Healthcare Associated Infection Bimonthly Report

November 2012

Section 1– Board Wide Issues

Key Healthcare Associated Infection Headlines

NHS Grampian

  • Monthly ward hand hygiene audit results show that compliance has remained above 95% across NHS Grampian as a whole since October 2011.
  • Cleaning and estates monitoring compliance remains stable and above the 90% target.
  • Clostridium difficile infection (CDI) case numbers for August and September were 17 and 15 respectively.
  • There were 14 Staphylococcus aureusbacteraemias (SABs) in August and 13 in September

Aberdeen Royal Infirmary

  • Monthly ward hand hygiene audits show that compliance remained above 95% since October 2011 until September 2012. During September wards that did not meet the target were closely monitored and supported to achieve compliance by the end of the month.
  • Cleaning and estates monitoring compliance remains well above the 90% target.
  • The number of CDI cases numbered 3 in August and 6 in September.
  • There were 3 SABs in August and in September.
  • There has been a single case of MRSA bacteraemia in the last 12 months

Dr Gray’s Hospital

  • Hand hygiene compliance remains very high in Dr Gray's Hospital.
  • Cleaning and estates monitoring results are comfortably above the 90% target.
  • There was a single case of CDI in August but no cases in September.
  • There were 2 cases of MSSA bacteraemia in August but none in September.

WoodendHospital

  • Hand hygiene compliance remains above the 95% compliance target.
  • Cleaning monitoring compliance remains stable and estates monitoring compliance remains just below the national 90% target, although this is steadily improving.
  • There were single cases of CDI in WoodendHospital in August and September but no cases of S aureus bacteraemia since the last report.

Community Hospitals

  • Due to the size of these hospitals and the number of SABs and CDIs, AberdeenMaternityHospital, RoyalCornhillHospital, Royal Aberdeen Children's Hospital and Roxburgh House figures are included in this scorecard.
  • There were no cases of CDI or SAB in August and September.

Out of Hospital

  • There were 12 cases of CDI in August and 8 in September diagnosed out with or within 48 hours of being admitted to hospital.
  • SABs numbered 9 in August and 4 in September
  • More than 50% of the cases of CDI and 60% of the cases of SAB in August and September were diagnosed out with or within 48 hours of being admitted to hospital.

Staphylococcus aureus (including MRSA)

Staphylococcus aureus Bacteraemia Surveillance

The Health Protection Scotland(HPS) quarterly report on the surveillance of Staphylococcus aureus bacteraemias which was published on 3 October 2012showed that between 1 April and30June2012the reported SAB rate in NHS Grampian was 0.259episodes per 1000 acute occupied bed days (AOBDs) compared with 0.302 for NHS Scotland as a whole.

For MRSA bacteraemia the rate was 0.046 episodes per 1000 AOBDs compared with 0.042 in NHS Scotland. For MSSA bacteraemia the rate was 0.213 cases per 1000 AOBDscompared with 0.259 in NHS Scotland.

Current HEAT Status

Health Protection Scotland’s report also demonstrated that, for this target period (April 2011 to March 2013), NHS Grampian’s quarterly rolling year SAB rate was once again on trajectory at 0.28 cases per 1000 acute occupied bed days over the 12 months 1 July 2011 to 30June 2012.

Clostridium difficile

Clostridium difficile Infection Surveillance

The HPS quarterly report on the surveillance of CDIwhich wasalsopublished on 3 October 2012 showed that between 1 April and 30June 2012the reported CDI rate in patients over 65 years old in NHS Grampian was 0.299 episodes per 1000 total occupied bed days (TOBDs)compared with 0.308 for NHS Scotland as a whole.

Hand Hygiene

The NHS Hand Hygiene Campaign 21stBi-monthly Audit Report which was published on 26 September 2012 confirmed that NHS Grampian achieved a compliance figure of 95%. While this is a 3% drop in compliance since the last auditing period, it is still well above the national target of 90%, which has been consistently achieved since the beginning of 2010.

Cleaning and the Healthcare Environment

Cleaning and Estates Monitoring

The Health Facilities Scotland (HFS) National Cleaning Compliance Report Quarter 1 results were published in Ocotber 2012 and cover the period April to June 2012.

The report shows that NHS Grampian achieved 95% compliance with the NHSScotland National Cleaning Services Specification across all hospital sites.

In relation to estates monitoring compliance, overall NHS Grampian is compliant. However, WoodendHospital is 87.0% compliant. HFS acknowledged that it is clear from the detailed responses and the Senior Management oversight of WoodendHospital that NHS Grampian is robustly managing the situation. Older buildings present particular problems for cleaning the fabric of the Estate.

Healthcare Environment

The recent Healthcare Environment Inspectorate (HEI) visit to Aberdeen Royal Infirmary (7 & 8 August 2012) resulted in 6 requirements and 1 recommendation.

The HEI found that NHS Grampian is making progress against the NHS QIS standards to protect patients, staff and visitors from the risks of acquiring an HAI. In particular, they observed good compliance with:

  • dress code and uniform policy
  • hand hygiene opportunity and technique
  • sharps and linen management.

However, the inspectors did find that further improvement is required in the following areas:

  • providing clarity on the roles and responsibilities for infection prevention and control
  • ensuring compliance with standard infection prevention and control precautions, particularly in relation to patient isolation, waste segregation and personal protective equipment (PPE) selection
  • ensuring staff adhere to the local policy for equipment cleaning
  • ensuring staff adhere to the local peripheral venous catheter (PVC) care bundles and complete the associated documentation.

A full action plan was developed and is available on the HEI website. A member of the Acute Sector Healthcare Environment Group will be asked to provide regular updates to the Infection Control Committee and organisation wide issues will be monitored via the HAI Work Plan.

The full report and action plan can be found on the HEI website at:

Incidents and Outbreaks

Norovirus Prevalence

Monday Point Prevalence Surveillance figures are reported to Health Protection Scotland. These capture the significant outbreaks of Norovirus in NHS Grampian and the prevalence of Norovirus activity in close to real time. They are not, and should not be interpreted as data for benchmarking or judgement. The data can be used for the assessment of risk and Norovirus outbreak preparedness only.

During Augustand September2012 the following instances of Norovirus were submitted:

On Monday 13 August, 1 hospital in NHS Grampian had 1 ward closed with 4 patients and 0 staff members affected.

Data on the numbers of wards closed due to confirmed or suspected norovirus is available from HPS on a weekly basis at:

Other HAI Related Activity

Surgical Site Infection (SSI) Surveillance

NHS Grampian participates in the Surgical Site Infection (SSI) surveillanceprogramme that is mandatory in all NHS boards in Scotland. All NHS boards are required to undertake surveillance for hip arthroplasty and caesarean section procedures as per the mandatory requirements of HDL (2006) 38 and CEL (11) 2009. In addition NHS Grampian carries out surveillance for in-patient breast surgery.

Readmission surveillance is carried out using prospective readmission data on orthopaedic and breast procedure categories under inpatient surveillance up to 30 days post operatively. Post discharge surveillance until day 10 post operation is also carried out for all caesarean sections performed.

Last available quarter (1 April to 30 June)

Category of Procedure / Number of operations / Number of Infections / NHS Grampian SSI rate (%) / National dataset SSI rate (%)
Breast Surgery / 171 / 1 / 0.6 / 0.4
Caesarean section / 411 / 4 / 1 / 2
Hip arthroplasty / 192 / 1 / 0.5 / 1
Knee arthroplasty / 153 / 0 / 0 / 0.4

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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 ofcases ofStaphylococcus aureusblood stream infections (alsobroken down into MSSA and MRSA) and Clostridium difficileinfections, as well as hand hygiene, cleaning and estates monitoring 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 difficileinfections (CDI)and Staphylococcus aureusbacteraemia(SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureusbacteraemia(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 difficileinfectionsand 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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