Surrey and Sussex Healthcare NHS Trust
Infection Prevention Masterclass
East Surrey Hospital
23rd October 2013
Our visit to East Surrey Hospital in Reigate Surrey was a very moving experience. Russell Kimble, a survivor of necrotising fasciitis (NF), told his story about the condition and the devastating effects it had on him and his family. No-one could fail to be moved by his experience.
Doreen Marsden founder of the Lee Spark NF Foundation presented facts about NF, showing how something as innocuous as the simplest graze can result in life changing injury and sadly death. She spoke of her campaigning with the Sepsis Trust; a high proportion of NF victims will have sepsis as an advancing complication of their illness.
Streptococcus is the most common causative organism involved in the bacterial infection, occasionally other organisms are involved and in a recent survey of 60 victims only 2 had Staphylococcal infections.
The Lee Spark NF Foundation, provides necrotising fasciitis support and education and raises awareness with the public and with healthcare practitioners. They have made a DVD which is available from their website at http://www.nfsuk.org.uk/
Evonne Curran spoke about how systems can contribute to causing or stopping infection outbreaks.
In general bad things happen and are caused by people who only intend to do good and mean no harm, or sometimes as in the case of Harold Shipman for example, do harm. Neither is acceptable or safe for patients or healthcare workers. So what elements are in a system?
Patients, healthcare workers, visitors and pathogens are the populations in the healthcare environment. The environment, equipment and nursing methods can provoke events that cause or stop infection.
In terms of infection, Streptococcus was the primary organism that caused infection up until the 1950s, then Staphylococcus aureus became the number one pathogen in maternity and surgical units.
Organisms change, new threats emerge. Modifying practices to achieve goals can cause secondary complications.
Healthcare had provided the opportunity. We couldn't wash the blankets, mattresses were horse hair, nightingale wards and few single rooms contributed. Staff developed septic lesions from Staphylococcal colonisation and infections.
Maternity units in the 50s, were developed during bombed out Britain. Two week bed rest promoted outbreaks, mums with Strep and babies with Staph.
NICUs were caring for babies who would not have survived before the war. Operations were being carried out on people who would not survive.
It's easy to focus on the wrong thing and miss the obvious. Our aim is to provide the most cost effective healthcare whilst managing all potential complication risks.
We must accept the negative outcomes, new acquisition of MRSA, CDI, SSI, CAUTI, pneumonia etc as a system output and adjust the elements with our healthcare system to reduce the likelihood the negative elements arise.
- Improve devise use
- Improve hand hygiene, antibiotic use, assessment on admission
- Improve the environment, single rooms, wash hand basins
- Improve care - monitor and address issues
Health Protection Scotland website has good resources on preventing catheter associated urinary tract infections (CAUTIs) in community settings. Invasive devices can cause bloodstream infections so easily, their use should really be limited.
In A&E some units now put up a picture of the alternative to a catheter if devices are too large to store at the bedside to prompt healthcare workers to seek the alternative - these simple systems save patients from the risk of infection and ultimately unnecessary complicating infections, money and ultimately lives.
Catheter passports mean you have to document why it's gone in and these are a good way to reduce their usage.
Julie Storr, president of the Infection Prevention Society asked where we go from here. There was now a big antimicrobial resistance focus, and on May 5th 2014, a hand hygiene focus.
Charities such as the IPC, Lee Spark NF Foundation and MRSA Action UK can provoke great media interest and make a huge difference to lobbying. We can influence the input into national guidelines. Our shared vision is that no person is harmed by a preventable infection.
IPC should not be separate from the day job. The way we talk and act will influence perceptions. If IPC is seen as an add-on we've failed, we can't relax standards.
There are opportunities to embed the five moments in all practical training, for example if you were learning safe lifting and moving a patient, think about the moment you come to touch the patient and their surroundings and the right time for hand hygiene.
The IPS now has two patrons Professor Didier Pittet, of the World Health Organisation and Professor Tricia Hart a Chief Executive who led on the Francis Inquiry hearings.
Derek Butler spoke of the people who had been bereaved by what were mostly avoidable incidents and infections, and some of the better experiences that had happened. Communication was a common theme in the good and bad experiences. Interaction and talking to patients and their families is not only a great social thing to do, but can help in making sure patients are receiving the right treatment and understand what is going on.
Some of the incidents that Derek referred to were shocking for some staff, some absolutely fundamental areas of care, such as not allowing patients to soil themselves, making sure catheter bags were insitu and not on the floor with invasive devices bent or disconnected; soiled sheets shoved under beds; inflatable mattresses deflated to demobilise unconscious patients - and of course, failure to wash hands and disregard for good aseptic practice.
These were clear instances of poor practice and neglect, and some of the consequences were unfortunately inevitable.
The event ended on a positive note with the speakers joining a member of staff who was given a special award as a hand hygiene champion, audits had taken place, which staff were unaware of, and his diligence was rewarded with the award.