Health Business | Volume 10.6
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INFECTION CONTROL
Blackpool Fylde and Wyre NHS Foundation Trust, was awarded the HCAI Technology Innovation Team award in 2009 from Department of Health & National Purchase & Supply agency for the most innovative use of a cutting edge technology to spearhead the trust healthcare associated infection programme and demonstrating a reduction of 78 per cent in MRSA bacteraemia Hand hygiene audit results are also displayed at ward level, for patients, visitors and staff to see. In addition most wards have access to hand hygiene light boxes, which are utilised to train staff in hand hygiene and also to demonstrate to visitors. Hand hygiene is part of all induction, and mandatory updates ensure that all health care staff are trained on an annual basis. It is also imperative that all patients receive adequate hand hygiene, and hand wipes are routinely used on the wards when patients are unable to access hand wash sinks particularly after using toilet facilities and prior to meals. A COMMITMENT TO INFECTION CONTROL Infection prevention is an important measure that has been adopted throughout the trust; all healthcare workers are committed to ensuring that healthcare associated infections are greatly reduced. There have been a number of initiatives incorporated, which have led to a change in culture within the trust, including MRSA screening, hand hygiene, MRSA Bacteraemia counter on the trust Intranet homepage and a performance management meetings for all incidences of MRSA Bacteraemia and avoidable incidences of Clostridium difficile infection. Mandatory infection prevention road shows led by executive directors are presented on a monthly basis for all new starters to the trust; all current 4,000 employees have attended an event. Infection prevention is strongly led from the board to ward to ensure commitment from all staff. Poor practice is challenged in all aspects of infection prevention. SCREENING FOR MRSA Following a successful six-month pilot, a rapid screening process was adopted to enable swift identification on MRSA positive patients. This test is one of the many strategies employed within the trust to help reduce MRSA infection rates. Since the introduction of the test MRSA bacteraemia rates have fallen by 78 per cent in the first year, and incidences of MRSA bacteraemia continue to fall, with an overall decrease of 80 per cent. The trust introduced screening for all emergency patients in April 2008. In order to ensure best quality care for patients, the decision was made to utilise a rapid screening
process called Polymase Chain Reaction (PCR). The test reduces turnaround time for MRSA results from 72 hours to just two hours. By identifying MRSA early, patients are isolated quickly and receive the decolonisation treatment to significantly reduce the risk of transmission to other patients; thereby the quality of care to patients is greatly improved. The availability of rapid results quickly identifies a patient’s MRSA status, which is used to complement clinical decision making regarding the patient’s management and optimal use of single rooms. The rapid test also assists in optimising antimicrobial therapy and thereby enhancing antimicrobial stewardship. Not only has there been a reduction in the use of certain antibiotic groups, a reduction in MRSA bacteraemia but there has also been a reduction of approximately 33 per cent in MRSA wound infections. The Microbiology laboratory, operates a seven day service between 8am and 12 midnight, the average turn-around-time of results is five hours (two-eight hours). There has been approximately four per cent of patients detected as carrying MRSA. Rapid identification of positive patients ensures reassurance to the vast majority of patients and provides confidence to the MRSA carriers that targeted infection prevention protocols are initiated for them. BENEFITS OUTWAY THE COST Although this screening process is more expensive than the conventional use of culture and sensitivity, the investment pays off quickly and the savings are much greater in terms of finance and the quality of care given to the patient. The introduction of this process has had a significant impact on healthcare associated infections. By using this test the trust is saving lives. The associated benefit to patients and to clinicians is that we rapidly know within a few hours the MRSA status of patients coming into our hospital. This means that we can quickly identify which patients need to be isolated and which patients can be treated on an open ward. Preventing hospital infections is one of the trust’s key priorities and during the six-month trial of PCR the number of cases of MRSA bacteraemia fell by 63 per cent. The introduction of the rapid
screening test along with a number of other initiatives has maintained the dramatic reduction in MRSA bacteraemia. AWARD WINNING CAMPAIGNS Blackpool Fylde and Wyre NHS Foundation Trust was awarded the HCAI Technology Innovation Team award in 2009 from Department of Health and National Purchase & Supply agency for the most innovative use of a cutting edge technology to spearhead the trust healthcare associated infection programme and demonstrating a reduction of 78 per cent in MRSA bacteraemia. The Trust has also been sharing best practice nationally and internationally. A team from the trust was invited to the European Parliament in Brussels and to meet the Minister and Department of Health to share the excellent work done at the trust. Preventing hospital infections is one of the trust’s key priorities as it is one of the biggest areas of public concern. The trust has introduced several initiatives aimed at preventing hospital infections such as the ‘Ban the Bugs’ campaign, Chlorhexidine 2% skin disinfectant, trust wide roll out of aseptic non touch technique, quarterly saving lives audits, a robust surgical site surveillance programme and the hand washing campaign by enforcing strict hand washing standards for staff, patients and visitors. The ‘Ban the Bug’ campaign was an extensive programme to raise awareness of infection prevention within the hospital aimed at patients, visitors and staff. The eye-catching posters are displayed across the site both internally and externally to raise infection prevention awareness and to aid in significantly reducing the risk of acquiring an infection. Chlorhexidine 2% was introduced as a skin disinfectant for the reduction of bacteria carried on the skin when inserting peripheral lines, central lines and for taking blood cultures. Aseptic non touch technique is an aseptic procedure which ensures vital parts of equipment are not touched when preparing and administering intravenous drugs, thereby reducing the risk of infection. All these initiatives have assisted in dramatically reducing the levels of MRSA bacteraemia and wound infections. The appointment of a new director of infection prevention and control, enhanced and cohesive working of the infection prevention nurses, two consultant microbiologists and antibiotic pharmacist have all helped in bringing about a transformational change in the approach and attitudes of staff working in the trust towards infection prevention and healthcare associated infections.
Written by Johanne Lickiss, nurse consultant infection prevention Yvonne Widdows, senior site services manager Carol Gibson, monitoring and residences manager Dr Achyut Guleri, consultant microbiologist.
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