09.01.11
New ways of tackling HCAI
Lindsey Webb, director of nursing and governance, Royal Orthopaedic Hospital NHS Foundation Trust The Royal Orthopaedic Hospital is an NHS foundation trust serving a local population of around 1 million people, with patients attending from further away for some specialised services. Fifty per cent of the clinical work undertaken is for residents outside Birmingham, and the trust provides services to patients from more than fifty commissioners from across England and Wales.
It is the largest orthopaedic centre in Europe, with over 45 consultant medical staff involved in providing care to adults and children with bone and joint disorders. The core elective surgery activities are joint replacement surgery, joint arthroscopy and reconstruction, plus hand and foot surgery. The trust is one of only two specialist centres for the diagnosis and treatment of bone and soft tissue cancers in the UK and it also provides a regional spinal service.
It has a track record of effectively managing the prevention of infection over a number of years which is evidenced through a number of national data collection exercises. These include the National Patient Safety Agency surgical site infection monitoring scheme, in which the trust is below the national average for surgical site infections acquired following hip and knee replacements. The mandatory reporting of MRSA bacteraemias and clostridium difficile also demonstrates that the trust is one of the best performing in the country. There have been no MRSA bacteraemias for over a year.
Nevertheless, the trust is not complacent and takes infection prevention and control extremely seriously. Through its internal governance arrangements and infection prevention leads it ensures that it continues to be vigilant in ensuring good practice, constant monitoring and raising awareness of infection prevention amongst staff, patients and visitors. The trust also works closely with its patient and public representatives, through a range of forums to deliver this.
Examples of this work include:
an annual audit calendar clearly identifies the type and frequency of audit required in each area. The audit tools used are all based on national best practice
an MRSA pre-screening policy that ensures all patients are screened prior to admission and if positive receive treatment in the community before surgery
bi-weekly environmental inspections carried out by a local clinical, infection control and facilities team.
close links between the infection control leads and the estates and facilities department
all clinical areas have designated infection control notice boards and patient information.
infection control training is provided within induction training for all staff.
annual mandatory infection control updates for all nursing staff.
the use of the Saving Lives high impact tools
Specific work has been undertaken on line-related infection, the cause of the last MRSA bacteraemia using the high impact tool which has resulted in the implementation of specific documentation relating to the insertion, observation and removal of cannulae.
Alongside this, the hospital has purchased a number of innovative products, designed with silver antimicrobial technology which can help reduce the presence of organisams such as MRSA and clostridium difficile. These include new curtains, bins, commodes and dressing trolleys.
Silver is not just a beautiful metal, it is also a natural antibacterial, which means it reacts with bacteria, mould and fungi and inhibits their growth, so that over time they die. A pioneering new technology has been developed which impregnates silver into standard hospital equipment and furniture, reducing the amount of bacteria on their surface by up to 99.9% over a 24 hour period.
The hospital has purchased a number of products such as including waste bins, cubicle curtains and dressing trolleys, all of which contain silver. With fewer bacteria on the surface of these products, the risk of cross contamination reduces, and could help further reduce the possibility of patients acquiring MRSA or other infections.
Products protected in this way still need to be cleaned by ward staff. However, the silver technology works between cleans to reduce levels of bacteria on the surface.
The trust also has links with the infection control team at University Hospital Birmingham NHS Foundation Trust and is watching with interest their work on the use of copper as this may be another area for future development.
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