Agenda item

Lois Howell, Company Secretary and Linda Dempster, Head of Infection Control will be in attendance for this item.

(Lois Howell, Company Secretary and Linda Dempster, Head of Infection Control were in attendance for this item)

(1)       In response to a question about whether there was an issue around public perception of the Trust, particularly people in those areas most likely to use the Trust’s services, the Trust acknowledged that getting the right message out to the public was a challenge but that the Trust did have a very good communications team. 

(2)       In response to a question about infection control, the response was that for infection control the team were working towards a level of zero tolerance.  In recent years the issue of infection control and its profile had been substantially raised and the public’s awareness of its importance recognised.

(3)       The targets for infection control which had been put in place had really helped the Infection Control Team within the Medway NHS Trust, but there were also a number of other areas which needed to be addressed. 

(4)       In response to a question relating to the Trust declaring on the Health Care Commission Core Standards for 2007/08 that the Trust had not met the requirements for decontamination the response was that it was not an issue of patient safety but related to some of the facilities that the Trust had during that year which prevented the Trust from declaring that it was compliant with this standard.

(5)       The area that was non-compliant was the cold sterilisation facility for endoscopes.  A brand new unit had been established and so this year the Trust were able to declare in their self assessment that they were compliant.

(6)       In answer to a question about infection control and MRSA, Mrs Dempster responded that MRSA screening took place for all admissions and screening of in-patients also took place every week.  She informed the Committee that this was a credit to the Microbiology Unit at the Trust who had looked carefully at the way they worked and increased the number of tests that they conducted from 1,000 to 17,000.

(7)       In answer to a question about the policy on ‘bare arms below the elbow’, Mrs Dempster answered that the Trust had a stringent performance management regime.  It was Trust policy that staff were ‘bare below the elbows’.  This had strengthened the infection control policy.  All staff from the cleaner to the Chief Executive were empowered, as were the public, to challenge anyone who was found not adhering to this policy.  There had been no need to date to taken any formal disciplinary action against any member of staff not adhering to the policy.

(8)       A question was asked about an item within the papers before the Committee which indicated that the Healthcare Commission had undertaken a review at the Trust in January 2009 and whether the outcome of that inspection had been received from the Healthcare Commission.  In response, the Committee were advised that the official feedback had not been received but the initial feedback had been very positive.

(9)       In answer to a question as to why silver was used in catheters or central lines, Mrs Dempster responded that this was proven to reduce infection for patients.

(10)     Acknowledging that bacteria was everywhere, a question was asked about the cleaning of trolleys and whether the paper medical notes used by professionals were cleaned and what the risk was.  In response, Mrs Dempster said bacteraemia was the real risk, but in all cases it was about assessing the real risk and how that risk could be reduced.  Hand hygiene was key.  Bacteria can be found on notes, door handles, anything that is touched.  It was important that professionals washed their hands immediately before dealing with a patient.  Mrs Dempster said while notes could be seen as a perceived risk, she did not consider that there was a real risk relating to the notes.

(11)     In answer to a question about infection control, and control of the wards, the answer given was that Ward sisters have control of the ward, which means they had ownership and power of what happens in the ward in terms of performance management.  There was a direct line of performance management up to the Director of Nursing and onwards to the Board.  The Board looked at the policy safety for each of the wards, including looking at issues of uniform, policy, considering whether there were any problems of skill mix for each of the wards which would then be addressed.

(12)     In answer to a Member’s question, relating to infection control targets and how they are set, the response was that the targets are initially set by the Government, but then the South East Coast Strategic Health Authority issued a ‘stretched target’ to each Trust.

(13)     This was demonstrated by the number of cases of MRSA that were expected across the health economy this year and the stretch target that the Strategic Health Authority had imposed.  The Trust would be expected to reduce the total of 63 cases in any one year by a further 10% this year based on outturn.

(14)     The Committee were informed that following each case of infection, thorough investigation was undertaken to ensure that from the Medway NHS Trust’s point of view, the risk was being reduced.

(15)     Exploring this issue of zero tolerance further and stretch targets, the representatives of the Trust acknowledged that it would be harder and harder to achieve zero cases and percentages become less meaningful.  The only appropriate response was to look at each incidence of infection on a case by case basis.

(16)     In answer to a question about whether staff were screened for MRSA, Mrs Dempster answered that this would not be practical as staff could present for a shift and be totally clear of any MRSA, but on leaving that shift they could be positive or vice versa.

(17)     She added that in terms of training, by the following week, i.e. the last week in March, 100% of the staff should have been trained.

(18)     With regard to student nurses, Mrs Dempster said that part of the training took place in university and part within the hospital setting.  Within the first week of being employed by the hospital, nurses were trained on the basic skills and they had to demonstrate that they had the competencies to undertake those basic tasks effectively.  The Trust had gone back to basics in terms of hygiene and she said that there was now an ethos within the Trust of checking that people were competent in terms of changing beds, drips procedures etc.  The danger had been over the last 30 years that once a student nurse had been trained, there was an assumption that they were competent.  All staff were now assessed for their competency.  In terms of infection control specifically, there was a necessity not only for clinical staff but also for non-clinical members of the Board and Executive Directors to take a refresher course each year.

(19)     Mrs Dempster added that people would be suspended without pay if they had not undertaken this mandatory training.  This is a new policy coming in from April 2009.

(20)     In response to a question about whether the Trust used agency staff, Mrs Dempster said there had been some agency staff utilised recently in Accident and Emergency, but over and above that, they had their own bank of staff which were used.

(21)     Asked about compliance with anti-bacterial prescribing, Mrs Dempster said that all prescribers of drugs had to go on training and all junior doctors were trained as part of their initial induction.  The Trust had clear guidelines about prescribing, and how antibiotics were to be prescribed.

(22)     The amounts of antibiotics on each ward were audited and regular reports were made to the Governors Risk Committee for assessment.  If it was acknowledged that there was over-prescribing on a particular ward, this would be addressed.  In addition, the Risk Committee would be given additional reports if there was an outbreak of, for example, C Difficile.

(23)     The Committee noted that on display on each ward were statistics relating to the number of breaches of hand hygiene, bed sores, ‘slip, trip and falls’, unclean commodes etc.  This really focussed staff minds to ensure that all these basic issues were attended to and embarrassment avoided.  This was also available for the public to see. 

(24)     Asked about whether the Committee would get to know what was going on within the Foundation Trust, as many of the meetings took place in private, the response was that Board papers were published on the website and Minutes were made available following those meetings.