Ring Fenced Beds in Orthopaedics - Aintree experience Aintree University Hospitals NHS Foundation Trust May 2015 1.

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Ring Fenced Beds in Orthopaedics- Aintree experience

Aintree University Hospitals NHS Foundation Trust May 2015


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CRG Specialised Orthopaedics

• Provider – service RequirementsA defined ward for specialist orthopaedic patients ie. ‘ring fenced orthopaedic beds’

< 10% loan kitsDefined theatre suiteExpertise and volumesCCU/HDUMDTTertiary referral centres


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Why Ring Fenced Beds?

• Traditional (any evidence?)-MRSA screening-Decrease Infection risk

• Quality of Service-Specialist nurses / physio-appropriate environment


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BODS SURVEY RESULT DEFINITION

MRSA screened elective orthopaedic admissions

+/- screened semi-elective trauma+/- other screened clean elective surgery

Breach = stop elective surgery until deep clean


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BODS Survey ResultsDo you have ring fenced beds?

27 replies

Yes

19(70%)

3 separate elective facilities

No

8(30%)


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Aintree JRU


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JRU Development

• 2000 – Audit of infection

• At Best – 6.5%• At worst – 15%

• Independent enquiry


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JRU Development

• Isolated Infection Controlled JRU– Cost benefit analysis– 2005!

‘Space’ suitsTheatre disciplineDedicated theatresMDT input – microbiology support


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JRU Development

• No evidence any one intervention works either locally or in the literature

• BUT

• TKR audit post changes – 0.4% infection rate• Been robustly defended since


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Aintree JRU SOP

• 16A – 12 Beds• 16B – 8 Beds & 10 daycase trolleys

• Restricted access– Screened patients– Visiting 6.30 – 8PM

• Admission Control– Ward Manager/ Orthopaedic lead/ Microbiology Lead


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Aintree JRU SOP


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Aintree JRU Admissions

MRSA screened elective orthopaedic admissions

+/- screened semi-elective trauma

+/- other screened clean elective surgery

Breach = stop elective surgery until deep clean

• But…. We can ½ the ward…. Detrimental?


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Aintree JRU Admission Criteria

• MRSA Screened patients• No Antibiotics• No evidence infection• Patient zero tolerance to ward discipline• No open wounds / Ex-Fix• Inpatients from other wards

• Revision patients? Separate discussion / exception


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Aintree JRU SOP

• MRSA SCREENING– Just moved from 4 to 8 weeks pre-surgery– Previous MRSA = 3 negative swabs 1 week apart

• WOUND DRESSINGS– Designated treatment room– Staff yearly aseptic technique assessment


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‘Times of high bed pressures’

• FULL JRU– Full ward under rules

• HALF JRU– 16A isolated behind ‘locked’ doors

• NO JRU– Joint Replacement surgery shut down

DEEP CLEAN BEFORE RE-OPENING


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Cleaning specifications

• Daily clean• Enhanced clean– Area gets special attention each day of the week

• Uniform– Nurses have 5 pairs of uniform for JRU only– Blue aprons, hands, BBTE’s etc.


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JRU Conclusions

• Does it reduce infection rates?– Probably, but we lack conclusive evidence

• Do the patients like it?– Yes, looks professional with specialist staff

• Do the staff like it?– Yes, it is now an essential part of our care


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Questions?

Ring Fenced Beds in Orthopaedics - Aintree experience Aintree University Hospitals NHS Foundation Trust May 2015 1.

Documents

aintree jru admissions

aintree jru sop mrsa

orthopaedic beds

jru joint replacement

rules half jru

ring fenced beds

semielective trauma

separate elective facilities