Agenda item

Mr M Devlin, Chief Executive and Mrs I Smith, Director of Infection Prevention and Control were in attendance for this item.

 

(1)               Mr Devlin and Mrs Smith made it clear that they did not want to say much in the way of introduction but leave the majority of the time for questions from those Members present.  However, by way of introduction the Chief Executive indicated he had struggled with a low tolerance for infection control and in particular MRSA.  The Trust allowed for 12 cases of MRSA per year and that included community acquired infections detected at hospital.  However, the numbers of MRSA cases to date were 30% lower than the previous year.  The Trust had taken a much higher profile with regard to prevention in terms of hand hygiene and alcohol gels. 

 

(2)               A programme of deep cleaning had been undertaken and was a continuous, on-going programme. 

 

(3)               In answer to a question about the risks associated with infection control in an emergency or for elective surgery.  Colleagues from the Trust responded and talked about the processes that they had in place at the Dartford & Gravesham NHS Trust which included the pre-assessment clinics for elective surgery.  Since July 2007, screening had taken place for all routine admissions of all adults.  This had resulted in the reduction of post operative ward infections, e.g. levels of MRSA and had therefore been a successful strategy.

 

(4)               The Committee were informed by Trust colleagues that screening would be extended to include emergency screening in accordance with the Departmentof Health advice by 2011.

 

(5)               The Trust informed the Committee that by the end of March 2009 screening of all elective cases would begin.  Guidance was still being issued and work was also be undertaken to assess the amount of inpatient days patients stayed which gave a measure of success for the pre-assessment.

 

(6)               In answer to a question about the amount of time that it took to do the screening, Mrs Smith informed the Committee that with pre-assessments there was enough time to have the swab analysed.  This generally took 2 days.  However, there was provision, which was very expensive, to analyse a swab within 4 hours.  This was particularly important in higher risk areas such as the Intensive Care Unit (ICU).  The Trust continued to look at the use of new technology to assist in this process.

 

(7)               The Committee noted that within the document that the Trust had prepared in advance for the Health Overview and Scrutiny Committee one of the sections related to success and challenges.  The Trust had identified that the success of the IP Management pathway had been extended to urinary catheters as they were recognised as being a source of hospital acquired infection (HAI).

 

(8)               Mrs Smith responded that the IV lines Management pathway had been a great success.  She spoke about the importance of education and training, recognising new diseases and auditing what was going on.  She said that there had been one incident of canula infection during the past year but this was one too many.  The Trust had learnt an awful lot from the IV Management pathway and they were extending this to other parts of the organisation.  Canulas and catheters presented a greater risk for infection.  

 

(9)               In answer to a question relating to the Trust’s policy of “bare below the elbows” uniform policy, adopted by clinical staff thereby facilitating hand hygiene practice the Committee were informed that policy being adopted by the Trust of “bare below the elbows” was being dealt with where there were issues on an individual basis.

 

(10)          The Committee were advised that this policy was not confined purely to the hospital and some colleagues were challenging this policy.  Mr Devlin added that he did feel that the message was getting through to the staff concerned and this was a consistent message from himself as Chief Executive, Iris Smith as the Director of Infection Prevention and Control (DIPC) and the Trust’ Medical Director.  Those members of staff who were not complying with this policy he did not feel were doing this wilfully.  He said they were not covered by the evidence.

 

(11)          The elective cases not screened were the day cases.  The trust needed to look at elective day cases. 

 

(12)          In answer to a question as to whether children were screened Mrs Smith answered that they were not routinely screened, which was in line with the Department of Health Guidance.

 

(13)          Asked about the challenges surrounding a patient’s length of stay and the impact in terms of infection control Mrs Smith responded that the longer a patient stayed in hospital the more likelihood was that the general condition and not if infection would be increased, i.e. because of being in a shared environment and the immobility of a patient made them at a higher level of risk for hospital acquired infection and the spread of that infection.  Mr Devlin informed the Committee that the Trust were undertaking a significant piece of work to achieve the outcome of reducing the length of stay of patients.

 

(14)          One of the difficulties referred to was that many of the patients, before they even present to the hospital have a community acquired infection.  What the public did not appreciate is that a percentage of the population already have MRSA and C Difficile but do not appreciate that they have it.  What concerned the Member is where was the public awareness campaign, and what was happening in the community in terms of presentation and raising the awareness of community acquired infections.  It was not joined up with the PCTs.

 

(15)          Mr Devlin acknowledged that the statement made by the Member was very true and that this was another very important strand that the Trust would be tackling as part of the ‘whole system’s’ approach with its Primary Care Trust colleagues.

 

(16)          He added that Primary Care Trusts were building up their expertises in the area of community acquired infections.  50% of all infections were community acquired.  Mr Devlin reaffirmed that it was important that the Strategic Health Authority, Primary Care Trusts, the community and the Department of Health were all working together and it was important that the education and public relations exercise was undertaken.

 

(17)          Asked the question about whether it would be appropriate not to take in patients who had the infection because ultimately that costs the National Health Service more Mr Devlin responded that that clearly would not be appropriate.  In an emergency urgent situation patients could not be turned away.  For elective surgery the pre-assessment for infection was reducing the risk.

 

(18)          However, he said that this continued to be a challenge for hospitals such as the Darent Valley Hospital because it was very different to somewhere like the Queen Victoria Hospital in East Grinstead which had no Accident & Emergency Unit – they run on elective services.

 

(19)          In response to a series of questions about hospital cleanliness including what is a deep clean, how is cleaning physically undertaken, especially around the beds, what was the Trust’s advice relating to visitors and what physically happens on the ward. 

 

(20)          Mrs Smith responded that there were three cleaning processes that she wished to describe.  The first was day to day cleaning, the second was cleaning of areas around patients with infection and the third was the deep cleaning process.

 

Day to day cleaning – with regard to the day to day cleaning each ward had a dedicated cleaner employed by Carillion, the external cleaning provider for the Dartford & Gravesham NHS Trust.  The cleaning schedule was designed in consultation with the Matron and ward sister.  There were also domestic supervisors who had a role of checking quality standards.

 

This was followed up by monthly monitoring which was normally unannounced and a number of unannounced meetings.

 

Deep cleaning – the challenge here was to initially empty an entire ward to thoroughly clean the ward bay by bay and room by room and then to carry out this process systematically throughout the hospital.  The Trust had purchased six steam machines.

 

(21)          The Committee noted the challenges associated with the deep cleaning process. 

 

(22)          Pushed further about the part of the question which had not been responded to on infection control Mrs Smith said that she was an advocate for soap and water as being one of the best preventions for infection.  Alcohol does have its benefits (particular for visitors) and she reminded the Committee of the huge push that had been undertaken by the Department of Health.  However, alcohol gel was not effective in terms of C Difficile.

 

(23)          She added that education was key to prevention.  With a regard to a patient who already had C Difficile then the process would be that that person would be isolated to a single room and Trust staff would talk to the patient and their visitors in terms of infection control management.

 

(24)          In response to a Member’s question relating to the role of nurses and how they are trained before they start work on the ward Mrs Smith stated that she too had been a nurse at the same time as the Member asking the question and the role had changed dramatically since she was nursing.

 

(25)          The induction process for new nurses was fairly broad but it was important that part of this training was going “back to basics” in terms of hygiene. 

 

(26)          Mrs Smith advised the Committee of the processes student nurses go through.  She explained that the Trust had set aside an area where there was a bed where nursing assistants and student nurses were trained on how to strip the bed and clean it.  With regard to agency staff Mrs Smith informed the Committee that the number of agency staff within the Dartford & Gravesham NHS Trust had significantly dropped.  However, agency staff had their own set standards but it was fair to say that those standards matched those standards that would be required by the Dartford & Gravesham NHS Trust.  Increasingly, as opposed to using agency staff, the Trust were relying on their own ‘bank staff’. 

 

(27)          In answer to a question about the screening process Mrs Smith informed the Committee that with regard to MRSA screening there were three sites on the body where swabs for MRSA were taken.  These sites were; underneath the arm; in the groin and nasal swabs.  These swabs were generally taken by a nurse based on the ward and were then sent to the laboratory.  If the results were negative this would be known within 24 hours but if the results showed that it was positive further tests would be undertaken   and these would be known within about 48 hours.  This was the general standard but there was a four hour rapid testing system available.

 

(28)          In terms of an urgent admission or emergency, the process also involved an assessment of risk and in appropriate cases antibiotic cover would be provided. 

 

(29)          Mrs Smith was unable to answer directly the cost associated with these tests in terms of the swab and consumables.

 

(30)          One Member spoke of recent visits to hospitals where innumerable people did not use the alcohol gels and parents not asking children who were visitors to the hospital to undertake the required level of hygiene. 

 

(31)          Mr Devlin responded to the Committee that the issue of hand hygiene needed to have a much higher profile.  Engagement with the public was key.  It was a case of continually refreshing and changing the message.  He spoke of work that the Trust had undertaken within the hospital to insure that whilst the message was the same it was dealt with in a different way so always had an impact.  Mrs Smith added that there was a need for a huge public campaign on hand hygiene and infection control.

 

(32)          In answer to a question relating to infection control for community hospitals Mrs Smith said that community hospitals were managed by colleagues in the Primary Care Trusts. 

 

(33)          In response to a question relating to infection control in nursing and residential homes she said that this was an issue for the Health Protection Unit.  The Committee noted that the registration process for nursing and residential homes for the new CQC was due to start next week.  The CQC would have the right to make spot check inspections of these establishments.

 

(34)          In answer to a question about the provision of domestic services the response from the Trust was that this was in-house.

 

(35)          Asked whether staff were screened for infections Mrs Smith responded that the screening of staff would increase the cost to the Trust considerably.  The Patients Association were advocating that staff should be screened but Mrs Smith said that she was not sure how that could be achieved, what the benefits were and how often it should be done. 

 

(36)          Mrs Smith responded to a question relating to the budget for infection control that initial screening was in excess of £30-50,000 per year on the initial part of the screening, but she could not give the exact cost at the meeting.  What was important was to identify those areas of greater risk, e.g. orthopaedics.  Ongoing training for all staff was very important.  Mrs Smith informed the Committee of the ongoing training programme which took place in the wards within the hospital rather than a thorough traditional tutorial approach.  There was much more informal and ward based training.

 

(37)          In answer to a question about the re-testing for infections for long stay patients Mrs Smith advised the Committee that this took place every 14 days if a patient remained in hospital.

 

(38)          In conclusion, as a local Member, Mrs Angell said that she had recently been a ‘mystery’ shopper and she wanted to congratulate the professionalism of the staff and the services provided at a very good hospital.