Mais les résultats doivent être attendus longtemps et il n'y a généralement pas de temps metronidazole prix L'autre cas, c'est que l'achat d'un ou d'un autre antibiotique dans une pharmacie classique nécessite des dépenses matérielles considérables et pas toutes les personnes ne peuvent acheter des produits pharmaceutiques aussi coûteux.
The royal wolverhampton hospitals nhs trust
Agenda Item Number: 12b
THE ROYAL WOLVERHAMPTON HOSPITALS NHS TRUST
MINUTES OF INFECTION PREVENTION & CONTROL COMMITTEE
HELD ON THURSDAY 28TH FEBRUARY 2008
10.00AM, CONFERENCE ROOM, HOLLYBUSH HOUSE, NEW CROSS HOSPITAL
(Consultant Anaesthetist - Cardiothoracic)
Mrs L Nickell
Minutes of Previous Meeting
Minutes of the meeting held on 31st January 2008 were accepted as a true record.
MC/JO had not had the opportunity to agree action regarding the use of
Cefuroxime by Orthopaedic surgeons, however JO reported that the matter was
discussed at their Directorate meeting and there is a degree of acceptance to
change but the surgeons required reassurance around alternatives.
3.2 Medical Staff IP Mandatory Training – Update
LN circulated a summary of the position to date for mandatory IP training
undertaken by Consultants and Non-Consultants. 77 Junior Doctors and 44
Consultants still had one or more areas of training to complete. All Consultants
have been contacted with their individual training record. Some Junior Doctors
have been paged persistently to give them their information but no response
received. Following discussion around the data, LN to meet with DL outside of
All of the training is covered by Trust Induction and Junior Doctors’ Induction. LN
and VW are working on an inter-active competency package. AP to discuss with
JO reported that the vast majority from his area had responded positively on this
issue but one or two had questioned the need to go through the process as they
consider what they do to be adequate. LN to send a letter to Consultants
explaining precisely what they must do as regards mandatory training. BGM
confirmed that Consultants/Junior Doctors have been told that non compliance
will result in a verbal warning followed 28 days later with a first written warning,
28 days after that a second written warning, followed by dismissal.
It was suggested that non-compliance should result in removal of Clinical
LN to bring updated mandatory training summary to the next meeting.
Environment Group Terms of Reference agreed and to be presented at next
PEAT Inspection will take place 06/03/08.
NVQ Level 2, Infection Prevention, training package purchased. SR to liaise with VW
SR to check that the National Cleaning Standards include regular cleaning of curtain
rails, and six-monthly cleaning of curtains in clinical areas, three-monthly in ICU. DL
suggested that weekly checks on basic cleanliness, i.e. underneath beds, should be
On target to complete Deep Clean by end March 2008. DL asked that meeting the
target was not achieved at the expense of interfering with nurse staffing.
RADAR Plan around National Specification of Cleanliness requires further work.
Targets and timescales to be included in the Plan.
GM raised an issue around deep cleaning in the IC area, and felt it necessary to
identify who is responsible for the deep clean. VW confirmed that steps were
underway to resolve this. DL commented that elective activity needed to be scheduled
CE commented that assurance of what will be happening next year was needed.
MC presented data relating to January 2008.
There were no cases in January, but one in February, bringing the Trust up to its
annual target of 15. This figure includes one case from Walsall.
5 MSSA bacteraemias (1 ES, 2 RDU, 1 D14, 1 D15)
Disappointing rise in proportion of positives that are contaminants. DL asked for
Junior Doctors to be advised of this information.
Figures for January just edged into ‘yellow’. The new targets will prove tough but they
Some wards achieved ‘green’, which was considered remarkable.
February to date has been the worst month for C.Diff for over a year.
The SHA is asking for a minimum target for three years of 10% improvement. AP
considered it important to sign up to the principle of whatever baseline is set for the
next three years and that RHWT agrees to it. MC to compose a letter to Cynthia
Bower for DL signature stating RWHT baseline.
C.Diff toxin positives peaked in November due to Norovirus. VW stressed the need for
January was a good month and February looks promising. RWHT isolates came down
in January, but there was no explanation as to why this should be.
Code of Practice for HCAI Action Plan
VW presented the current compliance with the Code of Practice and an Action Plan to
achieve compliance with the Code. The scorecard showed all core duties as ‘yellow’,
The group was asked to agree the Action Plan and rather than have an annual
programme of work in addition, just use one document combining all the relevant
information. The document will be reviewed as it progresses. This format would then
The Healthcare Commission will be checking on the action around the codes for three
months. It is anticipated that targets will be achieved by the end of May. JV expressed
concern at the density of work required to obtain the targets, however VW was
confident that with commitment in all areas they were achievable. DL asked to be advised of any areas where commitment to achieving targets was lacking. Following in depth discussion, the Committee accepted the proposed Code of Practice for HCAI Action Plan.
Annual Programme of Work 2008/09
Usage of more expensive antibiotics had reduced in January in most areas. Urology continues with high use of Ciprofloxacin, which increased by 150 over last month. Further investigation will be carried out to ensure that circumstances for use are appropriate. Division 2 A marked increase in Ciprofloxacin use was evident in Respiratory medicine and in Orthopaedics, appropriately, for two difficult patients on long term treatment. Use of Cefuroxime decreased in January. Interventions Incidents of Pharmacists stopping the antibiotic have increased now that pharmacists can stop inappropriate use of Metronidazole with Co-amoxiclav.
Divisional Reports – December 2007
Regarding the two incidents of MSSA, GM explained that if a line is put in during an
emergency there is uncertainty around how long it may have been there.
GM to meet with VW around HII gaps in his report for Head & Neck and Urology. This
issue to be brought back to the next meeting under Matters Arising.
Completion of RCAs for MRSA and C.Diff was not considered good. Matron Gill
Holland will discuss at Matrons Meeting.
C.Diff on D18. A number of these were related to Augmentin antibiotic.
A discussion between JO, MC and RF around antibiotics’ use to be continued outside JO/MC/RF
of this meeting.
Dr J Odum left the meeting at this point
10. Report of LNIP
Outbreaks of Norovirus affected a large number of areas in the Trust, with more than
100 patients, 25 staff and some visitors affected. Renal patients in particular were
Several preventative measures have been taken, as listed in the LNIP report.
Attention was drawn to the audit of practice in EAU resulting in low compliance with
VIP score. This was around peripheral cannulation and was considered an issue for
Matrons to deal with. Cannula insertion by ambulance staff not using the same
techniques as the hospital and insertion in patients who do not need a cannula may
Results of the EAU PVC audit were noted in the LNIP report. Matron Andrea Dodds is
developing and initiating an action plan.
An MRSA Screening Working Party is meeting fortnightly to devise a strategy, identify gaps in the MRSA screening process and co-ordinate actions to resolve these issues. New Documents Draft document: Clostridium difficile
A Ward to Board Approach; February 2008. Comments being accumulated.
Dr A Phillips left the meeting at this point
11. Any Other Business
MC reported on an event he attended last week called ‘The HCAI Technology
Programme & Showcase Hospitals 2008’. The Programme is led by Paul Cryer for
selected Trusts (Showcase Hospitals) to use technologies/products over a six month
period and a Rapid Review Panel (RRP) will review evidence submitted by firms
wanting to demonstrate that their technologies will reduce infection. One of the
technologies awarded is Bioquell Hydrogen peroxide vapour system, which is known
to this Trust. The panel will report to the Department of Health through Professor
Duerden, Chief Inspector of Microbiology. The start date is 1st April 2008, with
Showcase Hospitals receiving products in May 2008. Each Showcase Hospital will
appoint a technically trained local lead. Funding of £100K will be provided to boost
this person and associated case for a year. This post needs preferably to be filled
before April. MC and CE to talk about this.
12. Date of Next Meeting
The date of the next meeting is Thursday 17th April 2008, 10.00am -12.00 noon, Conference Room, Hollybush House.
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