a legal framework for the prevention and control of infection · hospital doctors, 40,000 general...
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A legal framework for the prevention and control of infection
Carole FryDepartment of Health (England)
EnglandWales
Scotland
Northern Ireland
ENGLAND
167 Acute Trusts
12 Ambulance Trusts
58 Mental Health Trusts
151 Primary care Trusts
DEPARTMENT OF HEALTH
STRATEGIC HEALTH AUTHORITIES
PROVIDERS OF CARE COMMISIONERS OF CARE
NHS ORGANISATION
NHS statistics
The NHS in England is the biggest part of the system by far, catering to a population of 51m and employing more than 1.3m people.
The NHS employs more than 1.7m people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff.
NHS statistics
NHS was launched in 1948 – free at the point of access
Funded directly out of taxation £100billion (€115 billion) Some 60% of the NHS budget is
used to pay staff. A further 20% pays for drugs and other supplies
1 million patients every 36 hours.
Wednesday, 30 November Wednesday, 30 November 20112011 Stocktake presentationStocktake presentation 77
Size of the problemThe media view
Staphylococcus aureus bacteraemia and methicillin susceptibility (voluntary reporting scheme):
England and Wales, 1990 - 2004
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
year
num
ber o
f rep
orts
Sensitive
No Information
Resistant
C. difficile voluntary reporting 1991 – 2005: England, Wales and Northern Ireland
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
year
num
ber o
f rep
orts
Interventions to reduce infection rates
Infection reduction targets for MRSA and C.difficile
Organisations performance managed against progress
Range of supportive materials including High Impact Interventions (care bundles)
Improvement team visits Focus on acute care in the first instance
Introduction of the Code of Practice
Health and Social Care Act 2008
Care Quality Commission was established as the new regulator of healthcare and adult social care in England
Providers to be registered against the same sixteen registration requirements –including a registration requirement for ‘infection control and cleanliness’.
CQC powers
The CQC will take account of these criteria when assessing providers against the registration requirement on cleanliness and infection control
Failure to meet elements of the Code of Practice will not necessarily mean that the registration requirement has not been met, but it will be considered by CQC in assessing whether the registration requirement has been achieved
If the registration requirement is not met CQC has a range of enforcement powers that it can consider using including financial penalties
JAN 2008
APR 2009
APR & OCT 2010
APR 2011 & APR 2012
OCT 2006
The Code of Practice -a brief history and next steps
The Code of Practice -changing registration requirements
NHS Bodies register against a single requirement“cleanliness & infection control”
NHS Bodies register against all requirementsincluding “cleanliness & infection control”
April 2009 April 2010 October 2010
NHS Bodies NHS Bodies
Adult Social Care
Independent Healthcare
NHS Bodies
Providers of primary dental care and independent ambulances, independent healthcare and adult social care register against all requirementsincluding “cleanliness & infection control”
Primary Dental Care
Independent Ambulances
Adult Social Care
Independent Healthcare
NHS Bodies
April 2011
Primary Medical Care
Primary Dental Care
Independent Ambulances
Adult Social Care
Independent Healthcare
NHS Bodies
April 2012
Providers of independent healthcare and adult social care register againstall requirements including “cleanliness & infection control”
Providers of primary medical & dental care and independent ambulances, independent healthcare and adult social care register against all requirementsincluding “cleanliness & infection control
Compliancecriterion
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 on infections 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 practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.
Code of Practice – compliance criteria
Evidence to demonstrate compliance
Timely surveillance data Cases, outbreaks, deaths
Audit results Hand hygiene Clinical protocols Isolation protocols Antibiotic prescribing Cleanliness inspections
Reviewed at all management levels Unit, ward, directorate, division, BOARD
Findings from CQC reviews of compliance with Outcome 8 on cleanliness and infection control
Number of reviews
Review period
Compliant % Minor concerns %
Moderate concerns %
Major concerns %
Hospitals 113 April -Oct
83 13 4 0
Independent hospitals
114 Oct -July
90 4 6 0
Care homes with nursing
566 Oct -July
70 16 10 4
Care homes no nursing
1115 Oct -July
72 17 8 3
Domiciliary care
264 Oct -July
86 9 5 0
2010/11 www.cqc.org.uk
Reducing HCAI….
Change the mindset From:
Infection being the problem of the infection control team
To: Infection prevention Patient safety Whole system approach
Figure 1. E. coli bacteraemia reports, England, Wales and Northern Ireland: 2004 to 2008* (voluntary reporting)
What next?
MRSA – maintain control What about MSSA? And PVL-SA??
C. difficile – stop the outbreaks What is the impact of the wider health
and social care community? Improved treatment?
Other organisms – ESBL-producers Carbapenemase-producers etc
Antibiotic resistance and prescribing