Infection prevention study day

University Hospital Coventry and Warwickshire NHS Trust invites
MRSA Action UK to their Infection Prevention study day
14th November 2012

Derek Butler, Chair of MRSA Action UK joined Kate Prevc Modern Matron for Infection Prevention and Control at University Hospital in Coventry for the Trust's Infection Prevention and Control Study Day.

The theme for the study day was joined-up thinking, looking at how the Trust works alongside the community, inter-departmental cooperation, and communication with patients. There were opportunities to highlight the good practice that was happening in the interactive presentations.

Dr Debra Adams talked of the HOUDINI approach to managing the use of catheters and preventing harm to patients. Dr Adams quoted Atul Gawande and referred to the opening quote in his book, Better "What does it take to be good at something in which failure is so easy, so effortless?"

Much of the culture of medicine focuses more on the consequences of mistakes than the rewards of going above and beyond. While factors such as limited funding and availability of technology play its part, there are things we can do to be simply "Better." This is applicable in the way simple nurse-led protocols can be used to have a huge impact on patient care and outcomes.

Urinary tract infections are the most common healthcare associated infection in acute hospitals. The risk of developing a catheter associated urinary tract infection increases the longer a urinary catheter remains in place. Around 32% of hospital patients have a urinary catheter inserted. The infection rate increases by 8% per day for every day the urinary catheter is in place, around 8.5% of bloodstream infections are caused by catheter associated urinary tract infections, E.coli being the predominant pathogen.

The HOUDINI protocol is a list of indicators that is used to determine the need for the retention of urinary catheterisation in patients, and should be the only legitimate clinical reasons for keeping a catheter in place, these were: frank Heamaturia (blood in the urine), urinary Obstruction, Urology surgery, open wound and Decubitus ulcers (pressure ulcers) in incontinent patients, Input-output fluid monitoring for haemodynamic stability (blood circulation), patients who are Not for resuscitation, comfort care, Immobility due to physical constraints - for example unstable fractures etc.

Assessing the need to retain the catheter using the protocol can have a significant impact on reducing the risks of catheter associated urinary tract infection. Trials show reductions in usage by 17% which can result in a decrease in infection rates by up to 70%.

The nurse-led protocol is being implemented to help reduce the risk of avoidable harm to patients. Applying the protocol is just one of the things that are simply "Better".

Josie McHale Owen presented "C.diff in the community". There had been recent clusters of cases in the community and The Trusts role included supporting community services, care homes, general dental, and GP practices with audit and, very importantly, education. They provided support to the Health Protection Agency in monitoring infection outbreaks and investigations, and would be providing support to Clinical Commissioning Groups from 2013. The joined up approach was important in reducing the number of healthcare associated infections in both the primary and acute setting.

Derek's presentation featured the importance of information, communication and education, and how this was key to improving patient outcomes. Staff were very moved by Derek's presentation and the patient stories that showed how the system can fail if communication is poor, it was important for patients and relatives to know how to manage healthcare associated infections to be able to play their part in caring and to raise concerns if conditions worsened. Examples of good practice were also given.

Staff also shared our concerns about the challenges of increasing cases of Staphylococcus and Clostridium difficile infections in the community. Some of the comments raised through the charity's use of social media had been used earlier on in the day, and the impact on the patient, giving the statistics real meaning.

During the event Derek was contacted by Sky News and was asked to take part in a TV interview on the use of DNA sequencing to help identify links in outbreaks of MRSA, this was timely since the earlier presentations featured dealing with outbreaks and the support that Trusts give to the Health Protection Agency in investigative work. The interview featured three of Derek's family members who had died from MRSA whilst receiving hospital treatment, and how helping to identify strains of MRSA can help to mitigate the risks of outbreaks continuing if the source can be identified.

If you or someone you care about has been affected by a healthcare associated infection and you wish to discuss this with us, please contact us at

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(c) MRSA Action UK 2012