A legal framework for the prevention and control of infection

Carole FryDepartment of Health (England)

EnglandWales

Scotland

Northern Ireland

ENGLAND

167 Acute Trusts

12 Ambulance Trusts

58 Mental Health Trusts

151 Primary care Trusts

DEPARTMENT OF HEALTH

STRATEGIC HEALTH AUTHORITIES

PROVIDERS OF CARE COMMISIONERS OF CARE

NHS ORGANISATION

NHS statistics

The NHS in England is the biggest part of the system by far, catering to a population of 51m and employing more than 1.3m people.

The NHS employs more than 1.7m people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff.

NHS statistics

NHS was launched in 1948 – free at the point of access

Funded directly out of taxation £100billion (€115 billion) Some 60% of the NHS budget is

used to pay staff. A further 20% pays for drugs and other supplies

1 million patients every 36 hours.

Wednesday, 30 November Wednesday, 30 November 20112011 Stocktake presentationStocktake presentation 77

Size of the problemThe media view

Staphylococcus aureus bacteraemia and methicillin susceptibility (voluntary reporting scheme):

England and Wales, 1990 - 2004

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

year

num

ber o

f rep

orts

Sensitive

No Information

Resistant

C. difficile voluntary reporting 1991 – 2005: England, Wales and Northern Ireland

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

year

num

ber o

f rep

orts

Interventions to reduce infection rates

Infection reduction targets for MRSA and C.difficile

Organisations performance managed against progress

Range of supportive materials including High Impact Interventions (care bundles)

Improvement team visits Focus on acute care in the first instance

Introduction of the Code of Practice

Health and Social Care Act 2008

Care Quality Commission was established as the new regulator of healthcare and adult social care in England

Providers to be registered against the same sixteen registration requirements –including a registration requirement for ‘infection control and cleanliness’.

CQC powers

The CQC will take account of these criteria when assessing providers against the registration requirement on cleanliness and infection control

Failure to meet elements of the Code of Practice will not necessarily mean that the registration requirement has not been met, but it will be considered by CQC in assessing whether the registration requirement has been achieved

If the registration requirement is not met CQC has a range of enforcement powers that it can consider using including financial penalties

JAN 2008

APR 2009

APR & OCT 2010

APR 2011 & APR 2012

OCT 2006

The Code of Practice -a brief history and next steps

The Code of Practice -changing registration requirements

NHS Bodies register against a single requirement“cleanliness & infection control”

NHS Bodies register against all requirementsincluding “cleanliness & infection control”

April 2009 April 2010 October 2010

NHS Bodies NHS Bodies

Adult Social Care

Independent Healthcare

NHS Bodies

Providers of primary dental care and independent ambulances, independent healthcare and adult social care register against all requirementsincluding “cleanliness & infection control”

Primary Dental Care

Independent Ambulances

Adult Social Care

Independent Healthcare

NHS Bodies

April 2011

Primary Medical Care

Primary Dental Care

Independent Ambulances

Adult Social Care

Independent Healthcare

NHS Bodies

April 2012

Providers of independent healthcare and adult social care register againstall requirements including “cleanliness & infection control”

Providers of primary medical & dental care and independent ambulances, independent healthcare and adult social care register against all requirementsincluding “cleanliness & infection control

Compliancecriterion

1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them.

2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

3 Provide suitable accurate information on infections to service users and their visitors.

4 Provide suitable accurate information on infections to any person concerned with providing further support or nursing/ medical care in a timely fashion.

5 Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people.

6 Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection.

7 Provide or secure adequate isolation facilities.

8 Secure adequate access to laboratory support as appropriate.

9 Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections.

10 Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.

Code of Practice – compliance criteria

Evidence to demonstrate compliance

Timely surveillance data Cases, outbreaks, deaths

Audit results Hand hygiene Clinical protocols Isolation protocols Antibiotic prescribing Cleanliness inspections

Reviewed at all management levels Unit, ward, directorate, division, BOARD

Findings from CQC reviews of compliance with Outcome 8 on cleanliness and infection control

Number of reviews

Review period

Compliant % Minor concerns %

Moderate concerns %

Major concerns %

Hospitals 113 April -Oct

83 13 4 0

Independent hospitals

114 Oct -July

90 4 6 0

Care homes with nursing

566 Oct -July

70 16 10 4

Care homes no nursing

1115 Oct -July

72 17 8 3

Domiciliary care

264 Oct -July

86 9 5 0

2010/11 www.cqc.org.uk

Reducing HCAI….

Change the mindset From:

Infection being the problem of the infection control team

To: Infection prevention Patient safety Whole system approach

Figure 1. E. coli bacteraemia reports, England, Wales and Northern Ireland: 2004 to 2008* (voluntary reporting)

What next?

MRSA – maintain control What about MSSA? And PVL-SA??

C. difficile – stop the outbreaks What is the impact of the wider health

and social care community? Improved treatment?

Other organisms – ESBL-producers Carbapenemase-producers etc

Antibiotic resistance and prescribing