Infection Prevention and Control
Infection prevention and control remains a major challenge in health and care settings. Nurses at all levels and in all specialties and environments are involved in initiatives aimed at preventing or minimising the spread of infection. This award was for individual nurses or teams working in acute or community settings, in the NHS or independent sector, and aimed to recognise projects that take an innovative approach to this important area of practice.
Central Surrey Health
Reducing inappropriate urethral catheter use in the community
Urinary catheters significantly increase the workload for district nursing services and are a major burden for health care associated infections. There is often a lack of information on referrals regarding why a urinary catheter was required or plans for removal (Prieto et al., 2020). In 2023, we identified that 21% (83/398) of the district nurses patients had a urethral catheter, and an audit highlighted that the clinical indication was unknown for 44% (19/43). The quality improvement project aimed to reduce inappropriate urethral catheter use. Following a process mapping session we completed a driver diagram. We then looked at what we could realistically achieve with the team of people who chose to be involved with the project. Many of the community nurses did not know when a catheter should be used so the first step was to improve the teams knowledge, this training was provided by the IPC nurse with support from the catheter specialist. Initially the district nursing team appeared reluctant and felt it was a huge task, but they quickly realised how beneficial the project was and it didn't take long for them to get engaged and to share the improvements with other district nursing teams within the organisation. We also set up a multidisciplinary team meeting with the local acute urology nurse to provide her expert advice, this has supported some of the more complex removals. IPC have provided bi - weekly drop ins to support the district nurses and project champions within the district nursing team have played a vital role in the success of the project. Future plans for this project include project training to be given in the mandatory training and monthly catheter reporting to the quality and governance meeting to ensure patients continue to be assessed.
HCA Healthcare
Reduction of bacteraemia in ITU
There was a slight increase in bacteremia noted within the ITU, prompting action from the IPC team. Following a collaborative effort involving the IPC team, the ward manager, and the matron, an analysis of potential contributing factors was conducted, culminating in the development of a comprehensive plan. To address the issue, several measures were implemented. First, a daily line assessment protocol, conducted by the nurse in charge, was introduced to promptly identify and remove unused lines, reducing the risk of infection. Additionally, a restriction was placed on doctors, prohibiting them from drawing blood from the lines, though this posed a significant challenge. To bolster infection prevention measures, all staff underwent retraining in ANTT protocols and were equipped with updated tools and equipment. Furthermore, new covers for line tips were introduced to enhance barrier protection. A count days system was established to track infection-free periods, providing a tangible measure of progress. Given that the majority of bacteremias were gram-negative, a dedicated drain disinfection program was initiated to mitigate this specific risk.
These proactive measures underscored a concerted effort to enhance infection control within the ITU, emphasizing collaboration, training, and targeted interventions tailored to address identified challenges.
HCA Healthcare
Invasive device leadership round
The patient cohort in our acute rehabilitation units consist of patients with high dependency and complex medical histories often accompanied by colonisation with multi drug resistant organisms (MDROs). This combination of risk factors poses a higher risk for developing bloodstream infections . Our initiative, "Leadership Invasive Devices Round," aimed to tackle the critical issue of the excessive use of unnecessary medical devices, such as PICC lines and urinary catheters in long-stay and rehabilitation patients. Prompted by a wider initiative aiming for the reduction of bloodstream infections, particularly amongst this cohort, we identified a pressing need to review and rationalise the use of these devices in this patient group. We approached the problem by establishing nurse-led interdisciplinary rounds, focusing initially on the ward with the most complex patient group, due to its high prevalence of patients colonised with MDROs and invasive device usage. The rounds involved a detailed review of each patient's need for invasive devices, utilising real-time data collection with MS Forms and Excel, filled out at the bedside on iPads. Our team was led by Infection Control Nurses and involved nurse leaders, bedside nurses, and Resident Doctors. In weekly rounds the necessity for each device was assessed and discussed while developing a weekly routine to assess, discuss, and decide on the necessity of each device. The primary challenges included overcoming resistance from staff accustomed to traditional practices and engaging Resident Doctors consistently. Despite these hurdles, we were able to remove 16 unnecessary medical devices since the implementation in November 2023, and improve compliance with care bundles. Moving forward, we plan to extend the initiative to other departments and integrate the approach into standard practice. Our ultimate goal is to institutionalise a culture of safety, vigilance, and continuous improvement, reducing hospital-acquired infections and enhancing patient care across the board.
Leeds Teaching Hospitals NHS Trust
A SIGHT C. difficile campaign 16 years on – a reduction of cases in specialty and integrated medicine
The Specialty and Integrated Medicine (SIM) unit in Leeds Teaching Hospitals Trust (LTHT) experienced a 44.7% rise in cases of Clostridioides difficile infection (CDI) in 2022/23. In the first half of 2023/24 CDI cases increased at a similar rate. In this clinical unit, 13 of 17 wards are for older adults and clinical concerns were raised as mortality rises following CDI in adults over 65, and steeply in those over 85 (UKSHA 2023). Control of infection in this group is difficult due to complex care needs, and confused patients walking with purpose. In 2023/24, LTHT agreed a trust-wide annual commitment to reduce healthcare associated infections (HCAIs), the SIM unit embarked on a 10-week multidisciplinary campaign to drive the reduction of nationally reportable CDI. Following an initial staff focus group exploring areas of new opportunity, a wide range of interventions were structured around the mnemonic SIGHT (DOH 2008) with a campaign strapline ‘Keep your eyes on best practice, Spread the message, not the spores!’. Since the introduction of the campaign, the unit experienced stabilisation of CDI in Quarter 3, and a reduction in Quarter 4 2023/24. In April 2024 SIM had only three cases of CDI compared with eight in April 2023. The CDI per 1000 bed-day data demonstrates that infections were below the mean for the last six months of the year. It is hoped the evaluation of, and sharing learning from, the campaign will have a positive impact on future HCAI reduction campaigns across our large Teaching Hospitals Trust, which will impact positively on both patient safety and experience. Resources from the campaign have been shared with the UK Health Security Agency (UKHSA), and the SIM team are planning to present at the UK’s Infection Prevention Society conference and hope to publish in national IPC journals.
Lincolnshire County Council
Education framework for adult social care
The LCC Health Protection Team have historically delivered an Infection Prevention and Control Link Programme. We saw an opportunity as we came out of the pandemic to review the current Link Programme and spent 12 months developing an Infection Prevention and Control Link Champion Education Framework. The previous iterations of the programme had previously been ad hoc, so the purpose of the framework was to provide more structure to the annual programme and deliver value to our Adult Social Care Residential Settings. The framework was adapted from Irelands HSE Infection Prevention and Control Guidance with their permission, and incorporates NHS England's Infection Prevention and Control Education Standards. During the development stage of the framework, the Health Protection Team engaged with our current IPC Link Champions to understand what they wanted from the annual programme going forward. Their feedback in terms of modes of delivery was invaluable in terms of informing the final programme. Whilst some Link Champions engaged with the development of the framework, of the 287 residential and nursing settings, approx. 50 homes provided feedback to us in terms of programme delivery. A broader view from across the different ASC settings e.g. Learning Disabilities Homes, would have given a more representative view and insight into the programme. Despite these challenges, the framework launched in April 2024 at a conference organised by the team with over 100 delegates in attendance. An introductory session to the framework enabled us to gather in person and timed feedback regarding the delivery of the programme going forward using Menti Meter and a post conference evaluation. The programme will be delivered quarterly in 20024/2025 and review each year to ensure that the content is relevant and evidence based and will be evaluated following each quarter and an end of year evaluation.
LloydsPharmacy Clinical Homecare
Management and monitoring of catheter related blood stream infections in clinical homecare settings
In response to a spike in Catheter Related Blood Stream Infections (CRBSI’s) within a small-time frame and geographical area in May 2022. LPCH reviewed and restructured our processes following receiving a report of confirmed or suspected CRBSI’s. A National review of current processess were undertaken which identified variences by region of how responses to confirmation of a CRBSI were investigated and reported. There was no standardised process in place, within the incidence system there was no coding specific to CRBSI which was causing miss coding not allowing for a central data set. First process was to set out what the standards of investigation required following confirmation of a CRBSI Second was to formulate a bespoke Root Cause Anaylsis (RCA) form to capture all relivent information for the investigation and outcomes. Thirdly coding was created within the incidence system to allow for data sets to be pulled. Fourth was training and implementation of the new process. Fifth was continous monitoring and defining monitoring periods and benchmarks Some of the challenges were the information recived from the admitting hospital, there have been CRBSI that have been reported to LPCH however did not meet the BAPEN guidance for CRBSI. Therefor processes also had to be implimented on how to downgrade these reports. The future plan is to publish an article with our data sets in from the last two years. The monitoring is being included in both Nursing Governance forums as well as business wide governance forums.
Maidstone and Tunbridge Wells NHS Trust
Quality improvement project to prevent bloodstream infections by improving the care and management of peripheral cannulas
Vascular devices are known to be associated with hospital-acquired infections, including bacteraemia (bloodstream infections), which result in increased morbidity, mortality, and healthcare costs. In 2022/23, the Trust identified seven likely avoidable MSSA bacteraemia caused by peripheral cannulas. With funding from the Kent and Medway Integrated Care Board (ICB), the Infection Prevention and Control (IPC) team at Maidstone and Tunbridge Wells NHS Trust recruited an invasive devices project Nurse on a one-year secondment to undertake a Quality Improvement Project (QIP) aimed at reducing infections related to invasive devices. Consequently, the first six months of this QIP focused on decreasing these infections by improving the care and management of peripheral cannulas, utilising the national Device Related Infection Prevention Practice (DRIPP) resources available at https://dripp.org.uk/Resources/vascular.html The project methodology included • Development and agreement of audit criteria, standards and tools • Baseline audit conducted across 16 wards • Analysis of findings identifying key areas for improvement • Bit size training, including utilisation of drip resources, posters / QR codes and dissemination • Follow up audit undertaken to measure improvement with finding shared via full and summary reports Challenges included: • Difficulty in capturing night staff and busy ward staff in training therefore short training video created and bit sized training • Cannula documentation still in paper format therefore working with electronic patient records team to create electronic version Outcome: • All wards demonstrated an improvement in their compliance (overall improvement of 50%) • There were no peripheral cannula related MSSA bacteraemia reported during the QIP period (compared to 4 during the same period the year before) Future plans include: • Sharing QIP with colleagues in the ICB for shared learning and implementation • Snap shot audit cycle / QIP to be included in annual programme of work to support sustainability of the project.
NHS Dorset and Dorset Integrated Care Partnership
Dorset Hydration Project – every drop, every cup, and every bite counts
In older people, dehydration is far more common, with evidence suggesting a link to urinary tract infections (UTIs), where increased fluid intake significantly reduces the risk. Lack of hydration may result in increased confusion, infections such as UTIs, and consequent risk of falls. ‘Tackling antimicrobial resistance 2019-2024: The UK’s five-year National Action Plan (NAP)’ was published to reduce Gram-negative bloodstream infections (GNBSIs) that cause UTIs and to reduce the use of antibiotics. Therefore, in response to this national initiative and given known increased GNBSIs in older people, this has prompted the development of a Dorset system-wide “Hydration, Nutrition, Continence and C. difficile” group. A range of educational hydration resources were co-designed and co-produced with stakeholders in the form of educational leaflets providing simple, clear, and visual information about the importance and benefits of hydration, a variety of food, drinks, and fruit as well as some of the worries associated with fear of incontinence and increased risk of falls. Other resources included hydration banners, posters, and hydration tabards for staff presenting a visual message, “How do you like your CUPPA?” ensuring that residents were encouraged and offered drinks to their preferences. In addition, the resources were used to reduce UTIs and falls, aligned with the national ambition plan. The pilot took place in 8 care homes, 6 wards in acute trust and 2 wards in community trust from April 2023. We have see excellent innovation and initiative from colleagues who raised importance of hydration among staff, residents ,patients and relative by involving them in various hydration activities. Wards and Care homes reported reduction in falls requiring ambulance and UTIs requiring antibiotics. Our ambition is for all people in Dorset to benefit from hydration to promote thriving communities. At the end of the day, we are the community. Rotherham NHS Foundation Trust
Development in infection prevention and control
Our initiative is dedicated to addressing infection prevention and control (IPC) challenges in all settings across the organisation through various innovative strategies. The initiative recognised the critical role nurses play in leading IPC efforts and involved multiple interventions to promote best practices and improve patient outcomes. The initiative began with investment in the leadership of our Healthcare Support Workers through the Florence Nightingale Foundation IPC champions. We have had 26 colleagues complete this course and we invite them all to the Board of Directors after completion to hand their certificate and ensure a board level profile of the importance of IPC. At the same time as the leadership development we launched the Golden Commode Award. Shared as an idea by colleagues at York Teaching Hospitals, this was embraced as a competition for clinical areas to be recognised in their commode cleanliness. If a clinical area achieved 3 consecutive months of 100% compliance in their commode audits, they received the Golden Commode Award. Two areas achieved the six month milestone and were invited to Board to receive a special trophy and recognition. One clinical area is now on eight months of 100% compliance. Seven clinical areas achieved the Golden Commode Award through 2023/4 The team used IPC week and Hand Hygiene day to further promote good Infection, Prevention and Control practices, using the network of IPC champions to support these messages. A hydration prize (Tea-Pot hamper) was given to Fitzwilliam ward for the most informative IPC display board during this week. By investing in the leadership of Healthcare Support Workers, we have seen a new enthusiasm for IPC. The clinical areas want to strive to achieve the Golden Commode award and take pride in the cleanliness of their areas.