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Trust Values

Infection Prevention and Control Annual Report 2012 - 2013

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Trust Strategic Goals

Our strategic goals are: To deliver high quality person centered models of care, throughout the organisation. To be at the centre of an integrated network of partnerships to provide holistic approach to care. To engage with our communities to ensure we deliver the services they require. To be a dynamic organisation driven by innovation To be one of the most efficient providers

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Contents

Introduction 4 Trust arrangements for Infection Prevention & Control 5 Compliance with the Health & Social Care Act 2008 7 Assurance framework 8 Annual Programme of Work 10 Legislative and Regulatory framework 10 Role of the IPCN 11 Surveillance and mandatory reporting 12 Meticillin resistant Staphylococcus aureus 13 Clostridium difficile infections (CDI) 14 Serious incidents 15 Escherichia coli 17 Antimicrobial prescribing 17 Hand Hygiene 18 Cleanliness 19 The Healthcare Environment 20 Seasonal Influenza Vaccine Campaign 21 Education and Training 23 Policy development and review 24 Quality Improvement 25 Mystery shopper programme 26 The Management of Medical Devices 27 Ambitions for 2013/14 28

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Summary and Conclusions 29 References 30 Appendix I Infection Prevention and Control Annual Programmes of Work 32 Appendix II Role of the Director of Infection Prevention and Control (DIPC) 41

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Introduction The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (Department of Health 2010) requires the Trust to produce an annual report and release it publicly. This document produced on behalf of the Director of Infection Prevention and Control (DIPC) for North Staffordshire Combined Healthcare NHS Trust details the actions taken by the organisation to minimise the risk of infection for the period April 2012 to March 2013. This document serves to inform Trust Board members of the current position and to demonstrate that infection prevention and control is an integral part of the Trust’s assurance framework. The report outlines progress measured against the stated objectives detailed in the Trust’s Annual Programme of Work including responsibilities, timescales and priorities for action. The focus of this report is the work associated with prevention and the provision of a safe environment for patient care. Individual sections outline compliance with key documents such as the Health and Social Care Act 2008 Code of Practice, the Operating Framework for the NHS (Department of Health 2001) and the NHS Outcomes Framework (Department of Health 2011) including -

Surveillance

MRSA admission screening

Outbreak prevention and management

Quality improvement and audit

Cleanliness

Policy development and review

Specialist advice

Training and education The Directors of Infection Prevention and Control for the Staffordshire and Stoke-on-Trent Partnership Trust and the University Hospital of North Staffordshire produce annual reports for those organisations. Details can be found on their websites.

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Trust Arrangements for Infection Prevention & Control

The Chief Executive (CE) has corporate responsibility for infection prevention and control and ensures that effective arrangements are in place throughout the Trust. The Chief Executive is Fiona Myers, who is also the Director of Infection Prevention and Control (DIPC).

Fiona Myers Chief Executive Steve Gregory Director of Quality and Operations The role of the Director of Infection Prevention & Control is to be directly accountable to members of the Trust Board and have the executive authority and responsibility for ensuring the implementation of strategies to prevent avoidable infection at all levels within the organisation. The role of DIPC transferred from Steve Gregory to Fiona Myers in December 2012. Infection Prevention and Control Specialist Nurse (IPCN) – The Trust employs one whole time Specialist Nurse who reports to the DIPC. The nominated Infection Prevention & Control Doctor (IPCD) is the University Hospital of North Staffordshire Consultant Microbiologist Dr Vasile Laza Stanca. Ward Managers and Service Leads work closely with the Trust IPCN to ensure that good infection prevention and control practice is applied by all. The Trust has a zero tolerance to avoidable infections and a collective responsibility which places a duty on all staff to minimise the risk of infection at all times. The Trust aims to care for patients in a safe environment protecting them from avoidable harm

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Compliance with the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance

The Care Quality Commission (CQC) is the independent regulator established to ensure that providers of health and social care meet the required standards of quality and safety. The table below outlines the ten criteria against which a provider is assessed. The Trust is registered with the CQC and has declared full compliance with the criteria detailed below.

Criterion What the registered 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 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.

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Assurance framework Infection Prevention and Control and the Management of Medical Devices Group The IPCMMDG meets four times a year and is chaired by the DIPC or deputy DIPC. Summary reports, briefing papers, policy and guidance documents, surveillance data, outbreaks, incidents and root cause analysis reports are presented to members of the Group for discussion, agreement and approval prior to submission to Quality and Governance Committee.

Membership of the Infection Prevention and Control and the Management of Medical Devices Group

Title Name

Director of Infection Prevention & Control (Chair) Steve Gregory & Fiona Myers

Deputy Director of Infection Prevention & Control

Kenny Laing

Infection Prevention & Control Specialist Nurse Sue Williams

Matron/s Jackie Wilshaw & Jackie Clowes

Support Services Advisor Anne Melville

Head of Estates Colin Plant

Senior Occupational Health Advisor Wendy Gould

Organisational safety representative Owen Myatt or Carol Sylvester

Senior Management Assistant, Harplands Joanne Orlando

Clinical Governance Lead Dianne Morris

Head of Pharmacy/Antimicrobial Pharmacist Louise Jackson/Rachel Tarbuck

Secretarial Support

Fay Smallman

Co-opted members as appropriate

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Infection Prevention and Control and the Management of Medical Devices Summary of Attendance

Title Name 18.04.12 04.07.12 31.10.12 28.01.13

Director of Infection Prevention and Control (DIPC)

Steve Gregory or Fiona Myers

√ √ - -

Head of Nursing (Deputy DIPC appointed November 2012)

Kenny Laing

- - - √

IPCN Sue Williams

√ √ √ √

Head of Estates Colin Plant

√ - √ -

Matron Jackie Wilshaw/ Jackie Clowes

√ √ √ √

Support Services Advisor

Anne Melville √ √ √ √

Antimicrobial Pharmacist

Rachel Tarbuck √ √ √ √

Organisational safety representative

Owen Myatt/Carol Sylvester

√ √ √ √

Head of Service Transformation

Paul Devlin - √ - -

Lead Occupational Health Nurse

Wendy Gould/ Sarah Austin

- √ √ -

Senior Management Assistant

Joanne Orlando - √ - -

Mystery Shopper Programme Lead

Amanda Boyd √

IPC for Staffordshire Cluster Commissioning

Allison Heseltine √

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Annual Programme The Health and Social Care Act 2008 Code of Practice requires the Trust to have an Infection Prevention and Control Annual Programme of Work which should:

Set clear objectives which meet the needs of the organisation and ensure the safety of service users

Identify priorities for action

Provide evidence that policies have been implemented to reduce infections

Report progress against the objectives in the DIPC’s annual report. The programme ensures that national objectives are met, assists operational performance and protects against variations in standards within and across the organisation. Members of the Infection Prevention and Control Group receive reports on progress of the Annual Programme, at each meeting, four times a year. The Annual Programme for the period of this report is detailed in Appendix 1.

Legislative and Regulatory Framework Department of Health 2010 The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance www.dh.gov.uk Department of Health 2010 The Operating Framework for the NHS in England 2012/2013 www.dh.gov.uk NHS Litigation Authority 2012 NHSLA Risk Management Standards for NHS Trusts providing Acute, Community or Mental Health and Learning Disability Services and Non- NHS Providers of NHS Care. www.nhsla.com/RiskManagement The Information Centre for health and social care 2011. Patient Environment Action Team Assessments 2012. www.ic.nhs.uk

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The Role of the IPCN

Criterion 1.8 of the Health and Social Care Act 2008 Code of Practice requires the Trust to ensure that the Infection Prevention and Control infrastructure has an infection control nurse (IPCN). The Trust employs one whole time IPCN, based at the Harplands Hospital. The IPCN undertakes the core work associated with infection prevention and control including -

Surveillance

MRSA admission screening

Outbreak prevention and management

Quality improvement and audit

Cleanliness

Policy development and review

Training and education

Preparation of the annual programme

Preparation of the annual report

Support to the DIPC, senior managers, service leads and clinical teams

Seasonal influenza campaign lead

Operational work associated with the management of medical devices.

Specialist advice is provided to all staff within the Trust with a focus on clinical teams providing inpatient and community care. This may relate to -

The management of individual patients with an known or suspected infection

Infection risks to staff

Refurbishment, redevelopment and upgrade projects

Quality and performance reports

Relevance of safety alerts.

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Surveillance and Mandatory Reporting

Criterion 4 and Criterion 8 of the Health and Social Care Act 2008 Code of Practice requires the Trust to provide suitable and accurate information on infection to any person concerned with providing further support or care in a timely fashion and to Secure adequate access to laboratory support as appropriate. Laboratory systems Clinical specimens generated by the Trust are managed by the University Hospital of North Staffordshire Pathology Laboratory. Reports are uploaded onto ICNet, a web based software system specific to the work of infection prevention and control teams. The purpose of surveillance Surveillance of laboratory reports allows the effective monitoring of specific and potentially pathogenic organisms. The subsequent review supports the analysis of trends and variances, the production of comparative data and the identification of emerging risks. The Consultant Microbiologists and the Trust Infection Prevention and Control Nurse undertake daily alert organism surveillance during periods of duty. Clinical teams are subsequently informed of the necessary actions required to minimise the risk of infection to the individual or other patients on the ward or unit.

Mandatory reporting The Department of Health requires the Trust to report Clostridium difficile infections (CDIs) Meticillin resistant Staphylococcus aureus (MRSA), Meticillin sensitive Staphylococcus aureus, and Escherichia coli blood stream infections (2011). National Objective For the period 2012/2013 the NHS in England was collectively asked to reduce the number of MRSA infections by a further twenty nine percent to reduce the number of bloodstream infections to 880 and the number of CDIs by seventeen percent from 19,754 to 16,100.

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Meticillin resistant Staphylococcus aureus (MRSA) The Trust is pleased to announce that there have been no MRSA bacteraemias reported to the Trust IPCN since September 2007.

MRSA Admission screening

Department of Health guidance (2008) requires NHS provider Trusts to undertake MRSA screening of patients admitted to emergency and elective hospital inpatient beds. In mental health Trusts, swabs are taken from the nose, any wounds and indwelling devices if the individual meets the criteria detailed below -

Admitted following surgical procedures

Transferred from an Acute Trust

Intravenous drug user

Self harmer

Affected by chronic wounds such as leg ulcers and pressure sores

Living with long term indwelling devices such as enteral feeding tubes

Individuals with MRSA positive admission screening swabs, who are colonised with MRSA, are offered a five days decolonisation regime in accordance with national guidance and the Trust MRSA Policy. The Trust IPCN monitors implementation through weekly MRSA admission screening returns received from all hospital inpatient areas. The Performance Department receive monthly data summary reports, while members of the Trust Infection Prevention and Control Group receive updates at each meeting. MRSA admission screening and the subsequent decolonisation of individuals who are carriers of MRSA forms part of the Trust’s strategy to minimise the risk of infection.

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Clostridium difficile infections (CDIs) The graph detailed below outlines the five year trend analysis for reported CDIs within the Trust.

During the period April 2012 to March 2013 one Clostridium difficile infection was reported at the Harplands Hospital. The case had been an inpatient for a few hours only when the symptoms of a CDI were noted and a stool sample obtained. In view of the time frame, this positive CDI reported for the organisation was clearly not acquired within the Trust and highlights the difficulties in attributing infections to organisations. The Trust is, therefore, pleased to announce that the organisation has sustained the same position for the equivalent period in the previous year.

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2

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2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

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Clostridium difficile reports for the period April 2008- March 2013

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Serious Incidents

The table below provides a summary of reported outbreaks of infection within inpatient units

Location Date Closed

Date Re-opened

Days Closed

Patients affected

Staff affected

Laboratory Reports

Florence House

Not closed - - 3 5 Norovirus

Ward 6 06.02.13 12.02.13 6 7 10 Norovirus

Ward 7 Harplands Hospital

11.02.13 20.02.13 9 10 7 Norovirus

Ward 5 Harplands Hospital

25.02.13 01.03.13 4 5 4 -

Total 19 25 26

Outbreaks of diarrhoea and vomiting affected three wards and one rehabilitation unit. The information and clinical picture reported by nursing teams resulted in all being managed as outbreaks of norovirus and subsequent laboratory reports supported this approach. All outbreaks of infection are managed in accordance with national guidance (HPA 2012), all are reported as serious incidents (SIs) and subject to a Root Cause Analysis (RCA) investigation. The aim is to determine the index case, the possible source of the outbreak and any contributory factors, while the subsequent action plan addresses the issues identified and lessons learned. Most patients are cared for in single rooms with hand washing facilities and this assists in implementing control measures during an outbreak of infection. The decision to isolate, however, is based on a balance of risk approach with consideration of any safety issues, particularly where the patient is confused, disorientated or in the acute phase of a mental illness. Patients with infections are therefore assessed individually and an appropriate plan implemented. The outbreak investigation for Wards, 5, 6 and 7 at the Harplands indicated that, against the advice from the IPCN, the movement of staff and equipment resulted in the spread of norovirus between the wards. Action plans have been developed to address this issue and will be revisited prior to the winter of 2013.

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Preventative measures implemented by the Trust to detect and minimise the impact of outbreaks of infection

Policy Section 12 of the Infection Prevention and Control Policy Manual is the Trust Policy and Procedure for the prevention and management of outbreaks of infection including viral gastroenteritis.

Training The correct hand hygiene procedure, the signs, symptoms and incubation period for norovirus and exclusion period following diarrhoea and vomiting due to an infectious cause are included in Trust Corporate Induction and Mandatory Training Programme

Information for staff

The Trust Toolkit for the detection and management of outbreaks of infection provides information and guidance for clinical teams

Information for members of the public

The Trust leaflet “Spread the Word not the germs” provides information on how members of the public can help the Trust in preventing infections

Isolation Rooms Most patients within the Trust are cared for in single rooms with hand washing or en-suite facilities. During an outbreak of infection and following a risk assessment, these rooms may be used as isolation rooms

Hand washing facilities

Newly refurbished areas have been equipped with electronic no touch Health Technical Memorandum 64 compliant hand washing facilities

Specialist advice The Trust Infection Prevention and Control Specialist Nurse provides advice on the prevention and management of outbreaks of infection

Cleaning Support services staff respond immediately to requests for additional cleaning from the Trust IPCN. Colour coded cloths and equipment are used specifically for isolation rooms and cleaning schedules are increased

Surveillance

Electronic access to laboratory reports through ICNet alerts the Trust IPCN of emerging risks

Communication and Partnership working

Infection Prevention and Control teams across Staffordshire share information on locations affected by outbreaks of infection to minimise the risk of spread through transfers into and from affected areas

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Escherichia coli (E.coli)

National data indicates that the NHS has been successful in bringing about reductions in MRSA and Clostridium difficile infections. With controls in place this may be the time to move away from this limited focus to address the emerging risks associated with E.coli blood stream infections and highly resistant organisms. There have been no reported infections within the organisation. However, E.coli accounts for approximately 36% of bacteraemias in England (HPA 2012) . Almost half of all antibiotics prescribed within the Trust relate to E.coli urinary tract infections (UTIs) (Trust Antimicrobial Pharmacist Reports) particularly in those locations caring for older people. For the Trust, there is, therefore, an emerging risk that E.coli UTI’s may progress to cause E.coli bacteraemias. The focus of infection prevention and control for the forthcoming year should be the prevention of urinary tract infections, particularly in older people.

Antimicrobial prescribing Criterion 9 of the Health and Social Care Act 2008 Code of Practice requires the Trust to have procedures in place to ensure prudent antimicrobial prescribing. The Chief Medical officer Sally Davies has warned that antibiotic resistance is one of the greatest threats to modern health and antibiotics are losing their effectiveness at a rate that is both alarming and irreversible (Department of Health 2012).

Antimicrobial Pharmacist

The Trust employs one whole time Senior Pharmacist, based at the Harplands Hospital,

with responsibility for antimicrobial prescribing. The role includes supporting prescribers

and monitoring practice to ensure that the most appropriate antibiotic is prescribed at the

correct dose for the correct period of time. Summary reports are presented to members of

the Infection Prevention and Control Group and discussed at each meeting.

European antibiotic awareness day November 2012 The Trust marked this event through an information stand in the reception area at the Harplands Hospital and the antimicrobial pharmacist presented information on best practice for prescribing, to medical staff on Wednesday 28th November. Antibiotic Prescribing guidelines The antibiotic prescribing guidelines have been updated, republished and circulated to prescribers to assist and standardise prescribing practice.

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Hand Hygiene

Criterion 2 of the Health and Social Care Act 2008 Code of practice requires the Trust to ensure that there is adequate provision of suitable hand washing facilities and antimicrobial hand rubs.

Actions taken by the Trust to promote good hand hygiene practice

Hand Hygiene Training Hand hygiene training is included at Corporate Induction and all mandatory updates

Hand Hygiene equipment

In Trust premises, all staff have access to a hand wash basin, liquid soap and disposable paper towels in wall mounted dispensers

Refurbishment and upgrade projects

Clinical specification hand washing facilities are provided for staff in all refurbishment and upgrade projects

Alcohol hand rub

Clinical teams and staff supporting clinical teams all have personal dispensers of alcohol hand rub. This complements hand washing

Quality Improvement and audit

Compliance with national guidance and Trust policies are regularly audited

Cleanliness audits

The cleanliness of hand washing facilities is monitored during monthly cleanliness audits

Information

Posters and leaflets are available for staff and members of the public

Trust Policy The Trust has a Hand Hygiene Policy detailing the correct hand hygiene technique, the critical points for hand hygiene and the World Health Organisation Five Moments for Hand Hygiene

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Cleanliness Criterion 2 of the Health and Social Care Act 2008 Code of Practice requires the Trust to provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections. Maintaining high standards of cleanliness is part of the Trust’s infection prevention and control strategy. Standards are monitored through quarterly audits and assessed against national standards, while annual Patient Environment Action Team (PEAT) audits are undertaken annually and validated through an external assessor.

Overall cleanliness scores for all Trust locations

Location Percentage overall performance

Community Premises

96.78%

Harplands

94.66%

Learning Disabilities

96.32%

Mental Health Resource Centres

96.68%

Total average 96.11%

Patient Environment Action Team (PEAT) Score Summary Chart

Site Name Environment

Score Food Score

Privacy & Dignity Score

Dragon Square Community Unit 5 excellent 5 excellent 5 excellent

Learning Disabilities Unit Hilton Road 4 good 5 excellent 4 good

The Bungalows, 1 - 6 Chebsey Close 5 excellent 5 excellent 5 excellent

Darwin - Clydesdale Centre 5 excellent 5 excellent 5 excellent

Harplands Hospital 5 excellent 5 excellent 5 excellent

Monitoring and reporting Standards of Cleanliness Cleanliness scores are reported to members of the Infection Prevention and Control Group at each meeting and included in performance reports. In 2013, PEAT will be replaced with Patient Led Assessment of the Care Environment (PLACE) inspections.

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The Healthcare Environment Following the publication of the document, Water sources and potential Pseudomonas aeruginosa contamination of taps and water systems (Department of Health 2012) and Health Technical Memorandum 04-01 Pseudomonas aeruginosa - advice for augmented care units (Department of Health 2013), a careful assessment of the potential risks within the Trust was undertaken. There are no augmented care units within the organisation, however, in view of the vulnerability and complexity of some patients cared for by the Trust the content of these documents was implemented and the following actions taken –

A water safety group was formed

Regular updates on water quality have been provided to the Infection Prevention and Control Group

The Trust Cleanliness and Disinfection Policy was amended to include flushing and cleaning regimes for taps and water outlets

Regular sampling and testing for Pseudomonas aeruginosa was implemented and results reported to the Head of Estates.

Refurbishment Projects Research has confirmed that the healthcare environment can be a reservoir for pathogenic micro-organisms, it is therefore important that good infection prevention and control practice is integrated into the planning, design and build process (Department of Health 2013) Harplands Hospital Ward 6 – The second phase The second phase of the refurbishment to Ward 6 at the Harplands has been completed, providing an additional ten beds to the unit. Electronic no touch sensor taps have been installed to provide staff with state of the art hand washing facilities, while hard flooring assists support services staff in maintaining high standards of cleanliness. Florence House Florence House is a community inpatient rehabilitation unit. Refurbishment and upgrading work was undertaken during 2012, and also included clinical specification hand wash basins, hard flooring and single rooms which may be used for isolation should an outbreak of communicable infection occur.

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Seasonal Influenza Vaccine Campaign Criterion 10 of the Health and Social Care Act 2008 Code of Practice requires the Trust to ensure that health and social care workers are free of and are protected from exposure to infections that can be caught at work.

During the 2012/13 winter period, influenza-like illnesses (ILI) remained low, however, the influenza virus is unstable and new strains are constantly emerging with the potential to have a devastating effect on individuals and service provision. Vaccination and immunisation is the most important way of protecting individuals from vaccine preventable infectious disease. Providing the seasonal influenza vaccine to healthcare workers benefits the individual and their families and helps to reduce the risk of transmitting the virus to vulnerable patients. Vaccinating staff is therefore part of the Trust’s strategy to prevent infections and is an integral part of winter planning and resilience. In January 2013 the Department of Health launched a “Catch it. Bin it. Kill it.” campaign (illustrated above) encouraging good practice to prevent the spread of the virus. In the Trust, this message was promoted in all mandatory training in addition to a poster, leaflet and electronic information campaign. Shropshire Community Health NHS Trust provide the Trust with Occupational Health Services from a centre in Fenton. In addition to the appointments system, a total of thirty one vaccination sessions were provided from a variety of locations across North Staffordshire, during the 2012/13 campaign.

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Uptake of the seasonal influenza vaccine in the Trust The overall percentage uptake of the vaccine was 34%, this included

14 out of a total of 64 doctors

141 out of a total of 487 nursing staff

74 out of a total of 154 therapists. The Trust Human Resources Department report that there were 625 episodes of staff absences due to cold, cough, influenza, and respiratory illness, resulting in and equivalent of 451 full time equivalent days lost (email from HR Department) with a consequential impact upon service provision. Anecdotal evidence and verbal reports during mandatory training suggest that there are fears that the vaccine –

causes flu

is not sufficiently tested

is unnecessary if the individual has been vaccinated or had the illness in prior years Information provided by the communications team on the Staff Information Desk (SID), in Team Talk and News Round worked hard to dispel these myths. The Trust seasonal influenza vaccine campaign achieved some success, with uptake of the vaccine by frontline staff better than previous years.

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Uptake of the seasonal influenza vaccine by Trust staff

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Education & Training Criterion 10 of the Health and Social Care Act 2008 Code of Practice requires the Trust to ensure that all staff are suitably educated in the prevention and control of infection. The principles and practice of the prevention and control of infection must be included in induction and training programmes for new staff and there must be appropriate on-going education for existing staff. The Trust includes infection prevention and control in Corporate induction and in the three- yearly mandatory update for all staff. A total of forty four “face to face” infection prevention and control training sessions were provided by the Trust IPCN. The interactive sessions which aim to foster a relationship with staff and promote best practice include –

An introduction to The Health and Social Care Act 2008 Code of Practice

Lines of accountability including the role of the Director of Infection Prevention and Control

Sharps awareness

Hand hygiene

Minimising the risks of outbreaks and exclusion periods for diarrhoea and vomiting

Topical issues such as seasonal influenza

Who to contact for advice and support. The Training Team report that the Trust overall percentage compliance with infection prevention and control mandatory training compares favourably with the equivalent period in previous years. 2012/2013 94% 2011/2012 89% 2010/2011 75% Feedback from face to face sessions is generally positive, however, releasing staff from clinical or service duties for training, remains an issue. In the forthcoming year staff will be offered the opportunity of infection prevention and control e-learning.

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Policy Development and Review

Criterion 9 of the Health and Social Care Act 2008 Code of Practice requires the Trust to have and adhere to policies designed for the individual’s care and provider organisations that will help to prevent and control infections The following Trust policies reflect the requirements of the above Act:

No Policy Title

1 Sources of Advice

2 Infection Prevention & Control Operational Policy

3 Policy for minimising the risk of infection through standard precautions

4a Hand Hygiene Policy

4b Policy for the use of Personal Protective Equipment (PPE) for staff working within and supporting clinical teams

5 Isolation Policy

6 Notifiable Diseases

7 Policy for the prevention of occupational exposure to blood borne viruses and the management of inoculation or splash injuries

8 Cleaning and Disinfection Policy

9 Food Safety Policy

10 Management of Pulmonary Tuberculosis Policy

11 Meticillin resistant Staphylococcus aureus (MRSA) policy

12 Policy for The Prevention and Management of Outbreaks of Infection including viral gastroenteritis

13 Management of Linen and Laundry Policy

14 Specimen Management Policy

15 Policy for the prevention and management of Clostridium difficile infections (CDI)

All policies are available electronically on the Staff Information Desk (SID) in the Infection Prevention and Control folder. Each document is subject to a planned programme of

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review every three years or prior to this date in response to changes in national guidance and published evidence based practice. All policies are up to date and the following polices have been revisited and updated during this period –

Cleaning and disinfection policy

Specimen Management Policy

Isolation Policy

Infection Prevention and Control Operational Policy. Guidance Documents The Trust Toolkit for the detection and Management of Outbreaks of Infection was updated and circulated to clinical teams in October 2012.

Quality Improvement

Criterion 2 of The Health and Social Care Act 2008 Code of Practice requires the Trust to ensure that a programme of audit is in place to ensure that key policies and practices are being implemented appropriately. Infection Prevention and Control standards are monitored through a structured programme of regular audit using nationally approved quality improvement tools endorsed by the Department of Health and the Infection Prevention Society (IPS 2012). Random unannounced visits and assessments are undertaken and a total of forty eight infection prevention and cleanliness audits were completed by the IPCN during the period of this report. A subsequent audit report details the standard required, the issue identified and the necessary action. The ward or unit manager is required to complete the report detailing the actions taken, the individual responsible and the timescale. Scores range from 77% - 100%. The lower scores are affected by compliance with the Trust Hand Hygiene Policy. Additional work is required to ensure that clinical staff do not wear nail polish, do not have long nails and do not wear jewellery while on duty.

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Mystery shopper programme The Trust welcomed the opportunity of taking part in the Mystery Shopper pilot which included an infection prevention and control (IPC) component. The aim was to obtain feedback for the IPC Nurses on hand hygiene practice within North Staffordshire Combined Healthcare and the University Hospital of North Staffordshire. A cohort of nine mystery shoppers received basic infection prevention and control training during a formal session in December 2012. Eight nominees were included in the face to face meeting, while one completed a distance learning pack. The pilot commenced at the end of December 2012 and was completed on 31st March 2013 and a total of seven reports were generated. Outcomes from the feedback made reference to -

An infection prevention and control notice board in the Harplands Hospital reception

The importance of asking visitors to wash their hands

The need for signage directing members of the public of where to wash their hands.

The Mystery Shopper Programme has resulted in additional work being undertaken to make improvements at the Harplands. This unique opportunity has provided helpful feedback from service users.

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The Management of Medical Devices The Health and Social Care Act 2008 Code of Practice requires the Trust to ensure that people who use services, work for, or visit the Trust should not be at risk or harmed from unsafe or unsuitable equipment. Outcome 11, Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 refers to the Safety, availability and suitability of equipment and requires providers to ensure that equipment is managed appropriately.

Trust systems to minimise risks associated with reusable medical devices

Policy Health and Safety Policy Folder 5.35 contains the Trust Policy and Guidance on the Management of Medical Devices

Equipment Managers All clinical teams have a nominated individual, called an Equipment Manager, who takes responsibility for the safe management of medical devices

Service Level Agreement with the University Hospital of North Staffordshire Clinical Technology Department

Ensures that all reusable mechanical and electrical items are serviced and tested to the appropriate safety standards. Where manufacturer’s instructions require, equipment is subject to a planned preventative maintenance programme

Head of Estates

Ensures that Trust engineers or external companies undertake maintenance and testing of clinical equipment such as hydraulic beds and hoists

Organisational Safety Department The Trust cascades safety bulletins and alerts to clinical teams to ensure the organisation responds to nationally reported issues

Infection Prevention and Control Specialist Nurse and the Senior Management Assistant

Unannounced and planned audits are undertaken to ensure that reusable medical devices have been tested and maintained as required.

Senior Management of Assistant (SMA) The Senior Management Assistant at the Harplands has a remit to centrally control and issue the stock of consumables for some key items of equipment

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Ambitions for 2013/14 The year-end analysis and review provides an opportunity to celebrate positive outcomes and to agree the Trust’s ambitions for the forthcoming year. The Trust aims to focus on further success in the following areas:

Prevent urinary tract infections.

Promote prudent antibiotic prescribing

Increase compliance with mandatory training to 95%

Improve uptake of the seasonal influenza vaccine by frontline staff

Monitor and minimise the risk from emerging resistant micro-organisms.

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Summary & Conclusion

People with a diagnosis of severe and enduring mental illness (SMI) such as schizophrenia and bipolar disorder are at increased risk of physical illness including infections (Department of Health 2006). The Trust, therefore, has a duty to protect vulnerable patients from avoidable infections through robust systems and procedures, particularly in inpatient locations. 2012/13 was a difficult and challenging year for everyone within the Trust with changes to structures, services and increasing cost pressures. Clinical teams, however, must be commended for their hard work in preventing infections and continuing to make some progress. The investigation into Mid Staffordshire NHS Foundation Trust considered the control of infection and viewed it as an important indicator of the quality of care. The Trust has noted the detail of the Francis inquiry and will carry forward the learning points into 2013/14. For the period of this report, the DIPC is pleased to announce that the organisation has sustained the position for the equivalent period in the previous year with one Clostridium difficile infection and no MRSA infections. Cleanliness scores are excellent or good, a reflection of the hard work and dedication of support services staff at the Harplands Hospital and community locations. The Trust’s commitment to learning is reflected in the number of training sessions provided at Corporate Induction and through the Mandatory Training programme, however, additional actions are required to achieve the target of 95% compliance. Standards are monitored through an on-going programme of audit and quality improvement undertaken by clinical teams and the Trust Infection Prevention and Control Nurse. Uptake of the seasonal influenza vaccine by Trust staff has increased to 34%, however, our ambition is to continue to make improvements in uptake by frontline staff. Outbreaks of infection affected three wards at the Harplands Hospital with evidence of spread between the wards. This is unacceptable and additional measures will be implemented prior to the winter of 2013. The Trust has noted the messages in the Chief Medical Officer’s Report (2012). There is a need for greater vigilance around the emerging risk from E.coli, highly resistant organisms and the necessity for prudent antimicrobial prescribing. The information provided in this report summarises the planned and responsive actions taken to minimise the risk of infection. This document serves to inform and provide assurance to members of the Board that the actions support the Trust’s aim to care for patients in a safe environment, protecting them from avoidable harm. .

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References

Care Quality Commission 2012 The essential standards of quality and safety. www.cqc.org.uk Department of Health 2006 Choosing Health: Supporting the physical health needs of people with severe mental illness www.dh.gov.uk/publications Department of Health 2008 Dear colleague letter Gateway reference 10324 MRSA screening operational guidance www.dh.gov.uk Department of Health 2009 Clostridium difficile infection: How to deal with the problem. www.dh.gov.uk/publications Department of Health 2010 The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance. www.dh.gov.uk/publications

Department of Health 2011 The Operating Framework for the NHS in England 2012/13 www.dh.gov.uk Department of Health 2011 Dear Colleague letter. Gateway reference 15353. Extension to mandatory surveillance to Meticilllin Sensitive Staphylococcus aureus (MSSA) and update Healthcare Associated Infections clinical guidance ( “HCAI Compendium”) www.dh.gov.uk Department of Health 2011 The NHS Outcomes Framework 2012/2013 www.dh.gov.uk Department of Health 2011 Dear Colleague letter. Gateway reference 15980 Extension of mandatory surveillance to E.coli bloodstream infections – June 2011. www.dh.gov/uk Department of Health 2012 Web page update on Tuesday 8th May. www.dh.gov/uk Department of Health 2012 Water Sources and potential Pseudomonas aeruginosa contamination of taps and water systems. Advice for augmented care units. www.dh.gov/uk Department of Health 2013 Water Systems Health Technical Memorandum 04 – 01 Addendum. Pseudomonas aeruginosa – advice for augmented care units

Department of Health 2013 Health Building Note 00 - 09 : Infection Control in the Built Environment www.dh.gov/uk

Hawker J, Begg N, Blair I, Reintjes R, Weinburg J. 2005 Communicable Disease Control Handbook. Blackwell Publishing

Health Protection Agency 2012 English National Point Prevalence Survey on Healthcare Associated infection www.hpa,org.uk Infection Prevention Society 2012 Clinical Practice Rapid Improvement Tools and Care Setting Process Improvement Tools www.ips.uk.net/

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National Patient Safety Agency 2007 The national specifications for cleanliness in the NHS: a framework for setting and measuring performance outcomes. npsa.nhs.uk National Patient Safety Agency 2009 The revised healthcare Cleaning Manual npsa.nhs.uk NHS Litigation Authority 2012 NHSLA Risk Management Standards for NHS Trusts providing Acute, Community or Mental Health and Learning Disability Services. www.nshla.com/RiskManagement Norovirus Working Party 2012 Guidelines for the management of norovirus outbreaks in acute and community health and social care settings. Health Protection Agency; British Infection Association; Healthcare Infection Society; Infection Prevention Society; National Concern for Healthcare Infections; NHS Confederation www.hpa.org.uk

Appendix I

Infection Prevention & Control and the Management of Medical Devices Annual Programme of Work for the period April 2012 – March 2013

The aim of this document is to set objectives and identify priorities for action through the Trust’s zero tolerance approach to avoidable infections and to minimise the risk of harm from medical devices. The stated actions aim to sustain and strengthen the Trust’s position in achieving compliance with The Health & Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (Department of Health 2010) and other key national documents. The programme aims to capture the essential components of the infection prevention and control service including – surveillance, policy development and review, outbreak prevention and management, audit, education and training, specialist advice including promoting compliance with regulation, legislation, guidance and evidence based practice.

Objective Actions Person/s Responsible Time scale & Priority

DIPC – Director of Infection Prevention & Control IPCN – Infection Prevention and Control Specialist Nurse, Sue Williams

Criterion 1 Systems to manage and monitor the prevention and control of infection

Assurance framework Quality and Governance Committee and the Board will receive regular reports and presentations (quarterly as a minimum) from the Director of Infection Prevention and Control The DIPC will ensure the Board agree and approve the –

DIPC DIPC

Quarters 1-4 Quarter 1

Annual programme of work

Annual report

Policy, procedure and guidance documents

PEAT and cleanliness scores

The DIPC will ensure that the Board is made aware of –

Emerging issues with the potential to impact upon patient safety and the delivery of clinical services

Unforeseen issues impacting upon progress of the annual programme

Ensure that progress of the annual programme is monitored by the Infection Prevention & Control Group and any identified or emerging issues affecting the programme are reported to the committee Ensure that the Infection Prevention and Control and the Management of Medical Devices Group, chaired by the DIPC meet four times a year

Support Services DIPC IPCN DIPC

Quarter 2 Review date At each meeting

Make a suitable and sufficient assessment of the risks of infection and take action to minimise the risk.

Undertake alert organism surveillance. Using ICNet, review laboratory reports during periods of duty and provide specialist advice to clinical teams on the management of individual patients Inform the DIPC of all MRSA, MSSA, E.coli bacteraemias and C.difficile infection and initiate the root cause analysis investigation process.

IPCN IPCN

Daily during normal working hours On receipt of the lab. report

Support clinical teams in complying with the Trust’s zero tolerance to avoidable infection Support clinicians and matrons in undertaking timely root cause analysis investigations of all bacteraemia’s and C.difficile infections. Assist teams in completing RCA reports and the development of subsequent action plans. Facilitate selective MRSA admission screening in accordance with Department of Health guidance. Ensure that data is collected, collated and presented to ICC and Performance Management Data analysis Present data summaries to IPC Group. Discuss statistical trends and any corrective actions taken to minimise identified or emerging risks. Present data summaries in the Infection Prevention & Control Annual Report outlining statistical trends and variances.

IPCN IPCN IPCN IPCN DIPC/IPCN

As required Within 5 days Monthly and quarterly Quarterly update Year end

Criterion 1.5 Surveillance Outbreaks

Undertake alert condition surveillance Respond to and investigate alert condition reports from clinical teams Respond to and advise on the management of outbreaks of infection Report all outbreaks of infection resulting in the closure of wards or units as a SI through Trust reporting systems. Inform the DIPC, senior management, Heads of Services, Performance

IPCN IPCN IPCN

Within 24 hours Within 24 hours Within 24 hours

Management and key individuals of outbreaks. Initiate the Root Cause Analysis investigation process Prepare outbreak summary reports and submit to IPCG, Quality and Governance Committee and the Board.

IPCN DIPC

Within 5 days At the next meeting

(Criterion 9) Policy and Procedures Have and adhere to policies, designed for the individual’s care and provider organisations, that will help to prevent and control infections Ensure that policies and procedures are relevant to the regulated activity of the registered provider and reflect legislation, regulations and evidence based practice.

Ensure that existing policies with a review date falling within this period are revised and comply with legislation, regulations, current guidance and evidence based practice –

Hand Hygiene (Nov 2012)

Cleaning and disinfection (June 2012)

Specimen Management (June 2012)

Amend additional policies in response to new documents or amendments to published guidance

IPCN IPCN IPCN IPCN

April 2011 May 2011 June 2011 Timely response

Education and training: (Criterion 10) Ensure that all staff are suitably education in the prevention and control of infection

Liaise with the Learning Centre, Service Leads and matrons to ensure that all staff are suitably educated in the prevention and control of infection. Provide an IPC contribution to the following programmes -

Corporate induction

Mandatory training days

Scheduled programme of updates

Provide a bi-annual update for the Equipment Managers Review e-learning packages and liaise with the Training Manager to assess the feasibility of implementing infection prevention and control e-learning within the Trust

IPCN/Training team

Timescale in accordance with documented programmes

(Criterion 1) Audit Ensure that key policies and practices are being implemented through a programme of audit

The IPCN will support service leads, matrons and ward managers in delivering the annual programme of audit using nationally approved audit tools. The IPCN will undertake a programme of random audits in clinical areas The IPCG will receive regular progress reports on audits and subsequent action plans Incident reporting forms and the effectiveness of subsequent action plans will be reviewed

IPCN/matrons/ service leads Service leads /Matrons/IPCN Risk manager/IPCN IPCN

Quarterly Quarterly Quarterly Documented schedule

(Criterion 10) Healthcare workers Ensure, so far as is reasonably practicable that staff are free of and are protected from exposure to infection that can be caught at work

Liaise with and support the Occupational Health Department in protecting healthcare workers from infection through – The review and follow up of inoculation or splash injuries Work with partner organisations to ensure that the Trust has systems and procedures which minimise the risk from emerging and resistant organisms including influenza The planning and delivery of the seasonal influenza immunisation programme

IPCN/OH DIPC/IPCN IPCN /Lead Occupational Health Nurse

August – January As above

Performance management : To promote compliance with legislation, regulations and guidance.

Ensure that monthly data summaries, incidents and outbreaks are forwarded to the Performance Team Ensure that the Performance Team receive appropriate information to support on-going registration with the Care Quality Commission and NHSLA assessments

IPCN IPCN

Monthly As required

Specialist advice Duty to provide specialist advice and information: To provide information and specialist advice on the prevention and control of

Timely and responsive specialist advice will be provided to staff working within and on behalf of the Trust including -

DIPC/Deputy DIPC

Clinical teams

Service Leads, matrons and managers

Estates Agency

IPCN

As required

infection to staff and members of the public

Patients, relatives or members of the public

Representation at key committees

Representation will be provided at key committees detailed below-

Infection prevention and control and the management of medical devices group

Quality & Governance Committee

Risk Review Group

New Build and refurbishment project groups

Education and Learning Group (ELG)

Weekly health economy surveillance meeting

Flu preparedness group

Water Quality Group

IPCN/DIPC DIPC IPCN IPCN IPCN IPCN IPCN IPCN

In accordance with agreed dates/schedules

Provide and maintain a clean and appropriate environment (Criterion 2)

Actively contribute to the following programmes -

The management of re-usable medical devices

Updating Equipment Managers

Liaising with University Hospital of North Staffordshire Clinical Technology and Supplies Departments

IPCN IPCN

Bi - annual As required

Undertaking random audits of re-usable medical devices

Provide an IPC perspective during cleanliness audits and PEAT inspections

Refurbish and renovation projects

IPCN IPCN/Support services advisor IPCN /Head of Estates

Random Agreed programme

Prudent antimicrobial prescribing (Criterion 9)

Contribute to – The North Staffordshire health economy review of antimicrobial prescribing guidelines The review of antibiotic prescribing through the incident reporting system and pharmacy data

Chief Pharmacist/IPCN As above

Agreed date Weekly

Appendix II Role of the Director of

Infection Prevention and Control

The role of the Director of Infection Prevention and Control is to:

Be accountable directly to the Chief Executive and to the Board (but not necessarily a member of the Board)

Be responsible for the organisation’s infection prevention and control team (IPT)

Oversee local prevention and control of infection policies and their implementation

Be a full member of the ICT and regularly attend its infection prevention and control meetings

Report directly to the NHS Board and, in non NHS care settings, the registered provider

Have the authority to challenge inappropriate practice and inappropriate antibiotic prescribing

Assess the impact of all existing and new policies on infections and make recommendations for change

Be an integral member of the organisation’s clinical governance and patient safety teams and structures

Produce an annual report and release it publicly as outlined in Winning Ways: working together to reduce healthcare associated infection in England.

Taken from the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (Department of Health 2010)