Rewarding the infection prevention champions

The many innovative and effective techniques that have been initiated and employed by healthcare professionals in recent years has resulted in healthcare facilities across the world making good progress on reducing the incidence of HAIs. To highlight the importance of these techniques and to ensure that momentum in the prevention of HAIs is maintained, Kimberly-Clark created the HAI WATCHDOG Awards, to recognise those making a difference in reducing and preventing these serious infections. The goal of the Awards is to publicise the most innovative HAI prevention initiatives and to empower healthcare providers to share and learn from each other through the creation of an HAI WATCHDOG online community via a dedicated website www.haiwatchdog.com. Commenting on the introduction of the HAI Watchdog Awards in the UK this year, Phil Crook, country manager for Kimberly-Clark in the UK and Ireland said: “Kimberly-Clark is committed to working in partnership with hospitals to deliver the best possible patient care and we feel that the HAI WATCHDOG Awards have an important role to play in highlighting pioneering work from across the UK.” The 2011 Awards covered three categories – ICU Infection Prevention, Operating Theatre Infection Prevention and the Clinician’s Choice Award, which was decided through online voting by registered HAI WATCHDOG community members. The winners of each category received a £1,000 educational grant. The winner of the 2011 Clinician’s Choice Award was Hull and East Yorkshire Hospitals NHS Trust for its Give Soap a Chance initiative which was created to raise awareness about the importance of hand washing – not just to hospital staff, but to the general public across the community too. The initiative was originally launched in 2009 and the Trust has worked with the University of Hull Business School to develop a multi-faceted campaign to demonstrate that hand hygiene and reducing infection is everybody’s responsibility and that it was not just a hospital healthcare issue. A website was developed (www.washhands. com) and this was promoted within the community through a series of posters and leaflets to promote it in and around Hull and East Yorkshire. A Business Pack was also produced to emphasise to employers and employees the importance of hand hygiene in helping to reduce sick days and loss of pay. In addition, the campaign included ‘hand hygiene challenges’ in the community to show people how to properly wash their hands. A key success for the project was the launch of Sammy Soap and the Clean Team, a Key Stage 1 teaching pack for primary schools. Sammy Soap now regularly visits schools with a combination of colleagues, ranging from environmental health officers, school nurses, infection prevention and control nurses in the promotion of hand hygiene to school children. Explaining more about the origins of this innovative project, Eileen Henderson, assistant to medical director/honorary clinical tutor Hull York Medical School, Hull and East Yorkshire Hospitals NHS Trust, said: “The campaign originated from the development of a patient leaflet for internal use in the hospital which worked well. We believed that if we could give this information to a wider audience, by taking the same advice out to the community, showing people how to properly wash their hands, we would be able to help reduce infection rates in the community. Of course, we could have taken the approach that this was not actually our responsibility, but we considered it to be a corporate responsibility project.” Eileen Henderson said that the Trust was surprised by the positive reaction the project received. “We never imagined that that the campaign would take off in the way it has. It has a simple message, which seems to have captured people’s attention and we have been getting four or five hits on the website every day requesting packs.” The campaign and the website has enabled the Trust to connect with healthcare professionals throughout the world and the site is now regularly receiving around 1,200 hits every month along with around 20 requests a month for business packs. The campaign has successfully raised awareness of the importance of effective hand hygiene to the whole community and has provided opportunities for collaborative working with business and schools across the region. Commenting on the project, Derek Butler, chair of MRSA Action UK, one of the HAI WATCHDOG Award judges said: “This is an excellent education initiative. The simple message used in hospitals has been taken out into the community to teach everyone the value of hand hygiene.” Unfortunately, the longer-term success of the project may be limited by the issue of funding. “We have limited funds for the project, although we did get some funding last year from one of our Primary Care Trusts. To ensure its longevity the service does need financial contribution. Currently, we are using free promotional streams to help promote the service but we do need to carefully consider how we market and fund the programme going forward. We have looked to see if there is any national funding available for the programme, without success so far, and we are still looking for further funding to help us keep this project moving forward.”

Operating theatre infection prevention

The winning entry in the category of Operating Theatre Infection Prevention was Northumbria Healthcare NHS Foundation Trust for its Zero Tolerance on Surgical Site Infection programme which set out to transform the culture and behaviour of the multi-disciplinary team to reduce infection rates in orthopaedic surgery to below the national average of 1%. Orthopaedic surgeon at the Trust, Mr Mike Reed, took on the role of ‘champion’ for the programme, establishing a team of key opinion leaders across all disciplines to look at the information available and to review current Trust practices that may affect infection rates. For the programme to work it was also important that the entire, 200-strong, team who undertake around 2,500 joint replacements every year, understood why they were being asked to change longheld practices and what was required of them. To further underline commitment to reducing SSIs in its operating theatres across the Trust’s three main sites, two designated SSI surveillance nurses were appointed to follow patients through the care pathway – from surgery, through discharge and on to recovery at home. “With full support from the Trust board and the lead taken by one of our consultant orthopaedic surgeons and microbiologists in December 2008, the first meeting of the Surgical Site Infection Surveillance group took place to take the proactive approach to reducing infections in this group of patients. Our aim was to maintain rates at or below the national average,” said Gail Lowdon, a surgical site surveillance nurse at the Trust. “We wanted to implement and maintain the best evidence-based practice.” Improvements to theatre practice included pre-operative skin assessment and preparation, including MRSA and MSSA screening and decolonising if positive, restricting access to the theatre suite including introducing a colourcoded uniform policy, introducing an initiative to maintain patient temperature, committing to the Patient Safety WHO Checklist which was released in 20091 and further raising awareness among staff of the importance of infection control. A total of 30 changes and standardisation of practice were introduced across 20 orthopaedic teams, working on three different sites. Return to theatre rates have fallen from 2% to 0.5%. Cost savings to the NHS amount to around £1.2 million, based on each local infection costing £12,000. “As with any project, questions were raised as to why the changes were required. However, when the project was explained, it was embraced by the teams, who have been involved throughout this project – we have listened to their views, identified champions to increase ownership of the project, and carried our regular reviews and given feedback,” said Ms Lowdon. Ms Lowdon went into more detail about some of the examples of changes made. “We developed and included the surgical site infection bundle of care into the WHO theatre check list, standardised use of chlorhexidene 2% skin preparation, and ensured that patients’ temperatures were maintained preoperatively and postoperatively through the use of warming techniques. We also standardised use of wound dressings and put into place a system for completing root cause analysis on patients who have a deep infection, to investigate the possible contributing factors that led to the infection and readmission and putting action plans in place, if required, to prevent reoccurrence. It was considered that communicating the policy objectives and the progress of improvements to the team was key to the success of the programme. To ensure that everyone was kept aware of progress, regular updates were given to a number of different groups and committees, including the trauma and orthopaedic board, clinical policy group and infection control committee as well as presentations to community nurse forums, the Trust chief executive and the Trust board. The wider orthopaedic community was also updated via articles in relevant peer reviewed journals. The HAI WATCHDOG Award judges were impressed with the ambition and innovative thinking that went into this programme. Andrea Denton, a member of the Infection Prevention Society’s (IPS) Education and Continuing Professional Development Committee, said: “The campaign clearly showed some innovative thinking and the potential impact of this kind of campaign throughout the hospital could be significant.” Derek Butler, chairman of MRSA Action UK, said: “Taking on these ambitious objectives is all about spending to save. Once resources have been made available you can inspire people to take ownership of change to see it through.” All the changes implemented as part of the programme were monitored and assessed by the project leaders and the results were fed back to the Trust board. The project has resulted in the team successfully reducing SSI rates to less than 1% and the lessons that have been learned by the orthopaedic surgery team have now been forwarded to other surgical categories, including breast surgery, obstetrics and gynaecology and the colorectal unit.