Thursday, 25 September 2008

Infection Control Reflections - An encouraging response

Some time ago I received the following encouraging response to my reflections on infection control practice in my local acute hospital:

Dear Mr xxxxxx

Following our previous e-mails I have some information to share with you.

I have had some dicsussions with the Lead Infection Control Nurse Specialist and we are looking into various ways we can improve the consistency of delivery of the topical treatments for MRSA. We feel that a multi-pronged approach is likely to be most effective and the ideas listed below are just for starters.

Topical treatment issues

    • We are looking into producing posters for applying treatment which would include pictures along with relevant brief text. These could be presented to wards as posters for display but could also be produced as an information leaflet for patients that accompanies the topical treatments to the ward. We will discuss with Pharmacy re putting these posters/leafets in with the topical treatments which could help overcome the lack of information you experienced over the weekend and form part of the overall process improvement.
    • We are investigating the possibility of a topical treatment pack which would include antiseptics, cotton buds, alcohol gel, wipes, information etc but we'd need to find out how we could make this work.
    • We are looking into doing a series of roadshows to educate/re-educate staff on how topical treatments should be applied etc. We might borrow a resusci-Annie type model rather than use real flesh - unless we get volunteers!

We are looking into the general MRSA information leaflet with a view to reworking it. One problem we have is that information leaflets have to be pitched at a certain level ( I think it is a reading age of 11) and if we add too much information we are asked to remove it as it is deemed to be too complicated. However, this is of course difficult given that this means that leaflets are often too bland etc for many people. We will see if we are allowed to produce a range of leaflets but there are all sorts of regulations etc that may prevent this.

Unanswered Questions
1) Our advice re shaving is to use disposable razors for the course of treatment, ideally using the Hibiscrub as the shaving foam. Any personal electric razor should also be thoroughly cleaned prior to re-use in case it's become contaminated.

2) The timing of MRSA screening is continually being reviewed and in fact we generally have a result on which we act within 18-24 hours. The Trust laboratories will shortly be processing and resulting MRSA screens seven days a week (currently 6 days a week) so any weekend delays should be a thing of the past. The issue of discharge screening is one on which there is no national agreement. One problem is that GPs have a variable response to being told a patient has MRSA. Many feel that they do not know what to do and therefore do not want to be repsonsible for informing patients of the results or for any follow up and mangement (I must stress some GPs are great but not all). We have addressed this issue with the PCT and we are currently appointing a PCT microbiologist and one of their roles will be to look into how to manage MRSA in the community and the education etc of community staff.

3) There is no correct dilution for Hibiscrub; it should be applied neat as you discovered.
4) We make widespread use of Infection Control policies and procedures in Sheffield Teaching Hospitals. For example, promotion of hand washing and audit of hand hygiene standards is a key feature of our Infection Control Accreditation Programme. Gloves and aprons are intended for routine use with non-infected patients when having contact with blood or body fluids such as dealing with commodes/bedpans, cleaning incontinent patients etc. Each of these is consistent with the approach of standard precautions, i.e. a set of precautions that should be applied at all times, with all patients, covering hand hygiene, use of protective equipment, disposal of waste, handling of laundry, dealing with blood spillage and covering of cuts/lesions. These are reflected in STH Infection Control Guidelines.

We agree that there is a tension between 'have to do' and 'should do' (point 7 of your reflections) but these targets have actually proved quite helpful to us in IPC to focus minds and resources. There are such a large number of issues which need to be addressed overall and there was a need to refine these to key ones at least to start with. Once these have been addressed other issues can be addressed over time. Please do not think that we will stop our efforts once the headline grabbing issues have been addressed, we have a long list of things we plan to do eventually. As you say these may vary locally but many effect the majority of areas. Also even when we do address something over time people forget etc and things need to be re-iterated time and again. As a Team we do try and help indivudal areas to address issues that are pertinent to them and this will increase once the big, healdine issues that effect all areas are sorted.

We would also like to support the senior managers in the Trust in respect of their efforts in respect of Infection Prevention and Control. They may not be perfect and perhaps come across as having the wrong focus and response when challenged but in our experience they are amongst the most supportive and receptive group of NHS managers and executives that we have come across. We will try subtly to suggest to them ways of reflecting this when they discuss/respond to infection issues publically etc.

Once again , thank you for sharing your experience and thoughts with use. The issues you have raised have been very useful and we will act on as many of them as we can. Things may takes several months to come to fruition but we do want to provide the best service we can although it is a long term project and will keep us busy for many years to come.

Kind regards, Christine

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