Infection prevention staff at Pennine Acute Trust take part in national NHS Improvement Project

Lorraine Durham, matron for infection prevention and control; Tracey Shaw, lead nurse – general internal medicine, cardiology and stroke services; Michelle Connaughton, lead nurse – general internal medicine, infectious diseases and respiratory; Val McGuigan, matron division of anaesthesia and surgery

Senior nurses at The Pennine Acute Hospitals NHS Trust are taking part in a national NHS Improvement 90 day project to reduce infection rates in hospitals.

The Trust which manages North Manchester General Hospital, The Royal Oldham Hospital, Fairfield General Hospital, Rochdale Infirmary and community services is taking part in the project to see which infection prevention interventions have the highest impact on a defined number of wards.

Infection prevention and control (IPC) remains high on the public and professional agenda and the NHS Improvement collaborative wants to support Trusts to be fully compliant with the Health and Social Care Act 2008 guidance and to deliver improvements in targeted IPC risk areas.

The rapid improvement team at Pennine Acute Trust includes Lorraine Durham, matron for infection prevention and control; Michelle Connaughton, lead nurse – general internal medicine, infectious diseases and respiratory; Tracey Shaw, lead nurse – general internal medicine, cardiology and stroke services; Val McGuigan, matron division of anaesthesia and surgery and Andrea Shenton, matron acting clinical matron on ward T7 at The Royal Oldham Hospital.

They are collectively working on methods to improve hand hygiene and the wearing of personal protective equipment (PPE) on three wards within the Trust and by focussing on these areas they can discover what works effectively and then roll-out the efficacy to all other wards and departments.

The pilot wards which are involved are G2 at The Royal Oldham Hospital site, ward 21 at Fairfield General Hospital and E1 at North Manchester General Hospital.

Integral to the project is the use of a new colour coded card system in order to improve staffs’ compliance with hand hygiene and the wearing of personal protective equipment (PPE).

The scheme was initially launched last year following a staff engagement project to improve PPE and hand hygiene practice, particularly among medics. Led by consultant physician and rheumatologist, Dr Vinodh Devakumar, he worked with the infection control team at the Trust to look at staff use of PPE, such as gloves, aprons and masks, and their coherence to the Trust’s infection control policy.

A red, yellow and green card system was devised to signpost staff and encourage better adherence to policies around infection control. The concept is adapted from the progressive coloured card system used in football, whereby infection control practitioners issue a yellow card to staff members not complying with infection control policy, for example wearing a watch in a clinical setting or not washing their hands between patients.

Lorraine Durham, matron for infection prevention and control, said: “The yellow card should not be construed as a disciplinary or punitive measure, it should be seen as a gentle reminder and invite for discussion and education surrounding hand hygiene and wearing of personal protective equipment compliance. A record is kept by the infection prevention team of the staff name, position and area of work and the reason for the yellow card being issued. There is no further action at this point as the yellow card is a reminder for staff to reflect on their practice and a chance to get it right next time.

“Staff noted to be receiving more than one yellow card for the same poor practice (or following a specified number of unrelated yellow cards) would, however be given a red card and their manager informed in order to address the situation. By introducing a colour coded card system, there is a tangible and hopefully powerful reminder of the standard of practice both observed, and expected. The cards are a quality gauging process, which unapologetically expect nothing less than excellent standards of care which our patients should receive.”

Dr Devakumar added: “The purpose of the scheme is to cultivate a culture within Pennine Acute Trust, where staff members feel more individual responsibility for maintaining a high standard of infection control behaviour, as well as notifying staff members about lapses in infection control. It also commends those staff which are performing well as green card holders are encouraged to become infection control champions who lead by example and have a positive effect on the whole clinical area.”

The three ward managers, matrons and nursing leads will have colour coded cards with them in order to challenge practice and to identify any gaps in knowledge and therefore discuss and train staff, and generally encourage discussions surrounding infection prevention compliance. Further down the line it is envisaged that all matrons and ward managers within the Trust will be carrying the cards.

Ms Durham added: “The improvement team are also looking at many other areas on wards which may affect infection rates such as staff training levels and cleaning. The team have attended four study days over the last few months along with 23 other Trusts in the UK , to share best practice in health improvement systems and learning experiences with other Trusts.”

Claire Chadwick, lead for infection prevention at Pennine Acute Trust, said: “Hopefully the work for this project will give the team other ideas for improvement projects in the future. It is hoped that by focussing on the three wards across the Trust and working in a supportive way with all the multi-disciplinary teams, we can affect any changes needed and build on the great work already done in these areas.”