Highland NHS Board Item 5.4 INFECTION PREVENTION & …...• A repeat of the point prevalence audit...

Highland NHS Board 1 December 2015

Item 5.4 INFECTION PREVENTION & CONTROL REPORT Report by Catherine Stokoe, Infection Control Manager and Dr Jonty Mills, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control The Board is asked to: • Note the performance position for the Board. • Note the progress to keep infection under control.

1. Aim The purpose of this paper is to update Board members of the current status of Healthcare Associated Infections (HAI) and Infection Control measures in NHS Highland.

2. Contribution to Board Objectives One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board. 3. Summary Table 1 shows NHS Highland Infection Prevention & Control targets and performance data

Group Target NHS Scotland

NHS Highland

Clostridium difficile

Age 15 and over HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/16

Apr – Jun 32.2

Apr – Jun15 47.94

Red

July – Sept 15 (not yet HPS validated data) 42.98

Red (not yet validated)

Staphylococcus aureus bacteraemia

HEAT rate of 24.0 cases per 100,000

Apr – Jun 33.0

Apr – Jun15 20.69

Green

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Group Target NHS Scotland

NHS Highland

AOBDs to be achieved by year ending 03/16

July – Sept 15 (not yet HPS validated data) 25.47

Red (not yet validated)

Hand Hygiene 95% 95% Green Cleaning 92% 96% Green Estates 95% 96% Antimicrobial prescribing (includes data from monthly audits to the end of September 2015)

Hospital- based Downstream ward audit (commenced June 2015)

95% Ward 7A 70%

Amber

Ward 4C 58%

Amber

Surgical antibiotic prophylaxis

95% 100% Green

(includes data from Q1 (Jan – Mar) of calendar year 2015)

Total antibiotic prescribing measure (primary care)

50% of GP practices at or moved towards target

53.6% 60% Green

Source: - Health Protection Scotland/ISD/Local data. Current NHS Highland Clostridium difficile case data (not yet validated by HPS) identifies our provisional rate for July - September 2015 as 42.98 against an expected rate of 32. Our position as of 1st of November 2015 is, 66 patient cases (44 cases age 65 and over, and 22 cases aged 15-65years) against the proposed target of 78 by end of March 2016. Current NHS Highland SAB case data (not yet validated by HPS) identifies our provisional rate for July – September 2015 as 25.47 against an expected rate of 24. Our position as of 1st of November 2015 is, 34 patient cases (1 MRSA, and 33 MSSA) against proposed target of 60 by end of March 2016, which means the Board remains on track to reach the SAB target. The Board needs to note that if the same number or more of cases/rates occurs within 2015/2016, as were reported within the previous year, we are at high risk of not attaining the CDI HEAT target come March 2016. 4. Achievements

• In order to learn from, and reduce future cases of infection, information must be gathered and data sets scrutinised by the Infection Prevention and Control Team. A data analyst is now in post (1 WTE fixed terms contract for 1 year) to action this.

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5. Challenges

• NHS Highland met the SAB HEAT target last year; our aim is to further reduce Staphylococcus aureus bacteraemias by engaging all clinical staff in hospitals and the community in initiatives to prevent and reduce invasive device/healthcare related infections.

• To continue to support all clinical staff in hospitals and the community in the prevention and reduction of infections, by focussing on prudent antimicrobial prescribing, and compliance with standard infection prevention and control precautions (SICPs).

• The Infection Control and Prevention Team (IPCT) in conjunction with the Health and Safety Team continue to work with staff to support them in providing personal protective equipment (PPE) training across their Operational units for preparation when dealing with infections such as TB, Flu, Ebola. This training is very resource intensive.

• The monitoring of Escherichia coli bacteraemia is to be implemented across all NHS Boards as a mandatory surveillance field in April 2016. This will have a significant impact on the IPCT, the Microbiology staff, and the supporting administration team, in terms of resource. All NHS Boards have been asked by HPS to undertake E coli bacteraemia surveillance from the 1st of September, IPCT are currently monitoring the impact this surveillance is having on workload.

• The Infection Prevention and Control nursing service across NHS Highland continue to deal with increasing workload demands such as the management of clinical infections such as chicken pox, and flu, which require contact tracing, whilst dealing with the existing demands of the service, including Norovirus outbreaks. Alongside this there are increasing workload demands from the clinical microbiology service, impacting on the Consultant Microbiologists and Infection Control Doctor work load and competing priorities. A service review, impact risk assessment and job plan review is being undertaken to ensure the service is fit for the future.

• The Infection Control Nursing team within Argyll and Bute currently has a vacancy for a 1WTE band 7 IPCN post which is currently out to advert again. Whilst awaiting a permanent appointment an experienced IPCN has been employed on the bank for two days per week, to assist in the delivery of the service alongside the existing fulltime IPCN band 6. The inability to recruit experienced IPCNs has been recognised nationally, and is now being discussed at a strategic level.

• Obtaining accurate data from Microbiology laboratory systems remains a challenge. The business continuity plan within Microbiology acknowledges this risk, and ensures that the reporting results would be paper based. In the longer term the system needs replacing and this is scheduled to go ahead in 2016/2017 following the implementation of ‘Ultra’ into Blood Sciences.

• ICNETs (infection control software programme) integration into Argyll and Bute was scheduled to be in place by June, however due to ICNETs previous commitments outside of NHS Highland this was delayed. Following the completion of ICNET Software update, E-Health are now in the position to progress the implementation with NHS Greater Glasgow & Clyde. Whilst we await this there is a risk that human factors might result in errors and delays in infection control information being received in a

http://www.google.co.uk/url?url=http://en.wikipedia.org/wiki/Pathogenic_Escherichia_coli&rct=j&frm=1&q=&esrc=s&sa=U&ei=oKpIVcn5Oe2R7Abzj4DIBg&ved=0CBoQ0gIoADAA&usg=AFQjCNHkRbps0Lo8zdiy4oFWTzXSiJQetQ

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timely and accurate manner, due to the reliance on manual data inputting and dissemination. ICNET will remove this risk due to automatic electronic data transfer.

6. Risks

The level of CDI cases is higher than that expected at this point in time, we continue to work with Health Protection Scotland and NHS Highland staff to ensure that all agreed actions to try to reduce infection are in place and that monitoring systems are robust. Additional note: The IPCT would like to seek the Board members approval to consider a proposal to review the design and structure of the Infection Prevention and Control Board paper submission. Catherine Stokoe – Infection Control Manager Jonty Mills– Consultant Microbiologist & Lead Infection Control Doctor, December 2015

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NHS Highland Healthcare Associated Infection Report Key Healthcare Associated Infection Headlines

1. Staphylococcus aureus (including MRSA)

1.1 Staphylococcus aureus bacteraemia target The target for 2015/2016 for NHS Highland remains at 24.0 cases or less per 100,000 acute occupied bed days for Staphylococcus aureus bacteraemia (including MRSA). For NHS Highland this means no more than approximately 60 cases by 31st March 2016. 1.2 Trends NHS Highland’s SAB incidence rate for July – Sept 2015 is 25.47 per 100,000 acute occupied bed days (not yet validated by HPS). NHS Highlands position as of 1st November 2015 (data not yet validated by HPS) is tabled below.

1st April 2015 – 1st November 2015

Total SABs = 34 33 MSSA cases 1 MRSA cases

8 preventable (SSI / PICC line related) 19 not preventable 1 Contaminant (taken in community) 6 under investigation

Hospital Acquired Cases = 7 cases Community Acquired = 14 cases Healthcare Associated = 7 cases Unknown undergoing investigation = 6 cases

Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at: Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252 NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at:

http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346


http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

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Figure 1: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2011. Figure 2: Quarterly rolling year Staphylococcus aureus rates per 100,000 Acute Occupied

Bed Days for HEAT Target Measurement

Apr 12 - Mar

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Jul 12 -

Jun 13

Oct 12 -

Sept 13

Jan 13 -

Dec 13

Apr 13-

Mar 14

Jul 13 -

Jun 14

Oct 13 -

Sept 14

Jan 14 -

Dec 14

Apr 14 - Mar

15

Jul 14 -Jun 15

Oct 14 - Sept 15 (p)

Actual Performance 21.8 21.4 25.0 25.1 25.4 23.4 22.9 22.8 22.1 26.4 22.5 Trajectory 26.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0

Target 26.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0

1.3 Current Initiatives

• A new policy and procedure for the management of central venous catheters and midlines has been produced.

• A repeat of the point prevalence audit for peripheral venous cannula care will be undertaken by December 2015. Alongside the introduction of a formal system for validation of all self-reported audit data, which is currently being tested across the four general hospitals.

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Apr 12 - Mar 13Jul 12 -Jun 13

Oct 12 -Sept 13

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Jan 15 - Dec 15

Actual Performance Target

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April May June July Aug Sept Oct Nov Dec Jan Feb March2011-12 2012-132013-14 2014-20152015-2016 Heat Target to 31-3-15

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2. Clostridium difficile

2.1 Clostridium difficile HEAT Target Current target for 2015/2016 for NHS Highland remains at 32.0 cases or less in patients aged 15 and over per 100,000 total occupied bed days. For NHS Highland this means no more than approximately 78 cases by year ending March 2016. 2.2 Trends NHS Highland’s CDI incidence rate for July – Sept 2015 is 42.98 (not yet validated by HPS). NHS Highlands position as of 1st November 2015 (data not yet validated by HPS) is tabled below. 1

st April 2015 –

1st November 2015

Total CDI cases = 66 Aged 15 +

Aged 15 – 64 = 22 Aged 65 + = 44

Hospital Acquired Cases = 9 cases; Community Acquired = 18 cases (including 4 re-occurrences) Healthcare Associated 33 Unknown 6 under investigation

The IPCT are keen to enhance the process of case review for each CDI case and ensure learning is shared with local teams by adopting the methodology utilised for SAB (the collection of root cause analysis data and the engagement of the executive management team when cases are being discussed with clinical teams). It is acknowledged that this process is very resource intensive, and will require a change in focus from SAB to CDI, which has been agreed by the Control of Infection Committee. NHS Highland is also part of a wider team across NHS Scotland which has introduced an antibiotic (Fidaxomicin) which has been linked to the reduction in the incidence of CDI relapse. This antibiotic has been prescribed, but it is too early to note its impact on our patients care and treatment.

Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at:

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at:

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

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Figure 3: NHS Highland Clostridium difficile infection cumulative case numbers age 15 years and over year on year since 2011. Figure 4: Funnel plot of CDI incidence rates (per 100 000 TOBDs) in patients aged 65 years and above for all NHS boards in Scotland in Q2 2015. NHS Ayrshire & Arran and NHS Tayside/NHS Borders and NHS Dumfries & Galloway/NHS NWTC, NHS Orkney, NHS Shetland and NHS Western Isles overlap.

HG = NHS Highland

0102030405060708090

100

Cum

ulat

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Cas

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umbe

rs

2011-2012 2012-2013 2013-20142014-2015 2015-2016 Heat Target to 31-3-15

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Figure 5: Funnel plot of CDI incidence rates (per 100 000 AOBDs) in patients aged 15-64 years for all NHS BOARDS IN Scotland in Q2 2015. NHS NWTC, NHS Orkney and NHS Shetland overlap.

Figure 6 : Quarterly rolling year Clostridium difficile Infection Cases per 100,000 occupied bed days for HEAT Target Measurement

Apr 12 - Mar 13

Jul 12 - Jun 13

Oct 12 - Sept 13

Jan 13 - Dec 13

Apr 13- Mar 14

Jul 13 - Jun 14

Oct 13 - Sept 14

Jan 14 - Dec 14

Apr 14 - Mar 15

Jul 14 - Jun 15

Oct 14 - Sept 15 (p)

Actual Performance 31.9 27.3 28.7 28.8 30.2 33.7 34.6 36.9 37.1 39.6 39.4

Trajectory 37.0 37.0 37.0 37.0 37.0 37.0 34.0 32.0 32.0 32.0 Target 32.0 32.0 32.0 32.0 32.0 32.0 32.0 32.0 32.0 32.0

2.3 Current Initiatives

• A business case is in progress to review the use of Fidaxomicin for recurrent CDI cases.

• A review of the methodology used to discuss clinical cases, capture and analyse surveillance data is underway.

0.05.0

10.015.020.025.030.035.040.045.0

Apr 12 -Mar 13

Jul 12 -Jun 13

Oct 12 -Sept 13

Jan 13 -Dec 13

Apr 13-Mar 14

Jul 13 -Jun 14

Oct 13 -Sept 14

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Apr 14 -Mar 15

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ActualPerformance

Trajectory

Target

Linear(Target)

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2.5 Antimicrobial Management Table 2: shows NHS Highland progress against the 3 national indicators.

Antimicrobial Indicator NHS Highland progress Data June 2015 to September 2015

Hospital-based prescribing – downstream ward duration audit In one medical and one surgical continuing care ward, data is collected from at least 5 patients per week on antibiotics and the following measures are assessed: indication documented; antibiotic choice in line with guidance; review date of IV antibiotics within 72 hours of starting and duration of oral therapy is documented on the drug kardex. The target is ≥ 95% for each measure. This data collection process has been modified and is not comparable to the previous downstream audit data. Data collection suspended in October due to national antibiotic survey as agreed by Scottish Antimicrobial Prescribing Group.

Ward 7A – Non-Compliant Data collection commenced in June 2015 so limited trend analysis is available. Median compliance with all elements of the audit is now 70%, an improvement from 63% in August. The documentation of a review date or duration of therapy has increased significantly in September to 94%. Ward 4C – Non-Compliant Data collection commenced in June 2015 so limited trend analysis is available. Median compliance with all elements of the audit is 58%. Improvements have been seen with the documentation of the duration of oral therapy up from 40% in August to 70% in September

Surgical antibiotic prophylaxis Duration of surgical antibiotic prophylaxis is less than 24 hours and compliant with local antimicrobial prescribing policy in above 95% of sampled elective colorectal surgical cases.

Compliant Data to end of September 2015 shows median compliance remains at 100% with surgical prophylaxis in elective colorectal procedures using the more stringent audit criteria as previously detailed.

Total antibiotic prescribing Total antibiotic prescribing rate is 1.8 items per 1000 patients per day or less. Target 50% of GP practices to meet or move towards the target.

Compliant Data from January to March 2015 shows 60 out of 100 practices across NHS Highland has met the total prescribing indicator as previously reported. This compares favourably with the national figure of 53.6% across Scotland and NHS Highland was one of 7 boards to achieve the indicator. Further work to investigate areas with high prescribing rates is ongoing in conjunction with the primary care prescribing advisors team.

Antimicrobial Ward Rounds A review of this pilot project is underway and will be shared in due course. NHS Highland participated in this national survey of acute hospital use of a number of very broad spectrum antibiotics, specifically piperacillin/tazobactam and meropenem. Preliminary results highlight excellent compliance with the antimicrobial alert policy for use of meropenem with a low incidence of prescribing and authorisation codes all in place. Use of piperacillin/tazobactam was also low and compliance with prescribing guidelines generally good. A full report will be discussed by the Antimicrobial Management Team (AMT) at the next meeting. European Antimicrobial Awareness Day, 18th November As in previous years, materials to support this event were made available to all professions. The goal of the campaign this year was to contribute to 100 000 registered Antiobiotic

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Guardians by the end of March 2016. If one in 25 clinical staff, one in 100 non-clinical staff and one in 1000 of the population signed up, the goal would be achieved. The AMT will be encouraging as many people as possible to sign up and the board members are asked to lead the way. The communications department will be supporting the campaign using social media messages to raise awareness. Update from Infection Intelligence Platform The fourth newsletter from the national Infection Intelligence Platform is available from Information Services Division of NHS Services Scotland. This describes a recent national study establishing the association between prescribing antimicrobials and Clostridium difficile infection in the community. If a patient is prescribed any antibiotic in the community, they are three times more likely to develop infection with C. difficile than a patient who has not had antibiotics. For a patient taking antibiotics for more than 4 weeks in a 6 month period, the risk is 5 times higher. Full details of the studies will be shared widely when they are formally published. 3 Hand Hygiene

3.1 Hand Hygiene Reporting Each Board is responsible for monitoring and reporting hand hygiene compliance data. The Infection Prevention & Control Team is in the process of reviewing the methodology for monitoring hand hygiene compliance rates in an effort to improve these. 3.2 Trends NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas. Compliance rates are being sustained above 99% July – Sept 2015.

Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at:

http://www.washyourhandsofthem.com/

NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national hand hygiene monitoring can be found at:

http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

http://www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/Infection-Intelligence-Platform/Communications/_docs/IIP-Newsletter-September-2015-edition-04.pdf?16:57:34

http://www.washyourhandsofthem.com/

http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

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4. Cleaning and the Healthcare Environment

4.1 Current Rates The monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated above 96% compliance in September and October 2015 for domestic monitoring, and 96% for estates monitoring in September and October 2015. The Independent Peer/Public Peer Review audits were carried out across NHSH over September 2015, and data is awaited. 4.2 Healthcare Environment Inspections No local inspections have occurred. Benchmarking continues against the HEI inspection reports in order to ensure learning is disseminated.

5. Outbreaks associated with NHS Highland 2/10/2015 - 15/10/2015 Auchinlea care home, Argyll & Bute Norovirus confirmed Ward 6C was closed on 12th November 2015 due to Norovirus outbreak. 10 patients and 12 staff were affected. The ward is due to re-open on 24th November 2015 if no further cases occur. ITU was closed on 17th November 2015 due to 2 cases of Norovirus (patients). No staff were affected. ITU was re-opened on 20th November 2015. 6. Surveillance

6.1 MRSA Clinical Risk Assessment (CRA) Screening Audit

As part of the national mandatory MRSA Screening Programme required by HPS, quarterly compliance data is submitted by NHS Boards to provide assurance that CRA compliance is at or above 90%.

The Infection Prevention and Control team conduct the data collection, and raise any issues with compliance at the time of the audit with the clinical teams.

For quarter 1, (April-June 2015) compliance was 75%.

Quarter 2, (July – Sept 2015) compliance was 72%.

Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%. The cleaning compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national cleanliness compliance monitoring can be found at:

http://www.hfs.scot.nhs.uk/online-services/publications/hai/

Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at:

http://www.nhshealthquality.org/nhsqis/6710.140.1366.html


http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

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Following the identification of low compliance rates the Infection Prevention and Control team have been raising awareness through the local clinical teams and the local infection prevention and control (IPC) groups. Educational sessions have occurred in September and October on the IP&C risk assessment document which includes the MRSA clinical risk assessment tool. This tool is also embedded into the common admission document, and the new assessment bundle. Enhanced monitoring is also in place. The next quarter submission will be completed in Dec 2015.

6.2 Surgical Site Infections (SSI)

NHS Highland continues to monitor SSI rates through mandatory and voluntary surveillance. The clinical teams alongside the Infection Prevention & Control Surveillance team, the Scottish Patient Safety Programme team and the HAI Quality Improvement Facilitators (HAI QIF) (work stream; Colorectal surgery) are working jointly to review all incidents of infection, and ensure that care practices are evidence based and maintained. Elective Colorectal Surgical Site Infection Elective Colorectal SSI rate Jan 2014 – Dec 2014 was 9.7% a significant improvement on the comparable figure for 2013 of 15.63%. For Jan –Sept 2015 the current SSI rate is 8.0%. Figure 7 highlights the monthly SSI percentage and is annotated to identify when improvements have been introduced or compliance achieved. Figure 7 shows monthly SSI rate in elective colorectal surgery, June 2011 – Sep 2015

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Figure 8: Number of cases between infections following elective colorectal surgery March 2012 – July 2015

A multidisciplinary team was formed in August 2012 and meets monthly. The team includes colorectal surgeons, infection prevention and control, pharmacy, stoma nurses, and ward and theatre staff. In Sept 2014 the quality improvement team became involved. The action changes are determined by reflection on root cause analysis of SSI cases and available evidence. The SSI bundle was developed for the ward and theatre. IPC Surveillance nurses monitor the wounds and diagnose SSI`s as per Scottish Surveillance of Healthcare Associated programmer (SSHAIP), using a standardised methodology. The data in figure 8 demonstrates random variation in the monthly SSIs rate. The spike in June reflects a lower denominator and equates to one infection in 15 procedures. Outcome measures are: • 95% or greater compliance of the SSI ward and theatre bundles by end December 2015

(currently at 90%) • Less than 10% SSI in Colorectal surgery by end December 2015 (currently at 8%)

Orthopaedic Surgical Site Infection Total hip replacement surgery continues to have a low rate of SSI on the comparable figures for 2013 – 0.25%, 2014-0.66%, and Jan to Sept 2015-0.35% Figure 9: Shows monthly SSI rate in Total Hip Replacement surgery Jan 2010 – Sept 2015

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Figure 10: Shows number of days between Total Hip Replacement surgery resulting in an SSI, May 2010 to September 2015

Date of last infection – 25/06/2015 Figure 11: Shows monthly SSI rate for Hemi arthroplasty surgery Jan 2010 to Sept 2015.

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Hemiarthroplasty SSI rate for 2014 – 1.7%, (2013 – 2.9%). Jan to Sept is currently 2.5% Figure 12: Shows number of days between Hemi Arthoplasty resulting in an SSI Jan 2010 – Sep 2015

Date of last infection - 10/05/2015

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Neck of femur, excluding hemi arthroplasty SSI rate for 2014 – 0.7%, (2013 – 1.8%) Jan-Sept 15 is currently 1.5% Figure 13: shows monthly SSI rate for fracture Neck of Femur excluding hemi arthroplasty Jan 2010 to Sep 2015

Figure 14: shows number of days between fracture neck of Femur surgery excluding hemiarthroplasty, surgery resulting in an SSI, 2010 to Nov 2015

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Caesarean Section (C-Section) Infections Elective C-Section SSI rate for 2014 was 0.7% (2013 - 1.4% SSI rate). A small increase is noted from the previous year, in the rate between Jan-Sept 2015, which currently is 2.0 %. Figure 15: shows monthly SSI rate for elective C Sections, Jan 2010 to Sept 2015

Figure 16: shows number of days between elective C-Section surgery resulting in an SSI, Jan 2010 to Sept 2015

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Emergency C-Section SSI rate for 2014 was 1.9%. (2013 - 2% SSI rate), and Jan-Sept 2015 is 2.2% Figure 17: shows monthly SSI rate for emergency C-Section, 2010 to Sept 2015

Figure 18: shows number of days between emergency C-Section, surgery resulting in an SSI, Jan 2010 to Nov 2015

The surveillance team met with the obstetric team during September. This was found to be a very positive, and a new process of Root Cause Analysis is currently being trialled for any SSIs detected.

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Abbreviations

ADTC Area Drugs & Therapeutics Committee

AMT Antimicrobial Prescribing Team

AMAU Acute Medical Admissions Unit

CHP Community Health Partnership

CDI Clostridium difficile Infection

CMO Chief Medical Officer

CNO Chief Nursing Officer

CPE Carbapenemase-producing Enterobacteriaceae

CVC Central Venous Catheter

ECDC European Centre for Disease Prevention & Control

GDP General Dental Practitioner

HAI Healthcare Associated Infection

HAI QIF Healthcare Associated Infection Quality Improvement Facilitator

HAIRT Healthcare Associated Infection Reporting Template

HEAT Health Improvement, Efficiency, Access, Treatment

HFS Health Facilities Scotland

HPS Health Protection Scotland

HSE Health and Safety Executive

JAG Joint Advisory Group

MSSA Meticillin Sensitive Staphylococcus Aureus

MRSA Meticillin Resistant Staphylococcus Aureus

PICC Peripherally Inserted Central Catheter

PPI Proton Pump Inhibitor

PVC Peripheral Venous Catheter

RIDDOR Reporting of Injuries, Diseases & Dangerous Occurrences Regulations 1995

SAB Staphylococcus aureus Bacteraemia

SHPN Scottish Health Planning Note

SHTM Scottish Health Technical Memoranda

SPC Statistical Process Chart

SAPG Scottish Antimicrobial Prescribing Group

SICPs Standard Infection Control Precautions

SPSP Scottish Patient Safety Programme

Hemiarthroplasty: An operation used to treat fractured hip similar to a total hip replacement,

But involves only half of the hip

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Healthcare Associated Infection Reporting Template (HAIRT)

Section 2 – Healthcare Associated Infection Report Cards

The following section is a series of ‘Report Cards’ that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics. Understanding the Report Cards – Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). More information on these organisms can be found on the NHS24 website: Clostridium difficile: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=1 Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346 MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1 For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out of hospital” report card. Targets There are national targets associated with reductions in C.diff and SABs. More information on these can be found on the Scotland Performs website: http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance Understanding the Report Cards – Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group.

http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=1


http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1

http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance

http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance

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Understanding the Report Cards – Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ Understanding the Report Cards – ‘Out of Hospital Infections’ Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital.


23

NHS HIGHLAND REPORT CARD NHS Highland Staphylococcus aureus bacteraemia (SABs) monthly case numbers

Nov 2014

Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

MRSA 0 1 0 0 0 0 0 0 0 1 0 0 MSSA 4 3 5 4 4 1 4 7 7 2 6 6 Total SABS

4 4 5 4 4 1 4 7 7 3 6 6

NHS Highland Clostridium difficile infection monthly case numbers

Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

3 1 1 0 0 1 5 2 2 5 4 3

Ages 65 plus

4 9 4 4 6 8 6 7 8 3 4 8

Ages 15 plus

7 10 5 4 6 9 11 9 10 8 8 11

012345678

Dec-

13

Feb-

14

Apr-

14

Jun-

14

Aug-

14

Oct

-14

Dec-

14

Feb-

15

Apr-

15

Jun-

15

Aug-

15

Oct

-15

SAB's NHS Highland

MRSA

MSSA

Total SABS

0

2

4

6

8

10

12

C.difficile NHS Highland

Ages15-64

Ages 65plus

Ages 15plus

24

Hand Hygiene Monitoring Compliance (%) Nov

2014 Dec 2014

Jan 2015

Feb 2015

Mar 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Board Total 99 96 99 99 99 98 99 99 98 99 99 99 AHP 100 97 100 99 98 97 100 99 100 100 98 100 Ancillary 99 99 97 100 100 100 99 100 97 100 99 99 Medical 98 92 98 97 99 97 95 97 97 94 98 96 Nurse 99 97 99 99 99 99 99 98 99 100 99 99 Cleaning Compliance (%)

Nov 2014

Dec 2014 Jan

2015

Feb 2015

March

2015

April 2015

May 2015

June 2015

July 2015

August

2015

Sep 2015

Oct 2015

Board Total

97

96 96 97 96 96

96 96 96 96 97 96

Estates Monitoring Compliance (%) Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sept 2015

Oct 2015

Board Total

99

98 97 96 96

97

97 93 97 97

96

96

25

NHS HIGHLAND RAIGMORE HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


0 1 0 0 3 1 1 2 0 0 2 2

Clostridium difficile infection monthly case numbers Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

1 0 1 0 0 0 1 0 0 1 0 1

Ages 65 plus

0 2 0 0 1 4 1 2 1 1 3 1

Ages 15 plus

1 2 1 0 1 4 2 2 1 2 3 2


2014 Dec 2014 Jan

2015 Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 100 99 97 99 98 99 98 99 98 98 98 99 AHP 100 100 100 100 100 100 100 100 97 97 100 100 Ancillary 100 100 93 100 97 100 98 100 98 97 95 97 Medical 100 97 98 96 96 98 93 99 97 98 98 97 Nurse 99 98 98 98 98 99 100 96 99 100 98 100 Cleaning Compliance (%) Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 97 97 97 97 97 97 96 96 96 96 97 97 Estates Monitoring Compliance (%) Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 99 98 97 97 96 96 96 95 97 97 97 97

26

NHS HIGHLAND CAITHNESS GENERAL HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


0 0 0 0 0 0 0 0 0 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 1 0 2 1 1 0 0 0 0 0

Ages 15 plus

0 0 1 0 2 1 1 0 0 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 100 99 98 100 100 100 100 97 100 98 99 99 AHP 100 100 100 100 100 100 100 100 100 100 95 100 Ancillary 100 100 - 100 100 100 100 100 100 100 100 100 Medical 100 96 95 100 100 100 100 89 100 90 100 95 Nurse 100 100 100 100 100 99 100 99 100 100 100 100 100 Cleaning Compliance (%) Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 99 99 98 99 100 99 99 98 99 98 98 92

27

NHS HIGHLAND BELFORD HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


0 0 0 0 0 0 0 0 0 0 0 1


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 0 0 0 0 1 0 0 0 0 0

Ages 15 plus

0 0 0 0 0 0 1 0 0 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 100 100 100 100 99 100 100 100 100 98 99 100 AHP 100 100 100 100 96 100 100 100 100 100 100 100 Ancillary 100 100 - - 100 100 100 100 100 100 100 100 Medical 100 100 100 100 100 100 100 100 100 90 94 100 Nurse 100 100 100 100 100 100 100 100 100 100 100 100 Cleaning Compliance (%) Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 99 100 99 98 98 99 98 99 100 98 99 99

28

NHS HIGHLAND LORN & ISLANDS HOSPITAL REPORT CARD


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


0 0 0 0 1 0 0 0 0 1 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

1 0 1 0 1 0 0 0 1 0 0 0

Ages 15 plus

1 0 1 0 1 0 0 0 1 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 91 92 93 91 92 91 94 92 92 93 92 92

29

NHS HIGHLAND NORTH & WEST OPERATIONAL UNIT COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include:

• Dunbar Hospital, Thurso • Town & County Hospital, Wick • Lawson Memorial Hospital Golspie • Migdale Hospital, Bonar Bridge • MacKinnon Memorial Hospital, Broadford • Portree Hospital, Isle of Skye

Staphylococcus aureus bacteraemia monthly case numbers Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


0 0 0 0 0 0 0 0 0 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 plus

0 0 0 0 0 0 0 0 0 0 0 0 Ages 15 plus

0 0 0 0 0 0 0 0 0 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 100 100 100 100 96 100 97 100 94 96 99 100 AHP 100 100 - 100 96 100 100 100 100 100 100 100 Ancillary 100 - - 100 100 100 100 100 89 100 100 100 Medical 100 - - 100 100 100 88 100 89 83 95 100 Nurse 99 100 100 100 100 100 99 100 99 100 100 99 Cleaning Compliance (%)

Nov 2014

Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 99 96 96 96 93 96 96 93 83 95 94 96 Estates Monitoring Compliance (%)

Nov 2014

Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 98 99 99 97 96 96 96 95 97 97 95 95

30

NHS HIGHLAND SOUTH & MID OPERATIONAL UNIT COMMUNITY HOSPITALS REPORT CARD


• Ross Memorial Hospital, Dingwall • County Community Hospital, Invergordon • Royal Northern Infirmary Community Hospital, Inverness • Town & County Hospital, Nairn • Ian Charles Hospital, Grantown on Spey • St Vincent’s Hospital, Kingussie • For the purposes of monitoring New Craigs Psychiatric Hospital is included in

this report card. Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


0 0 1 0 0 0 0 0 0 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 plus

0 1 0 0 0 1 0 0 0 0 0 1

Ages 15 plus

0 1 0 0 0 1 0 0 0 0 0 1


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 95 99 97 98 98 97 98 98 98 98 97 97

31

NHS HIGHLAND ARGYLL & BUTE CHP COMMUNITY HOSPITALS REPORT CARD


• Argyll & Bute Hospital Lochgilphead • Campbeltown Hospital • Cowal Community Hospital, Dunoon, • Dunaros Community Hospital, Isle of Mull • Islay Hospital • Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead • Victoria Hospital & Annex, Rothesay


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


0 0 0 0 0 0 0 0 0 0 0 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0 Ages 65 plus

0 0 0 0 0

0 0 0 0 0 0 0

Ages 15 plus

0 0 0 0 0

0 0 0 0 0 0 0

Hand Hygiene Monitoring Compliance (%)

Nov 2014

Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 98 99 96 97 96 97 98 97 97 97 96 97

32

Estates Monitoring Compliance (%) Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Total 97 96 97 97 95 88 94 94 94 96 94 97

NHS HIGHLAND OUT OF HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers Nov

2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015


4 3 4 4 3 1 3 5 7 2 3 0


2014 Dec 2014

Jan 2015

Feb 2015

March 2015

April 2015

May 2015

June 2015

July 2015

August 2015

Sep 2015

Oct 2015

Ages 15-64

2 1 0 0 0 1 4 2 2 4 4 2 Ages 65 plus

3 6 2 4 6 3 3 5 6 2 1 6

Ages 15 plus

5 7 2 4 6 4 7 7 8 6 5 8

Highland NHS Board Item 5.4 INFECTION PREVENTION & …...• A repeat of the point prevalence audit...

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