Table 1 Timeline of infection control interventions since Sep 2004

2004

Sep

‘Clean your hands’ campaign [3]

Compliance (against opportunities available) 62-72% at baseline rising to 82% by April 2008. Intense daily monitoring continued with results aggregated and compiled weekly until 95% compliance was achieved at which point frequency was reduced to weekly. In most locations within a few weeks the level of compliance rose to over 95%.

2006

May

Root cause Analysis (RCA)

The information capture tool was given to the clinical teams within hours of the identification of MRSA bacteremia. Once received back by the ICT further in depth investigation (if necessary) was carried out by the Infection Control Nurses (ICN). The clinical teams are updated during the regular visits by Microbiologists or ICNs. More formal feedback occurs during Clinical Governance or Operational board meetings, and also quarterly at Trust Board.

Jul

Infection Control Nurse Clinical Placement

Junior Doctor’s Induction Video

Sep

Support Worker’s Training

Nov

The peripheral vascular care (PVC) care plan (High Impact Intervention [4])

Two one day audits in April 2007 and May 2007 showed improvement in usage. Another audit commenced on 22nd October 2007 for 37 consecutive weeks showed the number of cannula in situ for >72 hours was only a few and improved compliance to other elements of the care plan viz., (1) removal if no continued clinical indication, (2) use of care plan, (3) daily visual assessment and (4) intact dressing was observed within a few weeks and maintained throughout the period.

Dec

2007

May

Universal Screening and decolonization

See result section for full description. 100% compliance both for elective and emergency admissions achieved by beginning April 2009.

The central vascular care (CVC) care plan

Weekly HCAI meeting

A weekly HCAI meeting chaired by the Director of Infection Prevention and Control has been held since May 2007 regularly attended by ICNs, consultant Microbiologists, ward matrons, domestic manager and the director of nursing among others. This group reviews three weekly audits carried out regularly: MRSA screening, PVC care plan and hand hygiene audits in addition to other infection control audits. Another daily meeting for enhanced management of known MRSA positives patients was introduced in March 2008. This group facilitates feedback of results to the relevant staff and ensures that recommended measures are backed by support from high level management in terms of resources.

Jul

Improved blood culture technique (‘Taking blood cultures: A summary of best practice’ (DoH, June 2007)

The blood culture policy was re-issued which required that indication was recorded in the medical notes and blood culture was authorised by a consultant/senior doctor. A training video was made available on the Trust intranet to demonstrate how to take cultures using aseptic technique. This was also shown at induction for new junior doctors. In June, the number of blood cultures taken fell from the monthly average of 1252 to 778, a 38% reduction, of which 16% were positive compared to 14.5% in the previous five months. The proportion that was skin organisms (e.g., coagulase negative staphylococci, diptheroids and propionibacterium) marginally reduced to 24% from 29%.

Patient Administration System (PAS) MRSA alert

Patients with previous MRSA history were tagged with an alert code on the PAS to allow for decolonisation to commence within 24 hours of admission in accordance with the MRSA policy.

Sep

Standardised Intra Venous (IV) cannula site dressing

Universal screening compliance audit

See above May, 2007.

Annual infection control study day and road show

Oct

PVC care plan compliance audit

See above November, 2006.

Web-based Audits Tool

A web based data capture was introduced to audit MRSA screening, peripheral cannula care and hand hygiene standards. This new system enabled the ICT to produce weekly audit figures efficiently at review in the weekly HCAI group meeting, identify the outliers and giving real-time feed back to the ward staff to reinforce corrective measures and best practice in a targeted and timely way.

ICN job description re-written to make duty and responsibility more explicit

2008

Jan

NPSA screen saver on all hospital PCs

General Practitioner’s education on Infection Control

New infection control ward entrance sign

Mar

Management of screening positives

Daily meeting for management of screening positives

MRSA Screening at day 10

Screening of all inpatients at day ten after admission (and then every ten days).

Apr

Hand hygiene audit

See above Sep 2004 (‘Clean your hands’ campaign)

Aseptic training for the staff

June

Junior doctor’s e-learning on Infection Control

Fluoroquinolone restriction

Consumption dropped from average 12 Defined daily Dose (DDD)/100 bed-days in previous 12 months to under 5 from June 2008 with a further drop in consumption to under 2 from June 2010.