Thursday 8th May 2008

Reducing MRSA to zero

Winchester and Eastleigh Healthcare NHS Trust has reduced its rates of MRSA bacteraemia infection to zero after introducing a simple prescription technique which could have dramatic effects on infection rates if introduced across the NHS.

The trust has begun "prescribing" the insertion of cannulae - the route for intravenous fluids as well as implementing a scorecard system to monitor them closely afterwards for any signs of infection. Previously, patients who were likely to need IV fluids or drugs in this way were given a cannula as a routine part of their medical care.

Since November cannulae are now treated as a "prescribed event" only given when absolutely necessary by specialists trained in their insertion and signed off by a doctor.

In 2007/08 the Trust had had 11 MRSA bloodstream infections - one under the maximum level of 12 the Government says is acceptable for this Trust. Four of these cases were cannula related.

Since the introduction of the new system in November there have been no new cases of MRSA bacteraemia at the trust, which runs the Royal Hampshire County hospital in Winchester and Andover War Memorial Hospital.

It is believed to be the first time a trust has introduced a combined prescription and monitoring procedure in the UK.

Once in, the cannula is flushed with a saline solution and inspected on a daily basis. Highly trained staff use a scorecard to rate its appearance and spot any irregularities or signs of infection.

Patients in medical wards were the first to experience this new, stricter method but the results have been so impressive that there are plans to roll this out across the rest of the organisation.

Dr Chris Gordon, consultant physician and divisional director for medicine at the Trust, recommended the change in practice, together with the medical assistants. He said: "It is well known that cannulae can cause bloodstream infections, such as MRSA, which is why we were so keen to make these changes.

"If we can prevent these, then we can reduce our MRSA bloodstream cases by a third. If all trusts did this just imagine what the national picture would be."

Sister Rachel Wright, who worked with Dr Gordon to implement the changes, added: "We always try to follow best practice but with this, I think it is fair to say we have gone one better. It just illustrates that simple measures, when strictly followed, can work."

Cannulation involves a needle being used to insert a tiny, flexible plastic sheath under the skin. The needle is then removed and the medicine or fluids can be introduced through the sheath which remains just under the skin.  There were 4918 cases of MRSA bloodstream infection nationwide in 2006/07. If the cannula related ratio was the same as at Winchester (36%), then 1770 cases could have been avoided by following Winchester's lead.

As well as its new procedures around cannulation, the trust is implementing measures such as hand hygiene audits and deep cleaning as set out in the NHS Saving Lives initiative "reducing infection and delivering clean and safe care" Ref: Department of Health (2004) Clean, safe care: Reducing infections and saving lives.

Derek Butler visited the Royal Hampshire County Hospital in Winchester to meet the team and some of the patients in the Taunton Ward and was impressed by the step change that the hospital has taken.  He made the comment "that the trust had taken one small step, and it was now up to the government to make that giant leap in introducing this step change nationally across the NHS.  If one hospital can make this difference then there is no reason why the remaining hospitals cannot do the same"

Derek Butler visited the Royal Hampshire County Hospital in Winchester to meet the team and some of the patients in the Taunton Ward and was impressed by the step change that the hospital has taken.  He made the comment "that the trust had taken one small step, and it was now up to the government to make that giant leap in introducing this step change nationally across the NHS.  If one hospital can make this difference then there is no reason why the remaining hospitals cannot do the same" Derek Butler, MRSA Action UK and Dr Chris Gordon

Martin Wakeley, Chief Executive, Sister Rachel Wright, Medical Assistants, Shelley Denham,
Melanie Ford, Shirley Mansfield, Dr Chris Gordon and Non-Executive Director Jacqui Thornton
 

Ward Sister Mary O'Shea joins Sister Rachel Wright and the team

 

Thursday 8 May 2008 Hospital praised for fighting MRSA

Winchester's Royal Hampshire County is defeating hospital super-bug