TRUST BOARD
/ 31 March 2009PAPER / Infection Control Report
PURPOSE / To update the Board on the position in relation to Infection Prevention and Control
FORMAT / Monthly Report
THE BOARD IS ASKED TO: / Receive the report and comment on any issues of concern
All data referred to is in the appendix data file
1. Executive Summary
The Trust remains on track to achieve the trajectory at year end for Clostridium difficile. The Trust remains on target for MRSA as per the original one set by the Primary Care Trust. The impact of the Norovirus outbreak continued until the beginning of March but has now abated.
2. Clostridium difficile
2.1 – Clostridium difficile performance against target April 2008 to March 2009 (Graph 1 and Graph 2)
The number of Clostridium difficile cases in February was under the revised monthly trajectory with 18 target cases and 24 overall cases reported. At the end of February 2009 the Trust is nine cases under the originally agreed trajectory. Current performance for March predicts an annual outturn for 2008/9 of 298 against an agreed trajectory of 305. Daily operational monitoring of active Clostridium difficile cases across the Trust highlighted that additional cohort capacity to the five single rooms on Ward 26A and the ‘step down’ area on Ward 29 was needed. Additional cohort capacity on Ward 29 was opened within 24 hours of the decision to open on 20th March.
Negotiations have taken place with NHS Bristol regarding targets for Clostridium difficile for 2009/10. The Trust will be performance monitored against the national target of 241 but with a local target set by NHS Southwest to achieve no more than 194 cases in the year.
2.2 Divisional Performance
(Graphs 3 - 6)
The position of thefourin-patient divisions is in the data sheets. Surgery Head and Neck and Women and Children’s Division have continued under their internal trajectories. Within the other two Divisions, both are currently over their internal trajectories. Caution is to be taken with divisional performance data due to the number of outliers, as a result of the capacity pressures and wards closed for Norovirus during February.
2.3 Clostridium difficile Action Plan
The action plan continues to be delivered to timescales.
2.4 Clostridium difficile dashboard.
Graph 7 and 8 shows individual ward performance; the two graphs are presented as different monitoring data are reported on weekly. Graphs 9-14 shows Trust-wide trend data. Results in the dashboard are discussed and actions agreed at the weekly Clostridium difficile meetings as well as within Divisional meetings. Monitoring of the use of the Bristol stool chart has now been added to the dashboard. Compliance to both data entry and use will improve as the process is embedded.
3. MRSA
3a. Performance (Graphs 15 –17)
Graph 15shows that the trust is continuing to achieve the initially agreed target for post-48 cases with one case being reported in February. Graph 16 shows the total of pre and post 48 hour cases against the incorrect target submitted by Bristol Primary Care Trust.
Negotiations have taken place with NHS Bristol regarding targets for MRSA for 2009/10. The Trust will be performance monitored against a target of 32 but with a local target set by NHS Southwest to achieve no more than 20 cases; these figures include both pre and post 48 hour cases.
A small cluster (three) of MRSA colonised[1] babies was noted in the neonatal care unit at the end of February and beginning of March. A link between the cases has yet to be confirmed through additional off-site testing of samples. An immediate review of the unit was undertaken by the Infection Control Team and followed up with a review by the Medical Director and Interim Chief Nurse. No major areas of concern were identified but some repairs to the fabric of the building are being actioned. No further cases have been identified on regular screening since the beginning of March.
3b. MRSA Action Plan
The action plan continues to be delivered to timescales.
3c. MRSA Screening
The Trust MRSA screening policy and compliance statement has been published on the Trust internet. Following further information from the Department of Health, a data validation exercise was completed which verified that screening compliance is reaching the required level (Graph 17). Compliance figures are reported monthly to NHS Bristol and are expected to be included in Monitor’s compliance framework. Monthly compliance figures will be reported in future Board reports.
4. Glycopeptide resistant Enterococci bacteraemias (Graph 18)
Pending validation, no cases of glycopeptides resistant Enterococci were reported in February 2009.
5. Hand Hygiene Audits
Graphs 19-21 show results for the monthly hand hygiene audits.
5. Other Issues
5a. Universal Action Plan
The action plan is on target.
5b. Cleanliness (Graph 22)
A Trust wide average score for Cleanliness of 90% is reported, a 2% increase on last months score. This improvement is mirrored in the very high risk area category where the average score has also improved by 2% to 93%. An average score of 90% has been maintained within high risk category areas. There remains further work to be done as not all areas are performing to this high standard. Most notable is the achievement this month of scores of 100% in areas within oral surgery and theatres at BristolDentalHospital.
5c. Norovirus Outbreak Activity
Norovirus activity decreased in early March, however, the Trust is still experiencing sporadic cases and occasional ward closures. The previously increased Norovirus activity was reflected in the national level of the infection being greater than expected and locally Norovirus activity remains high. Continued vigilance is in place for all admitting areas.
5d. Care Quality Commission Registration
The outcome of Trust’s application to register with the Care Quality Commission is still awaited; this outcome is expected by 1st April 2009.
Prepared and presented by:
Pat Fields
Interim Chief Nurse
Christine Perry
Assistant Chief Nurse and Director of Infection Prevention and Control
1
[1] Colonisation is the presence of the bacteria found from testing without there being any signs or symptoms of infection present.