• Trust’s outgoing director of infection prevention and control warns team is “working against a background of governance structures not in line with the Health and Social Care Act”
  • Says “lack of engagement from middle managers, medical and nursing establishment all went under the radar”
  • Adds Medway FT’s new structure and team means there will be “little organisational memory”

An acute trust’s outgoing director of infection prevention and control has warned infection control was “not driven from the centre of the organisation” and that a lack of engagement from managers, and the medical and nursing establishment went “under the radar”.

Rella Workman’s annual report for Medway Foundation Trust, which was delivered to the trust’s September board meeting, detailed eight hospital-acquired MRSA infections and a deteriorating picture on gram negative and C difficile infections. This had prompted visits from NHS Improvement, Medway Clinical Commissioning Group and the Kent and Medway Sustainability and Transformation Partnership.

Dr Workman, who recently retired after 21 years leading the infection control service at the trust, wrote in the report: “The Infection Prevention and Control team and DIPC were working against a background of governance structures not in line with the Health and Social Care Act, where the DIPC did not report directly to the board or the chief executives.

“Infection control was not driven from the centre of the organisation. The four-hour targets, financial pressures and the fallout from the move of the laboratory to North Kent Pathology meant that the deteriorating infection performance or lack of engagement from middle managers, medical and nursing establishment all went under the radar.”

A new structure and team meant there would be “little organisational memory” in infection control going forward, she added.

The trust’s medical director – who is not a microbiologist – has now taken on the DIPC role. The trust, however, said three consultant microbiologists are employed and the team may be expanded in the future.

The DIPC’s annual report also highlighted:

  • The trust’s eight hospital-acquired MRSA cases were all avoidable and “occurred as a result of disjointed consultant ownership, multiple ward moves and suboptimal nursing practice or procedures”, while similar lapses occurred in the C difficile cases;
  • The launch of a pathology venture with Dartford and Gravesham Trust – North Kent Pathology Services – led to delays in specimen receipt and timeliness of results which “had a direct impact on patient management at the ward level and the day-to-day operational work of the infection control team”;
  • For three months, hydrogen peroxide vapour machines – bought specifically to carry out deep cleans – were not used after each case of appropriate infections;
  • A shortage of pharmacists and lack of engagement of clinicians and nurses made it difficult to undertake an antimicrobial prescribing and stewardship programme. Instead, the focus was on achieving Commissioning for Quality and Innovation targets;
  • A lack of engagement meant that post-infection reviews were not held on MRSA and C difficile cases while an attempt to appoint a fourth consultant microbiologist was halted on financial grounds; and
  • When NHSI representatives visited in May, they saw issues with infection control practices on wards from nurses and doctors and felt a drive for improvement needed to come from the senior management of the organisation.

David Sulch, the trust’s medical director and now DIPC, said: “The annual report for last year reflected on where we were at a point in time, and acknowledged that there was more we needed to do to ensure improvements in infection prevention and control to provide the best of care for our patients.

“Much has changed this year in terms of leadership and governance on this important area, and we have in place a comprehensive improvement plan which is being implemented across the hospital. Over the past six months we have reviewed our processes and I am confident we have addressed the issues that had led to a dip in our performance.”