Healthcare Associated Infection Reporting Template (HAIRT)

Section 1– Board Wide Issues

Key Healthcare Associated Infection Headlines for January2011

  • There were zero cases of Multi-resistant Staphylococcus aureus(MRSA) bacteraemiain NHS Grampian in November 2010
  • The incidence of Methicillin Senistive Staphylococcus aureus (MSSA) bacteraemia rose in October and November but fell to the lowest level (7 cases) for the whole year in December 2010.
  • There were no cases of Staphylococcus aureus bacteraemia (MRSA or MSSA) or CDI in Dr Gray’s Hospital in November or December 2010.
  • There have been no cases of MRSA bacteraemia in Woodend Hospital throughout 2010 and only 2 cases of MSSA bacteraemia since May 2010.
  • There was also a dramatic drop in MSSA bacteraemias identified by General Practitioners or within 48 hours of admission to hospital (Out of Hospital) from 11 cases in November to 2 in December 2010, the average number of cases per month in 2010 being 8.
  • The number of cases of Clostridium difficile infection (CDI) across NHS Grampian fell to 8 in December 2010, the lowest number of cases for any month in 2010.
  • The number of cases of CDI identified by General Practitioners or within 48 hours of admission (Out of Hospital) showed the most dramatic decrease from 17 in November to 3 in December 2010, the average number of cases per month in 2010being 14.
  • Hand Hygiene compliance across NHS Grampian reached an all time high of 99% in December 2010.
  • Hand hygiene compliance hit 100% in Dr Gray’s Hospital in November 2010.
  • It would appear that the considerable amount of effort that has gone into producing and publicising the antibiotic guidelines has been hugely beneficial in reducing CDI rates with this reduction being sustained for well over a year.

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Staphylococcus aureus (including MRSA)

Current HEAT Status

It is now clear that NHS Grampianwill not meetthe newStaphylococcus aureus bacteraemia HEAT target for2010/2011.

The HPS quarterly report on the surveillance of Staphylococcus aureus bacteraemias which was published on 12 January showed that between 1 July and30 September2010 the reported SAB rate in NHS Grampian was 0.340episodes per 1000 acute occupied bed days (AOBDs) compared with 0.348 for NHS Scotland as a whole.

For MRSA bacteraemia the rate was 0.053 episodes per 1000 AOBDs compared with 0.058 in NHS Scotland. For MSSA bacteraemia the rate was 0.287 cases per 1000 AOBDs

compared with 0.290 in NHS Scotland. NHS Grampian’s MRSA and MSSA bacteraemia rates arelower than the national average.

Actions are concentrating on working with clinical areas experiencing the highest rates of SABs to reduce the number of medical device-associated infections and lower the number of false positive blood culture tests.

Clostridium difficile

Current HEAT Status

NHS Grampianis currently on trajectory to meet our HEAT target. Revision of theClostridium difficile HEAT target in May 2010 now gives NHS Grampian a HEAT target to reduce the rate of Clostridium difficile infection in patients over 65 years old by atleast 50% by April 2011. This means that the rate of CDIs should be no greater than 0.381 per 1000 total occupied bed days (TOBDs) in patients over the age of 65 by April 2011. Please note that this template, and specifically the HEAT target graphs onPage 7,cannot be amended to reflect this latest target.

The HPS quarterly report on the surveillance of CDIwhich waspublished on 12 January 2011showed that between 1 July and 30 Septemberthe reported CDI rate in patients over 65 years old in NHS Grampian was 0.51 episodes per 1000 TOBDscompared with 0.46 for NHS Scotland as a whole.

Hand Hygiene

The NHS Hand Hygiene Campaign 10thBi-monthly Audit Report which was published in November confirmed that NHS Grampian achieved a compliance figure of 96%, the same as during the previous auditing period.

Cleaning and the Healthcare Environment

Cleaning

Health Facilities Scotland published theirNational Cleaning Services Specification Quarterly Compliance Report Results for July 2010 – September 2010 in December. For this quarter NHS Grampian’s overall compliance score remained above 90% but drilling down into the detail of the results the following results were noted:

  • Aberdeen Royal Infirmary (NHS Grampian) continues to score well with a Quarter 2 average well in Green with 93.9%;
  • WoodendHospital (NHS Grampian) has dropped slightly from June 2010 with a result in Green at 90.9% to Amber with a result of 89.1% for the whole Quarter and 86.1% in September.

Local data collection shows that the results for October, November and December 2010 had not improved significantly. As noted in the last report, external verification of audit results were to be sought as it was thought there may be inconsistency of monitoring. The issue of domestic staff being pulled away from cleaning for patient related duties appears to be most acutely felt at WoodendHospital. Discussions are ongoing to resolve these issues and an options paper has been submitted to the Delivery Team to address the domestic staffing issues.

Outbreaks

During November 2010, 6 wards in NHS Grampian’s acute and community hospitals were closed or partially closed for a total of 43 days due to norovirus. 36 patients were affected by diarrhoea and/or vomiting in these areas but not all were confirmed to have norovirus.

Antibiotic Prescribing

Appendix 1 contains antibiotic prescribing data Aberdeen Royal Infirmary, WoodendHospital, Dr Gray’s Hospital, RoyalCornhillHospital and CommunityHospitals between July 2008 and September 2010. The dataare presented in three graphs showing:

  • All antibiotic use
  • 4C antibiotics (clindamycin, co-amoxiclav, cephalosporins, quinolones are those most associated with increasing the risk of CDI) individually
  • 4Cs as a percentage of total antibiotic packsvs number of cases of CDI (in ARI, Dr Gray’s Hospital, WoodendHospital and CommunityHospitals

In ARI the trend in overall antibiotic usage is static at present but there has been a downward trend in the use of the 4Cs since June 2009. There has been a corresponding fall in the number of CDI cases for the same time period.

The same patterns can be seen in other acute hospital sites. In WoodendHospital the dramatic reduction in 4C usage was due to the removal of these antibiotics from the ward drug cabinets.

In the CommunityHospital graph for 4C usage, the reduction is not as dramatic due to clinicians there using both primary and acute care prescribing guidelines but a considerable decrease is still seen in their use and a slightly delayed drop in the number of cases of CDI.

It would appear that the considerable amount of effort that has gone into producing and publicising the antibiotic guidelines has been hugely beneficial in reducing CDI rates with this reduction being sustained for well over a year.

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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 – delete if appropriate] in the Board, on the number ofcases ofStaphylococcus aureusblood stream infections (alsobroken down into MSSA and MRSA) and Clostridium difficileinfections, 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 aureusbacteraemia(SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureus bacteraemia(SAB) casesare further broken down into Meticillin SensitiveStaphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data are presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website:

Clostridium difficile:

Staphylococcus aureus:

MRSA:

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.

Understanding the Report Cards – Hand Hygiene Compliance

Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website:

Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital report card presents the percentage of hand hygiene compliance for all staff inboth graph and table form.

Understanding the Report Cards – Cleaning Compliance

Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website:

The first page of each hospital Report Card gives the hospitals cleaning compliance percentage in both graph and table form.

Understanding the Report Cards – ‘Out of Hospital Infections’

Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemiacasesare 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. Given the complex variety of sources for these infections it is not possible to break this data down in any more detail.

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