HCAI improvement: the journey

The Royal Liverpool and Broadgreen University Hospitals NHSTrust manages a total of 870 beds, 47 in-patient wards across three sites, housing 982 medical staff, 1,660 qualified nurses, 1,717 allied health professionals and 1,757 support staff. It offers both regional and tertiary services in terms of renal dialysis and renal transplant, and the hospital houses a state-of-the-art haematology unit, and cares for patients with very complex pancreatic conditions. On average, the Trust sees 54,000 inpatient admissions, 568,000 outpatient visits, and 88,000 A&E attendances and 86,000 day cases per year. The organisation has been rated ‘Double excellent’ by the Care Quality Commission (CQC). Ms Wake took up the position as director of infection prevention and control at the Trust three years ago. Explaining the journey undertaken by the Trust in relation to HCAIs, she said: “In the time I have been here focusing on this agenda, it has sometimes felt like we were working against the tide. One of the keys to reducing HCAIs has been the hard work that has gone into embedding our mission vision and values throughout the organisation and everyone’s commitment across the board to reducing healthcare-associated infection.” The hospital has received Government approval to build a new hospital, to replace the existing ageing Royal Liverpool University Hospital and it is hoped that this will be completed by 2016. The new hospital will consist of 100% single rooms, all with en suite facilities. The current Royal Liverpool Hospital site has very limited single room accommodation, with the majority of accommodation on the inpatient areas being six-bedded bays. “In the acute medical unit, which takes all the emergency GP medical referrals we only have one single room, making it a challenge to safely isolate and manage patients,” said Ms Wake. “The commitment and dedication of our staff and their vigilance on this agenda has been key.”

 Zero tolerance

Discussing the Trust’s aim to achieve zero tolerance for HCAIs, Ms Wake said: “We are on a journey to zero which has provided some challenges. In 2007 the Royal Liverpool was a national outlier for its performance in terms of HCAIs. In a bid to understand the reason for this, the Trust undertook a detailed analysis of the systems and processes to address HCAI reduction. “We needed to compare our cleaning regimes to those of other organisations, locally, regionally and internationally,” said Ms Wake. As part of this comparison exercise, Ms Wake and a team of clinicians were funded by the PCT to travel to The Johns Hopkins Hospital in Baltimore in the US. In 2007, Johns Hopkins published that, within its hospitals throughout Michigan, there had been no healthcare related bacteraemia for over 12 months, in its critical care facilities. “We really wanted to find out more about how this had been achieved. In 2007 we had reported 72 cases of MRSA bacteraemias and we needed to radically change this,” said Ms Wake. The Johns Hopkins Hospital identified that its reduction in HCAI rates was partly related to its system for deep cleaning. On the educational trip Ms Wake found out about the practice of hydrogen peroxide vapour (HPV) fogging of rooms following patient discharge, and this really interested her. On her return, she gave a presentation to executives and the Trust board and a decision was made to look closely at current cleaning procedures and to consider wholesale change within the organisation. “We had to look closely at the benefits and risks of introducing a new system. We needed to embed training and to retrain staff, making sure that the training was robust and to ensure that we could provide ongoing support to clinical areas where we would be making radical changes.