Derek thanked everyone for attending; it was heartening to see so many people from the healthcare profession, as there was representation from the Department of Health, Care Quality Commission, NHS, National Patient Safety Agency and others.  We are a small charity and we had come on a long journey, we are now being heard.  Five years ago what happened to his friend and stepfather John, taught him that what John had always said, if there was a wrong we should put it right.  Healthcare infections were a global problem and we were privileged to have Jeanine Thomas our guest from Chicago and a survivor of MRSA and Clostridium difficile, and spokesperson for the MRSA Survivors Network.  We had formed a strong alliance.

 

Derek outlined that he had been a Trade Union convenor so was used to overcoming difficulties, his present job as Chair however was tougher, but the most rewarding job, he had found true friends, it was a privilege and he was proud to do the job.

 

President Professor Hugh Pennington spoke of the Public Inquiry he had chaired, which had become known as Pennington 2, this inquiry was as a result of 50 school children contracting E.Coli 157.  Pennington 1 was in 1997 where the circumstances were identical, we hope that lessons will be learned and we do not have a Pennington 3 in ten years time.

 

There had been great strides made in reducing MRSA, however there seemed to be an acceptance that MSSA was there, but it's preventable, success in tackling the problem is patchy.  Staphylococcus aureas was discovered in 1880 in Aberdeen, so it's not new.  Professor Pennington stated that the influence of the Charity has stimulated the politicians no end.  There was a Public Inquiry in Scotland.  Hugh's grandfather was a chief male nurse married to a nurse in an isolation hospital.  Asylum dysentery was prevalent in 1900 and hand washing and isolation were key interventions to prevent the spread.  There were lessons to be learned from history.  Professor Pennington said that the Charity kept everyone on their toes and would continue to be needed.

 

Juliet Magee said she felt very humbled to be here and felt honoured that Derek and Maria had invited her to speak.  Juliet outlined how everyone was passionate about infection prevention and control at Bedford Hospital, and that they had had no bacteraemias for 8 months.

 

Bedford Hospital has 403 beds serving 270,000 people, it is the vascular hub for the area.  They have 2,500 staff and a budget of 121 million pounds.  They had an Infection Prevention and Control Programme which was key to the work going on.

  

Hand hygiene awareness week was for the benefit of staff, patients and visitors and was a fun way to engage and remind everyone of their responsibility to play their part, Derek and Maria came to the event last year and Derek has been invited to speak again this year to present the patient perspective.

 

Route cause analysis was used for any infection and linked with the ethos of "Every Patient Matters", where "Every Infection Matters".  Bedford had reclaimed space to make more room on the wards and installed shower and changing facilities.  Hands free taps, and zones where the five moments of hand hygiene must be used meant it was difficult not to comply.

 

There was an Infection Prevention and Control Station where performance was posted, and space available for the Charity's leaflets.

 

Juliet had been able to increase her team and this included an invasive devices nurse, bacteraemias had dropped to zero and this has been maintained for 8 months.  All staff attend a 5-day mandatory infection control course, at the end of which they do a presentation outlining what they will do to make a difference.  Ideas are shared and implemented.  There were action learning and master classes to keep up to date.

 

Ron Stein asked how many others were doing this.  Juliet explained that this was a requirement and it was about thinking of ways to get engaged, it was about practice, there were lots of policies out there, but you wouldn't necessarily know them all, but you would know how the practical approach to clean, safe care, other Hospital Trusts would be doing similar things, they were required to engage in infection prevention and control to be able to meet the Care Quality Commission's registration requirements.

 

Professor Hugh Pennington said Juliet and her colleagues were to be congratulated for adapting the culture that has led to this success, what was the secret to this shared passion, how could we replicate Juliet's work?  Juliet outlined that the Chief Executive and Trust Board were as passionate about infection prevention and control, everyone demonstrates leadership.  Targets and the need to register had been drivers too.

 

Mavis Law said Juliet was inspirational, she asked if there were networks where she could share their success.  Juliet said yes and she also kept in touch with her former hospital.

 

Another initiative they were currently implementing was the Productive Ward, where it is clean, tidy and organised.  Since publishing hand hygiene scores on ward doors, compliance has shot up.

 

Hugh asked how can you boil down the complexity of what's required into the Nitty Gritty.  Juliet said the High Impact Interventions developed by the Department of Health summarised the key clinical elements of what was needed, refresher training had taken place with the recruitment of the invasive devices nurse along with aseptic technique training, and these combinations of things will have made a difference.  There were opportunities to think beyond the hospital setting and look at broadening the approach to training and development with midwives, district nurses and Primary Care Trusts, opening this up to external delegates.

 

Stephen O'Brien MP said we needed champions like Juliet, there also needed to be a focus on discharge planning to help in alleviating healthcare associated infections.

 

Derek thanked Juliet for her inspiring presentation and introduced Martin Kiernan, President of the Infection Prevention Society.

 

Martin thanked Derek for the invitation and talked of the ongoing work to broaden the surveillance of Healthcare Associated infections, he had been unable to attend the service having travelled down from Runcorn and a panel discussing the method and scope of monitoring IV and urinary catheter infections.  The campaigning work of the charity was helping to ensure this type of work would continue.  Martin briefly spoke of his background and role as President of the Infection Prevention Society, he did his training in Medway, Kent and following a number of roles was now Infection Control Lead at Southport & Ormskirk Hospital NHS Trust.

 

Martin's presentation "Bad Bugs Know No Boundaries" looked at lessons from history, as Hugh's did, and the work of Florence Nightingale who had reformed nursing in the Crimean War, changing conditions in Scutari.  Florence was a statistician and had noted the high mortality rates in the Barracks Hospital.  42% of troops treated died.  Patients had frostbite, dysentery, cholera and typhus, the poorly ventilated hospital was built over a cesspool.  No one would take responsibility for the conditions, she took over and the mortality rate fell to 2%.  She created order, provided nurses, rations and provisions, kitchens, cleaning and sanitation.  She changed the hospital design, instigated nurse training and brought in standards.

 

 

 

 

Wards were ordered, there was not much surgery, assiduous hygiene kept infections at bay.

 

In the 21^st century more people are treated, there are more devices, it's a 24 hour service with constant activity with a focus on care delivery and limited resources, a low value of cleaning and those who clean had developed.

 

With the complexity of care now needed the challenge was to protect those having surgery at the most vulnerable period of their life, and recognise the value of cleaning and keeping the environment safe.

 

There was a real risk from micro-organisms in the environment and cleaning and the environment is now seen as a priority, and rightly so.  At Southport & Ormskirk Trust the cleaning teams were in-house, although not all Trusts had in-house cleaning Martin believed this worked well in terms of accountability.

 

There were high impact interventions that were making a difference, the use of IV lines were down by 14%, they are not routinely used.  Personal accountability is taken for looking after lines. 

 

There were new challenges with the bugs, screening had identified strains they had not been seen before, and people who had not received hospital care before were showing colonisation and infection.  Community acquired MRSA was increasing.  The National Audit Office recommended more surveillance, as the Charity did, and he said that without the campaigners we wouldn't be reducing.

 

The Department of Health were looking at the Matching Michigan programme where open reporting of untoward events were published on the hospital's website, so accountability was now being pushed harder.

 

 

Martin outlined the ethos in his Trust that an infection such as Clostridium difficile meant that person would have a horrible illness and it was important to do everything possible to avoid that, they didn't talk about numbers during training, it was about people.  Route cause analysis was important if this happened, making sure we don't do something by prescribing inappropriate antibiotics or not following procedures such as changing a line could cause a problem.  If a bacteraemia happened then this would need to be explained to the Chief Executive, personal accountability was important.  Martin ended his presentation emphasising that "NOTHING MATTERS UNTIL IT IS PERSONAL"

 

Sue Tait asked about the value of using probiotics, could this be useful in helping to prevent Clostridium difficile if patients had to take antibiotics.  Martin said there had been various studies, unfortunately these had not been conclusive, nutrition is important and probiotics would probably not be harmful, unless it was a severely immuno compromised patient, then there may be a small chance that this may cause gastroenteritis.

 

Sue also asked about the value of giving forms to patients and relatives with regard to the patients treatment, engaging with relatives and carers was important as they will know the patient better than the nursing staff, and any observations may help.  Martin felt that this was a good idea, and one he had not considered before.

 

Annette Jeanes was in attendance and later confirmed that the event proved very useful with opportunities to network, Annette came away with lots of ideas following the interaction at the events.  During networking ideas were shared for MRSA Awareness Month and World MRSA Day, so work with colleagues in the Health Economy will continue.

 

The need to continue to work together and build on the success of everyone's campaigning was the catalyst to reducing infections and making our healthcare safer.