Agenda item

Sara Mumford, Director of Infection Prevention and Control, Flo Panel-Coates, Director of Nursing and Claire Roberts, Head of Quality and Governance were in attendance for this item.

(1)               Attached as an appendix to these Minutes is a copy of the presentation that the Trust had prepared but was not delivered to the Committee and a Healthcare Commission press release which was positive for the Maidstone & Tunbridge Wells NHS Trust.

(2)               All those Members who asked questions of colleagues from the Maidstone & Tunbridge Wells NHS Trust were very pleased to acknowledge the hard work of the Trust which had resulted in the Healthcare Commission press release and they hoped that this was reflected in the local community and by the local press.

(3)               In answer to a number of specific questions the Trust were invited to explain to the Committee the development of the C Difficile Integrated Care pathway.

(4)               In answer to a question about the screening processes within the Trust and the different processes in terms of those patients who present in an emergency situation at Accident & Emergency and elective care Ms Mumford answered in terms of the two organisms of major concern.  Turning first to MRSA Ms Mumford advised the Committee that patients that were attending the hospital for elective treatment were screened and pre-assessed.  For those patients presenting in an emergency setting not all of them were screened.  Then it was an issue of identifying those areas of greater risk, i.e. orthopaedics, surgery patients, those that require coronary care, intensive care, whether the patients were at risk of bringing in a community acquired infection, for example from a nursing home setting or whether they had any chronic wounds that made them of higher risk, such as ulcers.

(5)               Mrs Stockell said that the Trust must not become complacent.  She had certainly noticed people within the Hospital that were not using the alcohol gels or hand washing and she asked how working together there could be a campaign for the public on the importance of using the facilities provided in a hospital to avoid infection as well as working with schools to change the culture and educate young people.  Ms Mumford responded that it was important that the public were constantly reminded of the importance of using the facilities to avoid infection as a means of infection control within the hospitals.

(6)               The Trust had recently introduced new signage which was much more noticeable but she said they could not force the public to use the facilities available but they could be encouraged. 

(7)               Staff had spent time, sometimes up to an hour at a time, welcoming and greeting members of the public to advise them of the importance of using the gels or hand washing but it was not an optimum use of time to do this all the time. 

(8)               In answer to questions about staff walking from one ward to another and not using the facilities and the new culture that had been explained to the Committee of continuous development Ms Mumford responded that the importance of staff having it emphasised to them the importance of using the gels and appropriate hand washing.  All wards now had dedicated domestics and they were part of the ward team.

(9)               Members of the cleaning team management hierarchy also took part in the nursing and infection control meetings. 

(10)          In response to a question about deep cleaning Ms Mumford informed the Committee of the process within the Trust.  She said that there was often pressure on beds but what they did in the case of a deep clean was to empty a ward where possible or if not possible then to systematically bay by bay thoroughly clean with steam and chemicals so that every ‘nook and cranny’ is cleaned. 

(11)          In answer to a question about spot checks Ms Mumford responded that these were periodically undertaken and of course the Trust was open to external scrutiny.  Internal inspection, the cleaning of hospital wards, did take place on a fairly regular basis.  As part of this deep cleaning disposable curtains around the bed were replaced annually. 

(12)          Mr Fittock then asked the question about how the deep cleaning was undertaken in public areas and also reminded the Trust that bed spaces had been an issue for the Trust before.  The response was that there was a programme of deep cleaning and the first task was to identify those areas of high risk and these areas are prioritised.  The Trust had pulled together various strands of evidence to produce one audit standard and spot checks were undertaken by Matrons against this standard. 

(13)          The issue of space between the beds had been addressed at both sites. 

(14)          Ms Mumford said that everything to do with the Hygiene Code was discussed at a monthly meeting which included the Director of Nursing, the Medical Officer, the Chief Operating Officer and the Director of Infection Prevention and Control and regular reports were made by the Trust Board. 

(15)          In response to a question and where children are playing with toys as to how often the toys are cleaned the answer was that the toys were cleaned on a regular basis. 

(16)          In answer to a question about how often the trolleys in Accident & Emergency were cleaned Ms Mumford said that this happened every morning.  The incidents of infection arising from this area had reduced significantly. 

(17)          Asked about community acquired infection and what activities the Trust were undertaking to ensure that the public were aware of preventative measures the Trust said representatives they were putting a strategy in place, it was about the Trust being excellent at being proactive and trying to change the public’s behaviour. 

(18)          In answer to why Trusts tended to only screen for MRSA and C Difficile Ms Mumford responded that there were other infections which would require other facilities and equipment to screen. 

(19)          The Committee noted that the Trust would not routinely screen for C Difficile as there was no reliable method for doing so. 

(20)          In answer to a question about the screening which takes place in London Ms Mumford responded that the challenges for London hospitals were very different to those such as the Maidstone & Tunbridge Wells NHS Trust.  

(21)          Asked about the separate treatment centre at the Maidstone Hospital site and whether they were compliant to infection control Ms Mumford responded that whilst they were a separate body she could confirm that the policies they had for infection control were compliant with the Trust’s standards.  Ms Mumford said that the treatment centre did not have the same issues with C Difficile or MRSA. 

(22)          In answer to a question about transferring patients from the Kent & Sussex Hospital, Tunbridge Wells to Maidstone or by ambulance from London patients to the Trust’s hospitals and whether there would be additional resources for infection control made available by the Government to Trusts Ms Mumford responded that the funding for infection control was an ongoing funding stream. 

(23)          The current funds which had been made available by the PCT were for the Trust’s recovery period following the Healthcare Commission’s reports into the outbreaks of C Difficile which had contributed to the death of a number of patients.  Pushed for an answer relating to whether patients from the Kent & Sussex had to be transferred to Maidstone because the Kent & Sussex Hospital, Tunbridge Wells did not have the facilities for treating a person with C Difficile Ms Mumford confirmed that there were facilities at the Kent & Sussex Hospital.  However, the isolation ward had recently had to be closed in Tunbridge Wells which necessitated a patient being transferred to Maidstone. 

(24)          A Member asked whether, because of the pressure on beds, the opportunity to use these was reduced.  Ms Mumford replied that this had been an issue the week before but it was an ongoing issue that she discussed with the Trust’s Operational Director. 

(25)          In conclusion the Trust welcomed the opportunity for the discussion with the Health Overview and Scrutiny Committee and recognised that the Committee saw the positive contribution and continuous improvement the Trust had made since the outbreak of C Difficile.