GNBSI programme FAQs from events
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The document compiles frequently asked questions related to gram-negative bloodstream infections (GNBIs) and sepsis, highlighting data capture, epidemiology, community healthcare challenges, and NHS improvement initiatives. It emphasizes the importance of local understanding and cross-system collaboration in addressing GNBIs, alongside targets for reducing infections and improving reporting and leadership in healthcare settings. Additional resources for managing urinary tract infections and sepsis training are also provided, aiming to enhance prevention and control strategies across health systems.
GNBSI programme FAQs from events
- 1. FAQs These are questions asked at one or more of the Gram-Negative Blood Stream Infections (GNBSI) and sepsis contact events over the last year, grouped into themed areas. June 2018
- 2. 2 |2 | Q: How do we capture more information to allow us to understand the unknown causes of GNBSI? Understanding the epidemiology is essential. Entering the data and the risk factors into the PHE HCAI data capture system will allow a better understanding of the national epidemiology. One of the key messages being given at all GNBSI events is that people ensure they have a cross system collaborative working group in order to review their cases and understand their local epidemiology and develop local plans for improvement. We know from the sentinel study completed that 50% of GNBSI are from the urinary tract so that is a starting point however local understanding of your own data is essential for developing local improvement plans. Q: Most of the GNBSIs are community onset. With CCG's having very little access to patient healthcare records how can we find out more about these cases and therefore reduce occurrence? There are CCGs who are already collecting and reporting a core primary care data set for all E coli BSI cases. This is included in the Quality Premium scheme for 2018/19 and CCGs are required collect data for a minimum of 100% of all E coli BSI cases in Q2 and 50% of all E coli BSI cases in Q3. Local cross system groups should discuss complex cases to share learning and identify the ‘quick wins’. Alternative review methodologies are in place by securing resource as part of an acute IPC team or identifying a specific data resource to complete the task. Q: Some CCGs have concerns relating to Information Governance and access to Patient Identifiable information. PHE and organisations such as CCGs and NHS providers can share information where the patient is being looked after from a public health intervention point of view. We are delivering a public health intervention here to reduce healthcare-associated infections, and therefore, PHE have advised that the CCG and the NHS should share the data on their patients and enter risk factor data onto the data capture system. GNBSI Presentation title
- 3. 3 |3 | Q: We often find that it is not easy to identify the source of the E. coli BSIs, despite looking at records and investigations. Is it easier to default to one source to limit the number of further mandatory questions you need to complete? In most instances the team reviewing the patient will have a view as to the source of E.coli BSI and this will be recorded in the medical records. Some patients are complex which is why it is essential to ensure there is wide engagement with all members of the team and discussions about those complexities and where improvements might be made. Q: The urinary tract is not the only cause of GNBSI. How do we deal with GNBSI from other sources? The NHS improvement resource hub has identified a number of interventions people can take to reduce infections from sources other than the urinary tract You will find these on the website under the topic ‘Focus of Infection’ https://improvement.nhs.uk/resources/preventing-gram-negative-bloodstream- infections/ In addition, NHS Improvement is starting to work with the ‘Get it right first time’ (GIRFT) team, and further developments will be published in due course. Q: When you talk about community onset GNBSI, which settings are you thinking of? Community onset GNBSI are specimens collected within the first 48 hours of hospital admission. Review of the case will then identify the province of the patient e.g. care home, own home, community care. Not all of these will be associated with healthcare interventions. Q: Can you clarify the criteria for healthcare associated GNBSIs? A healthcare associated Gram-negative BSI will be a laboratory-confirmed positive blood culture for a Gram-negative pathogen in patients who had received healthcare in either the community or hospital in the previous 28 days. See; https://improvement.nhs.uk/documents/1394/HCA_BSI_definitions_guidance.pdf GNBSI continued Presentation title
- 4. 4 |4 | Q: What incentive schemes are on offer across the health system to focus on GNBSI? Reducing GNBSI will improve patient outcomes in terms of mortality and morbidity, and for organisations, will result in admission avoidance and reduced length of stay. From a financial perspective, the 2017/19 CQUIN scheme for acute providers includes an indicator to reduce the impact of serious infections. This focuses on timely identification and treatment for sepsis and a reduction of clinically inappropriate antibiotic prescription and consumption. There is also a focus on reducing E.coli BSI by 10% 2017/8 and a further 10% in 208/9 across the whole health economy via a Quality Premium payable to CCGs. Incremental premium payments can be awarded where successful reductions that meet the criteria can be demonstrated. Q: What is the GNBSI reduction target? In response to the O’Neill independent review of Antimicrobial Resistance (AMR) in May 2016, the Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI) put forward the recommendation to reduce healthcare associated Gram-negative bloodstream infections by 50% by 2021. With an initial focus on E coli BSI, the reduction target in all E coli BSI reported at CCG level based on 2016 performance data is a minimum of 10%. Further incentives are offered if CCGs achieve 15% and 20% reduction from their 2016 data (https://www.england.nhs.uk/wp-content/uploads/2018/04/annx-b- quality-premium-april-18.pdf). Q: Where will I find examples of work to reduce GNBSI? The ‘Preventing healthcare associated Gram-negative bacterial bloodstream infections’ page on the NHS Improvement Resource site (https://improvement.nhs.uk/resources/preventing-gram-negative- bloodstream-infections/) has resources, tools and local examples of best practice. This is regularly updated. GNBSI continued Presentation title
- 5. 5 |5 | Q: What is the impact of dental prescribing on developing antimicrobial resistance? Dentists are restricted in what they can prescribe on the NHS so for example, they are not allowed to prescribe ciprofloxacin. There has been a lot of work completed by the British Dental Association around educating dentists and dental students on appropriate antibiotic prescribing. Because dental prescribing is a very small proportion of the total antibiotics prescribed in England, we need to be focusing on the larger areas of prescribing such as general practice and secondary care prescribers. Prescribing Presentation title
- 6. 6 |6 | Q: Where can I go for sepsis training resources? “THINK SEPSIS” is a Heath Education England programme aimed at improving the diagnosis and management of those with sepsis; https://www.e-lfh.org.uk/programmes/sepsis/ Q: How can we bring Sepsis Six nearer the patient in the community? The cross-system sepsis programme board, which consists of a group of experts from across the health and care landscape including the UK Sepsis Trust, Royal Colleges, and patients and expert clinicians has published an updated “Cross system sepsis action plan” in September 2017. Actions to improve sepsis interventions in primary / community care include: • Working with GP software providers to update their sepsis alert algorithms. • Supporting the NHS 111 pilot work on clinical remote assessment of sick children. • Embedding safety netting among all healthcare professionals assessing patients with infections. • Ensuring a specific focus on sepsis education for staff groups such as community pharmacists, community nurses, health visitors and healthcare assistants in care homes. • The publication of the CCG Improvement Assessment Framework (IAF) on raising awareness of sepsis amongst healthcare professionals. • Promoting the implementation of a range of educational resources on sepsis produced by Health Education England and Royal Colleges. • Continuing to roll out the GRASP-fever tool in primary care • Work with NHS RightCare to produce a sepsis scenario. This will include sub optimal and optimal pathways, financial and variation data, case studies and other resources. • To encourage the use and evaluation of NEWS in ambulance and primary care services. Sepsis Presentation title
- 7. 7 |7 | Q: Where will I find national guidance for the management of UTI? National guidance on the management of UTI is currently available; https://www.gov.uk/government/publications/urinary-tract-infection-diagnosis In addition, NICE is currently consulting on draft guidance for managing recurrent urinary tract infections: https://www.nice.org.uk/guidance/indevelopment/gid-apg10006/consultation/html- content with publication due in January 2019. Q: What support is provided to GPs to improve GNBSI especially from UTIs/CAUTIs? The PHE Primary Care unit has worked with the Royal Society of GPs to produce resources for GPs and patients – information is on the TARGET website (http://www.rcgp.org.uk/TARGETantibiotics/). These include; • Treatment algorithm • ‘How to prevent UTI and what to do if you have one’ - a leaflet for older adults (out for public consultation) • ‘Treatment of UTI leaflet for patients’ (a leaflet to be given to patients with uncomplicated UTI • Webinar for prescribing in UTI – includes reference materials • Links to free RCGP UTI online course UTI Presentation title
- 8. 8 |8 | Q: What are the opportunities and challenges in infection prevention and control (IPC) and antimicrobial stewardship (AMS) strategies as a result of emerging Sustainability and Transformation Partnerships / Integrated Care Systems? With the support of NHS England and NHS Improvement, three health systems in England are piloting a co-designed system-wide IPC leadership model on their STP / ICS footprints. The learning from these pilot areas will potentially inform future approaches. System working Presentation title
- 9. 9 |9 | Q: What is being done to support improved board reporting of GNBSI and other healthcare associated infections and the quality of infection prevention in a trust? NHS Improvement has worked closely with the CQC to support the development of the Well Led inspections including the review of the IPC leadership, reporting and cross system working. A masterclass for senior leaders, board members and non-executive directors on ensuring board assurance against national standards was held on May 1st. A review of provider board assurance around IPC has been undertaken and regional NHS Improvement teams will be supporting those trusts where a gap in assurance was identified. NHS Improvement has commissioned a DIPC development leadership programme for new and aspiring DIPC to support executive leadership to Trust boards, currently running cohort 1 and a second cohort will be delivered in the autumn of 2018 to support sustainability in the system. Board reporting and leadership Presentation title
- 10. 10 |10 | Q: When will the PHE Data Capture System be updated to ‘community onset’ and ‘hospital onset’ as opposed to ‘Trust-‘ and ‘Non-Trust apportioned’? There is no set date for when this change in terminology will take place, however those GNBSI that are currently ‘Trust apportioned’ will become ‘Hospital-onset’ and ‘Non Trust-apportioned’ will become ‘Community-onset’. Q: Why are there not national IPC policies? NHSI and PHE have recently been working with providers of health and social care to explore whether there is a need for a national IPC Policy and the response to date has been positive. This is one of the workstreams of the NHSI Infection Prevention and Control Programme in 2018/19. Q: Why is there not a public health programme for prevention of UTIs? There is currently a lot of collaborative work both in public health, primary care and secondary care to prevent urinary tract infections. The work across the health and social care sectors has been mapped out so that the most effective interventions can be targeted. Public Health England has a Primary Care Unit that has worked with the Royal Society of GPs and other stakeholders to develop resources to prevent and treat UTIs. Q: Are there any plans to have a campaign to look at improving hydration for the elderly? At the moment there are no plans for a national campaign. NHS Choices provides a number of resources for the public and gives messages about hydration in the prevention of urinary tract infections. See; https://www.nhs.uk/conditions/urinary-tract-infections-utis/#preventing-utis. Local health economies are addressing some improvement initiatives such as hydration and nutrition but including them in other key work streams rather than stand alone. One example: https://www.nice.org.uk/sharedlearning/reducing-incidence-of-urinary-tract-infections-by-promoting- hydration-in-care-homes. Public health Presentation title
- 11. 11 |11 | Q: Where is the guidance on IPC for health building design? NICE has published Quality Standard QS113 Healthcare associated infections - Quality statement 4: ‘Planning, design and management of hospital facilities’ and Public health guideline PH36 Healthcare-associated infections: prevention and control - Quality improvement statement 10: ‘Trust estate management’. Infection prevention and control should be considered when procuring, commissioning, planning, designing and completing new and refurbished hospital services and facilities (and during subsequent routine maintenance). The guidance also refers to ‘Infection Control in the Built Environment - Health Building Note 00-09’ (Department of Health 2013). Others Presentation title