Developing Education, Developing Education, Training and Competence on Training and Competence on

the Wardsthe WardsJanet Shepherd

Deputy Chief Nurse, NHS London

&Pat Cattini

Head Infection Prevention and Control Nurse Royal Brompton and Harefield NHS Trust

If you cannot measure it, If you cannot measure it, you cannot improve ityou cannot improve it

Lord Kelvin 1824 Lord Kelvin 1824 –– 19071907

Define the problemDefine the problem

Data informationProduction of KPI scorecardFeedback to wardsEnsuring staff recognise that reduction of infection is a trust priorityDecide how to further cascade information

The score cardThe score cardUse of SPC provides clarityDefine ‘in or out of control’Know when and where to target Can demonstrate results

Clostridium Difficile Toxin From April 2006Over 65 yr old +ve Patients from KHT requests

05

101520253035404550

Apr

-06

May

-06

Jun-

06Ju

l-06

Aug

-06

Sep

-06

Oct

-06

Nov

-06

Dec

-06

Jan-

07Fe

b-07

Mar

-07

Apr

-07

May

-07

Jun-

07Ju

l-07

Aug

-07

Sep

-07

Oct

-07

Nov

-07

Dec

-07

Jan-

08Fe

b-08

Mar

-08

Weekly SPC Weekly SPC Clostridium Difficile by Week (hospial cases only all ages)

0

2

4

6

8

10

12

14

16

18

04/0

9/20

06

18/0

9/20

06

02/1

0/20

06

16/1

0/20

06

30/1

0/20

06

13/1

1/20

06

27/1

1/20

06

11/1

2/20

06

25/1

2/20

06

08/0

1/20

07

22/0

1/20

07

05/0

2/20

07

19/0

2/20

07

05/0

3/20

07

19/0

3/20

07

02/0

4/20

07

16/0

4/20

07

30/0

4/20

07

14/0

5/20

07

28/0

5/20

07

11/0

6/20

07

25/0

6/20

07

09/0

7/20

07

Week beginning

Num

ber o

f cas

es

C Diff Positive CasesAverageControl LimitU Li i

Tackling the problemTackling the problemCleanlinessAntibiotic ManagementIsolation

Education Education Education!

Educational OpportunitiesEducational OpportunitiesMandatory Infection Control UpdateCorporate Induction Junior Doctor TrainingMedical Staff CommitteeAudit/ Governance MeetingsDivisional Board MeetingsSisters/ Senior Nurse MeetingsInfection Control Committee Support Services TrainingWard Based TrainingHospital Management Committee

Overall aimOverall aim……

Education + Information

= Individual’s recognition of their responsibilities in reducing HCAI

Responsibilities reflected in Job descriptionsKSF – e-tool gateway for career progression

Recognise the problemAlert Infection Prevention and Control TeamUnderstand what to doConformity – use of BSC

TrainingTraining

Ward visits by Infection Prevention and Control Team , - provide on the spot guidance, and re-enforcement DNS / Matrons walk rounds, - heighten awareness on wards

Changing Culture and Changing Culture and PracticePractice

Unconscious incompetence Unconscious competence

Developing the StandardsDeveloping the Standards

Hand Hygiene policy reviewed and expectations made explicitIncreased ward based trainingHCAI Project TeamWeekly hand hygiene auditsFeedback of results

Hand Hygiene Results by Ward/ Hand Hygiene Results by Ward/ DepartmentDepartment

Hand Hygiene Audit by Ward, week commencing:

0%

10%20%

30%40%

50%

60%70%

80%90%

100%

A&E

Bly

th

Bro

nte

Der

wen

t

Ham

ble

Har

dy

Kea

ts

Ken

net

MAC

Win

ter

Cam

brid

ge

Can

bury

Cla

rem

ont

Ale

x

Ast

or

Syc

amor

e

DSU

ITU

Isab

ella

Sun

shin

e

Map

le

Mat

erni

ty

NN

U

Wor

cest

or

Coo

mbe

Mai

n O

PD

Orth

opae

dic

Phy

sio

OPD

Rad

iolo

gy

REU

Thea

tre

Medical OrthopaedicSurgeryCriticalCare

Women & ChildHealth

Other

Ward

Sco

re

WardTarget (Aug 06)

22-Mar-07

Hand Hygiene Results by Staff Hand Hygiene Results by Staff GroupGroup

Hand Hygiene Audit by Staff Group, Week Commencing:

0%10%20%

30%40%50%60%70%

80%90%

100%

Nurses Doctors AHPs Contract Staff Other TrustStaff

Staff Group

Sco

re 22-Mar-07Target (Aug 06)

22-Mar-07

Hand Hygiene TrendHand Hygiene Trend

Hand Hygiene Audits

50%55%60%65%70%75%80%85%90%95%

100%

03/0

7/20

06

17/0

7/20

06

31/0

7/20

06

14/0

8/20

06

28/0

8/20

06

11/0

9/20

06

25/0

9/20

06

09/1

0/20

06

23/1

0/20

06

06/1

1/20

06

20/1

1/20

06

04/1

2/20

06

18/1

2/20

06

01/0

1/20

07

15/0

1/20

07

29/0

1/20

07

12/0

2/20

07

26/0

2/20

07

12/0

3/20

07

26/0

3/20

07

Date

Sco

re

Hand Hygiene Audit ResultTarget

Other initiativesOther initiatives……

Audit of Isolation Practice– Feedback to staff– Re-iterate good practice

Staff knowledge questionnaireUse of HII CDT tool

Competency assessmentCompetency assessment

Observations of careQuestion staff knowledgeUse HII toolUse E-Tool as part of KSFStaff JDsPerformance appraisalNot easy!!

Impact on CDT rates 2006Impact on CDT rates 2006CDT all requests 2006

05

101520253035404550

Jan-0

6Mar-

06May

-06Ju

l-06

Sep-06

Nov-06

+ve HospitalRequests+ve CommunityRequestsAll +ve

Impact 2007Impact 2007……Clostridium Difficile Toxin From April 2006

Over 65 yr old +ve Patients from KHT requests

05

101520253035404550

Apr

-06

May

-06

Jun-

06Ju

l-06

Aug

-06

Sep

-06

Oct

-06

Nov

-06

Dec

-06

Jan-

07Fe

b-07

Mar

-07

Apr

-07

May

-07

Jun-

07Ju

l-07

Aug

-07

Sep

-07

Oct

-07

Nov

-07

Dec

-07

Jan-

08Fe

b-08

Mar

-08

LessonsLessons

CDT is a diagnosis in its own right and requires specific managementImplementation of BMA e-tool CDTFurther use of High Impact Intervention Tool

RecommendationsRecommendations

Ensure clear management directivesStrong leadership Personal accountabilityZero-tolerance poor practiceDo everything

If you get caught on the way If you get caught on the way homehome……