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Transcript of QAH HospitalPortsmouth Hospitals NHS Trust04/09/2015Page 1 Infection Prevention and Control Quality...
QAH HospitalPortsmouth Hospitals NHS Trust 19/04/23 Page 1
Infection Prevention and Control
Quality and Safety
Infection Prevention Team
2012
QAH HospitalPortsmouth Hospitals NHS Trust
Preventing Infection2,940 people died on Britain’s roads 2007
247,780 people were injured
9,000 people died from MRSA/C.diff alone
300,000 had an HCAI
Estimated that paediatrics accounts for 1-2% of HCAI
QAH HospitalPortsmouth Hospitals NHS Trust
Meticillin-resistant Staphylococcus aureus (MRSA) Bacteraemia
Infection Prevention & Control Department
48 hours after admission 12 month rolling total
MRSA bacteraemia12-month rolling total
0
10
20
3040
50
60
70
Ap
r 0
5 -
Ma
r 0
6
Jul 0
5 -
Ju
n 0
6
Oct
05
- S
ep
06
Jan
06
- D
ec
06
Ap
r 0
6 -
Ma
r 0
7
Jul 0
6 -
Ju
n 0
7
Oct
06
- S
ep
07
Jan
07
- D
ec
07
Ap
r 0
7 -
Ma
r 0
8
Jul 0
7 -
Ju
n 0
8
Oct
07
- S
ep
08
Jan
08
- D
ec
08
Ap
r 0
8 -
Ma
r 0
9
Jul 0
8 -
Ju
n 0
9
Oct
08
- S
ep
09
Jan
09
- D
ec
09
Ap
r 0
9 -
Ma
r 1
0
Jul 0
9 -
Ju
n 1
0
Oct
09
- S
ep
10
Jan
10
- D
ec
10
Ap
r 1
0 -
Ma
r 1
1
Jul 1
0 -
Ju
n 1
1
Oct
10
- S
ep
11
Jan
11
- D
ec
11
Ap
r 1
1-
Ma
r 1
2
July
11
-Ju
ne
12
pre 48 hours post 48 hours
MRSA Bacteraemia >48 from Admission (Totals & Rates)
10 6 6 5
2.80
1.681.88
1.56
0
2
4
6
8
10
12
2008/09 2009/10 2010/11 2011/12
Year
To
tal
Cas
es
0.00
0.50
1.00
1.50
2.00
2.50
3.00
Rat
e p
er 1
00,0
00 B
ed D
ays
Total Cases
Rate per 100,000 Bed Days
Performance against Targets 2012-2013
1 1 1
2 2 2
3 3 3
4 4 4
1 1 1 1
2
0
1
2
3
4
5
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2012-2013
Trajectory
Total number of cases >48 hours
QAH HospitalPortsmouth Hospitals NHS Trust Page 419/04/23
Screening for MRSA
Admission within the last 12 months Transfer in from another hospital/abroad Indwelling IV device/urinary catheter Chronic wounds/leg ulcers Chronic skin condition History of MRSA IV drug user Military staff / students / healthcare worker Admitted for high risk surgery (e.g. ortho)
Page 419/04/23
QAH HospitalPortsmouth Hospitals NHS Trust Page 519/04/23
Managing MRSA Reservoirs
High risk – start suppression therapy Low risk – wait for swab results Suppression Therapy – Why, How, When? “Once positive, always high risk”
QAH HospitalPortsmouth Hospitals NHS Trust
MSSA Bacteraemias
70 6762 61 59 57 58 57
54 56 55 54 5359 59
63 64 65 65 66 6662
6562 62
57 60 62 5963
29 28 2723 23 23 24 23 24 23 23 24
28 27 27 28 28 29 27 28 29 30 30 29 28 28 28 26 26 28
1 1 1 1 1 1 1 3 3 3 2 2 2 2 2 3 2 2 2 0 0 0 1 1 1 1 1 1 1 1
0
10
20
30
40
50
60
70
80
Sep 0
8 - A
ug 0
9
Nov 0
8 - O
ct 0
9
Jan
09 -
Dec 0
9
Mar
09
- Feb
10
May
09
- Apr
10
Jul 0
9 - J
un 1
0
Sep 0
9 - A
ug 1
0
Nov 0
9 - O
ct 1
0
Jan
10 -
Dec 1
0
Mar
10
- Feb
11
May
10
- Apr
11
Jul 1
0 - J
un 1
1
Sep 1
0 - A
ug 1
1
Nov 1
0 - O
ct 1
1
Jan
11 -
Dec 1
1
pre 48 hours post 48 hours community
QAH HospitalPortsmouth Hospitals NHS Trust
Clostridium difficile Infection72 hours after admission 12 month rolling total
Portsmouth Hospitals NHS Trust C.difficile cases > 72 hours from admission 12-month rolling total
264256246235235
217206202204196
184174168162155
144135132124119113117115114110109108111105100101101979188909292868490908782736767635854
0
50
100
150
200
250
300
350
Jun
07 -
May
08
Sep 0
7 - A
ug 0
8
Dec 0
7 - N
ov 0
8
Mar
08
- Feb
09
Jun
08 -
May
09
Sep 0
8 - A
ug 0
9
Dec 0
8 - N
ov 0
9
Mar
09
- Feb
10
Jun
09 -
May
10
Sep 0
9 - A
ug 1
0
Dec 0
9 - N
ov 1
0
Mar
10
- Feb
11
Jun
10 -
May
11
Sep 1
0 - A
ug 1
1
Dec 1
0 - N
ov 1
1
Mar
11
- Feb
12
Jun
11- M
ay 1
2
no
of
case
s
Performance against Targets 2012-2013
6
1319
2429
3439
4449
612
17 19
676255
0
10
20
30
40
50
60
70
80
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2012-2013
No
. o
f C
ases
SHA Trajectory (2012-13)
PHT accountable cases (2012-13)
C.difficile Cases >72 hours from Admission (Totals & Rates)
293 184 115 88 65
81.88
51.31
31.9825.23
19.80
0
50
100
150
200
250
300
350
2007/08 2008/09 2009/10 2010/11 2011/12
Year
To
tal
Cas
es
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
Rat
e p
er 1
00,0
00 B
ed D
ays
Total Cases
Rate per 100,000 Bed Days
QAH HospitalPortsmouth Hospitals NHS Trust
SSuspect that a case may be infective where there is no clear alternative cause for diarrhoea
IIsolate the patient immediately and consult with the infection prevention team (IPT) while determining the cause of the diarrhoea
GGloves and aprons must be used for all contacts with the patient and their environment, with chlorine cleaning of all equipment and touch points
HHand washing with soap and water should be carried out before and after each contact with the patient and the patient’s environment
TTest the stool for toxin, by sending a liquid specimen immediately
QAH HospitalPortsmouth Hospitals NHS Trust Page 1419/04/23 Page 1419/04/23
Identify the good & poor practice with this device
No insertion time or date
No extension set or swanlock
Insertion site is exposed for inspection
Blood in the hub
Dressing completely
covers device
QAH HospitalPortsmouth Hospitals NHS Trust
Influenza (A/H1N1 & B)
3 days post influenza
7 days post influenza
QAH HospitalPortsmouth Hospitals NHS Trust Page 1619/04/23
Infectious Agent
Susceptible Host
Portal of Entry Portal of Exit
Reservoirs
Means of Transmission
QAH HospitalPortsmouth Hospitals NHS Trust Page 1719/04/23
Infectious Agent
Susceptible Host
Portal of Entry Portal of Exit
Reservoirs
Means of Transmission
Bacteria
Fungi
Viruses
Prions
Respiratory
Genitourinary
Vascular
Gastrointestinal
Skin
Mucous membranes
People
Water & solutions
Instruments & equipment
Soil & air
Direct contact
Inhalation (airborne, droplet)
Ingestion
Innoculation
Broken skin
Puncture wound (IV lines etc)
Surgical Site
Mucous membranes
Devices eg urinary catheters
Patients
Service providers
Ancillary staff
Community members
QAH HospitalPortsmouth Hospitals NHS Trust Page 1819/04/23
Cleaning & Decontamination
Actichlor plus – infected cleaning 1.7G tablet disssolved in 1 litre cold waterNeutralising spillages (blood) - 10 tablets dissolved as above (2 minute contact time)
Sani-cloths - general cleaning