1

Staffordshire and Stoke on Trent Partnership Trust Infection Prevention and Control team

Director of Infection Prevention and Control

Annual Report

April 2012 to March 2013

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Executive Summary

Throughout the year a vast number of clinical audits and quality inspections have taken

place. This has helped to maintain and raise standards and awareness of good infection

control practices. Educational infection control sessions have been embraced by staff

ensuring that at all times our mandatory training compliance target of 80% has been

met monthly throughout the year. Significant developments in services have taken

place to ensure treatment areas are safe and comfortable areas for patient treatments,

which have all contributed in the reduction of HCAI.

The highlights to the year include:

No concerns and agreement by the Care Quality Commission that the criteria

were met to register The Partnership Trust as a newly authorised Trust

The rate of Clostridium difficile in the community hospitals was on trajectory, 11

cases isolated for the year against a trajectory set by the Commissioners of 11

A successful MRSA screening programme for elective and emergency admissions,

with high compliance rates, with an average of 99.5% compliance to the

screening protocol per month

The successful introduction of Director led panels, to review MRSA bacteraemia

and Clostridium difficile root cause analysis. This has reinforced ownership of the

action plans within clinical teams and enabled ward managers and medics to

talk directly to Senior Executives within the Trust on operational issues relating

to HCAI

An extensive Capital Programme incorporating a comprehensive refurbishment

programme of Leek Hospital inpatient and outpatient wards and departments

The achievements and hard work that all Partnership Trust staff has shown over the last

year has been tremendous. Staff as individuals and team members have shown their

dedication in embracing zero tolerance towards HCAI. I would personally like to thank

all staff for their hard work and dedication during 2012-2013 and thank them for

supporting me in my role as the Director of Infection Prevention and Control (DIPC)

Thank you

Siobhan Heafield

Director of Nursing and Quality/ Director of Infection Prevention and Control

The prevention and control of health care

associated infections (HCAI) in

Staffordshire and Stoke on Trent

Partnership Trust (SSOTP) continues to be

a key priority. This year represents another

year in which the National Health Service

has continued to make significant

progress in the control and prevention of

HCAI. This report outlines the progress

made in prevention and control of HCAI

by The Partnership Trust for the period

April 2012-March 2013 and sets out the

annual programme of work for 2013-2014

to ensure continued improvement in the

prevention and control of infection.

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Introduction

The strategic and operational aim of the Infection Prevention and Control Services is to

increase organisational focus and collaborative working to effectively maintain

standards to ensure the Staffordshire and Stoke on Trent Partnership Trust (The

Partnership Trust) meet the ten criteria presented in The Health and Social Care Act

2008 (amended in 2010) Code of Practice on the Prevention and Control of Infections

and Related Guidance. The objective is to engage staff at all levels, through effective

leadership, in order to develop and embed a culture that supports infection, prevention

and control within the trust.

The purpose of this annual report is to outline the progress made in prevention and

control of HCAI by Staffordshire and Stoke on Trent Partnership Trust for the period

April 2012-March 2013.

The DIPC and the Infection Prevention and Control Team have worked in collaboration

throughout the year with Operational Leads and members of the Nursing and Quality

team to maintain an effective service that has delivered a broad infection control

programme of work.

The programme of work has been supported and monitored by the Infection

Prevention and Control Committee. The Committee is accountable to the Quality

Governance Committee and provides assurance to the Board via the DIPC. A designated

Non Executive Director joined the membership of the Infection Prevention and Control

Committee from September 2012 and has been a very active member since joining.

The following section of the report describes The Partnership Trust annual programme

of work in terms of delivering and maintaining compliance with the ten criteria of the

‘Code of Practice’, in which all providers of healthcare and adult social care are required

to demonstrate in order to register with the Care Quality Commission.

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Code of Practice for the Prevention and Control of Healthcare Associated Infections

Compliance

Criteria

What a service provider will need to demonstrate

1

Systems to manage and monitor the prevention and control of

infection. These systems use risk assessments and consider how

susceptible service users are and any risks that their environment and

other users may pose to them

2

Provide and maintain a clean and appropriate environment in managed

premises that facilitates the prevention and control of infections

3

Provide suitable accurate information to service users and their visitors

4

Provide suitable accurate information on infections to any person

concerned with providing further support or nursing/medical care in a

timely fashion

5

Ensure that people who have or develop an infection are identified

promptly and receive the appropriate treatment and care to reduce the

risk of passing on the infection to other people

6

Ensure that all staff and those employed to provide care in all settings

are fully involved in the process of preventing and controlling infection

7

Provide or secure adequate isolation facilities

8

Secure adequate access to laboratory support as appropriate

9

Have and adhere to policies, designed for the individual’s care and

provider organisations that will help to prevent and control infections

10 Ensure, so far as is reasonably practical, that care workers are free of

infection and are protected from exposure to infections that can be

caught at work and that staff are suitably educated in the prevention

and control of infection associated with the provision of health and

social care.

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Criteria 1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any

risks that their environment and other users may pose to them.

It is the responsibility of all healthcare providers to ensure that organisations have in

place appropriate arrangements for Infection Prevention and Control, to protect

patients from the risk of acquiring Health Care Associated Infection (HCAI) and to

ensure compliance with the Health and Social Care Act 2008 (2010). The Trust board

members are committed to their responsibilities for minimising the risk of preventable

infection. An annually updated Strategy and Programme of work was agreed by the

Board in April 2012 outlining responsibilities of all staff within the organisation in

reducing avoidable HCAI’s.

The Infection Prevention and Control Team (IPCT)

During 2011 a considerable amount of work was completed looking at the most

effective way for the Infection Prevention and Control team to work on a daily basis.

The Infection Prevention and Control team has been restructured to reflect the

operational structure. The teams were re organised in to a North and a South division

location to mirror the Operational team’s structure. This structure was decided on, as it

would be more practical and aid response time to queries and actions which required

follow up as the teams were more centrally based within the two divisions. This

structure has proven to be the most effective and therefore agreed as the permanent

structure during April 2012-2013. The two main offices utilised are ST Chad’s Health

Centre in the South division and Longton Cottage Hospital in the North division,

however due to the nature of the role, the team members use the hot desks available,

throughout the Trust on a daily basis to allow them to be with front line staff.

The Infection prevention and Control Team sit within the Nursing and Quality

Directorate, together with the DIPC. The Associate Director for Professional Leadership

has a large input with the team and directly line manages the Head of Infection

Prevention and Control.

The team structure consists of a

Head of infection Prevention and Control

One Team leader, who covers both North and South division

1.00 WTE Band 7 covering The Partnership Trust services

1.60 WTE Band 3 covering The Partnership Trust services (0.6 post currently on

Maternity Leave)

1.80 WTE Band 6 covering The Partnership Trust services

3.00 WTE Band 5 covering The Partnership trust services

2.40 WTE Band 6 covering Independent Services as part of the block contract

1.0 WTE Band 5 covering Independent Services as part of the block contract

The new structure was agreed in July 2012 by the Infection Prevention and Control

Committee following the retirement of two Senior Infection Prevention and Control

nurses.

There are two Service Level Agreements (SLA) in place for Infection Control Doctor

(ICD) advice. A Consultant Microbiologist from Burton Hospitals Foundation Trust

provides ICD 24 hour advice for the south geographical area Dr Paton and a Consultant

Microbiologist at University Hospital North Staffs (UHNS) Dr Banavathi provides a

24hour service for the north geographical area.

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Advice on individual patient specimens continues to be sought from the laboratory in

which the specimens are sent to for processing. Due to the organisations geographical

area this refers to a number of acute trust hospital laboratories. The main hospitals are

Mid Staffordshire NHS Foundation Trust, Burton Hospitals Foundation Trust, University

Hospital North Staffordshire and all the hospitals on the boundaries including The

Royal Wolverhampton hospitals, Heart of England Foundation Trust and Dudley Group

NHS foundation Trust.

The work undertaken by the IPCT requires a flexible and responsive approach to

spontaneous requests for infection control advice and support, whilst ensuring

planned projects and deadlines are also met in a timely manner.

Over the last year the service has successfully provided reliable infection prevention and

control advice during normal office hours (Monday to Friday) with extra cover during

the weekend in the winter period when outbreaks occurred, to support the on call

microbiologist and clinical teams. The Infection Prevention and Control committee

agreed that the service should be extended in 2013 on a permanent basis, so that

clinical teams can receive advice from the infection control nurses seven days a week.

The Infection Prevention and Control nurses have continued to maintain skills and keep

up to date with current research by being active participants in the Infection Prevention

Society West Midlands regional group. The current Head of Infection Control is the

group secretary. Other members of the team have assisted in the preparation and

running of the West Midlands annual study day and contributed to writing Infection

Prevention Society documents.

All band 6 nurses within the infection Prevention and control team and above are

encouraged and supported to attend and complete a degree level module in infection

control at The University of Birmingham to enable them to become an infection control

specialist nurse. Within the current staffing there is one remaining Band 6 who is

currently completing this course and will finish June 2013.

All members of the team have developed their knowledge and skills further

throughout the year. They regularly deliver training sessions, within the Trust training

programme and externally, as invited speakers on Degree level courses at Staffordshire,

Keele and Wolverhampton Universities, Infection Prevention and Control courses and

The Masters in Public Health course delivered at the University of Birmingham.

As in previous years the IPCT extensive infection prevention and control annual

programme of work, relied on collaborative working with Facilities and Estates leads,

Hospital Matrons, Continence team, Tissue Viability, Dental managers, Podiatry

managers and the Professional Leads for District Nursing and Allied Health

Professionals.

During 2012 an extensive piece of work was carried out with the Facilities team and

Operational Directorate at Leek Moorlands hospital. A refurbishment programme has

taken place to improve the environment for patients as well as increase the amount of

space between beds to meet Health and safety, infection control and dignity and

privacy needs of the patients. Bathrooms, sluice rooms and clinical rooms have been

updated with new fixtures and fittings a dedicated waste room has been created to

improve the separation of waste. Similar work has been agreed and tendered at

Longton Cottage and Bradwell Hospitals, work commenced in April 2013.

Quality compliance audits based on the Saving Lives Programme have continued in

community hospital departments, dental services, podiatry teams, prison healthcare

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teams and district nursing services. The audits involve self and peer audit, which are fed

back within teams and reported as part of either the Hospital Matron Dashboard or

individual reports to the Safety and Effectiveness north and south groups chaired by

the Chief Operating Officers. Exceptions are fedback at the Infection Prevention and

Control Committee. Results of audits have been displayed within the individual

departments for patients and members of the public to view.

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Assurance framework

The Partnership Trust has an active IPCT with an agreed annual programme of work,

which is agreed by the Infection Prevention and Control Committee (IPCC). Members of

the Committee include the Medical Director, Non Executive Director, Consultant in

Communicable Disease Control West Midlands North Health Protection Unit (HPU),

Pubic Health Consultant, DIPC, Head of Infection Prevention and Control

Commissioning, Head of Infection Prevention and Control The Partnership Trust and

senior operational leads. (Full membership listed in appendix 2)

The IPCC provides The Partnership Trust Board of Directors and Commissioners with

assurance that the Trust is compliant with the ‘Code of Practice’ element of the Health

and Social Care Act 2008 (updated 2010) by providing evidence and assurance in the

form of

Infection Prevention and control surveillance data trends and analysis reports

Compliance with audit programmes

Matrons Dashboard

Quarterly Cleanliness scores

Annual Patient Environment Action Team scores

Serious Incident and Internal Safeguard reporting

Outbreak reports

Route Cause Analysis action plans

Criteria 2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections

Facilities and Estates services are provided via a combination of Service Level

Agreements and in house staff. The Partnership Trust Associate Director for Estates

works closely with the Infection Prevention and Control Team. This ensures

environments are fit for purpose. Sites are inspected using The National Standards of

Cleanliness 2007 audit tools and Infection Prevention Society national audit tools.

Action plans are monitored by the Infection Prevention and Control Committee.

Patient environment action team inspection

In addition to the monthly and quarterly cleanliness audits carried out by the

Operational team, each year a Patient Environment Action Team (PEAT) inspection has

been carried out by a multidisciplinary team, the team consisted of a patient

representative, an external inspector from a neighbouring Trust, and members of the

nursing, facilities and infection prevention and control teams.

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Table 1; Results of the National Peat inspection 2012

Site Name

Environment

Score

Food

Score

Privacy &

Dignity

Score

HAYWOOD HOSPITAL 5 Excellent

5

Excellent 5 Excellent

LONGTON HOSPITAL 5 Excellent

5

Excellent 5 Excellent

LEEK MOORLANDS HOSPITAL 5 Excellent

5

Excellent 5 Excellent

CHEADLE HOSPITAL 5 Excellent

5

Excellent 5 Excellent

BRADWELL HOSPITAL 5 Excellent

5

Excellent 5 Excellent

The Partnership Trust have extended the PEAT audits to include six of the prison

healthcare environments, following the successful introduction last year. The prison

healthcare audits are reported to the IPCC. From the audits an action plan has been

developed to ensure that the high standards are maintained throughout the year. For

2013-2014 the PEAT audits will be replaced by Patient Led Assessments of the Care

environment (PLACE) Therefore the Head of infection control, Facilities leads and

Patient Expereince Manager have been involved in the preparation workshops to move

over to this programme from April 2013.

A review of hospital cleaning services was undertaken during 2012. Cleaning schedules

and a new monitoring programme have been agreed. A considerable investment in

additional domestic cleaning hours has been supported by the Executive team,

Recruitment to all post will be complete May 2013. Criteria 3 Provide suitable accurate information to service users and their visitors

Performance against Local Health Economy Trajectories:

The Prevention and Control of HCAI’s continues to be a major priority for the

Partnership Trust as a provider of healthcare. We continue to ensure focused delivery

on improvements in both the rates of infection and in the overall quality of care.

The two key performance indicators that were set during 2010/2011 have continued

and remained the main performance indicators associated with alert organism

surveillance data. The performance indicators relate to the number of Meticillin

Resistant Staphylococcus Aureus (MRSA) bacteraemias (in the blood) and the number of

Clostridium difficile infections (CDI) cases in people over the age of two year old. In

addition the Local Commissioners requested that the Meticillin Sensitive Staphylococcus

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Aureus (MSSA) and Ecoli bacteraemias isolates were reported to ascertain the number

of positive specimens, within Staffordshire and Stoke on Trent. No reductions or

trajectories were set for MSSA or E.coli Bactereamias.

The Commissioners agreed the number of root cause analysis required as it was not

possible to carry out a detailed root cause analysis (RCA) on all data reported due to

the number in the large geographical area. The root cause analysis were completed in

conjunction with clinical teams and Acute Trust Infection Prevention and Control

Teams, to ascertain themes and trends.

In addition to mandatory reporting of MRSA bacteraemias the Partnership Trust is also

reporting on the number of MRSA clinical isolates within the community hospitals

inpatient beds.

A clinical isolate is a swab taken from an area which has signs and symptoms of a local

infection such as redness, heat, temperature, pain or a discharging wound. The

specimen maybe taken from a wound sputum or a urine specimen. A small number of

positive specimens were received from the community hospital wards the cases were

isolated cases, which received appropriate treatment and no further transmission took

place.

Effective surveillance is essential in reducing healthcare associated infection (HCAI)

rates and its associated harm and costs. Data routinely collected on HCAI’s are

monitored daily by the Infection Prevention and Control team (IPCT). The results are

disseminated to clinical teams on a daily basis and to the management team and

commissioners on a monthly basis.

Wider team engagement has taken place. Tools such as the Trust weekly newsletter

“The Word” and team brief have been used to distribute information, as well as

presentations at professional district nurse forums and team leader meetings.

A pre 48 hour MRSA bacteraemia is defined as a blood culture specimen taken within

the first 48hrs of the patient’s admission to an acute Trust or a sample taken by GP in

their practice. These bacteraemia figures are not recorded against The Partnership

Trust. The Partnership Trust IPCT start the RCA, if the RCA findings highlight that the

patient has received care by a healthcare provider a joint RCA is completed.

Between April 2012 and March 2013 a total of 11 Pre 48 hour MRSA bacteraemias

11

were isolated across the health economy and reported to the Infection Prevention and

Control Team.

Table 2 The table represents the number of Pre 48hr MRSA Bactereamias reported from The Partnership Trusts geographical area. Apr

il May June July Aug Sep Oct Nov Dec Jan Fe Mar Total

North

0 1 1 0 0 0 0 0 1 0 0 0 3

South 0 0 1 1 0 1 0 0 3 1 0 1 8

Source of Bacteraemia

N/A

Su

rgic

al w

ou

nd

Fem

ora

l lin

e/

Ch

ron

ic w

ou

nd

Skin

co

lon

isati

on

N/A

Ch

ron

ic W

ou

nd

N/A N/A

Uri

ne

Skin

Skin

Sp

utu

m

Hic

km

an

lin

e

N/A

Ch

ron

ic W

ou

nd

Running Total

0 1 3 4 4 5 5 5 9 10 10 11 11

The pre 48hr MRSA Bacteraemias are segregated in to North and South geographical

areas headings as requested by the Head of Infection Prevention and Control for the

Staffordshire Primary Care Trust. The Partnership Trust IPCT investigated all 11 MRSA

bacteraemias and completed a RCA with the relevant clinical teams as part of the

infection control Service Level Agreement (SLA) with the commissioners. The probable

source of the bacteraemia was identified for each case.

The RCA’s have enabled lessons to be learnt across the Health Economy. During 2011

RCA themes highlighted that urinary catheters were one of the main risks associated

with MRSA bacteraemias. A considerable amount of work was carried out with district

nursing teams, care homes and Acute hospitals improving documentation and

communication and reviewing the need for the continued use for the catheter. For the

coming year, work has commenced focusing on chronic wounds and indwelling devices

such as peripheral cannulae management in the community.

The Partnership Trusts Community Hospital inpatient wards infection data was

collected weekly. A local trajectory of One MRSA bacteraemia case was set by the

commissioners. There was one of MRSA bacteraemias isolated during the time period. A

full review was held with the Chief Executive, Director of Nursing and Quality, Medical

Director, Director of Operations, clinical staff involved and the Infection Prevention and

Control team. The review highlighted that further training was required on the

management of peripheral lines, which has been completed.

Clostridium difficile infection The Partnership Trust Community Hospitals inpatients

Between April 2012- March 2013, the Clostridium difficle toxin rates within the

hospitals

remained on trajectory. There were a total of eleven cases isolated against a trajectory

of 11. A Period of Increase incidence (PII)of CDI was reported in April 2012 as a Serious

Incident (SI) at Leek hospital. The PII was managed by members of the Infection

Prevention and Control Committee.

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To maintain low Clostridium difficile infection rates remains of high importance. The

key achievements to meeting this trajectory, have been due to the review of the

antibiotic prescribing guidelines which has incorporated the three original documents

in to one standardised document. Appropriate antimicrobial prescribing is a vital

element in the prevention and control of Clostridium difficile infection. Improving the

ward environments by replacing fixtures and fittings and re decoration has aided the

cleaning of the environment. In addition increasing the amount of space between beds

and creating separate waste rooms to improve segregation has all contributed to

meeting the trajectory.

Table 3 The table represents the number of Clostridium difficile cases isolated

between April 2012 and March 2013 in The Partnership Trust Community Hospital

inpatient wards.

A trajectory of 11 cases was set by the commissioners for the year.

Community hospitals Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total

Day of admission plus four

(Admission date is day one) 4 1 2 1 1 0 0 0 0 0 2 0

11

Toxin+

Running Total SSOTP

4

5

7 8 9 9 9 9 9 9 11 11 11

Trajectory 1 2 3 4 5 6 7 8 9 10 11 11 11

Clostridium difficle in Care Homes As part of the Service Level Agreement with local Commissioners, the Infection Prevention and Control Team provide educational and audit support to care homes. Between April 2012 and March 2013 two care homes were identified as having a period of increased incidence (PII) of Clostridium difficile. The homes isolated two cases of Clostridium difficile over a short period of time. The care homes were audited and supported by the Infection Prevention Control Team. The support actions included providing training sessions, RCA with GP input, educational posters and sharing of the Partnership Trust Clostridium difficile policy. The Health Protection Unit West Midlands North was informed of all cases and lead on the PII investigations. Outbreaks in The Partnership Trust Community hospitals Outbreaks of diarrhoea and/or vomiting can occur at any time during the year, but are particularly prevalent during the winter months. They are often referred to as ’winter vomiting illness’. All outbreaks of infection are reported through The Partnership Trust Risk team and reported to the NHS England as a Serious Incident (SI.) SI’s are subject to a root cause analysis investigation. Actions are then monitored through the Infection Prevention and Control Committee. During December –March the number of norovirus cases within the community was very high, compared to the same time period the previous year. This was the case across the whole country. Of the 20 outbreaks that occurred, the index cases of 15 of the outbreaks were thought to have been patients admitted with symptoms. Table 4 The number of outbreaks reported as an SI during April 2012- March 2013 in the Community Hospital inpatient wards.

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Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total

Number 1 1 1 0 2 0 0 0 5 1 4 5 20

Cause

No

roviru

s

No

roviru

s

No

roviru

s

0

No

roviru

s

0 0

No

roviru

s

No

roviru

s

No

roviru

s

No

roviru

s

No of affected Patients

/Staff

18/3 5/4 10 0 10 0 0 0

55/

32 11/1 21/4

37/1

4

157/

48

Criteria 4 Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion

The criteria for the movement and transfer of patients who are known or suspected to

have an infection was reviewed in May 2012 following the Period of Increased

Incidence (PII) of Clostridium difficile cases. The newly designed documentation

contains details of infections and the treatment that the patient has been prescribed.

The documentation aids communication between different wards and teams and

allows the receiving team to provide for any continuing needs/ treatment and ensure

that quality of care is not compromised during the transfer due to lack of information.

Throughout the year the Medicines Management team has provided educational

support to the non- medical prescribers such as nurses and therapists. This has

supported in the reduction of high risk antibiotic prescribing and inappropriate

prescribing. The team has continued to issue a letter to prescribers if high risk

antibiotics were prescribed educating them of the risks. Following the establishment of

the Partnership Trust the Pharmacists in the community hospitals have increased their

engagement with the Infection Prevention and Control team, inputting into RCA

process, maintaining antibiotic audits and following up of any inappropriate

prescribing. The Medicines Management team and the Infection Prevention and

Control team have prioritised the plan of work for April 2013 onwards, to concentrate

on Medical staff prescribing within The Partnership Trust, This will take place once the

new structure of the Medical staff cover for the Community hospitals has been fully

implemented and will involve a training program led by the Medical Director.

The Infection Prevention and Control Team have worked closely during the year with

the Pharmacy teams in the Clinical Commissioning Groups (CCG), data from RCA’s has

been shared which has enabled the pharmacists to follow up inappropriate antibiotic

prescribing for care home patients and General Practitioner (GP) samples.

To support healthcare staff in providing patients with the appropriate information

concerning treatment and management of specific infections. The IPCT has a catalogue

of Infection Prevention and Control related leaflets. During 2012 the team reviewed

the patient and carer leaflets available with The Partnership Trust Communications

team. All leaflets are available electronically for staff to access.

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Criteria 5 Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people

All patients admitted to the Partnership Trust Community hospitals are assessed for the

risk of infection. Using a locally designed assessment tool on admission. The tool will

demonstrate if the patient requires to be nursed in an isolation room or whether they

can be nursed in a communal bay.

All patients are screened on admission to Community Hospitals for MRSA . Elective

patient admission screening figures is reported monthly to the ward Matron, the

Infection Prevention and Control Committee, Management team. This information is

also provided to our Commissioners each month at a Clinical Quality Review (CQR)

meeting. A target has been set by the commissioners of 100% compliance. SSOTP

compliance rates have been recorded as between 99-100% over the whole year.

Table 5 demonstrates the number of MRSA elective screening swabs sent in the last six

months, during march one specimen form was inappropriately labelled therefore the

swab was not processed and a repeat swab required sending.

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Table 5 The Bar chart represents the MRSA screening compliance data for Quarter 3

and Quarter 4 2012.

Criteria 6 Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection

All Partnership Trust employees are required to act as a role model and take steps to

prevent and control infection. This includes adopting bare below the elbow and

standard infection control/ hygiene precautions.

If staff are not compliant with following policies, initially this would be followed up by

local team leaders and supported by Senior managers, matrons and heads of services.

Performance is monitored via the appraisal route.

The Link Worker Programme remains a strong forum, meeting on a quarterly basis. The

meetings update staff on new policies and guidance issued by the Department of

Health or the Health Protection Agency, which staff are asked to take back to their

individual teams. This year has seen the group split into six dedicated groups

General group ( North and South division)

Care home staff group (North and South division)

Prison Healthcare

Dental team

This split has enabled the meetings to focus on more areas pertinent to the individual

services.

MRSA Elective Screening Compliance

Community Hospital Admissions 2012-

2013

100 100 100 100 100 99.7

0

20

40

60

80

100

Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

Month

Perce

ntage

16

The Annual Infection Prevention and Control study day took place in October 2012 with

90 staff taking part. The study day brought together infection control link workers

from all areas, this enabled staff to share ideas and innovations from all specialities

relating to infection control. The day was opened by the Director of Nursing and

Quality who gave a key speech to delegates on The Partnership Trusts vision relating to

Healthcare infections and how each individual staff member can make a difference to

the quality of care each patient/ client receives.

Training continues to play a large role in bringing about change, ensuring staff are

motivated and reminded of factors that can prevent or minimise risks of infection. All

staff receive a basic training session when they commence working in the Trust as part

of the Induction Programme.

The training needs analysis template was updated in 2012 in agreement with the

Training Department. In addition to induction, all clinical staff are required to attend

an annual update. The training is available to staff in several forms, face to face session,

handbook or e learning. Non-attendance is followed up by the Training Department

and the individual managers.

Attendance figures are reported to Infection Prevention and Control Committee,

Quality Governance and Trust Board, at frequent intervals throughout the year.

Attendance has consistently remained at 80% or over throughout 2012-2013. Currently

there is not a set target for attendance.

The 2012-2013 mandatory training package emphasises standard infection control

precautions required to work safely and has concentrated particularly on aseptic non

touch technique (ANTT). ANTT has remained in the programme to help standardise

practices across the new Trust. In conjunction with the tissue viability team, clinical

practice educators (CPE) team and the continence team, ANTT has been strongly re

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enforced as a standardised approach for dressings, cannualtions or any procedure

requiring an aseptic technique procedure.

During 2012 in addition to the mandatory training programme the Infection Prevention

and Control nurses continued to support the Integrated Support Workers (ISW) and the

band 5 Registered Nurses development programmes. The IPCT continued to accept

student nurse placements within the team, the allocations last for one week per

student and throughout the team on average there are three student nurses attending

per week. Criteria 7 Provide or secure adequate isolation facilities

Isolation of patients was monitored very closely by the clinical team and reported as

part of the matron’s dashboard. Patients requiring isolation were reviewed daily by

ward staff and weekly during the Infection Control Nurse ward round. The Trust has

105 single rooms which can be used for patient isolation within the Community

Hospital. Criteria 8 Secure adequate access to laboratory support as appropriate

Due to the large geography of the Trust several laboratories’ services are used across

Staffordshire and Stoke on Trent for processing microbiology samples. The main

laboratories are University Hospital North Staffordshire, Mid Staffordshire Foundation

Trust, Burton Hospitals Foundation Trust , Heart of England Foundation Trust, Russell’s

Hall and New Cross Hospital Microbiology Laboratory. All of the laboratories used are

nationally CPA accredited. Details of the accreditation can be found on the website

www.cpa-uk.co.uk . Microbiology advice concerning the specimen results is obtained

from the laboratory which processed the specimen.

Criteria 9 Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections

The Infection Prevention and Control team have continued to ensure that the

Partnership Trust staff and patients have access to robust, evidence based up to date

policies. During the year the Infection Prevention and Control Team has reviewed all of

the infection control policies from the three previous predecessor organisations to

standardise the contents of the policies.

During 2012 Norovirus Toolkits and folders were reviewed in the Community hospitals.

The folders comprise of posters, leaflets, cleaning schedules and data collection tools to

be used during an outbreak.

.

Audit has driven the service forward to provide a systematic approach to infection

control and ensures compliance with Trust policies and the ten criteria of The Health

Act 2008 Code of Practice for the Prevention and Control of Health Care Associated

Infections (Revised 2010) and National Health Service Litigation authority (NHSLA).

The audits support the identification of areas for improvement.

A rolling programme of infection control audits based on the Infection Control Nurses

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Association tool (2011) have been completed in the Community hospital, departments,

Community dental services, Prison Healthcare departments, Health Centres and a small

number of GP buildings. Clinical audit can be used as a training aid as well as to

monitor clinical effectiveness. It has shown to be an effective tool in monitoring

standards and influencing change.

Prison healthcare services

Infection control practices were reviewed in the six prison healthcare departments

covered by the Partnership Trust. The Infection Prevention Society audit tool was used

to conduct the audit. All areas scored over 85% this would RAG rate as green.

Sharps safe working practice audit

The management of sharps was audited

across, wards, health centres and prison

healthcare departments. The audit

demonstrated that the standardisation of the

boxes that was carried out in the previous

year had been successfully completed.

Community staff carry sharps around in their

cars on a daily basis, the audit identified that

further work was required on the safe

transport.

As not all staff were securing boxes during

transport.

Observational practices were excellent with staff scoring highly on sharps management and wearing of personal protective equipment. A small number of rooms required refurbishments; Healthcare managers are working with the Prison estates departments and Prison Governors to coordinate the refurbishments.

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Annual Infection Prevention and Control audits

The audits are carried out on a rolling programme by the IPCT. Once completed audits

are shared with the service leads and action plans are developed and monitored

through the Infection Prevention and Control Committee.

Ward

Gen

Management Practices Equipment Linen

Waste

Management PPE Sharps

Sycamore 90% 82% 96% 90% 57% 100% 53%

Oak 90% 97% 96% 90% 57% 100% 67%

Bennion 100% 86% 90% 100% 57% 100% 66%

Ward 1 100% 94% 100% 100% 85% 100% 100%

Ward 2 100% 95% 100% 100% 85% 100% 100%

Saddler 100% 95% 96% 100% 57% 100% 92%

Cottage 100% 89% 100% 90% 57% 100% 92%

81%

86% 85%

97% 97%

91% 89%

86%

90%

97% 97%

91%

97% 96%

92%

70%

75%

80%

85%

90%

95%

100%

Overal Scores. SSOTP Community Hospital Wards. 2012 IPC audits

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Aynsly 90% 79% 89% 100% 71% 100% 76%

Smithchild 95% 91% 84% 85% 71% 100% 75%

Jackfield 100% 99% 100% 92% 100% 100% 92%

Scotia IP 95% 97% 96% 100% 100% 100% 92%

Sneyd 86% 93% 90% 85% 100% 100% 84%

Broadfield 100% 95% 96% 100% 100% 100% 92%

Grange 100% 88% 90% 100% 100% 100% 92%

Chatterly 95% 92% 93% 69% 100% 100% 100%

Areas of good practice highlighted within the environment standard:

Individual teams are using cleaning schedules to demonstrate that cleaning

has been completed

All healthcare teams have access to detergent cleaning wipes to clean the

work environments and medical devices after use

Personal protective equipment was widely available for staff to use

Posters demonstrating an effective hand hygiene technique and what first

aid to carry out if an inoculation incident occurs were displayed in the

majority of healthcare environments

Areas highlighted as requiring further work were include

Bradwell and Leek hospitals did not have separate waste rooms, therefore

clinical waste and clean items were being stored in close proximity, new

waste rooms have now been built in both hospitals

Sluice room fixtures and fittings out dated and worn at Leek and Longton

hospitals, sluice rooms have now been refurbished

Flooring worn at Leek hospital, now replaced

Bathrooms refurbished at Leek hospital

Urinary catheters

Throughout the year work has continued on the reduction of inappropriate insertion of

urinary catheters. The work entailed collecting data on the number of catheters and

ensuring that catheter life charts or diaries were in use, which act as an aid memoire to

review catheter use and remove if not required any longer. As the programme

progressed throughout the year, the number of catheter diaries in use has increased to

98% consistently resulting in more appropriate catheters in use and less inappropriate

catheters. Improved documentation has also helped with the communication

concerning the catheter when patients were visiting other healthcare providers.

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Criteria 10 Ensure, so far as is reasonably practical, that care workers are free of infection and are protected from exposure to infections that can be caught at work and that staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.

During 2012-2013 the Occupational Health service was provided by three individual

contracts. One team based at Mid Staffordshire General Hospital Foundation Trust, the

second team at Burton Hospitals Foundation Trust and a third team that covered the

North division.

The services could be accessed by all Trust staff. A range of services were available

which included advice and information for staff when suffering from infections,

vaccinations, occupational health screening and risk assessments following inoculation

injuries. Data relating to inoculation injuries reported to occupational health was

presented at the Infection Prevention Control Committee.

From April 2013 a new Occupational Health service Team Prevent will be providing the

Occupational Health service to The Partnership Trust.

To support staff in the prevention and control of infection the IPCT in The Partnership

Trust have an agreed Mandatory training programme. During April 2012-March 2013

4460 staff members attended an infection control training session.

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The Partnership Trust IPCT work with independent contractors and Social Care Sector Care homes to provide advice and support on compliance with infection control standards as part of a service level agreement with the local commissioners. General Dental Practices Engagement

Between April 2012 and March 2013, Independent Dental practices received a follow up

visit by the Dental Officer and a member of the IPCT. The Director for Dental services

decided on which practices should be audited depending on the results of the self-audit

completed and the number of complaints received concerning the individual business.

All actions were followed up by the commissioners as part of the contract reviews

The IPCT have reviewed twenty decontamination rooms, building plans with

independent practices to ensure the building works met HTM 01-05 guidance.

General Medical Practice Engagement

The IPCT have continued to strengthen relationships with general practice teams.

Training sessions for practice nurses and practice staff have been arranged on request.

General Practitioners (GP’s) have been encouraged to actively take part in the RCA of

alert organisms which are reported through the national surveillance programme.

Regular newsletters and updates to policies have been circulated to practice teams.

Infection control policies are available on the external web site and Practice teams are

advised to adapt these for use in their own teams.

There were 135 Practice Nurses attended a number of Infection control training sessions

held throughout the patch, concentrating on Standard Precautions and carrying out a

Infection Prevention Society audit and were asked to disseminated the information

with their own teams.

Care homes, hospices and care agencies

Work in this area has continued to increase during 2012 the SLA with commissioners

was reviewed to include increased support to care homes, no further resources were

available therefore annual General Practice audits were discontinued unless a specific

concern had been raised, from a incident, complaint or positive microbiology sample.

A large number of training sessions were held throughout the Health Economy for care

home staff to attend. There were 560 staff in total who attended and took part in the

sessions throughout the year. Staff were asked to cascade the information within their

own care setting.

The care home link worker programme has continued to go from strength to strength,

with new link nurses form residential and nursing homes being added to the group on

a weekly basis. Educational meetings are held on a quarterly basis.

A Care Home Tool to aid compliance with CQC registration was re circulated by the

IPCT to all homes across Staffordshire and Stoke on Trent geographical area. The IPCT

continued to follow up diarrhoea and vomiting outbreaks in care homes, in conjunction

with the Health Protection Unit. The outbreaks continue to be managed by the HPU

with the IPCT visiting the home within the first 48hrs after the outbreak commences, to

check advice is being followed and that specimens and relevant data are being

collected appropriately and to facilitate the management of the outbreak. The visits

often encompass an educational session and an audit.

Between April 2012 and March 2013 76 infection control audits were completed in

nursing homes and residential homes. The audits provided homes with up to date

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information on working safely reducing the risk of infection for both patients and staff.

The commissioners and Care Quality Commission have used the evidence to support

performance issues and concerns highlighted for a small number of homes under

scrutiny. There were three main audits carried out. An IPS audit was carried out, this is a

general tool developed by the Infection Prevention Society, the tool covers all areas of

the environment and includes observing practices, the second audit is a tool used

during a Diarrhoea and vomiting outbreak, the tool asses if the home is compliant in

managing an outbreak and has implemented control measures to reduce the spread

and the third audit is only carried out when a care home is treating a patient who has

Clostridium difficile. The aim of the tool is to ensure that the patient is receiving the

most appropriate treatment and that precautions have been instigated to reduce the

risk of cross infection.

Audits completed in the South Staffordshire Care homes

Quarter IPS Outbreak CDI

Quarter 1 8 10 2

Quarter 2 1 2 0

Quarter 3 2 3 0

Quarter 4 2 1 2

Total for 2012/2013 13 16 4

Audits completed in North Staffordshire and Stoke on Trent Care homes

Quarter IPS Outbreak CDI

Quarter 1 11 3 1

Quarter 2 14 0 0

Quarter 3 5 2 0

Quarter 4 2 5 0

Total for 2012/2013 32 10 1

Data collection related to organisms isolated in care homes has continued as previous

years. This includes all Clostridium difficile cases, MRSA bacteraemias, MSSA

bacteraemias and E coli bacteraemias. Due to the amount of time a RCA takes to

complete effectively only a small number are completed by the IPCT the data is used to

ascertain trends, however care homes are encouraged to follow up on all of their own

individual cases internally.

Summary

The strategic and operational aim of the Infection Prevention and Control services is to

increase organisational focus and collaborative working to effectively implement and

maintain The Health and Social Care Act 2008 amended in 2010, Code of Practice for

the Prevention and Control of Infections. The year 2012 -2013 has been a very

productive year for the Trust. It is recognised that an increased engagement with

different staff groups at all levels has taken place, collaborative working within the

Trust with the Continence team, Tissue Viability team and the District Nurse

Professional lead has enabled the trust to continue to develop and embed a culture

further that supports and promotes infection, prevention and control within the Trust.

One of the main focuses has to improve The Partnership Trusts owned estates, ensuring

that the buildings, fixtures and fittings are maintained and fit for purpose.

The Infection Prevention Control team look forward to another productive year, which

will see further work on

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increase collaboration with Social care teams and Community teams

following the development of integrated teams. The IPCT will develop a

programme

of work with the Chief Operating Officers to encompass social care services to

ensure all elements of ‘The Hygiene Code’ are met.

improving health centre clinical environments

working with Podiatry teams to launch a Diabetic Foot Ulcer pathway which

incorporates a antimicrobial treatment advice section

work on the improving the safety of sharps related procedures

working to succeed in meeting the new local Clostridium difficile trajectory 8

cases set by the Commissioners

improving MRSA screening compliance to meet 100% consistently

working with medicines management and pharmacy team to standardise

improve Antibiotic prescribing compliance

Working with neighbouring Trusts and organisations to reduce the number of

inappropriate admissions and successfully manage outbreaks in the Community,

preventing further spread

Examples of newsletters and articles presented in the Staff Newsletter throughout

2012.

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Appendix 1- Attached as a separate document

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Appendix 2

Infection Prevention and Control Committee Membership

Director of Nursing and Quality, Director of Infection Prevention & Control (DIPC)

Associate Director of Professional Leadership

Associate Director of Quality

Lead Infection Prevention and Control Nurses

Infection Control Doctor/ Microbiologists

Medical Director

Staffordshire County Council representative

Health Protection Agency, Consultant in Communicable Disease Control

Non-Executive Director

Director of Finance Resource and Estates Representative

Chief Operations Officer/s

Hospital Manager

Decontamination Lead/s

Head of Infection Prevention and Control Commissioning Support Unit

Public Health representative