The Risk Management of HAI: A proposed Methodology for NHSScotland Consultation Document
ANNEX 2: Examples of practical application
It was noted in late 2003 that there were a number of worrying Infection Control issues within the Renal Unit. Patient throughput had increased, the number of patients with MRSA and Clostridium difficile infections were increasing, and recent environmental audits were poor. Also Central Venous Catheter (CVC) related infections were high, including one CVC Blood Stream Infection (BSI) related death. Risk assessment indicated a red Risk Exposure rating, and Risk Control Levels were poor. Risk Ranking on the risk Register indicated this was a high priority area for immediate action.
A multidisciplinary meeting agreed that the situation was unacceptable and that measures needed to be introduced to effect change. Two new infection link nurse posts were created and an ongoing program of education for the both multidisciplinary team providing care and services within the unit and its visitors.
Utilising monies available from Clinical Governance to fund the services of a nurse two days per week for a 3 month period, a surveillance project was initiated to address the problem of the high CVC related BSI. Infection Control Team liaised with the Scottish Centre for Infection and Environmental Health (SCIEH), producing a pilot audit form. Surveillance, by infection control team and the appointed nurse, commenced for a three week period, quickly followed by the investigation, in March, of the present surveillance program. The objectives for the surveillance was to identify and report incidences of CVC related BSI, feedback to the multidisciplinary team and take action according to the data. Research into connection/disconnection and exit site dressing practice was completed, leading onto audits of nursing practice for these procedures.
Results, conclusions and changes made
Staff training followed in these areas, improving practice and increasing staff awareness regarding CVC related BSI and relevant infection control issues. This resulted in a reduction in CVC related BSI from 4.05 per 1000 days (pilot study) to 2.72 per 1000 days covering the period March to August. The money from Clinical Governance has resulted in lower CVC related BSI and improved patient care. The revised Risk Exposure rating was amber, and Risk Control Level scores were greatly improved. A still better Target Control Level was set to ensure continuing longer term improvements, and a Tolerance Control Level was set to ensure no deterioration from the current status quo.
- Increased renal population
- Increased bacteraemias: 4.05 bacteraemias per catheter 1000 days
- 65% MRSA positive patients
- Poor environmental audit results
- One inpatient death