Extract from Healthcare Associated Infections Event
Department of Health and Stakeholders
7th November 2007
Inmarsat,
MRSA Action UK attended the event and were impressed by the Presentation on The
The never ending story...... beating the bugs
In August 2005 there was a view that the target for reduction in MRSA bacteraemias was not statistically sound and unrealistic. In Maternity Services MRSA bacteraemias were showing a rising trend:
03/04 – 38
04/05 – 66
05/06 – 83
It was important to get the message across and not to miss the point, it’s the issues that contribute to the target that are important. The emphasis in 2005 was on “Infection Control” rather than “Prevention”, dealing with what had already happened rather than stopping it happening. In August the changes commenced, including:
These were all positive actions to change the culture. The organisation had a steer from senior level, change to put staff in who had clinical knowledge and leadership expertise. MRSA turnaround teams were invited in.
There were a number of interventions that showed instant improvement in the figures and in the environment for the staff and patients. Within three weeks of replacing the commodes the C diff rate “dropped like a stone”, and it was better for the patients and staff as this was not only safer but had a better visual impact. Cheryl outlined that they had lower occupancy rates at the start of the journey, and now they were up around 90-94%, so she believes its about what patients you have in the beds rather than occupancy rates, so its not necessarily occupancy rates that have a significant impact on infection rates in every instant, its more about what you do.
In May 2006 there was a meeting with the Department of Health. The credo for change commenced…. It was recognised that behaviour had to change – the Department of Health were checking out the culture of the organisation, when they visit you be sure that they want to know that you are serious – engagement with them and the processes and behaviours needed is key to success, there is no room for complacency, and they will know if you are serious about infection prevention.
Staff and patient involvement
It is important to listen to complaints and use them to improve service and change policy, the policy on wearing of uniforms outside of the hospital environment was implemented in response to a complaint. Sometimes you have to manage expectations, for example a complainant wanted a standard for visitors to adhere to, but this was unrealistic as you can’t judge how ‘clean’ visitors’ clothing is.
People don’t go into nursing to harm people, they don’t want to see people getting infections – sometimes its inevitable because of people’s vulnerability – however there must be zero tolerance, we should do everything we can to try to avoid it, its about turning policy into reality, for example – matrons will visit the car park to enforce the uniform policy if necessary and challenge. It takes courage to challenge so the champions play a really important part.
Cheryl outlined a process map showing how interventions impacted on C diff positive toxins. There was a need to review and follow up and look to see what else is happening where blips in performance show. Commode replacement, mattress replacement and continuous audits made good impacts (audit – matrons took eye off the ball and figures fluctuated), cannot be complacent. Even though Cheryl can see massive improvements she believes levels were still far too many, but interventions and the guidance from the improvement team visit have led to far fewer bacteraemias if these actions had not been taken. Infection is an insult.
What made the difference
How the improvement is being maintained
The performance reporting was a great motivator – showing green on charts for performance monitoring – who’s amber – internal peer pressure – grapevine – what do we need to do differently.
Cheryl showed a video with all the team taking part in communicating their success. Dr Mike Cooper, Consultant Microbiologist outlined that 18 months ago they had one of the highest rates in the country, now they had the lowest in the region, MRSA acquisitions were steady but were now very low. Cheryl outlined the matrons high visibility, the champions, and how everyone has infection prevention in their job descriptions, communication to all staff in the organisation, whether its good or bad. Doreen Black the Ward Sister was proud of the clutter free wards, and talked of the route cause analysis, interventions. Elizabeth Shurman, Cleaner, had great pride in working on the wards. Dr Zaman spoke of the Junior Doctors’ Infection Prevention Event, it was good to rethink antibiotics, an excellent microbiology quiz, good to have the handwashing reminder, now there was a culture of people being aware of the need to mitigate risk. Sally Brown, Programme Manager spoke of the way the Department of Health were able to work with teams on high impact interventions, showing great rewards for
John Rostill, Chief Executive of Worcestershire Acute Hospitals NHS Trust, went on walkabouts and saw everything was really happening, everybody was convinced that prevention was key. The video clearly demonstrated everybody was on board.
Cheryl outlined more about the Junior Doctors’ Infection Prevention Event. 180 new doctors had been recruited, everyone believed this may have a negative impact on infection prevention, however the junior doctors were brought in for theoretical testing on antibiotics prescribing, they took blood cultures on a dummy and practised handwashing. It took some organising – but they came – it was a real exam. Some of the smaller things they failed on, but these were important and it was possible to identify these and put this right.
The success was down to:
Infection prevention is seen as everyone’s business, even the Medical Secretary –– she handles notes – everyone must gel their hands, even if they are not ‘seeing’ a patient. But there are blips…. so we refocus our efforts and implement
It’s not what happens to you in life, it’s how you deal with it
You need to find new things to do all of the time
Cheryl’s biggest challenge is getting 5,000 people to do everything right every time
Cheryl holds the matron to account and ward sister. Formal letters are given if there are breaches in Codes of Practice and infection prevention measures are not followed, if there are other breaches then this could mean disciplinary action – that has rocked the organisation. The Chair of the Consultant’s Committee is asking if he can lead on the dress code – he is well respected – he will change their minds. This ‘tough love’ approach has impacted.
In response to questions on the SHA and disseminating good practice Cheryl outlined work within the SHA and avenues for disseminating good practice
You need to find from within, we are actually doing what’s needed in the Saving Lives toolkit – it really is NIKE – Just do it
You need the right team with the right personality, ability and leadership skills to do it. It takes a leap of faith, turn away from money, and it will bring about improvements.
Click the image to see Cheryl's presentation: