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Healthcare associated infections in Cwm Taf Health Board

Cwm Taf Health Board takes the safety of patients very seriously. This means doing everything we can to reduce the risk of anyone acquiring an infection while they are in our care. Infection prevention and control is regarded as everyone’s business and we are committed to supporting staff in preventing infections. We have a zero tolerance approach to preventable infections.

HCAI Report

An infection occurs when a germ (bacterium or virus) enters the body and attacks or causes damage to the whole body or part of it. Some infections can reach the blood stream and become generalised throughout the body. This is known as a bacteraemia or bloodstream infection.

Healthcare associated infections (HCAIs) are infections which develop as a direct result of medical or surgical treatment or contact in a healthcare setting. They can occur in hospitals, health or social care settings in the community and can affect both patients and healthcare workers.

We know that on any one day in Welsh hospitals, one in 25 hospital patients will have a healthcare-associated infection. This is similar to hospitals across the UK and Europe.

Common infections include Clostridium difficile (C.diff) and methicillin resistant Staphylococcus aureus (MRSA) and these infections are counted monthly in every health board and NHS trust which treats inpatients in Wales.

Staphylococcus (Staph) aureus is a very common germ carried by many people but it is also a common cause of both community and healthcare infections. Some of these Staph aureus are resistant to some antibiotic treatments and these are known as MRSA.

Clostridium difficile (C.diff) can cause diarrhoea, especially when it infects people who have had antibiotics, and it can sometimes cause very serious illness. Controlling it can be difficult because the germ produces spores which can remain in the environment for long periods of time.

High standards of cleaning are needed to remove it so areas where patients may be particularly at risk or where someone has the infection are cleaned with products containing chlorine that destroy the spores. Hand hygiene is also very important – hands must be washed with soap and water to remove the spores as they are not killed by using alcohol hand gels.

Unfortunately, the fact that someone is in hospital in the first place makes them more vulnerable to infections. Sometimes the illness the patient has means their immune system is under pressure which increases their susceptibility to picking up an infection. Being in close proximity to other people who are ill also means there is a higher risk of passing on an infection.

This means we know that hospitals will always be places where people are at increased risk of getting an infection and while there is no one thing that we can do to eliminate such risks, there are a lot of measures we can and do take to significantly reduce that risk.

The health board takes actions to prevent infections in the first place and to prevent the spread of infections where they occur. Such measures include significant staff training, hand washing, hospital hygiene, careful management of catheters and other medical devices and preventing the unnecessary use of antibiotics.

The numbers of infections reported here include the number of patients with C.diff, MRSA and MSSA in the health board area (including samples from GP practices). In addition, we report the number of patients with an infection who have been in a general acute hospital. These numbers are based on where the patient was when the test was taken and include inpatient wards, outpatients and those who attended A&E.

We also report these numbers per 1,000 hospital admissions and per 100,000 population. While we report these numbers related to hospital admissions, this does not necessarily mean that the patient acquired the infection in hospital, even though it was diagnosed there.

This information will be updated every month. The data published for the current financial year (April-March) is provisional and may be modified as further information becomes available. Provisional information is marked in red.

Information on deaths where C.diff was recorded on the death certificate is provided by health board and by general acute hospital.

Deaths mentioning Clostridium difficile (as underlying cause or mentioned on death certificate) by major acute hospital site in Cwm Taf Health Board, all persons, 2008-2012:

Hospital 2008 2009 2010 2011 2012

Prince Charles Hospital, Merthyr Tydfil

26 11 8 <5 6
Royal Glamorgan Hospital, Llantrisant 21 10 10 5 <5

 

For a number of years, Public Health Wales has made national data available on a range of HCAIs on the Welsh Healthcare Associated Infection Programme website.

From July 2013, and for the first time in Wales, individual health boards and NHS trusts are making HCAI data available directly on their websites.

In providing this information and data the NHS in Wales is demonstrating its commitment to providing more:

  • Openness, transparency and candour
  • Accurate, useful and relevant information

In December 2011, the Welsh Government asked healthcare organisations and Public Health Wales to work together to produce data and information in a form that was easily accessible and understandable. This is available here

As an organisation, we have been working hard over recent years to reduce the rates of HCAIs in Cwm Taf. These efforts are reflected in the decrease in C.diff rates over the last few years. We have implemented a C.diff care pathway to ensure patients receive appropriate treatment with close monitoring and that infection control measures and procedures are followed to prevent spread.

There has been a slight decrease in MRSA bacteraemia rates over time but there has not been a significant change in the trend (rate per 100,000 population).

The increasing trend in MSSA bacteraemia rates over the last few years is reflected across Wales. The majority of MSSA infections were in patients who were admitted to hospital – the infection was not acquired during the patients’ stay in hospital.

Over the last month there has been a slight increase in MSSA infections in Cwm Taf – but in almost two thirds of cases, patients have acquired these infections in the community, before they were admitted to hospital.

Of those MSSA infections which were hospital acquired, some were related to the use of IV devices. We are carefully monitoring this and carrying out some more detailed work across our hospitals.

Cwm Taf Health Board’s aim is to reduce these preventable HCAIs as far as possible. There are several measures – called care bundles – in place to help prevent these infections and when they do occur to monitor their impact and to have standardised processes for the care and treatment.

The health board’s infection, prevention and control team continues to provide training and education for staff members and conducts regular audits to ensure compliance and that good practices are being upheld. This includes hand hygiene audits where the hand washing of all grades of staff is observed, reported on and measures are put in place to improve practice.

hcai.jpgFor example, a general awareness day about the importance of hand hygiene was held by Cwm Taf Health Board staff at Royal Glamorgan Hospital (pictured) on July 9.

We take HCAIs seriously and we are committed to reducing these rates and exercise zero tolerance towards HCAIs.

The chances of developing some infections can be significantly reduced if healthcare staff clean their hands before and after examining every patient. However, for a number of reasons, including time pressures on staff, this does not always happen.

Ask the healthcare staff who come to examine you if they’ve washed their hands or used the alcohol rub, which should be available on every ward. Remember there is no need to feel embarrassed or awkward about requesting that staff clean their hands. For more information, visit the Clean Your Hands website.

The same advice for hand-hygiene also applies to visitors providing personal care, such as bathing, washing, dressing, helping to feed and toileting for the patient. The staff caring for you should always offer you the opportunity to clean your hands after using the toilet or bedpan/commode and before eating drinking or taking medicines. Cleaning your hands at these times can reduce your risk of getting diarrhoeal infections such as C.diff.

Tell your doctor or nurse if you’ve been taking antibiotics prior to your admission to hospital. This will have a bearing on the treatment given to you in the event of an infection developing.

Try and ensure you have no more than two or three visitors at any one time. Friends and family who are ill – for example, suffering from coughs and colds, or diarrhoea and/or vomiting – should stay away. If they are unsure, you should advise them to phone the ward and ask a nurse for advice.

Please heed the requests of staff for visitors to leave if, for example, you need to be examined, have your dressing changed or your ward area needs to be cleaned. It is sensible to take children only if absolutely necessary and it is important they are kept under control by an adult visitor.

Patients may be isolated or “barrier-nursed” to help prevent the spread of infection to others. In some cases they may be placed in single rooms or cubicles. It is always best to ask the hospital staff caring for the patient about the procedures to follow while visiting.