Reducing Healthcare Acquired Infections

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Reducing Healthcare Acquired Infections

Our efforts to reduce the number of patients with Healthcare Acquired Infections (HAIs), such as MRSA (Meticillin Resistant Staphylococcus Aureus) and Clostridium Difficile infection(CDI), across our hospitals continue to be a top priority.

We continue to reduce HAIs by improving our use of antibiotics and by creating an environment and culture whereby our staff understand the importance of ensuring wards and patient areas are clean and that we all practice good infection prevention and hygiene when caring for our patients.

All staff, both clinical and non-clinical, must complete mandatory hand washing training every year. Our staff are encouraged to be vigilant and report cleanliness issues. We routinely ask patients and visitors to use the hand gel provided when coming onto the wards.

All relevant elective (planned surgery) and emergency patients are screened for MRSA, as required by the Department of Health.

Improvements

According to national figures, we are among the top performing NHS Trusts across the country who has managed to significantly reduce the number of patients with MRSA blood steam infections (bacteraemia) since 2006. The Trust has successfully reduced the number of MRSA bacteraemia (hospital acquired) by 97% in six years from 105 in 2006/07 to 6 in 2013/14.

MRSA bacteraemia and CDI cases are reported via Public Health England (PHE) and in 2013/14, the Trust met and exceeded its targets for the reduction of  hospital acquired CDI. This is a sustained improvement, with year on year reductions in HAI cases.

We carry out in-depth investigations of all MRSA bacteraemia and CDI cases, including collaboration with staff from partner agencies who work in the community teams. The aim is to continue to learn lessons across the whole health economy in an effort to reduce cases, with robust action plans implemented where necessary.

A series of actions to support the continued reduction of both MRSA and CDI continue to be implemented. These are listed below. The Trust will continue to aim to deliver quality healthcare services safely with infection prevention at its core. 

MRSA

We continue work to prevent bacteraemia (blood stream infections), including MRSA with an extensive programme of screening and decolonisation which we continue for the duration of a patient stay. In addition, we ensure high standards for infection prevention and control practices including hand hygiene and aseptic procedures.

An investigation is undertaken for each MRSA involving the clinical and nursing team and actions from lessons learnt are implemented with personalised training and policy review. This includes information sharing across all our hospital sites in the form of ‘Patient Care Alerts’ where the actions from the investigations are communicated at nursing handover for each shift for a week. A key message from the Patient Care Alert focussed on ensuring screening for MRSA including any existing wounds or lesions was carried out at the time of admission. This has been regularly reviewed with a consistent improvement in compliance observed. In addition, we have implemented a number of actions across the Trust over the last year to reduce MRSA cases further. These include:

  • Standardised nursing care plans and patient care pathways, including protecting against infection during care of  urinary catheters.
  • Ongoing staff education and assessment for ANTT (aseptic non-touch technique) and aseptic wound care standards.
  • Routine audit of observations of clinical practice among staff to assess compliance with standards of practice for hand hygiene, care of intravenous (IV) and urinary catheter devices.
  • Ongoing audit of compliance with the integrated nursing care plan for MRSA and CDI patients, including correct isolation nursing practices.

Clostridium Difficile (CDT)

We have seen a substantial reduction in cases over the past 6 years and our antibiotic stewardship is of a high standard and improvements in our antibiotic guidelines are designed to minimise the risk of Clostridium difficile . All hospital attributed cases of Clostridium Difficile receive a detailed root cause analysis in collaboration with clinical, microbiology and pharmacy teams. From the investigations, lessons learnt are incorporated into actions and policy review.

We aim to reduce Clostridium difficile infection to an absolute minimum and we have a highly-active Clostridium Difficile programme and this is backed up by a comprehensive action plan. Standards of cleanliness in our wards have been a focus, including a deep clean where cases of Clostridium Difficile have been reported, which includes the use of specialist decontamination equipment such as hydrogen peroxide vapour. We have enhanced our infection prevention and control practices to support the rapid isolation of patients with symptoms of diarrhoea with the launch of our "Don’t wait, Isolate" campaign.

The national benchmark for all acute hospitals for Clostridium difficile infections is reported as the rate per 100,000 bed days and this remains comparable to other hospitals of similar size across England. The Pennine Acute Hospitals NHS Trust intends to take the following actions to improve this rate per 100,000 bed days for Clostridium Difficile by continuing to focus on good practice to reduce healthcare acquired infections, working with staff to:

  • Continue to improve infection prevention clinical practices with a new ‘Don’t wait, Isolate’ campaign for patients with symptoms of diarrhoea. This will focus on supporting the rapid implementation of infection prevention practices, including isolation for patients with diarrhoea.
  • Sustain and continually improve antibiotic prescribing to enhance and support the national "Start Smart, then Focus" antibiotic stewardship programme.
  • Promote high standards in hand hygiene and asepsis protocol through audit and education programmes
  • Maintain the excellent standards of hospital cleanliness, together with enhanced deep cleaning and specialist decontamination of ward environments.