Shared Learning: Infection Prevention and Control

Oldham Care Organisation, Part of the Northern Care Alliance NHS Group

Provide a brief overview of your project:

The incidence of C.difficile infections (CDI) was identified to be a recurring problem on the gastroenterology ward at The Pennine Acute Hospitals NHS Trust. The problem was compounded in 2014 when an outbreak of the hypervirulent 027 strain of CDI occurred in the Trust, which was mostly concentrated on the gastroenterology ward. In response to this, an action plan was developed to mitigate any further cases. This included a number of different work streams being introduced concurrently and sought support from the wider multidisciplinary team to maximise its impact.

As a result of the interventions the rate of CDI attributed to the ward fell by 71.4% from 2015/16 (n=7) to 2016/17 (n=2) and the occurrence of ribotype 027 fell from 4 in 2015/16 to 0 in 2016/17. The interventions resulted in a 17. 5% reduction in the DDD/1000 bed days occupied (BDO) of all antibiotics, 25.6% reduction in the DDD/1000 BDO of carbapenems and a 45.9% reduction in the DDD/1000 BDO of “high risk antibiotics” prescribed. Furthermore there was an average 25.5% increase in compliance with infection control standards during the intervention period.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

Multidisciplinary team meetings were used as a platform to educate the ward’s medical and nursing staff regarding all aspects of antimicrobial stewardship, the importance of prudent antibiotic prescribing. Ward specific antimicrobial guidelines were developed by the microbiology and pharmacy team to promote the use of narrow spectrum antibiotics. Daily visits by the care organisation’s antimicrobial pharmacist helped to ensure that all antibiotics prescribed were reviewed regularly and that an appropriate prescribing decision was made. All of these interventions resulted in a 17. 5% reduction in the DDD/1000 bed days occupied (BDO) of all antibiotics, 25.6% reduction in the DDD/1000 BDO of carbapenems and a 45.9% reduction in the DDD/1000 BDO of “high risk antibiotics” prescribed.

How is the project to be developed in the future?:

The value of this project on improving patient safety has been recognised and the format is being replicated on other wards in the Trust to improve patient care. Due to the nature of the project it is can be easily adapted to facilitate the control of other infections and can be scaled accordingly.


Royal Cornwall Trust (Winner – Antibiotic Guardian Awards 2018)


Provide a brief overview of your project:

It has been suggested that many issues in health care carrying a major threat, like AMR, can be mitigated against using very simple and straightforward changes to practice and behaviour.

The AMR Strategy highlights three such objectives:

  • Good infection prevention and control measures.
  • Effective diagnosis techniques and treatment regimens with adherence to them.
  • Better transfer of education and understanding of AMR.

This prompted the Directors of Infection Prevention and Control at the Royal Cornwall Hospitals NHS Trust (RCHT) to establish a nurse-led project to achieve these goals. Two Nurse Educators were employed for twelve months from September 2016 with funding from the Health Education South West Innovation Scheme and due to it’s success, achieved substantive funding in 2017 for 1 nurse to continue. The ‘Bug and Drug Project’ was a joint venture between Local Authority Public Health (Cornwall Council) and RCHT. The project is entirely innovative with no other national projects to follow for inspiration or to share ideas.

Objectives of the project were:

  • Education:

To deliver a teaching package including preventing infection, and regarding the management of urinary tract infections (UTIs) to Nursing Homes across Cornwall.

  • UTI management tool for adults >65years:

To implement an algorithm to aid the diagnosis and management of UTIs. This followed a change facilitation model and the outcomes were fully evaluated.

  • Public awareness and professional education:

To work with health professionals and the public at an array of events, workshops and teaching sessions by using a locally developed, multi-tiered and integrated education approach that increases understanding of their role in protecting patients against both infections and inappropriate antibiotic use.

Crucially, this scheme aims to bring together individuals from different occupations and agencies in an integrated education approach that increases understanding of their role in protecting patients against both infection and inappropriate antibiotic use throughout the patient pathway.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

  1. Education for Care Homes: Protecting antibiotics by improving understanding of AMR; preventing infection; and improving the diagnosis and management of UTI.

Nurse Educators have visited 50 Nursing Homes out of 53 (94%), and spoken to over 600 healthcare staff. This campaign now focuses on residential care homes. The teaching session has received 100% satisfaction from attendees. There was an 80% improvement in attendees’ knowledge of AMR, and an 88% improvement in the knowledge of best practice for managing UTIs.

The Project delivered an Education Roadshow to 11 venues across Cornwall titled ‘Leaking the News’. Managing conditions better and improving our ‘basic nursing care’ delivery will no doubt relieve the pressure on antibiotic consumption. Over 200 carers, nurses and matrons attended from care homes, domiciliary care agencies, GP surgeries, community hospitals, and community nursing teams. Feedback was numinously positive, with comments that included “this workshop should be mandatory”.

  1. The UTI Management Tool

The UTI management tool was devised to aid health care staff within nursing and residential homes. It encompasses SIGN 88 guidance to focus of the signs and symptoms of UTI’s rather than using dip stick tests for the diagnosis of those aged over 65. The tool was piloted and found to reduce antibiotic usage and improve patient outcomes. Considerable cost savings of almost £1000 per home were found in the 3 month pilot and extrapolated data analysis suggests a potential saving of £500,000 if rolled out county wide. The data collected retrospectively and post-implementation showed that, over the three month period of using the tool, there were only 8 residents diagnosed and treated for a UTI (versus 23 pre-implementation; a 66% reduction). In the three month period of using the UTI tool the use of prophylactic antibiotics reduced from 12 residents to just 1 resident (92% reduction). This work was published in Dec 2017.

  1. Antibiotic reduction in Secondary Care

The UTI tool has proved such a success in primary care that an initiative to reduce urine dip sticking on admission to secondary care has now been undertaken. This change management project has seen a decrease of 60% in the use of antibiotics for treating UTI in our acute hospital.

How is the project to be developed in the future?:

The ethos of this project is to empower carers and nurses in various settings, to make the link between basic nursing care not only to achieve measurable improvement in patient outcomes… but also to the wider global health challenge that AMR presents.

We believe education is key to understanding WHY antimicrobial resistance is an issue to us as care providers as well as humans.

With this is mind the objective of teaching in every care home in Cornwall is becoming an achievement target and a second road show has been organised for May-June. In the autumn we are planning a third road show with a flu and Lower respiratory tract infection (LRTI) theme, which is of course the condition that uses to highest proportion of antibiotics. This session will target vaccination uptake and diagnosing and managing LRTI according to guidelines with the objective being to improve patient outcomes, reduce hospital admissions to secondary care and reduce inappropriate antibiotic usage. A fourth Road show has had much support in focussing on Tissue Viability including surgical site infections and pressure ulcers.

We are confident the already successful formula of education delivery to improve IPC, and understanding of conditions as well as promoting a strategic approach to managing them, will continue to protect antibiotics.

When the funding was achieved for the substantive Nurse post a bid was also granted for an online learning resource hub. This will help RCHT to protect antibiotic use across Cornwall. It is not possible to reach all the primary care staff, secondary care staff, informal carers and care workers through face-to-face education and therefore there is the need to use a digital resource. A library of videos has been created to focus on antibiotic use, UTI, IPC. This focused and central portal will provide the core information that is required in a single place. This resource can then be shared widely with all the target audiences and we can monitor up-take and performance.

The Nurse Educator from the Bug and Drug Project is now steering The Cornwall Antimicrobial Resistance Group (CARG). This innovative and effective committee which brings together key professionals from human, animal, farming and environmental specialities within the county. The work from this group has already had national recognition but one exciting project currently being planned involved the Nurse Educator from the Bug and Drug Project collaborating with a Vet and a Environmental science fellow. This is to deliver education to secondary school pupils in line with their curriculum requirements and covering AMR and antibiotic use, in the hope of both improving awareness of the next generation of health service users and inspiring young people to take an interest in science and health careers.

St John Ambulance and University Hospitals of Leicester NHS Trust

Provide a brief overview of your project:

Antimicrobial pharmacists from the University Hospitals of Leicester NHS Trust work with a team infection prevention nurses, one of which is a volunteer for St John Ambulance (SJA) in the role of Infection Prevention Lead in the East Midlands (North). Together the development of a unique educational session and public awareness campaign was created.

The vast majority of volunteers within St John Ambulance are not healthcare professionals and are trained to provide first aid at a variety of different events from village fairs to providing cover at large stadiums and music festivals. There are also healthcare professionals from all disciplines including nurses, doctors, midwives and those from the allied healthcare sector.

The St John Ambulance infection prevention lead provided an educational session for a large number of St John Ambulance volunteers and covered topics such as antimicrobial resistance, the use of antibiotics and the importance of antimicrobial stewardship. This provided a fantastic opportunity for discussion and questions to be raised and some wrongs to be righted! All volunteers were asked to sign up as Antibiotic Guardians on the AG website and ask friends and family to also pledge.

Whilst providing first aid cover for the Leicester Tigers there was an opportunity to deliver further antimicrobial stewardship education to volunteers not at the education session. Antibiotic Guardian pledge posters were printed out and given to the volunteers enabling them to make an antimicrobial stewardship related pledge. Pictures of the pledges were taken and posted on social media accounts to raise awareness within the first aid community and ambulance services.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

The project highlighted to protect antibiotics via the following three ways in line with national public health campaigns:

1: Providing education for St John Ambulance volunteers in Leicester about antimicrobial resistance, what it is, why it is increasing and what the volunteers can do to reduce the risk of antimicrobial resistance. The use of small discussion groups were fundamental in the session, this allowed the SJA infection prevention lead to gauge the level of understanding among the volunteers. Many of the volunteers were not aware of the gravity of the situation and were shocked to discover that there were simple actions to help prevent antimicrobial resistance increasing.

2: St John Ambulance volunteers were also educated about the appropriate use of antibiotics. Key messages such as antibiotics only work for bacterial infections and not viruses were provided, this was new information for many of the volunteers.  Which infections are caused by bacteria and viruses along with education regarding the culture associated with ‘patients expecting/demanding antibiotics from doctors’ were communicated in interactive way.

3: St John Ambulance volunteers were also educated about the importance of preventing infections. Hand hygiene is very important to minimise the spread of infection to friends, family and themselves. Understanding the importance of preventing infection is essential for all volunteers providing first aid at events. Education regarding transmission of infection, safe removal of personal protective equipment and effective decontamination of the environment are also provided.

How is the project to be developed in the future?:

  1. To continue to work with antimicrobial pharmacists at UHL to ensure current research and understanding is being delivered to St John Ambulance volunteers at an appropriate level.
  2. To increase the education of antimicrobial stewardship awareness to the other areas within the region (Derby, Nottingham, Lincoln and Northampton). There are many adult units in each area that have received no information regarding antimicrobial stewardship and increasing awareness is essential to volunteers providing first aid treatment. To provide refresher training for Leicester based units.
  3. To increase the education and support for those volunteers who provide first aid treatment during events in the importance of preventing infections and understanding how to provide advice to those individuals that present with potentially infected wounds.
  4. To promote the Antimicrobial Guardian pledge and for many more volunteers to sign up to the website.