The Healthcare Commission has announced substantial improvements in infection control at Maidstone and Tunbridge Wells NHS Trust since its investigation in 2007, which identified serious failings.
The earlier investigation estimated that 90 people definitely or probably died as a result of Clostridium difficile, during two outbreaks of the infection at the Trust in 2005 and 2006, along with a further 30 between April 2004 and September 2005. The Commission said “huge strides” have been made since this report and commended the Trust for reporting its lowest rate of C. difficile infection in three years, for the period January to March 2008. However, the Commission highlighted some areas that still require further work such as recruiting more nursing staff and learning from complaints and incidents. The spotcheck in October found a number of breaches of the hygiene code. The most serious breach related to decontamination of equipment in the endoscopy unit. This had been addressed by the time the Commission made its final investigation followup visit to the Trust in November. Key improvements identified in the investigation follow-up report include:
• A re-structured board with new nonexecutive directors and many new directors. This new structure has clear lines of reporting and processes for escalating issues up to the board. Infection control is a consistent item at the top of the board’s agenda.
• New clinical governance and risk reporting structures which allow the Trust to address key risks. A new head of governance and quality has been appointed who has revised the governance committee structure, creating four clinical governance directorates within the Trust.
• Increased leadership, size and effectiveness of the infection control team led by a new director of infection prevention and control. There are two additional senior infection control nurses and a new microbiologist.
• C. difficile is now recognised as a serious diagnosis in its own right, and a “care pathway” has been designed and implemented for patients with the infection, ensuring they receive timely and appropriate care.
• Specific wards have been allocated for the isolation of infected patients.
• Better standards of cleaning and improvements to the hospital environment. Extra cleaning staff have been appointed, new audit systems implemented, and nurses find urgent cleaning needs are more rapidly addressed.
• The removal of beds and the installation of new wash basins to ensure appropriate spacing between beds and improved levels of cleanliness. • An ongoing process for infection control training has been implemented, including areas such as hand hygiene techniques and sharps handling. The infection control team also runs an extensive training programme for other members of staff.
