INFECTION CONTROL UPDATE

1. INFECTION CONTROL UPDATE Donna Kinnair Director of Infection Prevention and Control

2. Key Issues and Priorities for Southwark re HCAIs Monitoring of MRSA and C.difficile rates at KCHFT Dulwich Intermediate Care Unit Care Homes and Care Homes with Nursing Community Services

3. Work In Progress or Completed Healthcare Act 2006 – Code of Practice - Gap analysis Infection Control and Minimum Standards for Premises Audits of all PCT and GP Practice Premises - completion end Nov 07 Mandatory Infection Control Training for all relevant staff on appointment and yearly thereafter All training required for Core Standards will be audited as part of 07/08 Core Standards Quality Assurance Plan Development of a Quick Reference Guide for Staff, Patients and Carers

4. Planned Work Nov 07 – April 08 Targeted work around standards of care Review of guidelines for the management of high risk patients DIPC and Senior Nursing Staff to work with front line staff Joint work with KCHFT & HPA to review the management of high risk patients transferring from acute to community setting Successful bids – NHS London reduction in incidence of HCAIs - £31,050.00 awarded - Infection control audits Care Homes - Infection Control Conferences 5th/18th Feb 2008

5. Healthcare Commission Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust October 2007 April 2004 – June 2006 Healthcare Commission estimates deaths definitely or probably due to C.difficile were between 47 and 127 Implications for PCT as both a provider of in-patient care, community care and as a commissioner of acute services and services from independent contractors.

6. Key Lessons Learnt Robust Governance systems Trust boards must be well informed Clear guidelines on the effective isolation of patients Guidance on risks of broad spectrum antibiotics High quality medical and nursing care

7. 5 National Recommendations 1. The diagnosis of C.difficile needs to be regarded as a diagnosis in its own right, with proper continuity of management.  2. Further consideration needs to be given to the education and supervision of trainee doctors, with a view to improving the recording of C. difficile on death certificates.  3. Antibiotics should be targeted, of the narrowest spectrum possible, and used for the shortest possible time.  4. The NHS and HPA should agree clear and consistent arrangements for the monitoring of rates of C. difficile infection.  5. The board of every NHS Trust must understand the roles and responsibilities of the Director of Infection Prevention and Control (DIPC), and receive regularly, information about incidence and trends.  

8. Specific Recommendations For PCT’s as Commissioners Communications between the PCTs and Trust must focus on the quality of care and not soley on numbers of patients treated and associated costs. Service Level Agreements must include indicators related to healthcare acquired infections and be monitored both at performance meeting between the PCT and Trust and by PCT Boards