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UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST

Director of Infection and Prevention

ANNUAL REPORT 2015/2016

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Contents Introduction from the Director of Infection Prevention and Control…………..4 Summary…………………………………………………………………………..........5 Headlines……………………………………………………………………………....5

Target Summary……………………………………………………………………....6 National MRSA rates 2001 -2015……………………………………………………7 Meticillin Sensitive Staphylococcus Aureus blood stream infections………8 Clostridium difficile infection……………………………………………………….9 Analysis of 2015/16 CDI PIRs……………………………………………………....13 Escherichia Coli Bacteraemia………………………………………………………13 Carbapenemase Producing Enterobactariaceae (CPE)……………………….14 Vancomycin / Glycopeptides Resistant Enterococci (VRE/GRE)……………15

Tuberculosis (TB)…………………………………………………………………….15

Surgical site infections (SSI)………………………………………………………..16

Norovirus outbreaks………………………………………………………………….16 Influenza outbreak…………………………………………………………………….17 Group A Streptococcus outbreak (GAS)………………………………………….17 Actions taken to support improvements in HCAI………………………………..18 Antimicrobial stewardship…………………………………………………………...18 Education and training………………………………………………………………..19

Providing a clean safe environment………………………………………………..20

Water Systems Management…………………………………………………………21

Communications………………………………………………………………………..22

Final Message………………………………………………………………………..….23

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Introduction from the Director of Infection Prevention and Control

Infection prevention and control is fundamental in improving the safety and quality of care provided to patients. Healthcare Associated Infection (HCAI) poses a risk to patients, staff and visitors. They can cause significant harm to those infected and avoidable costs for the NHS. As a result, infection prevention and control is a key priority for the University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT). It is with pride that I present the Director of Infection Prevention and Control annual report for 2015/16.

Over the last year we have continued to experience unprecedented challenges and continue to be extremely busy. However, we have risen to the challenges and have maintained a culture of continuous improvement which is both patient-centred and safety-focused. Our vision is to constantly provide the highest possible standards of clean, safe care across the healthcare economy. Together, with our external partners, we have created a vision and clinically led strategic plan for the future. To support this plan the infection prevention expertise is being integrated across Morecambe Bay to enable sharing of best practice to ensure that throughout the patient’s journey there is a continuity of clean safe care.

This report demonstrates how the Infection Prevention and Control (IPC) agenda has continued to be strengthened with the highly visible and respected Infection Prevention Team lead by the Matron, Angela Richards. Angela and the team are positive role models and all of the team are undertaking academic work to further develop their contribution to improving standards across the Trust. The development of our IPC nurses is in line with the national core competency frame work, developed by the Infection Prevention Society and endorsed by the Department of Health (2011). The IPC team share a vision and commitment to working with our commissioners to promote infection prevention and control and to reduce HCAIs across the Bay. Their involvement, nationally, regionally and locally in IPC, has influenced and continues to influence the landscape of IPC at both an operational and strategic level.

I would like to thank the IPC team, the microbiology team and Dr David Telford, Consultant Microbiologist, for his continued support in the role of Deputy Director of Infection Prevention and Control. David has provided medical leadership to his colleagues and continual support to both me and the IPC team. I would like to thank Melanie Weeks, Non-Executive Director, for her support chairing the Infection Prevention and Control Committee (IPCC) Meetings and finally I would like to acknowledge the commitment and hard work of Board colleagues, all staff, governors and volunteers across UHMBT, Clinical Commissioning Groups (CCG) and Public Health England (PHE) colleagues for keeping safety, quality and experience of patients, carers and staff at the forefront of all they do.

Improvements in health and care are linked and the NHS and its public, private and voluntary sector partners can only provide the best and most effective service for patients and public when we work together to achieve their objectives.

Sue Smith

Executive Chief Nurse and Director of Infection Prevention and Control

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Summary Key Performance Indicators (KPIs), developed by the IPCC, to provide ward to Board assurance, have been reviewed and amended over time to address the on-going challenges of the prevention and control of HCAIs. These KPIs continue to be reported on a monthly basis to the Infection Prevention Operational Group (IPOG) and quarterly to the IPCC with each division demonstrating accountability and responsibility towards the reduction in avoidable HCAI’s. KPIs provide evidence of assurance or early warning of concerns to UHMB compliance with the regulations set out in the Health and Social Care Act and the Care Quality Commission regulations. Potential concerns or incidents are discussed three times a day at Patient Safety and Flow meetings to enable speedy response and clear understanding of all staff of risks, mitigations and effect of actions taken. UHMBT continues to promote and support a zero tolerance towards avoidable HCAI’s. Over the last year assurance data has been collected for:

Meticillin Resistant Staphylococcus aureus (MRSA) blood stream infections

Meticillin Sensitive Staphylococcus aureus (MSSA) blood stream infections

Clostridium difficile infections (CDI)

Escherichia coli (Ecoli) blood stream infections

Norovirus outbreaks

Outbreaks

Periods of increased incidence of infections

Hand Hygiene compliance

Incidence of surgical site infections

Antimicrobial prescribing compliance

Headlines

End of Financial year headlines for 2015-2016 are as follows:

Over the last year five patients have been diagnosed with an MRSA blood stream infection, three cases identified within 48 hours of admission and two cases post 48 hours after admission. Of the two acute apportioned cases, one of these was later identified to be a skin contaminant and not an infection, and another was identified as being associated with a device inserted in the community.

The Trust reported 35 hospital apportioned Clostridium difficile cases against a target of 44 for the year. 15 of these have been identified as having no lapses in care.

A total of 57 cases of MSSA blood stream infections were reported, of which 39 were community associated and 18 acute associated. (There is no national target for MSSA, data is gathered for surveillance only).

245 cases of E-coli blood stream infections were reported, of which 200 were community associated and 45 were acute associated. (There is no national target for E-Coli, data is gathered for surveillance only).

UHMBT had a total of 15 outbreaks of Norovirus type gastrointestinal illness, within RLI and FGH, during the year.

UHMBT had an outbreak of influenza, within RLI, between January and March 2016.

UHMBT had an outbreak of Group A Streptococcus (GAS), within FGH, in July 2015.

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Target Summary

Target for 2015/16

Number in Q4

YTD apportioned to Acute

Trajectory for end of Q4

MRSA Blood stream infections

Zero 0 2 0 Over trajectory

CDI 44 3 35 actual -15 deemed as ‘no lapses in care’

44 Below trajectory

METICILLIN RESISTANT STAPHYLOCOCCUS AUREUS BLOOD STREAM INFECTIONS Staphylococcus aureus (S. aureus) is a bacterium that commonly colonises human skin and mucosa without causing any problems. It can also cause disease, particularly if there is an opportunity for the bacteria to enter the body, for example through broken skin or a medical procedure. If the bacteria enter the body, illnesses which range from mild to life-threatening may then develop. These include skin and wound infections, infected eczema, abscesses or joint infections, infections of the heart valves (endocarditis), pneumonia and bacteraemia (blood stream infection). Most strains of S. aureus are sensitive to the more commonly used antibiotics, and infections can be effectively treated. Some S. aureus bacteria are more resistant. Those resistant to

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the antibiotic meticillin are termed meticillin resistant Staphylococcus aureus (MRSA) and often require different types of antibiotic to treat them. Those that are sensitive to meticillin are termed meticillin susceptible Staphylococcus aureus (MSSA). MRSA and MSSA only differ in their degree of antibiotic resistance: other than that there is no real difference between them. Hospital acquired MRSA infections at University Hospitals of Morecambe Bay remain lower than the national rate. During 2015/16 a zero tolerance approach has continued in relation to avoidable cases of MRSA blood stream infections. There have been two MRSA bloodstream infections identified 48-hours after admission (hospital acquired) in UHMBT during the year. We continue to work collaboratively with our co-commissioners and partner organisations to learn lessons that support the reduction of avoidable HCAIs.

The benchmark position when compared to other NHS Trusts in the North West can be seen on the following table:

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METICILLIN SENSITIVE STAPHLOCOCCUS AUREUS BLOOD STREAM INFECTIONS Following a Secretary of State announcement on 5 October 2010, there was a mandatory requirement for all NHS acute trusts to report MSSA bacteraemia. This applied to all cases diagnosed after 1 January 2011. MSSA blood stream infections cases continue to be monitored by UHMBT. Currently this data collection is part of national surveillance only. In total this year there have been 39 community associated (identified within 48 hours of admission to UHMBT and 18 hospital associated cases (post 48 hours after admission) reported. The Trust benchmark position when compared to Trusts in the North West can be seen below:

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CLOSTRIDIUM DIFFICILE INFECTION

Up to and including 2015/16, NHS organisations have continued to be required to demonstrate stretching year on year reductions in Clostridium difficile Infection (CDI) based on the previous year’s trend reduction in CDI cases. However, as published data shows, the rate of improvement for CDI has slowed over recent years. Infection prevention and control experts from within the NHS and from Public Health England advise that this is likely to be due to a combination of factors including the biology and epidemiology of the Clostridium difficile (CD) organism. There are indications that, for some organisations at least, the level of CDIs may be approaching their irreducible minimum level at which these infections will occur regardless of the quality of care provided. This can occur due to the fact that some people carry CD in their bowel and will develop symptoms due to their underlying clinical conditions or as a consequence of the antibiotics they have to take. Put simply, some infections are a consequence of factors outside the control of the NHS organisation that detected the infection. In total this year there have been 107 community associated (identified pre 72hours of admission to UHMBT, or GP specimens): Of these 107 cases, 62 were residents of South Cumbria, 44 were residents of North Lancashire and 1 was a resident out of area.

The annual trajectory for 2015/16 was set at 44 cases for UHMBT. This is a reduction of 2 cases from our 2014/15 actual cases. During the year there were 35 cases of hospital attributed Clostridium difficile identified. Our aim is that no patient is harmed by a preventable infection and this is a maximum number of cases, not a target. During the year,

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20 of the 35 cases of CDI have been attributed to the Trust due to lapses in care. It should be noted that the lapses in care are not necessarily directly related to the individual case of CDI.

UHMBT CDI cases from 2007 to present UHMBT reviewed all post 72 hours CDI cases and carried out post infection reviews (PIR). These were led by the Ward Manager responsible for the patient’s care and were supported by clinical staff involved in the patient’s journey. The Matron and Lead Nurse attended monthly HCAI meetings to review all CDI cases with the co-ordinating commissioners for North Lancashire Clinical Commissioning Group, South Cumbria Clinical Commissioning Group and Lancashire County Council (LCC) Public Health Infection Prevention Team. This provided an additional opportunity to further discuss each case and conclude whether the cases were linked with lapses in care and therefore apportioned to UHMBT. All 35 CDI cases have had a PIR completed, 20 have been identified as being apportioned to UHMBT due to lapses in care and 15 cases have no lapses in care identified. To comply with national reporting requirements the total number of CDI cases assigned to UHMBT remains as a raw actual number on the National Public Health England Data Capture System (DCS), i.e. the number of cases identified post 72 hours after a patient has been admitted. The reduced ‘apportioned’ number is the number used for contractual purposes against the UHMB annual target of 44 (see graph below). A lapse in care would be indicated by evidence that policies and procedures consistent with national guidance and standards were not followed by the relevant provider. This would include evidence of:

Transmission of CDI in hospital confirmed by ribotyping

Poor compliance in cleaning standards

Poor compliance with infection prevention precautions such as hand hygiene

Concerns identified with choice, duration, or documentation of antibiotic prescribing

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50

100

150

200

250

300

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It must be noted that true causes of infection can rarely be identified. However, themes across UHMBT mirror those nationally. These include issues in relation to hand hygiene compliance and the prescribing of antimicrobials and proton pump inhibitors (PPI).

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Cumbria Clinical Commissioning Groups (CCG) have continued to show a high burden of CDI when compared with other CCGs, as demonstrated by the graph below. The graphs below illustrate the benchmark position for UHMBT and for community acquired cases across the North West. Community cases are identified as General Practitioner (GP) specimens and/or those identified within 72 hours of admission to any acute hospital.

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From the Nov – Feb, 2015/16 UHMBT saw an unprecedented time, since the Trust merger 18 years ago, without any acute attributed CDI cases (64 days). This was an improvement on last year’s longest period between January and March, since Trust merger, of 49 days. Analysis of 2015/16 CDI PIRs Of the 35 UHMBT cases:

57% of patients were prescribed proton pump inhibitors either in the community or in the hospital and were on them at the time of diagnosis.

71% of patients were recently prescribed antibiotics either in the community or in the hospital.

57% of patients were recently prescribed laxatives either in the community or in the hospital.

43% of patients had recent bowel surgery or inflammatory bowel conditions (including known previous CDI).

ESCHERICHIA COLI BACTERAEMIA Escherichia coli (E coli) bacteria are frequently found in the intestines of humans and animals. There are many different types of E. coli, and while some live in the intestine quite harmlessly, others may cause a variety of diseases.

The bacterium is found in faeces and can survive in the environment. E. coli bacteria can cause a range of infections including urinary tract infection, cystitis (infection of the bladder),

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and intestinal infection. E. coli bacteraemia (blood stream infection) may be caused by primary infections spreading to the blood.

Enhanced surveillance of E. coli bacteraemia has been mandatory for NHS acute trusts since June 2011. Patient data of any E. coli bacteraemia are reported monthly to PHE.

E. coli blood stream infection cases continue to be monitored by UHMBT. Currently this data collection is part of national surveillance only. In total this year there have been 200 community associated (identified within 48 hours of admission to UHMBT) and 45 hospital associated cases (post 48 hours after admission) reported.

CARBAPENEMASE PRODUCING ENTEROBATERIACEAE (CPE) The use of many different types of antibiotics in hospitals creates evolutionary pressures that encourage the development and spread of antibiotic resistant bacteria. This process is a natural consequence of the use of antibiotics and cannot be stopped, only managed.

Enterobacteriaceae are a group of bacteria carried in the gut of all humans and animals, which is perfectly normal. While they are usually harmless they may sometimes spread to other parts of the body such as the urinary tract or into the bloodstream (bacteraemia) where they can cause serious infections.

This can occur after an injury or via the use of medical devices such as urinary catheters or intravenous drips where the skin is punctured allowing the bacteria to get into the body.

CPE is the name given to some strains of gut bacteria that have developed the ability to destroy an important group of antibiotics called carbapenems, making them resistant to these drugs. Carbapenems are considered to be antibiotics of ‘last resort’ and doctors rely on them to treat certain difficult infections when other antibiotics would or have failed. Infections caused by CPE can usually still be treated with antibiotics. However, treatment is

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more difficult and may require a combination of drugs or the use of older antibiotics to be effective

PHE have launched a toolkit for hospitals to detect, manage and control antibiotic-resistant bacterial infections caused by CPE. At UHMBT the toolkit has been implemented. During 2015/16 UHMBT did not have any newly diagnosed cases of CPE. However, UHMBT continued to manage known previously colonised cases with the support of the PHE toolkit.

VANCOMYCIN/GLYCOPEPTIDES RESISTANT ENTEROCOCCI (VRE/GRE)

Enterococci bacteria are frequently found in the bowel of normal healthy individuals. There are many different species of enterococci, but only a few have the potential to cause infections in humans. They can cause a range of illnesses including urinary tract infections, bacteraemia and wound infections. Glycopeptide-resistant Enterococci (GRE) are enterococci that are resistant to glycopeptide antibiotics (vancomycin and teicoplanin). GRE are sometimes also referred to as VRE (Vancomycin-Resistant Enterococci). Infections caused by GRE mainly occur in hospital patients. However, GRE are sometimes found in the faeces of people who have never been in hospital or have not recently been given antibiotics. The Department of Health advised that from 1 April 2013, VRE / GRE is no longer the subject of mandatory surveillance. Trusts are still encouraged to report this data voluntarily and UHMBT have continued to inform PHE of newly diagnosed cases. UHMBT had 7 cases of VRE over 2015/16. All cases were sent to the PHE laboratory in Collindale for Ribo-typing, none of which were connected.

TUBERCULOSIS (TB) Tuberculosis (TB) is an infection caused by a bacterium belonging to the Mycobacterium tuberculosis complex. TB is a notifiable disease in the UK. Suspected and confirmed diseases must be notified within 3 working days. TB usually affects the lungs but can also affect almost any other area of the body. Most transmissions occur from some people with pulmonary or laryngeal TB are infectious. TB develops slowly and it usually takes several months for symptoms to appear. UHMBT had 1 case of TB confirmed over 2015/16.

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SURGICAL SITE INFECTIONS (SSI) The prevention of healthcare-associated infection (HCAI) has been highlighted as a priority for action by successive Chief Medical Officers. In April 2004 surveillance of SSI in orthopaedic surgery became mandatory for all English NHS Trusts. For the mandatory surveillance of SSI following orthopaedic surgery, all NHS Trusts must participate in a minimum of one surveillance period in at least one category of orthopaedic procedures during a financial year. UHMBT participates in the mandatory SSI programme with reasonable results. Historically UHMBT have submitted data collected on hip and knee replacement surgery between July and September. This data collection did not allow numbers required to provide any meaningful analysis to take place. However, with my support the Assistant Chief Nurse for Surgery has advanced plans for making the Trust’s participation more robust and for deriving more useful organisational information. It is intended that this data collection will span the full year as opposed to one quarter.

NOROVIRUS OUTBREAKS Norovirus causes gastroenteritis and is highly infectious. The virus is easily transmitted through contact with infected individuals from one person to another. Outbreaks are common in semi-enclosed environments such as hospitals, nursing homes, schools and cruise ships and can also occur in restaurants and hotels.

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The virus lasts for 1 to 2 days. Symptoms include vomiting, diarrhoea and fever. Most people make a full recovery within a couple of days but it can be dangerous for the very young and elderly people. In total from April 2015 to March 2016 UHMBT had 15 Norovirus type outbreaks on various wards across FGH and RLI sites. 184 total bed days lost over the year due to Norovirus. Total number of patients affected 112. Total number of staff affected 40. INFLUENZA OUTBREAK The viruses characterised so far this season are well-matched to the vaccine strain. Previous flu seasons suggest this strain particularly affects children, pregnant women, and adults with long term conditions (chronic heart disease, liver disease, neurological disease and respiratory disease etc.).For most people influenza infection is just unpleasant, but for some it can lead to serious illnesses, including bronchitis and secondary bacterial pneumonia, which can be life threatening. UHMBT have had 3 confirmed outbreaks, on 3 ward areas on the RLI site, of Influenza A and B strains. Between January and March 2016 UHMBT had, within the patient population, 57 A strain and 52 B strain cases confirmed. In addition 9 staff cases were confirmed (7 B and 2 A strains). UHMBT followed PHE guidance on Infection control precautions to minimise transmission of acute respiratory tract infection in healthcare settings. This guidance supported the development of a procedure on a page document for seasonal flu for use at operational level. This information has been widely disseminated across the organisation through the management structure. Whilst managing cases, within PHE guidance, proved to be a challenge the organisation was able to successfully support requirements and manage accordingly. The outbreaks were supported by PHE and a debrief, facilitated by an external Emergency Preparedness Manager from NHSE NE, of the situation will take place in May, 2016. Following the debrief a report will be developed and taken to the July, 2016 IPCC. GROUP A STREPTOCOCCUS (GAS) OUTBREAK GAS is known to be highly virulent and can cause post-partum sepsis. It was the pathogen in the nineteen century that killed significant number of women post-partum due to the lack of hand hygiene of the health care workers. Ignaz Semmelweis; Gynaecologist introduced hand washing on his maternity ward in 1847, which reduced the mortality rate of the puerperal sepsis caused by GAS from 10-30% to 1-2%. During the week commencing 24/7/2015 three patients (two women and one new-born baby (not connected with either of the cases) were identified as being positive to GAS. The patients were at the Furness General Hospital. All of the GAS isolates were recovered from samples taken between 24/7/15 and 30/7/15. None of the abovementioned patients nor anyone from these clinical areas had GAS isolated 6 months before or since this increased incidence. An investigation, supported by PHE, was undertaken with the aim to find out any potential existing source, any route of the cross-infection, and any lapse of care that could have resulted in local spread of GAS in the unit.

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The thorough investigation did not find any obvious primary source apart from in the first clinical case, who may have been the index case where the bacterium most likely was transferred to the other two cases by hand of health care staff. As there was no evidence of obvious staff colonisation, and no further cases detected the risk of further spread of organism is very unlikely due to the lack of the existence of an index case. Maintaining hand hygiene is the single most effective way to reduce cross-contamination of any infectious microorganism. A series of formalised hand hygiene reminder sessions took place following the identification of this outbreak and were attended by all unit staff. ACTIONS TAKEN TO SUPPORT IMPROVEMENTS IN HCAI Governance

As part of the strategic plan a Better Care Together Health Care Associated Infections Steering Group has been formed. The purpose of this group is to integrate the infection prevention expertise across Morecambe Bay. This will allow the sharing of best practice to ensure that throughout the patient’s journey there is a continuity of clean, safe care.

Monthly meetings continue to be held between the IPC Matron, IPC lead nurse and commissioners, with Lancashire County Council to review all health care associated infections (HCAI).

Quarterly strategic infection prevention meetings continue to be held between the IPC Matron, microbiologists, PHE, NHSE and Lancashire County Council to review IPC strategies across the health economy of Lancashire and Cumbria.

Infection Prevention Operational Group (IPOG) continues to meet monthly to review, monitor and action operational infection prevention issues. This group reported to the Infection Prevention and Control Committee (IPCC).

The IPCC, a sub-committee of the board of directors and chaired by a non-executive director, continue to meet quarterly to present assurance on UHMBT’s Infection Prevention co-commissioning contract.

Antimicrobial Sub-Committee continues to meet quarterly to review, monitor and action any issues related to antimicrobial management.

Multidisciplinary walk rounds including, Corporate Quality Review inspections (led by the Matron for Quality and supported by the Executive Team, operational staff, patient representatives, Health watch and CCG’s): RAISE inspections (led by the Matron for Quality and supported by the Strategic Nursing team and operational staff including students) continue to be undertaken on a regular basis across the Trust and reported through the quality assurance structure.

The IPC team continue to work with Information Technology (IT) to develop a robust alert system for patients affected with HCAI’s to ensure that through the patients journey across UHMBT staff are aware of the patients potentially infectious status.

Staff IPC mandatory training, aseptic technique and hand hygiene training continued to be centrally collated on a live database in the Training Management System (TMS).

Antimicrobial stewardship

UHMB Medical Director, David Walker, continues to support and gain medical engagement to support the IPC strategy and compliance with the antimicrobial stewardship.

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In order to provide senior pharmacy antimicrobial leadership the pharmacy staff have been reconfigured to ensure robust leadership and to embed antimicrobial pharmacy in all existing pharmacists’ duties.

The process for recording monthly point prevalence antibiotic audits by Divisions has been established. Each division has set up monthly antimicrobial audits, undertaken by allocated and named foundation doctors.

A4 laminated versions of the local antimicrobial guidelines have been updated and distributed to all wards/depts.

A link to the antimicrobial guidelines is displayed on the front page of the Trust intranet.

Trust prescription sheets have been redesigned with a page specifically for antibiotic use and a requirement to state the indication of the antibiotic

Pharmacy is supporting the monitoring of antimicrobial prescribing at ward level and undertakes a point prevalence audit on antibiotic prescribing.

Education and training

The IPC team has provided mandatory hand hygiene training for all UHMBT employees through induction days, monthly mandatory divisional study days, and ward based enhanced training targeting bank staff.

The induction infection prevention training package was updated to reflect the requirements of new employees entering UHMBT.

The IPC team provided comprehensive Infection Prevention training for the Junior Doctor Induction days.

A high profile poster campaign in support of hand hygiene remains on display across UHMBT sites.

The World Health Organisation (WHO) ‘5-Moments of Hand Hygiene’ is in use across UHBT with the support from communications. This campaign continues to be communicated both internally and externally with the support from local media.

The IPC team continues to work collaboratively with suppliers and procurement team to audit and monitor standards relating to hand hygiene, environmental and equipment decontamination and sharps management.

Additional on-going Infection prevention surveillance and support continues across UHMBT with daily infection prevention visits to high risk areas.

Bespoke infection prevention training continues to be provided by the IPC team for staff on wards and departments, international new recruits and apprentices.

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Bespoke infection prevention training has been developed, in line with HBN 00-09, for all preferred contractors coming into UHMBT. This training is a pre-requisite for contractors to undertake prior to working on site.

The Infection Prevention Clinical Support worker provided training sessions on commode decontamination to operational staff within the ward environments.

The IPC team continue to work with the Trust’s Engagement Manager to develop a group of patient volunteers to support hand hygiene promotion across UHMBT.

The IPC team continue to work with clinical staff and support clinical site managers with safe bed utilisation. A training package has been developed to support this and this training continues for all staff across UHMBT.

A training package has been developed to support staff with bed washing and cleanliness standards for safe bed utilisation. This training continues for all operational staff across UHMBT.

The IPC team facilitated the national anti-biotic awareness and hand hygiene days across UHMBT. These days were supported by UHMBT Consultant Microbiologists.

Providing a clean safe environment

The IPC team continue to monitor, on a weekly basis, the usage of isolation rooms to ensure that patients affected with diarrhoea were allocated an isolation room in a timely manner. This information is shared with matrons, assistant chief nurses and bed mangers to allow an informed risk assessment to be undertaken of isolation room use.

The IPC team continue to have a daily presence at the ‘patient flow’ meetings, established across UHMBT, and support unlocking delays in patient discharge and therefore reducing hospital stays, for appropriate patients.

IPC team continue to be involved in capital planning schemes to support the needs of IP across UHMBT in refurbishments and new builds.

IP Matron continues to co-chair the monthly cleanliness meetings chaired by the Estates and Facility Manager.

All divisions, including estates and facilities continue to support the environmental/clinical and antimicrobial audits that were reported to the IPOG, IPCC and cleanliness meetings.

UHMBT continue to use ward fogging, a specialised decontamination method for the removal of environmental contaminants.

Adenosine Triphosphate (ATP) hygiene monitoring is available to use alongside fogging and provides objective information on the cleanliness of the environment prior to and following the process of fogging.

The IPT have supported the standardisation of products across UHMBT in 2015/16. Products standardised include decontamination wipes, patient cleansing wipes, blood and body fluid spill kits and patient disposable wash bowls. The process has been undertaken with procurement and supports the Lord Carter approach to standardisation.

A paper developed by estates and facilities, health and safety and infection prevention was submitted to the director of finance for UHMBT for consideration. This paper will be reviewed and considered as part of 2015/16 capital planning schemes. The paper demonstrates rationale to increase the number of staff within domestic services to provide 24 hour domestic cover across the organisation.

Domestic staff continue to provide cover in all patient areas until 20.30hrs seven days a week and then the rapid response team was employed within FGH and RLI to provide night cover.

Training for domestic staff continues to be provided by British Institute for Cleaning standards and is refreshed annually.

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Matron’s environmental audits continue to be undertaken six monthly, supported by estates and facilities teams.

Monthly environmental audits continue to be performed by each division.

Patient environmental services continue a cycle of regular audits of patient environment.

UHMBT cleanliness and infection prevention group continue to meet monthly with the matrons and reviewed any issues identified by monthly audits. Action plans were generated, monitored and escalated through this group as appropriate.

Decontamination services across all sites for UHMBT are centralised with an accredited facility on both the Royal Lancaster Infirmary (RLI) and Furness General Hospital (FGH) sites.

UHMBT Theatres have continued with annual servicing of the ventilation systems. In addition regular microbial air count monitoring has taken place.

Water Systems Management

Following the Department of Health publication, ‘Water sources and potential Pseudomonas aeruginosa contamination of taps and water systems: advice for augmented care units’ (2012), UHMBT have continued to test and monitor waters from augmented care areas. Additional areas were tested if there was a clinical suspicion that waters may have been linked to a patient’s infection or colonisation. The consultant microbiologists have continued to give advice.

UHMBT strategic water safety group is responsible for the oversight of water safety and continue to meet on a quarterly basis.

Estates and Facilities, laboratory staff, consultant microbiologists and the IPC team have continued to support the water management process across UHMBT.

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Communications

The IPC team continue to meet monthly to update each other on areas of work and plan ahead. All IPN’s receive an annual appraisal.

The IPC team continue to work collaboratively with UHMBT communications team who disseminated IPC communications both internally and externally as required. This was also supported by local media across Lancashire and Cumbria.

The IPC team have an established Twitter account that enables communication internally and externally with the public and other organisations.

A communications campaign, supported by local media, continues to raise awareness of gastroenteritis and risk factors when visiting the hospital.

The Friday Message and Chief Nurse Newsletter continue to support and cascade messages from the IPC team across the organisation.

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Final Message 2015 - 2016 has been an exceptionally busy and challenging year for the IPC team and UHMBT staff. I am delighted in the number of infection prevention improvements that continue to improve the patients experience and strengthen governance, processes and standards. These improvements demonstrate UHMBT’s commitment to harm free care and reduction in avoidable health care associated infections. Together with our staff, governors and volunteers we have created a vision and values which clearly states where we are going and how, as a team, we will behave towards each other, our patients and partners. Infection prevention and control is the responsibility of all healthcare workers and is fundamental when delivering the vision and values of UHMBT. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating the principles of infection prevention into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care can be minimised. Staff have worked collaboratively and cohesively, across the healthcare economy, to continuously pursue potential improvements to the infection prevention strategy, service delivery and operational practice. Whilst we continue to progress positively we will continue to strive for excellence in order to ensure UHMBT is a great place to be cared for, a great place to work.