Ring Fenced Beds in Orthopaedics Aintree experience Aintree

Ring Fenced Beds in Orthopaedics - Aintree experience Aintree University Hospitals NHS Foundation Trust May 2015 1

CRG Specialised Orthopaedics • Provider – service Requirements A defined ward for specialist orthopaedic patients ie. ‘ring fenced orthopaedic beds’ < 10% loan kits Defined theatre suite Expertise and volumes CCU/HDU MDT Tertiary referral centres Aintree University Hospitals NHS Foundation Trust May 2015 2

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 3

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 4

BODS Survey Results Do you have ring fenced beds? 27 replies Yes No 19(70%) 8(30%) 3 separate elective facilities Aintree University Hospitals NHS Foundation Trust May 2015 5

Aintree JRU Aintree University Hospitals NHS Foundation Trust May 2015 6

JRU Development • 2000 – Audit of infection • At Best – 6. 5% • At worst – 15% • Independent enquiry Aintree University Hospitals NHS Foundation Trust May 2015 7

JRU Development • Isolated Infection Controlled JRU – Cost benefit analysis – 2005! ‘Space’ suits Theatre discipline Dedicated theatres MDT input – microbiology support Aintree University Hospitals NHS Foundation Trust May 2015 8

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 9

Aintree JRU SOP • 16 A – 12 Beds • 16 B – 8 Beds & 10 daycase trolleys • Restricted access – Screened patients – Visiting 6. 30 – 8 PM • Admission Control – Ward Manager/ Orthopaedic lead/ Microbiology Lead Aintree University Hospitals NHS Foundation Trust May 2015 10

Aintree JRU SOP Aintree University Hospitals NHS Foundation Trust May 2015 11

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 12

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 13

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 14

‘Times of high bed pressures’ • FULL JRU – Full ward under rules • HALF JRU – 16 A isolated behind ‘locked’ doors • NO JRU – Joint Replacement surgery shut down DEEP CLEAN BEFORE RE-OPENING Aintree University Hospitals NHS Foundation Trust May 2015 15

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 16

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 17

Questions? Aintree University Hospitals NHS Foundation Trust May 2015 18