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Minutes of the North East Essex Infection Control Committee Meeting

9.30 11.30 am, Friday 7th March 2008 Room 13a, Colchester Primary Care Centre
Members Present: Tim Young Mike Gogarty Jane Bazzali June Wright David Baker Trixie Baines Tony Elston Mohammud Edoo (TY) Chair (MG) (JB) (JW) (DB) (TB) (TE) (ME)

Natalie Coles (minute taker) 1 Apologies: Lynne Woodcock, Wendy Tankard (June Wright representing), Phil Hoile, John Henry, Gary McGuire, Liz Buxton (David Baker representing) Minutes: Infection Control Committee (Friday 14th December 2007) The minutes of the last meeting were agreed as accurate. The following updates were made from the minutes: Pages 1-2 Representation from Essex County Council MG contacted Kathy Mitchell regarding appropriate representation from Essex County Council at the HCAI meeting. Kathy confirmed that Helen Whitting will represent Essex County Council at future meetings. Page 5 Terms of Reference At the meeting on the 14th December it was agreed to review the Terms of Reference (including membership) at todays meeting. This was not included on the agenda, JB to look over the Terms of Reference and NC to ensure this is added to the Agenda for June. HCAI Meeting (Thursday 21st February 2008) The group looked through the minutes from the above meeting and the following updates were raised. Page 2 Renal Unit at Colchester Primary Care Centre The Renal Unit at Colchester Primary Care Centre is commissioned by the PCT. Following 2 cases of C.diff in the Renal Unit, JB and Heather
Infection Control Committee Meeting 07.03.2008

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Dakin visited the unit and raised concerns to the unit manager of the poor infection control. There was only a slight improvement in the cleanliness so MG and Denise Hagel revisited the unit and sent a letter to the CEO raising further concerns. The CEO confirmed the unit manager has been absent from work but will be returning and will address the poor infection control issues on their return. 3 Matters arising: There were no further matters were arising from the above minutes. Outbreaks and Incidents: JB circulated the attached graph. The graph shows the number of both patients (10) and staff (2) affected by an outbreak of D&V in Durban ward at Clacton Hospital.

D&V chart.doc (23 KB)

Standards for Better Health/Core standard C4a: The Infection Control Team are working through the self assessment tool to ensure year end compliance for C4a. They are working with HR to ensure Infection Control is added to all relevant Job Descriptions for staff. The PCT should be compliant for C4a, MG thanked and congratulated JB and TB for all their hard work on this. MRSA: Discussion took place as to whether MRSA and C.diff should be included on the Committee meetings Agenda. It was agreed it should still be and for this to be included in the Terms of Reference. Regional Task Group TE informed the group that the Regional Task Group are working on a policy for patients with MRSA in the community. The PCT would have to implement this policy and this would involve patients in the community being decolonised and notes being obtained from GPs for Route Cause Analysis. Many concerns were raised on this, and the group agreed to look into this more once the policy is out. Current Target The National target for MRSA bactereamia was 12, there have been 13 cases to date. The target was updated to allow for 6 cases in 6 months, to date there have been 4 cases. New Target MG confirmed the Target for next year is 14 cases of MRSA.

C. Diff: The number of C.diff cases in Acute has gone down but cases in General Practice havent.

Infection Control Committee Meeting 07.03.2008

A letter was sent to GPs in the community requesting if when needed they could obtain consent from C.diff patients allowing the Infection Control Team to have access to notes to enable them to do a Route Cause Analysis (RCA). Most surgeries were happy to do this but some have refused. Targets for C.diff per month April 08 March 09 April August ERHT (total for year 161) 14 April- July PCT (inc Gps, community 20 hospitals and any other commissioned beds) (total for year 232)

Sept March 13 Aug- March 19

The group discussed how the amount of antibiotic prescribing in Primary Care has an impact on the amount of C.diff cases. RCAs need to be completed on all C.diff patients first before the amount of antibiotic prescribing can be addressed. There were concerns with this because of the problems around obtaining patient notes from GP practices, MG and JB to look into this. ME suggested for the Health Protection Unit to help obtain the notes and it was suggested to have a GP lead on this group. 8 Antibiotic Prescribing: The attached graph was circulated to the group showing the reductions in the prescribing of Cephs and Quins in GP practices.

MG/JB

Ceph Quin Q1Q2onwards.xls (57...

The message that was put out to the public during Patient Safety Week (Busting the Bugs) was that antibiotics are not always needed. The group discussed the differences in GP and Patient expectations with prescribing of antibiotics. 9 Decontamination update (C4c): Dental Surgeries The PCT arranged a dental training evening for all dentists in North East Essex. The training event provided an update on clinical audit for General Dental Practice and an update on the decontamination legislation and infection control in Dental Practice. All dental practices that attended were asked to complete an audit tool and to produce their own Action Plan. Liz Buxtons team is collating the information from the audits that have been returned. JB needs to let Integrated Governance know whether the PCT is compliant or non compliant with C4c. If it is decided that the PCT is non compliant, it will need to be taken to the board meeting. The standards for decontamination in dental practices are low. JB to speak to Liz Buxton about this. Concerns were raised that either way if the PCT is compliant
Infection Control Committee Meeting 07.03.2008

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or non-compliant they could still be visited by the Healthcare Commission. MG to discuss at Board. GP Practices JB was asked to confirm that all GPs have signed to say they are not using autoclaves and that GP practices are no longer using the wipes, JB confirmed this. 10 Infection Control Guidelines Previous to this meeting JB circulated a copy of the Infection Control Guidelines to members of the group. The document has been set up in sections so that as updates occur just the relevant sections can be changed instead of the whole document. JB to send a copy of the document to ME. The group agreed to approve the Infection Control guidelines and ask for Board endorsement. Deep Cleans: Clacton Hospital Deep Cleans at Clacton Hospital have been completed in 3 ward areas, Reckitts Lodge, Maternity unit and Minor Injuries Unit are still remaining to be completed. Fryatt Hospital Deep Cleans are not being done at Fryatt Hospital yet. JB Learning Disabilities Learning disabilities will be Deep Cleaned, but a date has not been arranged yet. TY asked if a cost benefit analysis could be done for the Deep Cleans once complete. JB and Heather Dakin have recently visited Clacton Hospital, and Heather commented that since she last visited there is a huge improvement in the environment and cleanliness. It was suggested with the high costs involved in the Deep Cleans whether to employ a ward cleaner could be an option for the future. Acute Trust In the acute trust deep cleans took place mainly after outbreaks etc so the areas that are being targeted are the ones that have not had a recent outbreak. PEAT Inspections It was asked if there should be feedback from the PEAT inspections to the Committee. The group agreed. NC to add to the Agenda for the next meeting. 12 Any other business: Walk Around at Clacton and Harwich Hospitals JW asked if there will be any future Walk Around at Clacton and Harwich
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Hospitals. At ERHT one member of the Infection Control Team and an executive director do a walk around on a weekly basis. JB and Lynne Woodcock are doing a walk around after this meeting at Clacton Hospital. JB suggested arranging a walk around monthly, and also for JB and Heather Dakin to arrange a joint walk around the hospitals quarterly. Social Services and Training JW asked about who does the training for Care Homes. The Health Protection Unit arrange the training for Care Home staff. It was suggested whether to bring Essential Steps into Care Homes/Social Services. MG to arrange for JB to and MG to meet with Kathy Mitchell to discuss Essential Steps and other Infection Control Issues arising. Hand Hygiene Audits Link workers at Clacton Hospital are going to do the hand hygiene audits. At ERHT the number of observations have been low, so it has been agreed for the audits to be done in the morning as there is usually more activity. Representation from Provider The group agreed there should be representation from the provider side of the PCT at this meeting. TY to send a letter to Lynne Woodcock. The group discussed the possible effects on this meeting with the provider and commissioning split. The group agreed at present there need not be a representative from ERHT. The group agreed there should still be representation from provision and it was suggested to have a GP or practice manager at the meeting. JB to include the above in the Terms of Reference and Membership. 13 Date and time of next meetings: 4th June 2008 9.30 11.30 am Room 13a, Colchester Primary Care Centre 5th September 2008 9.30 11.30 am Room 13a, Colchester Primary Care Centre 3rd December 2008 9.30 11.30 am Room 13a, Colchester Primary Care Centre

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Infection Control Committee Meeting 07.03.2008