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

2. 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

3. Aintree University Hospitals NHS Foundation Trust May 2015
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

4. 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

5. BODS Survey Results Do 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

6. Aintree University Hospitals NHS Foundation Trust May 2015
Aintree JRU
Aintree University Hospitals NHS Foundation Trust May 2015

7. Aintree University Hospitals NHS Foundation Trust May 2015
JRU Development
2000 – Audit of infection
At Best – 6.5%
At worst – 15%
Independent enquiry
Aintree University Hospitals NHS Foundation Trust May 2015

8. Aintree University Hospitals NHS Foundation Trust May 2015
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

9. Aintree University Hospitals NHS Foundation Trust May 2015
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

10. Aintree University Hospitals NHS Foundation Trust May 2015
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

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

12. 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

13. 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

14. Aintree University Hospitals NHS Foundation Trust May 2015
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

15. ‘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

16. 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

17. Aintree University Hospitals NHS Foundation Trust May 2015
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

18. Aintree University Hospitals NHS Foundation Trust May 2015
Questions?
Aintree University Hospitals NHS Foundation Trust May 2015