Evidence session on Clostridium Difficile

Belfast Health and Social Care Trust

Belfast Health and Social Care Trust
response to the Health Committee

29 February 2008

Belfast Health and Social Care Trust response to 
the Health Committee 29 February 2008

Context

The Belfast Health and Social Care Trust is one of the largest healthcare providers in the UK. It treats on average 142,000 in-patients, and 680,000 new and review outpatients per annum. The Belfast Trust never refuses treatment to any patient, in any condition, and therefore has a complex case mix of the sickest patients in Northern Ireland.

For the first three quarters of 2007 validated figures show for that for every 1000 bed days the overall rate ofC. Difficile among patients 65 years and older in the Belfast Trust is consistently under 1. This is better than comparable organisations in Great Britain. In the area of infection control surveillance the Trust is a world leader. However, the Trust is not complacent and will work to the Minister’s target of reducing rates of C. Difficile by 20% by the end of 2009.

Approximately 3% of the population haveC. Difficile in their gut and 30% of patients over the age of 65 in any hospital are likely to haveC. Difficile present.

Although best-practice will not eradicate the presence ofC. Difficile, the Belfast Trust is clear that in addressing one area of infection prevention and control, it will address all areas of infection prevention. The Trust Board is fully engaged in management of infection prevention and control. There is clear corporate responsibility.

Practices in place in the Belfast Trust to address the issue ofC. Difficile

• Certain micro-organisms – including MRSA andC. Difficile – are known as alert organisms. On a daily basis when an alert organism is identified in our laboratories the infection control team liaise with nursing and medical staff to manage the patient appropriately. This surveillance ensures that the Trust is in a position to have early recognition of an outbreak in an individual clinical area
• The Trust has a programme of training in infection prevention and control for all staff
• There are infection control link nurses in clinical areas
• Belfast Trust has experience of handling outbreaks of infectious agents and will implement its plans in the event of aC. Difficile outbreak; including arrangements for isolation; cohorting; cleaning; and staffing
• Transferred patients are assessed for risk and managed accordingly
• Belfast Trust is undertaking a risk management review ofC. Difficile to further reduce risk

• The Trust is updating its antimicrobial prescribing policies to ensure responsible prescribing of antibiotics
• The Trust is recruiting an antimicrobial pharmacist
• The Trust is issuing guidance on the treatment and clinical management of patients withC. Difficile associated diarrhoea

• The Trust is part of the Institute of Healthcare Improvement’s Safer Patient Initiative which is introducing further opportunities to tackle healthcare-associated infections
• In line with Departmental guidance, the Trust is revising its visiting policy
• Hospital-associated infection reduction plans have been developed for each service area and ensure monitoring of progress against standards. This links to the Changing the Culture initiative at the Department of Health
• Cleanliness: hospital areas are categorised into very high risk; high risk; moderate risk; low risk; and are cleaned appropriately.
• Very high risk areas (e.g., theatres) are ‘scrub’ cleaned every day and after every case. High risk areas (wards) are cleaned daily and check-cleaned twice a day. Moderate risk areas (entrances, waiting areas) are cleaned the same as high risk areas – this is because of the volume of traffic in these areas. Low risk areas are external areas and are cleaned accordingly.
• Internal cleaning audits are carried out regularly and we self-assess ourselves. External audits show that the Trust is meeting its targets and is continuing to improve
• Trust has bids in to access the Minister’s offer of an extra £9m for infection control. It would use the money for enhancing rapid response cleaning.

Figures dated 01 January – 15 February (inclusive) re the number of cases of C. Difficile

Belfast City Hospital 20
Royal Victoria Hospital 17
Mater Hospital 14
Musgrave Park Hospital 1

Explanation of terms

Case: a single episode of C. Difficile
Cluster: over a period of time there will be more than one case but no causal link between them. The patients have not have infected each other or the staff
Outbreak: were cases or clusters start to self perpetuate and infect other people and staff

Figures dated 01 January – 15 February 08 (inclusive) re the number of deaths where C. Difficile was recorded on the death certificate

From 01 January – 15 February 08 (inclusive) there were 6 deaths in the Belfast Trust whereC. Difficile was referred to on the death certificate.