NHS GRAMPIAN
Infection Control Committee
Minutes from meeting held on 17th January 2013
Board Room, Aberdeen Royal Infirmary
11.00 – 13.00
Present:
RSD - Dr Roelf Dijkhuizen, Medical Director
PEH – Pamela Harrison, Infection Prevention and Control Manager
JA - Jane Adam, Public Forum Representative
GM – Gary Mortimer, Head of Facilities
AMK – Dr Anne Marie Karcher, Infection Control Doctor / Medical Microbiologist
RAB – Roy Browning, Infection Prevention & Control Senior Nurse
AM – Dr Alexander Mackenzie, Infectious Diseases Consultant
DOB – Deirdre O’Brien, Medical Microbiologist
GB - Gladys Buchan, Lead Nurse, North Aberdeenshire LCHP
KDW – Karen Wares, Local Health Board Co-ordinator
CL- Carol Low, SPSP Co-ordinator (deputising for Jenny Ingram)
GMac – Gillian Macartney, Antibiotic Pharmacist
MR – Dr Maria Rossi, Consultant – Public Health Medicine
JO – Jane Ormerod, Head of Professional and Practice Development Unit
EM – Eleanor Murray, Unit Nurse Manager, Acute Sector (deputising for Johnathon Lofthouse)
PM – Dr Pamela Molyneaux, Consultant Virologist
Anneke Street, PA to Infection Control Manager (Minute taker)
1 / Introduction and Apologies /
RSD opened the meeting. Apologies were received from :
Tommy Ovens (TO) Lynn Young (LY) Sue Swift (SS) Elinor Smith (ES) Sandy Thomson (ST) Frances Dunn (FD) Jenny Ingram (JI) Elizabeth Murphy (EM) Stewart Rogerson (SR) Elizabeth Murphy (EM)
Katherine Targett (KT) Heather Kelman (HK) Johnathon Lofthouse (JL)
2 / Minutes of last meeting
13th November 2012 /
The minutes from the 13th November 2012 were ratified by the Committee with no amendments.
Due to DOB attending a Problem Assessment Group meeting at Woodend General Hospital RSD asked AMK to give the Committee some background information on ESBL infections.
3 / Matters Arising
Item 3.1 /
CJD
AMK updated the Committee on this subject, confirming that, so far, 2 meetings between herself, Terry O’Kelly and the Management and Nursing Teams have taken place. Progress has been good with gaps in procedures having been tightened.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
RSD queried how the Infection Control Committee could be assured that the procedures put in place were complete and robust.
AMK feedback that there were 2 ways this could be assessed and confirmed
1) random audits performed, where confirmation could be obtained that the pertinent questions were asked
2) obtain a list of patients and select a cross section of records that can be examined to again confirm pertinent questions were posed to the patient
MR requested a copy of the admission documentation to view and EM replied that this could be arranged.
AMK also asked MR if she wished to see the minutes of the previous meetings that have taken place.
MR replied that she would.
4 / Standing Items
Item 4.1 / HAI Report
This report was not examined in full but certain areas were discussed.
RSD spoke of the general downward trend in Clostridium difficile infections and Staphlococcus aureus bacteraemias which is very promising although Community acquired infections being admitted are still on the rise e.g. intravenous drug users.
MR confirmed that needle exchange users within NHS Grampian are given help and advice to help combat the risk of infection.
With regard to the reduction in Clostridium difficile infections RSD fedback that this is attributed, mainly, to the volume of work done around antibiotic prescribing within both Acute and Community settings but NHS Grampian must remain vigilant that these figures continue to decrease.
RSD also invited DOB to speak on the subject at the next Infection Control Committee meeting in March.
AMK reminded the Committee that, shortly, NHS Grampian will be expected to report figures on the 15 – 64 age range in addition to the over 65s. This may be a difficult time for NHS Grampian due to the nature of business within Aberdeen (oil industry workers), who are routinely prescribed antibiotics when travelling to other countries. AMK is expecting the figures to rise when this age range is introduced.
With regard to Staphlococcus aureus bacteraemias PEH feedback that NHS Grampian are back on trajectory to meet the target and directed the Committee to view the graph, on page 8 of the report, which shows this. There will be a new target set at the end of March 2015, however NHS Grampian compares favourably to this, being just above it, at present.
RSD also spoke on the impact of Norovirus within NHS Grampian. He has recently spoke to MSPs on the particularly difficult 2 weeks at the end of November but hopes that the daily SITREPs, being distributed will help with the admission and transfer of patients.
EM also stated that she felt the 48 hours symptom free rule was firmly embedded within the organisation and that no pressure was being put on staff to return to work.
RSD also felt that staff should be praised for sustaining staffing levels over the Christmas period and during Norovirus outbreak periods and asked the Committee if they thought it was acceptable that this should be communicated to staff via a Global email by Richard Carey. The Committee agreed. / DOB
RSD
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…
Item 4.2
Item 4.3 / PEH also fedback that the Clinical Governance Committee had requested that the HAI Report no longer be submitted, in its entirety, to the Committee but a Template document should be presented instead. Would the Committee prefer to view and comment on this template prior to its submission to Clinical Governance ?
PEH also stressed that the full report would still be presented to the Board and to Government.
RSD agreed that the Committee should view the template prior to its submission and asked for it to be included in the papers for the next meeting.
HAI Work Plan 2012/13
PEH has updated the report but it was not discussed at this meeting.
Risk Control Plan
RSD asked the Committee if they felt any additional risks should be added to the register.
MR reminded the Committee of the recent dental incident concerning an independent dental practice. The incident highlighted the practice’s inadequate infection control procedures and suggested this was added as a risk.
DOB feedback that she had been involved in a meeting on 8 January regarding this and discussions were on going as to how to best implement infection control procedures. Another meeting is planned for the near future.
RSD asked for this to be added to the register and requested that DOB feedback on this matter at the next Committee meeting.
PM also raised the issue of Secondary Care staff being unable to access Primary Care IT and LABS systems.
RSD queried whether this was logged as a risk on the eHealth Risk Register. RSD and PM will investigate further.
AMK raised concerns regarding contact tracing issues during the ICNet upgrade. RSD replied that this should be included on the Infection Control Team’s Risk Register.
AMK also queried where the risks involving the Water Safety Group should be presented. GM replied that he chairs that Committee and any risks identified are feedback into the Infection Control Committee.
PEH and GM are to discuss whether water contamination and Legionella should become a fixed Agenda item.
RSD asked for the closed risks to be removed from the main report for the next meeting.
PEH then discussed the report with the Committee informing them of updated actions.
QIS 3b.1 - Compliance with Infection Control Policies
AMK replied that she had discussed the Dress Code with Sue Swift who had confirmed that it was now ratified and waiting to be uploaded.
RAB confirmed that the Policy is present on the Human Resources site but is unsigned.
EM informed the Committee that the Acute Sector were particularly pleased that there was now a ratified document and was sure this would lead to improved practice across NHS Grampian.
PEH asked for this risk to be closed. RSD agreed. / PEH
PEH/DOB
RSD/PM
PEH/GM
PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont… /
QIS 3b.6 - Risk Assessment and Patient Management
PEH feedback that this pertains to admissions or transfers. The Patient Placement Tool was launched through MRSA Screening and is on going.
RAB also commented that during discussions at the ?? Group meeting the NHS Grampian Tool was viewed favourably by the members.
EM and Catherine Mitchell have been visiting areas with the HAI Audit Tool. Some are still not aware of the need to use it and in these areas more work is needed to ensure compliance.
PEH added that Aberdeen Maternity Hospital and Royal Aberdeen Children’s Hospital have still to be liaised with regarding the use of the tool as MRSA screening was not pertinent to these areas when it was rolled out and therefore the tool is not as widely recognised.
QIS 4a.1 – Cleaning (Clear allocation of cleaning duties)
GM informed the Committee that there was still work to be done regarding exception reporting system of cleaning equipment across non acute areas.
QIS 4a.1 – Cleaning (Clear instructions for cleaning patient equipment)
PEH fedback that there are still issues with implementation surround this risk. There have been regular audits performed and Health Protection Scotland have also assessed. The feedback is favourable but we must continue to monitor certain issues. Suggested that the Likelihood be reduced to Possible. RSD agreed.
QIS 1a.7,2 – Communication (NHS Grampian’s effective communication flows)
There are still on going discussions around the effectiveness of Team Brief and Global emails. The Infection prevention and Control team do not rely on or use these methods to disseminate information to Staff or Managers; comprehensive distribution lists are used within the Department.
RSD replied that the Infection Control Committee will include this risk on the Control Plan and PEH is to add controls and reword actions using the wording “Communications Strategy”
QIS 2a.2 - Communication (consistency in distribution of HAI information)
PEH confirmed there are robust systems in place and asked for this risk to be closed. RSD agreed.
QIS 5b - Education (mandatory programme of HAI education)
Mandatory Hand Hygiene training has been available, to staff, for some time. PEH asked for this risk to be closed. RSD agreed.
QIS 5a.1 - Education (staff unable to be released to complete mandatory training)
QIS 2a.2 - Communication (consistency in distribution of HAI information)
PEH confirmed there are robust systems in place and asked for this risk to be closed. RSD agreed.
QIS 5b - Education (mandatory programme of HAI education)
Mandatory Hand Hygiene training has been available, to staff, for some time. PEH asked for this risk to be closed. RSD agreed. / PEH
PEH
PEH
PEH
PEH
PEH
Item / Subject / Action to be taken and Key Points raised in discussion / Action
4 / Standing Items cont…
Item 4.4
Item 4.5 / QIS 5a.1 - Education (staff unable to be released to complete mandatory training)
PEH feedback that the reason for this risk being high is due to no action being present. The Hand Hygiene
e-learning package is reviewed yearly and is on going.
JO replied that the list of mandatory training is being reviewed at present but work needs to be done around face-to-face appraisals, the number of which being completed, is very low at present.
RSD will report back on the number of doctors who currently do not have a PDP or use eKSF.
AS to submit a report, to the Committee, on the number of doctors who have completed mandatory training for the next meeting.
NHSG ICC1 – Organisational Practice (High risk CJD patients are not identified)
This requires an update from AMK
NHSG ICC3 - Organisational Practice (Disruption to service due to staff immune status being unknown)
PEH informed the Committee that there was no resolution to this.
RSD replied that it is a sensitive subject but could see how this would be relevant in certain areas. More work needs to be done surrounding Measels.
PM questioned whether the Health Protection Team had sought guidance from Health Protection Scotland.
MR replied that the response was not yet clear. Published guidelines are not consistent therefore Diana Webster has produced local guidelines; feedback on these is awaited from Health Protection Scotland.
RSD will speak to Human Resources and asked Pamela to list names within the Actions column of the risk.
Health Protection Scotland Exception Reports
There have been non since the last meeting
MRSA Screening Compliance
The compliance is better than expected although there are still complications with wound infections.
High risk areas must be focused on and these areas must take responsibility for their own compliance and monitoring.
RSD asked for this to be put back onto the next meeting’s Agenda and he will feedback to the Committee a description of the systems to be put in place. / RSD
AS
RSD
5 / New Business / RSD updated the Committee on the recent Inspection Team meeting that took place. It is relevant to the Committee as to how information is reported from the Sector Management Teams.
The proposed system to be put in place will involve the Infection Control Committee proactively asking sectors about their Infection Prevention and Control risks and discussing this at future meetings. Each sector will be expected to feedback on the Risk Control Plan and the HAI Work Plan and in addition to this they will also be able to report up to the Committee on issues concerning them.
An announced visit has been proposed for Summer 2013 (June?) and it is expected that the team will visit an area not inspected before. This could be the Emergency Care Centre.
GB asked if perhaps the area could be a Community hospital.
PEH replied that it has not been confirmed as to whether Community hospitals will be announced or visits.
February
GB informed the Committee that each Community hospital will be completing an audit prior to the end of February 2013.
RSD asked GB to liaise with PEH on any issues that might arise.
Item / Subject / Action to be taken and Key Points raised in discussion / Action
6 / Reporting to Clinical Governance Committee & Board / The reports will be submitted to the Board with the HAI template being submitted to the Clinical Governance Committee.
7 / AOCB /
MR informed the Committee that Dr Helen Howie was retiring at the end of February.
The topic of the new Emergency Care Centre was raised stating that the building was impressive and much can be learned from it. There are a few issues still to be “ironed out” such as Infection Control – barrier nursing signage not visible. This needs to be discussed between EM and PEH. EM has an audit prepared.
Operational Teams need to ensure regular inspections are undertaken and it was felt that it would be useful for to combine these inspections with the ones undertaken by the Infection Prevention & Control Team
GM raised the issue of not enough gel dispensers located on the walls within the centre and KDW replied that this was due to a change in practice and auditing and that gel is now located on the ends of the beds instead.
RSD fedback that a clinical meeting to discuss the Emergency Care Centre had been scheduled for 30 January.
PM wanted to bring to the attention, of the members, the lack of isolation, in ITU, being carried out with regard to Influenza patients. PM and AMK will discuss this with David Noble.
AMK commented that the number of beds that can be isolated is an issue.
8 / Date of next meeting /
21 March 2013 11.00 – 13.00 in the Board Room, Aberdeen Royal Infirmary.
1