Agenda Item No. 14bTHE ROYAL WOLVERHAMPTON HOSPITALS NHS TRUSTMINUTES OF INFECTION PREVENTION & CONTROL COMMITTEEHELD ON THURSDAY 25 TH SEPTEMBER 200810.00AM, CONFERENCE ROOM, HOLLYBUSH HOUSE, NEW CROSS HOSPITALPresent: Mr D Loughton (Chair) (Chief Executive) (DL)Dr M Cooper (DIPC) (MC)Ms V Whatley (LNIP) (VW)Ms F Sneddon (Asst. Director of Pharmacy) (FS)Dr A Phillips (Director of Public Health – WCPCT) (AP)Ms S Roberts (Hotel Services Manager) (SR)Dr J Odum (Divisional Director – Division 2) (JO)Dr G Martinelli (Consultant Anaesthetist – Cardiothoracic (GM)Ms S Reilly (Matron Representative) (SR)In Attendance: Dr M Ashcroft (Microbiology Registrar) (MA)Apologies: Ms C Etches (Director of Nursing & Midwifery) (CE)Mr B G Millar (Medical Director) (BGM)Mr J Vanes (Non-Executive Director) (JV)Dr R Fitzpatrick (Director of Pharmacy) (RF)Ms J Taylor (HCAI Programme Lead – SHA) (JT)Dr J Vidhya (Junior Doctor) (JVidhya)2. Minutes of Previous MeetingActionWith the exception of the following amendment, the minutes of the meeting heldon 28 th August 2008 were accepted as a true record:(5) Performance ReportThe heading ‘Toxin Positives’ should read ‘C.Diff. Toxin Positives’3. Matters Arising3.1 Junior Doctors’ Induction UpdateVW reported on the current situation as at 23/09/08:Junior and Middle Grades% CompleteAntimicrobial Prescribing 91%Antimicrobial Prescribing Competency 91%Blood Culture 93%Blood Culture Competency 88%Hand Hygiene (Annual) 92%Hand Hygiene Competency 93%Whilst the level of completion had improved considerably since the influx ofjunior doctors at the beginning of August 2008, there were still 6 individualswho had not completed any of the 6 IP requirements. Names of the 6 to begiven to Drs J Odum and R Horton.VW4. Environment ReportSR reported on the main action points arising from the Environment Groupmeeting held on 2 nd September 2008:Page 1 of 6
• The Cleaning Strategy and Operational Cleaning Plan to go to September2008 TMT meeting.• Food Hygiene and Pest Control Policies had been revised and were subject toapproval by the Environment Group.• The Deep Clean Team was due to undergo a two-week inductioncommencing 29 th September 2008. The Deep Clean schedule will addressvery high risk areas first, dependant on the activity and outbreak situation.• Technical Audit information had been reviewed and will be agreed with theDirector of Nursing & Midwifery at a 1:1 meeting on 30 th September 2008.• The Healthcare Commission report had been received. The schedule ofcleaning frequencies will be made publicly available on each ward and in otherareas across the Trust and will be completed in October 2008.• The Total Cleaning Responsibility Framework within the National Standardswould be reviewed separately by a small group from the Environment Group.5. Performance ReportMC reported on performance in August 2008:10 MRSA bacteraemias this year to date, with a target of 15 for the whole year.The last MRSA bacteraemia occurred on 8 th August 2008.Staph. Aureus BacteraemiasDivision 1: MRSA bacteraemia: 0MSSA bacteraemia: 0Division 2: MRSA bacteraemia: 0MSSA bacteraemia: 2 1 RDU (WDU); 1 D15This situation was considered good, and Division 2 shows remarkableimprovement.Blood Culture ContaminantsThere were several contaminants during the last week of August, although themonth as a whole was better than August 2007. September 2008, however, isworse than September last year. DL expressed concern with this issue. MC hadwritten to the individuals involved in the contaminants addressing the need forthem to undergo further training. DL enquired if all doctors how have rubberstamps with their GMC number. It was suggested that nurses also be issued withrubber stamps containing their PIN. AP recommended each patient having a PINrelated to the database. MC to instigate.C. Difficiles7 instances were attributable to RWHT during August. Ward D18 caused concernwith the number of cases on that ward equating to 25% of the total. It has notbeen possible to identify the reason for the high incident level on the ward. It wasthought that Coproxaclav may be the problem but introducing a ban of thisantibiotic was considered difficult to effect. DL asked that a meeting be arrangedwith the five Consultants involved in D18 and nursing staff to discuss what actioncan be taken to improve the C.Diff. situation on the ward. DL also to be informedon how C.Diff. in Gastroenterology at RWHT compares with other hospitals. MCto raise over-prescribing of PPIs at the Medicines Management meeting nextweek. AP commented that PPIs are very costly and there is a high degree ofwaste because they are over used; they comprise 10% of the PCT drug budget.MCVW/MCVW/MCMC
Division 1: 1 DeaneslyDivision 2: 4 D181 D191 D206Performance of WardsThere was just one ‘red’ area; C.Difficiles on D18. There had been 8 cases ofC.Diff. on D18 within six weeks, the reason for which had not been identified.Discussion took place around lack of isolation facilities. DL asked for D18 to bemoved to D17 and provision of an isolation facility found elsewhere.MCC. Diff. Toxin PositivesRemains below target.ESBLStill high in the community. AP pointed out that the community ESBL level wasbelow the national average.Sandra Roberts left the meeting at this pointAP felt that some of the data suggested a need to gain control of the situation, andthought there may be a case for developing a 12-month opening for a postgraduatestudent to address the issues. MC to put together a proposal and for APto advertise as soon as possible.MC/AP6. Pharmacy ReportFS reported:InterventionsDoses changes related mainly to duration of antibiotic therapy and dose.Pharmacists are stopping courses directly in some cases, however this is only themore senior pharmacists working within a particular speciality. Pharmacists oncritical care contribute more directly on the microbiology ward rounds. Renal doseadjustments are mainly from critical care but a significant proportion are from renalwards. The main drug implicated is tazocin. More training is recommended forthis area. Another area for intervention is changing doses and frequency ofvancomycin. Five of the treatment duration interventions are with fluxonazole.Breakdown of InterventionsIt was noted that there were a high number of interventions in critical care (49).No interventions had been necessary on D18.Division 1Use of high cost antibiotics rose in August. Cardiology, cardiothoracic andvascular wards and oncology have new use of meropenem in accordance withadvice from microbiology. Three times as much tazocin was used on critical carethis month.Division 2There was increased use of tazocin, meropenem and ertapenem in respiratorymedicine in accordance with advice from microbiology for patients with cysticfibrosis/bronchiectasis. Ciprofloxacin use was high, but appropriate forpseudomonas infections.56DDDs of ciprofloxacin used in elderly care was of concern; the courses werecommenced by and elderly care consultant working in EAU. This will beFS
investigated.7. Divisional ReportsDivision 1:GM reported:One MRSA bacteraemia was identified in critical care in early August and the RCAidentified the patient as being already colonised nasally. It is suspected that thebateraemia resulted from tracheostomy formation. Mouth wash and hand andnasal gel is being used in critical care. MRSA packs are now available in all threeareas to ensure decolonisation of relevant patients. The potential for obtainingsilver-based tracheostomy wound dressings is being investigated.No C.Diff. was reported for in-patients, however the IP Team reported C.Diff. in apatient discharged from Ward C5 (Head & Neck) within one week.Division 2JO reported:The scorecard showed red areas against D18 around the four cases of C.Diff. andHII 2 (Peripheral Intravenous Cannula Care Bundle) in D5 and HII 6 (Urinary CareCatheter Care Bundle). Local action plans have been implemented to address thenon-compliance.Performance reviews of EAU and A&E had highlighted the high cost of peripheralcannula packs, which was of particular concern. ChloroPrep use is also verycostly.8. Report of LNIPVW reported:Outbreaks/Major IssuesJO left the meeting at this pointTuberculosis on CHU153 patients recalled for testing for latent tuberculosis. 144 have so far beentested, with 20 positive, 54 indeterminate and 68 negative. It is planned thatpositive and indeterminate patients will have been followed up by 3 rd October.The Outbreak Committee agreed that as no patients were found to have activedisease and positives had existing risk factors, no further testing should takeplace. The further 332 patients written to will be advised that they are not requiredto be tested.Audit and Surveillance ActivityMRSA Admission Screening92% compliance in August 2008.Treatment of MRSAAudit on compliance with policy will commence in October 2008.Internal audit of IPC recommendations and actions were detailed in the LNIPreport. A full report will follow in due course.
Current IssuesPoliciesRevised Antibiotic Resistant Organism Policy out for consultation.Linen Policy will be reformatted in line with Trust Policy (OP1), agreed by IPCCand will be available on the Intranet. DL reminded the group that patient dignitywas a priority, which should be borne in mind when considering use of disposablecurtains.MRSA Screening/Testing Education InitiativeThree external applicants have been shortlisted for the Screening SystemsManager post and will be interviewed 30 th September 2008. DoH is discussing thepotential for new targets to significantly impact on MRSA infection rates. MCcommented that currently Maternity is not included in screening, but thedepartment does need to recruit two Band 2s and two Band 3s to undertakescreening as part of their role.DL informed the meeting that screening will continue at the Trust for the remainderof the year, despite new guidance coming through from DoH, and proposed that in2009/2010 academic assessment should be carried out to judge the way forward.DL raised the possibility of RWHT providing screening services as a business andrequested a meeting with MC, CE, VW, Matt Reid and Graham Danks to discussfurther. MC to advise DL of equipment costs.MCDL/CE/MC/VWMCShowcase HospitalsProject progressing as plan. Year 2 is under discussion, and the possibility ofincluding additional products. National press statement was accompanied by BBCregional news, radio and newspaper coverage of the Trust.Code of Practice for HCAI Action PlanThe current situation was detailed within the LNIP report, which included actionrequired around carpeted areas, particularly in Dermatology and OPD1. DLrequested replacement of the carpets be carried out quickly and not wait for theplan of replacement from Estates.VW9. ChloraPrep Business CaseVW referred to the Initial Feasibility Assessment for the Trust wide use ofChloraPrep prior to insertion of peripheral venous cannulae (PVC), central venouscatheters (~CVC), for routine CVC line care at dressing changes and prior toobtaining blood cultures. The annual cost for the product is £120,500. Theproduct is funded until December 2008 by the Showcase Hospitals project. DLasked for it to be written into the document that if the product becomes availableelsewhere at a lower price the Trust will be entitled to take advantage of thereduced cost. The Business Case to be submitted to TMT for views.VW10. Healthcare Commission ReportThe final report following the Healthcare Commission’s visit in May 2008 had beenreceived. Of the three areas inspected, Duties 2, 4 and 8, one was reported asbreached (core duty 4) and one in sufficient evidence (core duty 2). The HCCreport was rejected on the basis that the Trust did not consider the duties hadbeen breached or that there was insufficient evidence. HCC response is awaited.There is no timescale for this.11. ‘Fresh Eyes – New Ideas’MA gave a presentation highlighting ideas she had encountered around infection
prevention practices. MA explained that the ideas all had time and/or costimplications.Quick Action Guides: To be available on the Intranet and in ward areas. This wasconsidered a good way of educating and reinforcing infection prevention, andwould be adopted. VW to organise.VWPerformance Management Groups: Not considered a possibility at this time.IV Line Nurse Practitioner: It was suggested that a member of the nutritionistteam could attend an IPCC meeting.Computer Alerts: MC to contact Chris Wanley, Head of IT, to set up this facility.Bone Infection Group: Comprising a multi-disciplinary team. AP stronglyrecommended that an orthopaedic surgeon is agreeable to such a group being setup. DL and MA to meet with orthopaedic surgeon to discuss this issue.VWMCDL/MA12. Any Other Business12.1 VW reported that a risk assessment has gone out to areas across the Trustrelating to the misuse of alcohol hand gel including fire, theft and ingestion12.2 The DH has issued new HIV prophylaxis guidelines. These are to beactioned through the draft Sharps policy.12.3 DL asked that the newly appointed Patient Safety Manager be invited tobecome a member of this Committee.VWVW13. Next MeetingThe next meeting will take place on Thursday 30 th October 2008 at 10.00am in theConference Room, Hollybush House.