Infection Control News

Hygiene lapses discovered at hospital

Diana Cain — Wed, 10 Mar 2010 10:21:26 +0000

An inspection by the CQC at the end of January saw the hospital meet 13 out of 16 measures of a hygiene code, the Surrey and Sussex Healthcare NHS Trust said. Swift action had now been taken to remedy the remaining failures.

Summing up conditions at the hospital, the CQC said: "On inspection, we found evidence that the trust has breached the regulation to protect patients, workers and others from the risk of acquiring a healthcare-associated infection."

But the report acknowledged there was no cause for concern over 13 hygiene measures "and found areas of improvement in the remaining three".

Key items in the damning report were:

10 soiled commodes in areas within patients' reach.

Two out of five privacy curtains soiled with blood.

No consistently used mechanism in the trust to identify when patient equipment had been cleaned.

In the acute medical unit, two trolley mattresses were badly soiled. One, made up ready for use in A&E had a "foul odour" and the inner foam was wet. Inspectors also found dirt and debris - including a needle - beneath the mattress on two trolleys and blood stains on the underside of the mattress on two others.

In all three of the clinical areas, there were concerns about the standard of cleaning or maintenance of the environment.

Nurses were said to be unclear about cleaning procedures, including the use of equipment for body fluid spillages.

Following the report, chief executive Gail Wannell apologised to patients, relatives and visitors.

"We had been compliant with the hygiene standards since they were brought in and are very disappointed that on this occasion we have let our patients and ourselves down," she said.

Immediate action had been taken to "step up" the cleaning programme.

"We have learnt from this and can assure our community that the majority of the actions have already been carried out," she said.

Mental health care provider fined for standards breaches

Diana Cain — Wed, 10 Mar 2010 09:51:06 +0000

Care Principles, which operates Linden House in Market Weighton, near York, was prosecuted by the Care Quality Commission after spot checks in September 2008 revealed minimum legal standards of care were not being met.

The company, which pleaded guilty to the charges, was ordered by Beverley Magistrates Court to pay £17,015 in fines and costs for the breaches. Offences included failing to dispose of medication that had expired, not keeping drugs at the right temperatures and failing to train staff adequately on the safe storage of medication.

CQC senior enforcement manager Tim Weller said it was ‘disappointing’ that legal action had been required for the infringements to be addressed, although he welcomed the steps made by Care Principles since the legal proceedings had begun.

A new management team took over the health care provider in April last year. Care Principles chief executive Sean Sullivan said: ‘Our focus, as a new management team, has been and will continue to be the welfare of our patients... We will continue to work closely with our regulators to uphold the highest standards.’

Poor hand hygiene caused C diff outbreak that claimed five lives

Diana Cain — Thu, 25 Feb 2010 08:48:46 +0000

Poor hand hygiene has been blamed for a deadly outbreak of C diff which killed two patients and contributed to the deaths of three others.

An internal report into hygiene compliance at Ninewells Hospital in Dundee found that hand hygiene standards had dropped to 85% in the month before the strain of Clostridium difficile (C diff) took hold in the ward.

It also found that the 027 strain of the bug, which infected seven patients in total, “behaved in a very different way with rapid spread and high mortality”.

Two elderly patients died after contracting the bug during the outbreak on 19 October 2009 which is thought to have taken hold through damaged fabric and furniture in the ward.

The NHS Tayside report said that “the ward team worked on a number of initiatives to improve compliance” following the incident but admitted that it was “difficult to understand why in this instance there was continuing spread” of the C diff infection.

Tameside NHS trust to be reinvestigated after residents' campaign

Diana Cain — Tue, 23 Feb 2010 09:34:13 +0000

The trust was found to have some of the highest death rates in the country in November when the independent analyst Dr Foster, published its Good Hospital Guide.

At the time, the CQC was criticised as “toothless” when it claimed that no further action was needed to investigate the trust, previously rated “good” for quality of care.
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But an unannounced inspection in December found evidence that the trust had breached guidelines on the prevention of infections such as MRSA.

The CQC said that it would also look again at mortality rates and surveys of patients and staff at the hospital, while Monitor, the independent regulator for foundation trusts, will also carry out an independent review of the way the trust is run.

Andy Burnham, the Health Secretary and MP for Leigh, appeared last night to back the investigation by the regulators.

He said that the NHS was the finest embodiment of Labour values but added: “There are places where it [the NHS] is not good enough and I will never shy away from saying that. Where it isn’t, we have to bring it up to standard.”

The announcement comes after the hospital’s four local Labour MPs said that they had lost confidence in trust management.

More than 470 people have so far joined the MPs James Purnell, Andrew Gwynne and David Heyes in signing a petition to the Prime Minister that calls for an independent investigation into “a catalogue of failings” at the trust.

Tom Levitt, the Labour MP for High Peak, is also said to support the campaign, and a Facebook campaign with more than 1,500 members also called for bosses to go.

Christine Green, chief executive of the trust, which runs Tameside General Hospital, insisted that the hospital was an effective and safe place to be treated.

The Department of Health said in a statement: “We are pleased that the independent regulators the CQC and Monitor, along with the North West Strategic Health Authority and the Tameside Hospital NHS Foundation Trust are working together to investigate concerns about the performance of the trust.

“Patient safety is our top priority and we expect any issues identified to be swiftly addressed and actions taken to ensure standards are improved where necessary so that local people can be confident in the quality of care provided by the trust.”

Dirty Essex hospitals prompt call for system reform

Diana Cain — Fri, 27 Nov 2009 12:08:18 +0000

The Patients Association said the failings were not isolated cases and patients had suffered a lack of monitoring, lack of help with feeding and a lack of dignity.
Director Katherine Murphy said: "How many times do the public need to keep hearing about this before the government is embarrassed enough to do something about it?

"The evidence was there but not acted on. That is completely unacceptable. The system of regulation and supervision needs to be urgently reformed."

The trust, which has two hospitals serving about 300,000 people, said it was "not complacent".

Most inpatient care is provided at Basildon University Hospital, which has 777 beds, and outpatient care at Orsett hospital in Grays.

Trust chairman Michael Large said: "It is an extremely serious matter and we do not seek to underestimate its gravity.

"I want to reassure our local community that the safety and well-being of our patients is our highest priority."

The trust said more nurses have now been taken on, and a new emergency department is planned.

The Care Quality Commission (CQC) rated the trust as "good" overall in October.

But a new report from an unannounced inspection team carried out by the CQC found evidence of sub-standard care.

The inspectors saw:

• Floors and curtains stained with blood

• Blood-splattered on trays used to carry equipment

• Badly soiled mattresses in the A&E department with stains soaked through to the foam filling

• Items that should only be used once still in use

• Equipment in the resuscitation room that was past the use-by date

• A children's blood pressure cuff heavily stained with blood

• Suction machines contaminated with fluid inside and out with what looked like mould growing on the equipment

The inspectors criticised a poor care environment in A&E, in particular a lack of privacy for patients.

They also highlighted inadequate arrangements to treat children, with few specialist paediatric staff.

The CQC has asked the regulator of foundation trusts, Monitor, to take action.

An expert taskforce will be sent into the trust with a remit to drive rapid improvements in patient care.

Monitor chairman Dr William Moyes said: "We will be reviewing the trust's performance regularly and in detail - if we don't see measurable results quickly, we'll take further action."

The trust was one of the first in England to be granted foundation trust status in 2004. That gives the trust greater freedom to manage its finances.

Death rates

The independent hospital analysis website Dr Foster has found the Essex trust to have a hospital standardised mortality ratio of 136.

This means the rate of death among patients at the trust is a third higher than would be expected by looking at national figures, after adjusting for patients' age and the severity of their illness.

However, senior doctors at the hospital say they have investigated death rates, and do not believe there is a serious problem.

Cynthia Bower, CQC chief executive, said swift action was needed to "nip problems in the bud".

She said: "Our work has uncovered serious failings. The trust has high mortality rates for emergency admissions and we have found evidence of significant problems in different parts of the organisation.

"The trust has taken our concerns seriously but improvements are simply not happening fast enough.

"Our confidence in the management's ability to deliver on commitments and to turn the situation around has been severely dented."

Baroness Young, CQC chair, admitted the current inspection system - which the commission inherited from its predecessor - was flawed, and said reforms would soon be in place.

Political reaction

Health Minister Mike O'Brien said: "Patient safety must be a top priority for the NHS and all patients deserve the highest quality of care."

"We expect these issues to be dealt with quickly and effectively to ensure high quality, safe care for patients."
Hospital bed

Andrew Lansley, shadow health secretary, said: "I am extremely disturbed by this news and the effect that these shocking conditions may have had on patients.

"When the appalling standards of care at Stafford Hospital were revealed we were assured by Labour Ministers that it was "an isolated case" - that sort of complacency is simply not good enough."

Norman Lamb, Liberal Democrats health spokesman, said: "If these reports are accurate then it appears there has been a shocking failure in the standards of care at this hospital.

"People have a right to know how on earth a hospital can be rated 'good' a few weeks before such serious failings come to light."

Clean up and “give soap a chance” says MRSA Action UK

Diana Cain — Mon, 16 Nov 2009 10:59:50 +0000

Give Soap a Chance has been embraced by the public, business organisations and schools across Hull and Yorkshire region. Its aim, to cut down on infections within the community by encouraging proper handwashing, has struck a chord with people everywhere.

Give Soap a Chance was launched in March this year by Hull and East Yorkshire NHS Trust, which capitalised on its success as one of the best in the country at tackling healthcare infections within its hospitals by taking its hand-washing message out into the local community.

Eileen Henderson, Assistant Medical Director at Hull and East Yorkshire NHS Trust, is leading the campaign and was delighted when MRSA Action UK joined the partnership to help promote this campaign. MRSA Action UK fully endorses this campaign, soap and water is more effective on many of the viruses and bacteria we commonly face, hand gels are good in clinical care, but nothing beats the efficacy of soap and water, and of course effective handwashing.

“This is a great campaign and simple too. People often think that infections are something you get if you are in hospital, and don’t think flu or tummy upsets are caused by infections. It’s not just hospital superbugs that cause health problems and sometimes cost people their lives”.

Good hand hygiene is regarded as the single most cost-effective way of tackling infections spread by unclean hands. These include food poisoning and diarrhoea, viruses such as colds and flu, and more serious conditions such as MRSA. In the UK an estimated 32.9-million working days are lost each year through stomach bugs, flu and simple infections.

We hope the Department of Health will embrace this campaign and consider its use in a National Public Information Campaign to reduce the risks from infections that we know is now long overdue.

‘Lessons not learnt’ as five die in C diff outbreak

Diana Cain — Wed, 11 Nov 2009 13:09:46 +0000

Of the eight, two patients died as a direct result of the bug, while it contributed to the deaths of three others. None of the patients has been named.

The news emerged as NHS Tayside, the health board responsible for the hospital, prepared for an inspection from the new Healthcare Environment Inspectorate, an independent body set up by the Scottish government. The study will focus on the affected ward.

Last year, an outbreak of C. difficle at the Vale of Leven Hospital, Alexandria, struck down 55 patients and killed 18. An inquiry into the deaths, chaired by Lord Maclean, is to take place but opposition politicians said yesterday that this should be widened to look at cases across the country.

They claimed the Dundee deaths showed that “lessons have not been learnt” from the previous tragedy.

However, Nicola Sturgeon, the Health Secretary, said “no one should doubt” the SNP government’s commitment to tackling hospital-acquired infections (HAIs). She said she was fully aware of the situation in Dundee and was receiving regular updates.

“My thoughts are, first and foremost, with the families of all those affected and I would like to reassure them that everything possible is being done — both to bring the current outbreak to a close and to ensure that lessons are learned,” she said.

The Scottish government was notified of the outbreak by NHS Tayside on October 21, two days after it was declared. Outbreaks are triggered when three cases are detected within 30 days and regulations state that the government should be informed.

The ward was closed on October 19 but between then and November 6, five patients died. The board also looked back through its records of infections and found another case in September, meaning the outbreak is treated as spanning 10 weeks.

Andrew Russell, medical director of NHS Tayside, justified the board’s decision to make the outbreak public only yesterday. He said: “Our main priority throughout this situation was to deal with this outbreak and make sure all appropriate action was taken as quickly as possible.

“It would have been insensitive to discuss this publicly while the outbreak was ongoing and these patients were very unwell. However, staff on the ward have been in contact with those families involved throughout this period.”

He added that he was confident that the outbreak had been detected early, which meant that staff knew they were dealing with the 027 strain from the outset. Gabby Phillips, the lead infection control doctor for Ninewells, said the ward had been closed to new admissions as a precaution and to allow the infection to be managed.

“There have been no new cases identified in the ward for 10 days,” she added.

“I am confident that all appropriate procedures to deal with this infection were put in place immediately. Since the beginning of this outbreak we have sought external advice regarding our policies and procedures and we are reassured that our surveillance systems are robust.”

Ms Sturgeon said Health Protection Scotland was standing by to provide expert advice and the team from the Healthcare Environment Inspectorate would focus on the affected ward.

Last night, however, opposition politicians claimed the Dundee outbreak showed that too little was being done.

Jackie Baillie, Labour’s health spokeswoman, said: “Behind every recorded death is a personal tragedy but these are particularly tragic because deaths from C. difficile are avoidable. What we are seeing is the cost of Nicola Sturgeon’s complacency and failure to learn lessons from the Vale of Leven.

“Every family has the right to expect that when their loved ones go into hospital they will be treated in clean and safe conditions. This should be the health secretary’s single most important priority.”

Ross Finnie, health spokesman for the Lib Dems, said: “We have consistently argued that the C. difficile inquiry must cover the whole of Scotland.”

MRSA 'not the only threat to NHS'

Diana Cain — Tue, 10 Nov 2009 17:40:23 +0000

The Department of Health said it was already looking into the issue.

In England, MRSA rates are now a quarter of what they were at their peak in 2004, while C. difficile rates have fallen by nearly a third in the past year, following the introduction of targets.

But the MPs said these only accounted for about a fifth of the total number of all infections seen in hospital.

THE OTHER THREATS
E. coli
Pneumonia
Surgical site infections
Urinary tract infections
Gastrointestinal infections
Skin infections

While MRSA is the most high-profile bloodstream infection, E. coli is much more common and has actually increased by a third in the past four years, the report said.

It also highlighted surgical site infections, which were twice as common as bloodstream infections, and respiratory and urinary tract infections, which were three times as common.

MPs warned there was still no robust data on the extent and risks of at least 80% of bugs linked to hospital care.

Committee chairman Edward Leigh said this report was the third time the committee had warned about the threat of other infections, adding it was "disappointing" the issue had yet to be addressed.

"The government has taken its eye off the ball regarding all other healthcare associated infections - which actually constitute most by far of all infections."

The report suggested hospitals start reporting all types of infection and that they look to curb the use of antibiotics.

Antibiotic resistance

Professor Mark Enright, an infections expert at Imperial College London, said: "I can understand why the government focused on the infections it has, but now we are getting to grips with those it is time to look elsewhere.

"There are some strains of infections, such as E. coli, where we are seeing increasing levels of antibiotic resistance and that is concerning."

Nigel Edwards, of the NHS Confederation, which represents trusts, agreed it was time to review other infections.

But he added: "We would want to know the balance of costs and benefits from additional surveillance."

Katherine Murphy, director of the Patients Association, said: "This target culture is just like squeezing a balloon - if you squeeze one end it will bulge out at the other.

"But the problem for patients is that the balloon stays the same size.

"The problem of patient safety will stay the same huge size as long as it is regarded as an optional extra by some."

A Department of Health spokesman said: "We recognise that surveillance of other infections could be improved."

He said experts were looking at what should be done and that the department expected to receive a report on the issue shortly.

Care Quality Commission publishes NHS performance ratings

Diana Cain — Thu, 15 Oct 2009 07:36:44 +0000

While MRSA and C. difficile rates are decreasing, acute trusts still need to do more on infection control. This year 48 acute trusts did not meet at least one of the three relevant standards, compared to 44 last year.

Today’s assessment measures performance in the NHS in key priority areas set by government. Next year, CQC will further develop regulation to become more focussed on patients and outcomes. All trusts will need to register with the regulator to legally function.

CQC said compliance with core standards is a good indication of whether a trust is ready for registration. Overall compliance with standards has increased from 95% to 96%. However, only about half of trusts fully met all core standards and compliance declined in the acute sector with 59% fully met this year compared to 69% last year.

Cynthia Bower, CQC chief executive, said: “The NHS has performed well on quality, which is good news in the face of a rigorous assessment. Those rated ‘excellent’ deserve to be commended – it is not easy to achieve this rating and missing just one standard could drop the score. Trusts rated ‘good’ have also performed strongly.

“But it is clear that some trusts are struggling and that some issues are proving tough nuts to crack. My biggest concern is those trusts that are ‘weak’ and persistently ‘weak’ or ‘fair’. They must do better for their patients.

“I want to ring the alarm bell in the boardrooms of these organisations. Next year, all trusts must register with us to legally function. It is clear that many have significant work to do and a short time in which to do it.”

CQC is committed to making sure that services involve people and respond to their views. As part of this, it is today urging people to comment online about the NHS and their local services.

Results for Quality by trust type

Acute and specialist trusts: 22% are “excellent”, 48% “good”, 25% “fair” and 5% “weak”, compared to 31%, 46%, 18% and 5% respectively in 2007/08.

Primary care trusts: CQC rated 2% of PCTs “excellent”, 51% “good”, 45% “fair” and 3% “weak”, compared to 6%, 27%, 62% and 5% respectively in 2007/08. The improvement is driven by greater compliance with core standards and improved performance against some measurements, including that related to chlamydia screening. However, 22% of PCTs achieved their local plans to reduce the rates of teenage conception.

Mental health trusts: In 2008/09, 30% scored “excellent”, 46% “good”, 16% “fair” and 9% “weak”. Last year, the ratings were 64%, 25%, 7% and 4% respectively in 2007/08. Trusts are now assessed against eight new indicators. Trusts struggled to meet a new indicator relating to quality of basic data which is essential to monitor quality of care.

Ambulance trusts: No ambulance trusts scored “excellent”, two scored “good”, six “fair” and three “weak”. Last year, two were “excellent”, five “good”, one “fair” and three were “weak”. There are seven new indicators in the assessment. Nationally, the number of life threatening calls (category A) responded to within eight minutes dropped from 77% last year to 74.3% this year. However, this still represents a strong performance given a continued increase in calls and the eight minute clock starting earlier.

Core standards with lowest rate of compliance

* C11b (87.6%) – participation in mandatory training

A new registration system

Diana Cain — Wed, 07 Oct 2009 14:29:14 +0000

From 1 April 2010, the regulation of health and adult social care will change. Legislation is bringing in a new system that applies to all regulated health and adult social care services.

All health and adult social care providers, who provide regulated activities, will be required by law to register with the Care Quality Commission. New registration comes into effect on 1 April 2010 for NHS trusts (including primary care trusts) and 1 October 2010 for adult social care and independent healthcare providers.