Infection Prevention Infection Prevention & &

Control Control Every-ones businessEvery-ones business

Health Care Associated Infection Health Care Associated Infection (HCAI)(HCAI)

Any infection that arises as a Any infection that arises as a result of healthcare, regardless result of healthcare, regardless

of the care settingof the care setting

Why prevent/control Why prevent/control Infection?Infection?

• Impact on patientsImpact on patients

• Risks to staffRisks to staff

• Risks to communityRisks to community

• CostCost

The Reality of the RiskThe Reality of the Risk

• 7.6 % adult patients in UK & Ireland7.6 % adult patients in UK & Ireland• 8.2% adult patients in England. 8.2% adult patients in England. (3(3rdrd National Prevalence survey 2006) National Prevalence survey 2006)

A proportion of patients who develop A proportion of patients who develop HCAI will die and for many others it is HCAI will die and for many others it is a major contributory factor in their a major contributory factor in their death. death.

The Reality………………The Reality………………

• Viral infections: HIV, Hepatitis B & CViral infections: HIV, Hepatitis B & C

• Drug-resistant bacteria: MRSA, VRE, TBDrug-resistant bacteria: MRSA, VRE, TB

• New survival: Cystic fibrosisNew survival: Cystic fibrosis

• New technology: Bacterial infectionsNew technology: Bacterial infections

• And more, and more, and more…………And more, and more, and more…………

The reality in SUHTThe reality in SUHT

• MRSA, GRE, Clostridium difficile, MRSA, GRE, Clostridium difficile, TB, Norovirus, Blood borne viruses. TB, Norovirus, Blood borne viruses.

Trust Focus: Trust Focus: • MRSA bacteraemiaMRSA bacteraemia• Clostridium difficile. Clostridium difficile.

Facts – MRSAFacts – MRSA

Almost endemic in NHS acute trusts since 1980’s

MRSA bacteraemia 04/05 - >7,200 cases

MRSA FactsMRSA Facts

• National MRSA bacteraemia reduction National MRSA bacteraemia reduction target: 60% by 2008.target: 60% by 2008.

• SUHT Targets:SUHT Targets:2005/20062005/2006 49 (actual 92) 49 (actual 92)2006/20072006/2007 37 372007/20082007/2008 25 25

• Rank 4Rank 4thth worst performing NHS Trust. worst performing NHS Trust.• DH performance team visit. DH performance team visit.

MRSA BSI

0

2

4

6

8

10

12

14

16

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

2005/2006

2006/2007

Clostridium difficileClostridium difficile

• 1.7% adult patients 1.7% adult patients (3(3rdrd National Prevalence survey National Prevalence survey

2006)2006)

• 05/06 England & Wales: 44 000 05/06 England & Wales: 44 000

• 05/06 SUHT: 82305/06 SUHT: 823

Antibiotic use and C. difficile case / FCE in cardiac care group 05/06

0

200

400

600

800

1000

1200

1400

1600

Apr May Jun Jul Aug Sep OCT Nov Dec Jan Feb Mar Apr

2005 2006

WH

O D

DD

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5%C.diff/FCE

Co-amoxiclav

Cefuroxime

Ciprofloxacin

Clindamycin

15-30% Healthcare 15-30% Healthcare Associated Infections are Associated Infections are considered preventable.considered preventable.

(DOH, guidance)(DOH, guidance)

Frontline clinicians have the Frontline clinicians have the potential to significantly reduce potential to significantly reduce

infection rates by undertaking key infection rates by undertaking key activities correctly activities correctly every timeevery time..

(Saving Lives 2005(Saving Lives 2005))

Hand hygiene is the single Hand hygiene is the single most important measure for most important measure for

preventing the spread of preventing the spread of infectioninfection

(Pittet et al 2001)(Pittet et al 2001)

Hand Hygiene GuidelinesHand Hygiene GuidelinesSUHT 2004SUHT 2004

Decontaminate hands before Decontaminate hands before and after each patient and after each patient

contactcontact

Use correct hand hygiene Use correct hand hygiene procedureprocedure

Standard Infection Standard Infection Control PrecautionsControl Precautions

What are these and when What are these and when should they be used/ should they be used/

adhered too?adhered too?

Standard PrecautionsStandard Precautions

Personal Protective EquipmentPersonal Protective Equipment

Safe disposal of sharpsSafe disposal of sharps

Management f blood / body fluid spillagesManagement f blood / body fluid spillages

Disposal of waste & excretaDisposal of waste & excreta

Handling of soiled linenHandling of soiled linen

Cleaning & decontaminationCleaning & decontamination

Intravascular devices:Intravascular devices:

Guidelines for preventing Guidelines for preventing infectioninfection associated with associated with Central Venous Catheters Central Venous Catheters

& Peripheral Venous & Peripheral Venous catheterscatheters

Antimicrobial prescribingAntimicrobial prescribing

2 Key Prescribing Principles: 2 Key Prescribing Principles: • Limit use of broad spectrum antibioticsLimit use of broad spectrum antibiotics• Limit use of glycopeptide antibiotics.Limit use of glycopeptide antibiotics.

• Follow local guidelines / policiesFollow local guidelines / policies• Prescribe for correct duration & dosagePrescribe for correct duration & dosage• Administer correct dosage at correct time. Administer correct dosage at correct time. • Regular prescription reviews.Regular prescription reviews.• Seek microbiological advice. Seek microbiological advice.

Everyone’s Responsibility.Everyone’s Responsibility.

• Implement best practiceImplement best practice• Know & follow SUHT policies Know & follow SUHT policies

and guidelines.and guidelines.• Keep up to date.Keep up to date.• Meet your mandatory training Meet your mandatory training

requirements.requirements.