ring fenced beds in orthopaedics - aintree experience aintree university hospitals nhs foundation...
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Ring Fenced Beds in Orthopaedics- Aintree experience
Aintree University Hospitals NHS Foundation Trust May 2015
Aintree University Hospitals NHS Foundation Trust May 2015
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CRG Specialised Orthopaedics
• Provider – service RequirementsA defined ward for specialist orthopaedic patients ie. ‘ring fenced orthopaedic beds’
< 10% loan kitsDefined theatre suiteExpertise and volumesCCU/HDUMDTTertiary referral centres
Aintree University Hospitals NHS Foundation Trust May 2015
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Why Ring Fenced Beds?
• Traditional (any evidence?)-MRSA screening-Decrease Infection risk
• Quality of Service-Specialist nurses / physio-appropriate environment
Aintree University Hospitals NHS Foundation Trust May 2015
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BODS SURVEY RESULT DEFINITION
MRSA screened elective orthopaedic admissions
+/- screened semi-elective trauma+/- other screened clean elective surgery
Breach = stop elective surgery until deep clean
Aintree University Hospitals NHS Foundation Trust May 2015
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BODS Survey ResultsDo you have ring fenced beds?
27 replies
Yes
19(70%)
3 separate elective facilities
No
8(30%)
Aintree University Hospitals NHS Foundation Trust May 2015
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Aintree JRU
Aintree University Hospitals NHS Foundation Trust May 2015
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JRU Development
• 2000 – Audit of infection
• At Best – 6.5%• At worst – 15%
• Independent enquiry
Aintree University Hospitals NHS Foundation Trust May 2015
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JRU Development
• Isolated Infection Controlled JRU– Cost benefit analysis– 2005!
‘Space’ suitsTheatre disciplineDedicated theatresMDT input – microbiology support
Aintree University Hospitals NHS Foundation Trust May 2015
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JRU Development
• No evidence any one intervention works either locally or in the literature
• BUT
• TKR audit post changes – 0.4% infection rate• Been robustly defended since
Aintree University Hospitals NHS Foundation Trust May 2015
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Aintree JRU SOP
• 16A – 12 Beds• 16B – 8 Beds & 10 daycase trolleys
• Restricted access– Screened patients– Visiting 6.30 – 8PM
• Admission Control– Ward Manager/ Orthopaedic lead/ Microbiology Lead
Aintree University Hospitals NHS Foundation Trust May 2015
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Aintree JRU SOP
Aintree University Hospitals NHS Foundation Trust May 2015
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Aintree JRU Admissions
MRSA screened elective orthopaedic admissions
+/- screened semi-elective trauma
+/- other screened clean elective surgery
Breach = stop elective surgery until deep clean
• But…. We can ½ the ward…. Detrimental?
Aintree University Hospitals NHS Foundation Trust May 2015
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Aintree JRU Admission Criteria
• MRSA Screened patients• No Antibiotics• No evidence infection• Patient zero tolerance to ward discipline• No open wounds / Ex-Fix• Inpatients from other wards
• Revision patients? Separate discussion / exception
Aintree University Hospitals NHS Foundation Trust May 2015
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Aintree JRU SOP
• MRSA SCREENING– Just moved from 4 to 8 weeks pre-surgery– Previous MRSA = 3 negative swabs 1 week apart
• WOUND DRESSINGS– Designated treatment room– Staff yearly aseptic technique assessment
Aintree University Hospitals NHS Foundation Trust May 2015
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‘Times of high bed pressures’
• FULL JRU– Full ward under rules
• HALF JRU– 16A isolated behind ‘locked’ doors
• NO JRU– Joint Replacement surgery shut down
DEEP CLEAN BEFORE RE-OPENING
Aintree University Hospitals NHS Foundation Trust May 2015
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Cleaning specifications
• Daily clean• Enhanced clean– Area gets special attention each day of the week
• Uniform– Nurses have 5 pairs of uniform for JRU only– Blue aprons, hands, BBTE’s etc.
Aintree University Hospitals NHS Foundation Trust May 2015
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JRU Conclusions
• Does it reduce infection rates?– Probably, but we lack conclusive evidence
• Do the patients like it?– Yes, looks professional with specialist staff
• Do the staff like it?– Yes, it is now an essential part of our care
Aintree University Hospitals NHS Foundation Trust May 2015
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Questions?