QAH HospitalPortsmouth Hospitals NHS Trust04/09/2015Page 1 Infection Prevention and Control Quality and Safety Infection Prevention Team 2012.

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


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


Managing MRSA Reservoirs

High risk – start suppression therapy Low risk – wait for swab results Suppression Therapy – Why, How, When? “Once positive, always high risk”


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


Isolation


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


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




Removing the Means of

Transmission


Cleaning

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


Influenza (A/H1N1 & B)

3 days post influenza

7 days post influenza


Infectious Agent

Susceptible Host

Portal of Entry Portal of Exit

Reservoirs

Means of Transmission


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


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


Suspected Outbreak Management

2 or more patients with unexplained D or V

Rapid identification, isolation and cleaning prevents infection

Take immediate action

QAH HospitalPortsmouth Hospitals NHS Trust04/09/2015Page 1 Infection Prevention and Control Quality and Safety Infection Prevention Team 2012.

Documents

total slide

device slide

hcai slide

isolation slide

high risk slide

means of transmission

days post influenza

mrsa admission