinical teams overcome considerable challenges with bed capacity and staffing across our hospitals.

Ensuring and monitoring best practice at the bedside
The Synbiotix® web-based audit tool has been further advanced during the past year with new systems developed to capture data on patients with urinary catheters. The information is being used to reduce the use of catheters and minimise the risk of urinary tract infections.  

Education and research
Enrolment on the National Centre for Infection Prevention and Management’s (CIPM) MSc in infection prevention and management for managers and nurses will begin during autumn 2011 and will provide a quality training programme in this specialist area.

To coincide with the European Union Antibiotic Awareness Day in November 2010, the CIPM launched the first annual conference: Patient Advocacy and Quality Improvement -:  Nurses’ Role in Antimicrobial Stewardship. With several key members of the Trust presenting, the The day covered topics including principles of quality improvement science, communication and patient safety;, the role of the nurse as patient advocate;, and nurse participation in antimicrobial management. The second conference will take place again in November 2011.

Other progress

  • We have introduced a vascular access nurse specialist; a role which is key to  further developing and driving forward a unified approach to policy, product usage and associated practice.
  • A vascular access awareness week was held in January 2011. . This marked the launch of our new policies, products and education and training programme. During this time, over 360 doctors, nurses and support staff were trained. An ongoing education programme is now being delivered each month and is available to all clinical staff.
  • Systems for monitoring blood stream infections associated with central lines in intensive care and renal dialysis have been established and used to inform practice and reduce the risk of infection amongst theses high risk patients.