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Dartford and Gravesham Trust

Kent trust criticised for handling of MRSA outbreak

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An NHS trust has been criticised for its slow response after 14 patients contracted MRSA in less than a year, following the dropping of routine screening.

Dartford and Gravesham NHS Trust was visited by a team from the NHS Trust Development Agency in March, after reporting 14 cases in 11 months – the highest rate reported to Public Health England of any trust in England.

MRSA is a relatively common feature of many surgical site infections

MRSA is a relatively common feature of many surgical site infections

MRSA

The report, included in the trust’s March board papers, said: “The review team are not assured that the trust has taken the necessary action to ensure that risks have been reduced to prevent further cases of MRSA.”

It added there was “an urgent need for the trust to take immediate action… there has been a lack of pace with this high risk situation”.

It said there was a need for the board “to be fully sighted” on the risks around MRSA and board minutes did not reflect the seriousness of the position – although the TDA team were told the directors were “challenging” over MRSA performance.

“There’s an impression that the trust deflect issues outside of the organisation but have not addressed the factors which are within their control,” it said. “There is a lack of ownership of the [infection prevention and control] agenda outside of the infection prevention and control team.”

The dropping of universal screening for MRSA in April 2015 was highlighted as a major factor in the cases and the lack of knowledge around transmission, colonisation and infection – screening has now been reinstated.

Dartford and Gravesham NHS Trust

Kent trust criticised for handling of MRSA outbreak

Darent Valley Hospital main entrance

The team also had concerns over the length of time peripheral lines were left in patients – one patient with MRSA had a cannula in for 40 days. The trust had had just one case of MRSA in 2014-15.

The review team warned that an improvement plan agreed with North Kent commissioning groups in response to the outbreaks would not in itself deliver the improvements needed to prevent cases.

Among criticisms were poor practice around hand hygiene and using personal protective equipment, storage of linen and mattresses, an inconsistent approach to cleaning of patient equipment, and staff being unclear over some approaches.

The infection prevention and control team had been short staffed, contributing to it becoming “reactive and overwhelmed by the situation”, noted the team. Compliance with infection control training by other areas was sometimes poor, and workload and nurse vacancies made it hard for ward teams to take part.

The authority made a number of recommendations and has arranged for a short term secondment of a senior nurse to provide support. It also called for a review of 30 day mortality of patients with healthcare acquired infections, starting with those who had contracted MRSA.

Dartford and Gravesham NHS Trust

Kent trust criticised for handling of MRSA outbreak

Susan Acott

In her board report, trust chief executive Susan Acott said the organisation took infection control seriously and were focused on improving its position, particularly involving MRSA.

“The whole organisation is acutely aware of the problems that the trust is facing and is involved in the remedial action plan,” she added.

Nationally, MRSA cases in the NHS have dropped dramatically in the last decade and there are now only around 350 hospital contracted infections each year. 

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